Skip to main content
PMC home page
Journal of Neurology, Neurosurgery, and Psychiatry logoLink to Journal of Neurology, Neurosurgery, and Psychiatry
. 2001 Mar;70(3):323–332. doi: 10.1136/jnnp.70.3.323

Distinct behavioural profiles in frontotemporal dementia and semantic dementia

J Snowden 1, D Bathgate 1, A Varma 1, A Blackshaw 1, Z Gibbons 1, D Neary 1
PMCID: PMC1737271  PMID: 11181853

Abstract

OBJECTIVE—To test predictions that frontotemporal dementia and semantic dementia give rise to distinct patterns of behavioural change.
METHODS—An informant based semistructured behavioural interview, covering the domains of basic and social emotions, social and personal behaviour, sensory behaviour, eating and oral behaviour, repetitive behaviours, rituals, and compulsions, was administered to carers of 41 patients with semantic dementia and with apathetic (FTD-A) and disinhibited (FTD-D) forms of frontotemporal dementia.
RESULTS—Consistent with prediction, emotional changes differentiated FTD from semantic dementia. Whereas lack of emotional response was pervasive in FTD, it was more selective in semantic dementia, affecting particularly the capacity to show fear. Social avoidance occurred more often in FTD and social seeking in semantic dementia. Patients with FTD showed reduced response to pain, whereas patients with semantic dementia more often showed exaggerated reactions to sensory stimuli. Gluttony and indiscriminate eating were characteristic of FTD, whereas patients with semantic dementia were more likely to exhibit food fads. Hyperorality, involving inedible objects, was unrelated to gluttony, indicating different underlying mechanisms. Repetitive behaviours were common in both FTD and semantic dementia, but had a more compulsive quality in semantic dementia. Behavioural differences were greater between semantic dementia and FTD-A than FTD-D. A logistic regression analysis indicated that emotional and repetitive, compulsive behaviours discriminated FTD from semantic dementia with 97% accuracy.
CONCLUSION—The findings confirm predictions regarding behavioural differences in frontotemporal and semantic dementia and point to differential roles of the frontal and temporal lobes in affect, social functioning, eating, and compulsive behaviour.



