School of Psychology, The University of Sydney, Sydney, NSW, 2006, Australia.
Brain and Mind Centre, The University of Sydney, 94 Mallett Street Camperdown, Sydney, NSW, 2050, Australia.
J Neurol. 2023 Jun;270(6):3192-3203. doi: 10.1007/s00415-023-11638-w. Epub 2023 Mar 14.
Characterisation of the clinical profile of behavioural-variant frontotemporal dementia (bvFTD) has predominantly been based on Western samples. Some small studies have suggested that the clinical profile may differ in culturally and linguistically diverse populations. Additionally, there is evidence that patients from non-English speaking backgrounds may have more cognitive reserve, allowing them to tolerate more disease pathology before clinical symptoms emerge. This study aims to characterise the clinical profiles of patients with bvFTD from culturally diverse backgrounds. BvFTD patients were classified as Australian-born (Australian) or Culturally and Linguistically Diverse-English-speaking (CALD-English) and Culturally and Linguistically Diverse-Language Other Than English (CALD-LOTE). Clinical features, cognitive test performance and cognitive reserve were compared between groups. Voxel-based morphometry was used to examine the neural correlates of cognitive reserve. 107 patients with bvFTD (53 Australian, 36 CALD-English, 18 CALD-LOTE) and 51 controls were included. Analysis of neuropsychiatric features revealed more elation in Australian patients compared to CALD-English patients, with trends for CALD-LOTE patients to report more irritability. CALD-LOTE patients also had higher cognitive reserve and showed relatively greater verbal than non-verbal cognitive impairment. Neuroimaging analyses revealed that higher cognitive reserve was associated with lower integrity in the frontal-temporal regions associated with typical disease pathology in bvFTD. Our findings support the hypothesis that cognitive reserve may delay early cognitive decline in culturally and linguistically diverse patients, although these patients may still show poor verbal performance due to cultural testing biases. Clinically, these results highlight the need to consider cultural and linguistic background to inform the assessment of dementia.
行为变异额颞叶痴呆（bvFTD）的临床特征主要基于西方样本。一些小型研究表明，在文化和语言多样化的人群中，临床特征可能有所不同。此外，有证据表明，来自非英语背景的患者可能具有更多的认知储备，使他们能够在出现临床症状之前耐受更多的疾病病理。本研究旨在描述来自文化多样化背景的 bvFTD 患者的临床特征。将 bvFTD 患者分为澳大利亚出生（澳大利亚）或文化和语言多样化-英语（CALD-English）和文化和语言多样化-非英语（CALD-LOTE）。比较了各组之间的临床特征、认知测试表现和认知储备。使用基于体素的形态测量学来检查认知储备的神经相关性。共纳入 107 例 bvFTD 患者（53 例澳大利亚，36 例 CALD-English，18 例 CALD-LOTE）和 51 例对照组。对神经精神特征的分析显示，澳大利亚患者比 CALD-English 患者更兴奋，CALD-LOTE 患者则有更多烦躁的趋势。CALD-LOTE 患者的认知储备较高，且言语认知障碍相对大于非言语认知障碍。神经影像学分析表明，较高的认知储备与额颞叶区域的完整性降低有关，这些区域与 bvFTD 中的典型疾病病理有关。我们的研究结果支持这样一种假设，即认知储备可能会延迟文化和语言多样化患者的早期认知衰退，尽管这些患者由于文化测试偏见仍可能表现出较差的言语表现。临床上，这些结果强调需要考虑文化和语言背景，以便为痴呆症评估提供信息。
