Abstract Body

Behavioral Variant Frontotemporal Dementia is a neurodegenerative brain disorder associated with frontal, insular, and temporal lobar atrophy, characterized during its earliest stages by pervasive changes in personality and behavior, typically reported by the patient’s caregivers. Behavioral symptoms include loss of empathy, disinhibition, compulsive behavior, and a shift towards impulsive and socially inappropriate behavior, most of which generally precede the onset of cognitive deficits. Whilst patients with bvFTD usually exhibit deficits on executive functions tests, other cognitive functions, such as visuospatial abilities and praxis, remain relatively well preserved early in the disease (although a subset of patients do present with significant episodic memory disturbance). In the absence of a biological marker, clinical diagnosis of bvFTD depends on the detection of these core neuropsychiatric features, making it difficult for practicing physicians to diagnose early bvFTD. Several factors make diagnosis of a possible behavioural variant of frontotemporal dementia (bvFTD) particularly challenging, especially the overlap of certain symptomatic dimensions such as apathy, disinhibition, depression, anhedonia, stereotyped behaviour, and psychosis between bvFTD and several psychiatric disorders that appear in late adulthood. I will discuss the most frequent psychiatric conditions that can simulate early bvFTD symptoms, including late onset bipolar disorder, late onset schizophrenia-like psychosis, late onset depression, and attention deficit hyperactivity disorder in middle and older age.

Abstract Body

Two important neuropsychiatric syndromes associated with neurodegenerative conditions are apathy and loss of empathy. Both these disorders have a major impact on quality of life for patients and their caregivers. Neither of them have established treatments. Several lines of evidence across different neurodegenerative diseases have revealed that apathy and empathy are associated with dysfunction of brain circuits linking specific regions of frontal cortex involved in different aspects of behavioural decision-making or regulation.

Emerging evidence from the study of apathy in Parkinson’s disease and small vessel cerebrovascular disease implicates reduced incentivisation by low rewards when patients have to decide whether a particular outcome is worth investing effort. Apathy and aspects of such effort-based decision making for rewards are associated with altered white matter microstructure in circuits linking medial frontal regions to each other and to the basal ganglia.

Affective and cognitive aspects of empathy have been shown to be dissociable with respect to the brain regions supporting these functions. While patients with frontotemporal dementia have deficits in both of these processes, several studies have revealed that individuals with Alzheimer’s disease are more often impaired on cognitive empathy (such as being able to view a situation from another person’s point of view) than affective empathy (sharing another individual’s experience).

These investigations are paving the way for transdiagnostic understanding of apathy and empathy across neurodegenerative conditions.

Abstract Body

Neuropsychiatric symptoms in dementia are related to caregiver burden and institutionalization. A broad range of behaviors may occur, both early and late in the course of dementia, and symptoms may vary across dementias.

In this presentation, both pharmacological and non-pharmalogical management of the most common neuropsychiatric symptoms in Alzheimer’s disease, frontotemporal dementia, Lewy body dementia, and vascular dementia will be reviewed. We will also discuss the place of cholinesterase inhibitors and memantine in the treatment of neuropsychiatric symptoms in dementia.