Brain Advance Access originally published online on September 29, 2005
Brain 2005 128(11):2612-2625; doi:10.1093/brain/awh628
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Neuroanatomical correlates of behavioural disorders in dementia
Departments of 1 Neurology and 2 Radiology, University of California, San Francisco, 3 UCSF Memory and Aging Center, 4 Magnetic Resonance Imaging Unit, San Francisco Veterans Affairs Hospital, San Francisco and 5 Department of Psychology, University of California, Los Angeles, CA, USA
Correspondence to: Howard J. Rosen, UCSF Department of Neurology, Memory and Aging Center, 350 Parnassus Avenue, Box 1207, Suite 706, San Francisco, CA 94143-1207, USA E-mail: hrosen{at}memory.ucsf.edu
Neurodegenerative diseases are associated with profound changes in social and emotional function. The emergence of increasingly sophisticated methods for measuring brain volume has facilitated correlation of local changes in tissue content with cognitive and behavioural changes in neurodegenerative disease. The current study examined neuroanatomical correlates of behavioural abnormalities, as measured by the Neuropsychiatric Inventory, in 148 patients with dementia using voxel-based morphometry. Of 12 behaviours examined, 4 correlated with tissue loss: apathy, disinhibition, eating disorders and aberrant motor behaviour. Increasing severity across these four behaviours was associated with tissue loss in the ventral portion of the right anterior cingulate cortex (vACC) and adjacent ventromedial superior frontal gyrus (vmSFG), the right ventromedial prefrontal cortex (VMPC) more posteriorly, the right lateral middle frontal gyrus, the right caudate head, the right orbitofrontal cortex and the right anterior insula. In addition, apathy was independently associated with tissue loss in the right vmSFG, disinhibition with tissue loss in the right subgenual cingulate gyrus in the VMPC, and aberrant motor behaviour with tissue loss in the right dorsal ACC and left premotor cortex. These data strongly support the involvement of the right hemisphere in mediating social and emotional behaviour and highlight the importance of distinct regions on the medial wall of the right frontal lobe in regulating different behaviours. Furthermore, the findings underscore the utility of studying patients with dementia for understanding the neuroanatomical basis of social and emotional functions.
Key Words: frontotemporal dementia; neuropsychiatric inventory; voxel-based morphometry; right hemisphere; cingulate
Abbreviations: ACC = anterior cingulate cortex; FTD = frontotemporal dementia; MMSE = Mini-Mental State Examination; NPI = Neuropsychiatric Inventory; OFC = orbitofrontal cortex; ROI = region of interest; SGC = subgenual cingulate gyrus; SPM = statistical parametric mapping; TIV = total intracranial volume; vACC = ventral portion of the right anterior cingulate cortex; VBM = voxel-based morphometry; VMPC = ventromedial prefrontal cortex; vmSFG = ventromedial superior frontal gyrus
Received November 5, 2004. Revised July 28, 2005. Accepted July 29, 2005.
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