Cerebral metabolic and cognitive studies in dementia with frontal lobe behavioral features

doi:10.1016/0022-3956(90)90050-Z

Journal of Psychiatric Research

Volume 24, Issue 2, 1990, Pages 97-109

https://doi.org/10.1016/0022-3956(90)90050-Z Get rights and content

Abstract

Three subjects with dementia of the Alzheimer type (DAT) with frontal lobe features of behavioral disinhibition were studied using positron emission tomography with [18F]2-fluoro-2-deoxy-D-glucose (18 FDG) and standardized neuropsychological tests. The three subjects showed significant decrements (p < .05) in relative glucose metabolism (regional/mean gray metabolism) in the orbitofrontal, prefrontal and anterior cingulate regions when compared to healthy controls. Severity-matched subjects with DAT without the associated frontal lobe features did not show the relative reductions in glucose metabolism in these regions when compared to controls. However, on neuropsychological testing of frontal lobe cognitive functions the three subjects did not show decrements that were more severe than those shown by severity-matched DAT patients without the behavioral features. These data demonstrate physiologic dysfunction in specific cortical regions in subjects with behavioral aberrations attributed to these regions and an apparent dissociation between behavioral and cognitive functions of the frontal lobe.

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However, performance on these tasks does not reliably differentiate FTD from AD (Frisoni et al., 1995b; Pachana et al., 1996; Gregory et al., 1997; Thomas‐Anterion et al., 2000; Pasquier et al., 2001; Kertesz et al., 2003; Kramer et al., 2003; Rosen et al., 2004). There are at least three possible explanations for this: (1) impairments in executive skills, while present in FTD, are not specific to this condition (Kumar et al., 1990); (2) the complexity of these tasks causes poor performance by both patient groups; or (3) these tests measure impairment in dorsolateral prefrontal functioning, while it is the orbitofrontal and ventromedial frontal injury that occurs early and is more specific to FTD (Sarazin et al., 1998; Rahman et al., 1999a, b) (see Fig. 33.2B). Supporting this third hypothesis, FTD patients are more impaired than AD patients in theory‐of‐mind tasks (Gregory et al., 2002) that require making inferences about the mental status of others, and are mediated at least in part by ventromedial frontal cortex (Stuss et al., 2001).
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Cerebral metabolic and cognitive studies in dementia with frontal lobe behavioral features

Abstract

Archives Gerontol Geriatrics

Archives of Gerontol Geriatrics

Journal of Psychiatric Research

Lancet

Archives of Gerontol Geriatrics

Archives of Gerontol Geriatrics

Archives of Gerontol Geriatrics

Diagnostic and statistical manual of mental disorders

The Fluorodeoxy glucose 18F scan in Alzheimer's disease and multi-infarct dementia

Archives of Neurology

The measurement of aphasic disorders

Alternative formula for glucose utilization using labelled deoxyglucose

Journal of Nuclear Medicine

Subcortical dementia: Frontal cortex hypometabolism detected by positron emission tomography in patients with progressive supranuclear palsy

Brain

Cerebral glucose utilization as measured with positron emission tomography in 21 resting healthy men between the ages of 21 and 83 years

Brain

Positron emission tomography in Alzheimer's disease

Neurology (Cleveland)

A cross-section anatomy

Alzheimer's disease: focal cortical changes shown by positron emission tomography

Neurology (Cleveland)

Regional cerebral matabolic alterations in dementia of the Alzheimer type

Journal of Comparative Assist Tomography

The stroop color and word test: A manual for clinical and experimental uses