Full Text

The Full Text of this article is available as a PDF (157.6 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Adolphs R., Tranel D., Damasio H., Damasio A. R. Fear and the human amygdala. J Neurosci. 1995 Sep;15(9):5879–5891. doi: 10.1523/JNEUROSCI.15-09-05879.1995. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Ames D., Cummings J. L., Wirshing W. C., Quinn B., Mahler M. Repetitive and compulsive behavior in frontal lobe degenerations. J Neuropsychiatry Clin Neurosci. 1994 Spring;6(2):100–113. doi: 10.1176/jnp.6.2.100. [DOI] [PubMed] [Google Scholar]
  3. Baxter L. R., Jr, Phelps M. E., Mazziotta J. C., Guze B. H., Schwartz J. M., Selin C. E. Local cerebral glucose metabolic rates in obsessive-compulsive disorder. A comparison with rates in unipolar depression and in normal controls. Arch Gen Psychiatry. 1987 Mar;44(3):211–218. doi: 10.1001/archpsyc.1987.01800150017003. [DOI] [PubMed] [Google Scholar]
  4. Baxter L. R., Jr, Schwartz J. M., Guze B. H., Bergman K., Szuba M. P. PET imaging in obsessive compulsive disorder with and without depression. J Clin Psychiatry. 1990 Apr;51 (Suppl):61–70. [PubMed] [Google Scholar]
  5. Berthier M. L., Kulisevsky J., Gironell A., Heras J. A. Obsessive-compulsive disorder associated with brain lesions: clinical phenomenology, cognitive function, and anatomic correlates. Neurology. 1996 Aug;47(2):353–361. doi: 10.1212/wnl.47.2.353. [DOI] [PubMed] [Google Scholar]
  6. Bozeat S., Gregory C. A., Ralph M. A., Hodges J. R. Which neuropsychiatric and behavioural features distinguish frontal and temporal variants of frontotemporal dementia from Alzheimer's disease? J Neurol Neurosurg Psychiatry. 2000 Aug;69(2):178–186. doi: 10.1136/jnnp.69.2.178. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Bozeat S., Lambon Ralph M. A., Patterson K., Garrard P., Hodges J. R. Non-verbal semantic impairment in semantic dementia. Neuropsychologia. 2000;38(9):1207–1215. doi: 10.1016/s0028-3932(00)00034-8. [DOI] [PubMed] [Google Scholar]
  8. Brun A. Frontal lobe degeneration of non-Alzheimer type. I. Neuropathology. Arch Gerontol Geriatr. 1987 Sep;6(3):193–208. doi: 10.1016/0167-4943(87)90021-5. [DOI] [PubMed] [Google Scholar]
  9. Cooper J. The Leyton obsessional inventory. Psychol Med. 1970 Nov;1(1):48–64. doi: 10.1017/s0033291700040010. [DOI] [PubMed] [Google Scholar]
  10. Edwards-Lee T., Miller B. L., Benson D. F., Cummings J. L., Russell G. L., Boone K., Mena I. The temporal variant of frontotemporal dementia. Brain. 1997 Jun;120(Pt 6):1027–1040. doi: 10.1093/brain/120.6.1027. [DOI] [PubMed] [Google Scholar]
  11. Folstein M. F., Folstein S. E., McHugh P. R. "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975 Nov;12(3):189–198. doi: 10.1016/0022-3956(75)90026-6. [DOI] [PubMed] [Google Scholar]
  12. Gustafson L. Clinical picture of frontal lobe degeneration of non-Alzheimer type. Dementia. 1993 May-Aug;4(3-4):143–148. doi: 10.1159/000107313. [DOI] [PubMed] [Google Scholar]
  13. Gustafson L. Frontal lobe degeneration of non-Alzheimer type. II. Clinical picture and differential diagnosis. Arch Gerontol Geriatr. 1987 Sep;6(3):209–223. doi: 10.1016/0167-4943(87)90022-7. [DOI] [PubMed] [Google Scholar]
  14. Hodges J. R., Patterson K., Oxbury S., Funnell E. Semantic dementia. Progressive fluent aphasia with temporal lobe atrophy. Brain. 1992 Dec;115(Pt 6):1783–1806. doi: 10.1093/brain/115.6.1783. [DOI] [PubMed] [Google Scholar]
  15. LeDoux J. E. Emotion: clues from the brain. Annu Rev Psychol. 1995;46:209–235. doi: 10.1146/annurev.ps.46.020195.001233. [DOI] [PubMed] [Google Scholar]
  16. Leckman J. F., Grice D. E., Boardman J., Zhang H., Vitale A., Bondi C., Alsobrook J., Peterson B. S., Cohen D. J., Rasmussen S. A. Symptoms of obsessive-compulsive disorder. Am J Psychiatry. 1997 Jul;154(7):911–917. doi: 10.1176/ajp.154.7.911. [DOI] [PubMed] [Google Scholar]
