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Neural correlates of reduced awareness in instrumental activities of daily living in frontotemporal dementia

机译:额颞痴呆患者日常生活工具活动意识下降的神经相关因素

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A decline in instrumental activities of daily living has been described as the earliest functional deficit in patients with neurodegenerative disease. It embraces specific competencies such as: "recalling the date and telephone calls, orienting to new places, remembering the location of objects at home, understanding conversation and the plot of a movie, keeping belongings in order, doing mental calculations and handling money, remembering appointments and shopping lists and performing clerical work". Since changes in instrumental daily living activities are one of the descriptors of behavioural-variant frontotemporal dementia, we decided to investigate the neural correlates of a reduced awareness in this specific domain in twenty-three consecutive behavioural-variant frontotemporal dementia patients. Gray matter volume changes associated with a reduced awareness for the instrumental domain, assessed using a validated caregiver-patient discrepancy questionnaire, were examined. Interestingly, we found disabilities in instrumental daily living activities and a reduced awareness of these to be related to medial prefrontal cortex atrophy, where the mid-cingulate cortices, dorsal anterior insula and cuneous play an important role. Importantly, if the executive system does not function correctly, the comparator mechanism of action self-monitoring does not detect mismatches between the current and previous performance states stored in the personal database, and produces a reduced awareness for the instrumental domain. (C) 2016 Elsevier Inc. All rights reserved.
机译:日常工具活动的减少已被描述为神经退行性疾病患者最早的功能缺陷。它具有一些特殊的能力,例如:“回忆约会和打来的电话,定向到新的地方,记住对象在家里的位置,了解对话和电影情节,保持物品井井有条,进行心理计算和处理金钱,记住约会和购物清单以及执行文书工作”。由于工具性日常生活活动的变化是行为变异型额颞痴呆的描述因素之一,因此,我们决定调查23例连续的行为变异型额颞痴呆患者中这一特定领域意识降低的神经相关性。使用经过验证的护理人员-患者差异调查表评估了与仪器领域意识降低相关的灰质体积变化。有趣的是,我们发现工具性日常生活活动中的残疾和对这些活动的意识降低与内侧前额叶皮质萎缩有关,其中中扣带回皮质,背侧前岛鞘和楔骨起着重要作用。重要的是,如果执行系统无法正常运行,则比较器的动作自我监控机制不会检测到存储在个人数据库中的当前性能状态与先前性能状态之间的不匹配,并且会降低对工具域的了解。 (C)2016 Elsevier Inc.保留所有权利。

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