Cognitive and Neuropsychiatric factors related to functional impairment in patients with behavioral variant of Frontotemporal Dementia

Background: The cognitive and neuropsychiatric deficits present in patients with the behavioral variant of Frontotemporal dementia (bvFTD) impacts their functionality in the activities of daily living (ADLs). These activities are divided into advanced, instrumental, and basic domains, which begin to be undermined throughout the dementia progression. The detection of the cognitive and behavioral factors involved in the functional impairment of each ADLs domain is crucial for the implementation of suitable treatments. Methods: A retrospective cross-sectional study was conducted with 27 patients with bvFTD in its early stage (< 2 years of evolution) and 32 healthy controls. A neuropsychological assessment was carried out wherein measures of cognitive function, neuropsychiatric symptoms, and functionality were obtained. The informant- report Technology-Activities of daily living questionnaire was used to assess the percentage of functional impairment on advanced, instrumental, and basic...Show moreBackground: The cognitive and neuropsychiatric deficits present in patients with the behavioral variant of Frontotemporal dementia (bvFTD) impacts their functionality in the activities of daily living (ADLs). These activities are divided into advanced, instrumental, and basic domains, which begin to be undermined throughout the dementia progression. The detection of the cognitive and behavioral factors involved in the functional impairment of each ADLs domain is crucial for the implementation of suitable treatments. Methods: A retrospective cross-sectional study was conducted with 27 patients with bvFTD in its early stage (< 2 years of evolution) and 32 healthy controls. A neuropsychological assessment was carried out wherein measures of cognitive function, neuropsychiatric symptoms, and functionality were obtained. The informant- report Technology-Activities of daily living questionnaire was used to assess the percentage of functional impairment on advanced, instrumental, and basic ADLs. Therefore, higher percentages imply worse performance on ADL. To identify the best determinants for each ADLs domain, three separate standard multiple regression analyses were performed, considering each functional impairment as the dependent variable and executive function, social cognition, disinhibition, and apathy as independent variables. Results: For the basic ADLs, a model that explains 28.2% of the variability was found, in which apathy (β = 0.33, p = .02) and disinhibition (β = 0.29, p = .04) were significant predictors of functional impairment. Concerning instrumental ADLs, the model produced accounted for 58.8% of the functional variability, with apathy (β = 0.70, p < .001) and executive function (β = -0.30, p = .04) as the main contributors. Finally, in terms of advanced ADLs, the model found explains 52.9% of variance, wherein only apathy was a significant predictor (β = 0.69, p < .001). Furthermore, social cognition deficits did not show an influence on functional performance Conclusion: The results of this study show the strong influence of neuropsychiatric features such as apathy and disinhibition with the functional impairment of patients with bvFTD in its early stage. Apathy is the primary determinant of functioning for all the ADLs domains. These results could guide the planning of tailored interventions and quality of life improvement.Show less

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Cognitive and Neuropsychiatric factors related to functional impairment in patients with behavioral variant of Frontotemporal Dementia