  17. Mann D. M., South P. W., Snowden J. S., Neary D. Dementia of frontal lobe type: neuropathology and immunohistochemistry. J Neurol Neurosurg Psychiatry. 1993 Jun;56(6):605–614. doi: 10.1136/jnnp.56.6.605. [DOI] [PMC free article] [PubMed] [Google Scholar]
  18. Mann D. M., South P. W. The topographic distribution of brain atrophy in frontal lobe dementia. Acta Neuropathol. 1993;85(3):334–340. doi: 10.1007/BF00227731. [DOI] [PubMed] [Google Scholar]
  19. McGuire P. K. The brain in obsessive-compulsive disorder. J Neurol Neurosurg Psychiatry. 1995 Nov;59(5):457–459. doi: 10.1136/jnnp.59.5.457. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Mendez M. F., Perryman K. M., Miller B. L., Swartz J. R., Cummings J. L. Compulsive behaviors as presenting symptoms of frontotemporal dementia. J Geriatr Psychiatry Neurol. 1997 Oct;10(4):154–157. doi: 10.1177/089198879701000405. [DOI] [PubMed] [Google Scholar]
  21. Miller B. L., Cummings J. L., Villanueva-Meyer J., Boone K., Mehringer C. M., Lesser I. M., Mena I. Frontal lobe degeneration: clinical, neuropsychological, and SPECT characteristics. Neurology. 1991 Sep;41(9):1374–1382. doi: 10.1212/wnl.41.9.1374. [DOI] [PubMed] [Google Scholar]
  22. Miller B. L., Darby A. L., Swartz J. R., Yener G. G., Mena I. Dietary changes, compulsions and sexual behavior in frontotemporal degeneration. Dementia. 1995 Jul-Aug;6(4):195–199. doi: 10.1159/000106946. [DOI] [PubMed] [Google Scholar]
  23. Miller B. L., Darby A., Benson D. F., Cummings J. L., Miller M. H. Aggressive, socially disruptive and antisocial behaviour associated with fronto-temporal dementia. Br J Psychiatry. 1997 Feb;170:150–154. doi: 10.1192/bjp.170.2.150. [DOI] [PubMed] [Google Scholar]
  24. Mummery C. J., Patterson K., Price C. J., Ashburner J., Frackowiak R. S., Hodges J. R. A voxel-based morphometry study of semantic dementia: relationship between temporal lobe atrophy and semantic memory. Ann Neurol. 2000 Jan;47(1):36–45. [PubMed] [Google Scholar]
  25. Mummery C. J., Patterson K., Wise R. J., Vandenberghe R., Vandenbergh R., Price C. J., Hodges J. R. Disrupted temporal lobe connections in semantic dementia. Brain. 1999 Jan;122(Pt 1):61–73. doi: 10.1093/brain/122.1.61. [DOI] [PubMed] [Google Scholar]
  26. Neary D., Snowden J. S., Gustafson L., Passant U., Stuss D., Black S., Freedman M., Kertesz A., Robert P. H., Albert M. Frontotemporal lobar degeneration: a consensus on clinical diagnostic criteria. Neurology. 1998 Dec;51(6):1546–1554. doi: 10.1212/wnl.51.6.1546. [DOI] [PubMed] [Google Scholar]
  27. Neary D., Snowden J. S., Mann D. M., Northen B., Goulding P. J., Macdermott N. Frontal lobe dementia and motor neuron disease. J Neurol Neurosurg Psychiatry. 1990 Jan;53(1):23–32. doi: 10.1136/jnnp.53.1.23. [DOI] [PMC free article] [PubMed] [Google Scholar]
  28. Neary D., Snowden J. S., Northen B., Goulding P. Dementia of frontal lobe type. J Neurol Neurosurg Psychiatry. 1988 Mar;51(3):353–361. doi: 10.1136/jnnp.51.3.353. [DOI] [PMC free article] [PubMed] [Google Scholar]
  29. Stip E. Compulsive disorder and acquired antisocial behavior in frontal lobe dementia. J Neuropsychiatry Clin Neurosci. 1995 Winter;7(1):116–116. doi: 10.1176/jnp.7.1.116b. [DOI] [PubMed] [Google Scholar]
  30. Tonkonogy J. M., Smith T. W., Barreira P. J. Obsessive-compulsive disorders in Pick's disease. J Neuropsychiatry Clin Neurosci. 1994 Spring;6(2):176–180. doi: 10.1176/jnp.6.2.176. [DOI] [PubMed] [Google Scholar]
  31. Young A. W., Aggleton J. P., Hellawell D. J., Johnson M., Broks P., Hanley J. R. Face processing impairments after amygdalotomy. Brain. 1995 Feb;118(Pt 1):15–24. doi: 10.1093/brain/118.1.15. [DOI] [PubMed] [Google Scholar]

Articles from Journal of Neurology, Neurosurgery, and Psychiatry are provided here courtesy of BMJ Publishing Group

RESOURCES