Apathy and functional disability in behavioral variant frontotemporal dementia

Mônica S. Yassuda, Thais B. Lima da Silva, Claire M. O’Connor, Shailaja Mekala, Suvarna Alladi, Valeria S. Bahia, Viviane Almaral-Carvalho, Henrique C. Guimaraes, Paulo Caramelli, Marcio L. F. Balthazar, Benito Damasceno, Sonia M. D. Brucki, Ricardo Nitrini, John R. Hodges, Olivier Piguet, Eneida Mioshi

Research output: Contribution to journalArticlepeer-review

18 Citations (Scopus)
22 Downloads (Pure)


Background Behavioral variant frontotemporal dementia (bvFTD) has profound consequences on patients and their families. In this multicenter study, we investigated the contribution of cognitive and neuropsychiatric factors to everyday function at different levels of overall functional impairment. Methods In a retrospective cross-sectional study, 109 patients with bvFTD from 4 specialist frontotemporal dementia centers (Australia, England, India, and Brazil) were included. The measures administered evaluated everyday function (Disability Assessment for Dementia [DAD]), dementia staging (Clinical Dementia Rating [CDR]), general cognition (Addenbrooke’s Cognitive Examination–revised [ACE-R]), and neuropsychiatric symptoms (Neuropsychiatric Inventory [NPI]). Patients were then subdivided according to functional impairment on the DAD into mild, moderate, severe, and very severe subgroups. Three separate multiple linear regression analyses were run, where (1) total DAD, (2) basic activities of daily living (BADL), and (3) instrumental activities of daily living (IADL) scores were dependent variables; ACE-R total score and selected NPI domains (agitation/aggression, euphoria, apathy, disinhibition, irritability, aberrant motor behavior) were used as independent variables. Age, sex, education, and country of origin were controlled for in the analyses. Results Cognitive deficits were similar across the mild, moderate, and severe subgroups but significantly worse in the very severe subgroup. NPI domain scores (agitation/aggression, euphoria, apathy, disinhibition, irritability, aberrant motor behavior) did not differ across the DAD subgroups. In the multiple regression analyses, a model including ACE-R and NPI apathy explained 32.5% of the variance for total DAD scores. For IADL, 35.6% of the variance was explained by the ACE-R only. No model emerged for BADL scores. Conclusions Cognitive deficits and apathy are key contributors to functional disability in bvFTD but factors underlying impairment in BADLs remain unclear. Treatments targeting reduction of disability need to address apathy and cognitive impairment to ensure greater efficacy, especially in regards to IADLs.

Original languageEnglish
Pages (from-to)120-128
Number of pages9
JournalNeurology: Clinical Practice
Issue number2
Early online date14 Mar 2018
Publication statusPublished - Apr 2018

Cite this