Exploration deficits under ecological conditions as a marker of apathy in frontotemporal dementia
Front. Neurol.. 2019-08-28; 10:
DOI: 10.3389/fneur.2019.00941
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1. Front Neurol. 2019 Aug 28;10:941. doi: 10.3389/fneur.2019.00941. eCollection
2019.
Exploration Deficits Under Ecological Conditions as a Marker of Apathy in
Frontotemporal Dementia.
Batrancourt B(1), Lecouturier K(1), Ferrand-Verdejo J(1), Guillemot V(2), Azuar
C(3), Bendetowicz D(1)(3)(4), Migliaccio R(1)(3)(4), Rametti-Lacroux A(1),
Dubois B(1)(3), Levy R(1)(3)(4).
Author information:
(1)Inserm U 1127, CNRS UMR 7225, Sorbonne Universités, UPMC Univ Paris 06,
Institut du Cerveau et de la Moelle épiniére (ICM), FRONTlab, Paris, France.
(2)Institut Pasteur, Centre de Bioinformatique, Biostatistique et Biologie
Intégrative (C3BI), Paris, France.
(3)AP-HP, Groupe Hospitalier Pitiè-Salpêtrière, Département de Neurologie,
Institut de la Mèmoire et de la Maladie d’Alzheimer (IM2A), Paris, France.
(4)AP-HP, Groupe Hospitalier Pitiè-Salpêtrière, Département de Neurologie,
Behavioral Neuropsychiatry Unit, Paris, France.
Apathy is one of the six clinical criteria for the behavioral variant of
frontotemporal dementia (bvFTD), and it is almost universal in this disease.
Although its consequences in everyday life are debilitating, its underlying
mechanisms are poorly known, its assessment is biased by subjectivity and its
care management is very limited. In this context, we have developed
« ECOCAPTURE, » a method aimed at providing quantifiable and objective
signature(s) of apathy in order to assess it and identify its precise underlying
mechanisms. ECOCAPTURE consists of the observation and recording of the
patient’s behavior when the participant is being submitted to a multiple-phase
scenario reproducing a brief real-life situation. It is performed in a
functional exploration platform transformed into a fully furnished waiting room
equipped with a video and sensor-based data acquisition system. This multimodal
method allowed video-based behavior analyses according to predefined behavioral
categories (exploration behavior, sustained activities or inactivity) and
actigraphy analyses from a 3D accelerometer. The data obtained were also
correlated with behavioral/cognitive tests and scales assessing global cognitive
efficiency, apathy, cognitive disinhibition, frontal syndrome, depression and
anxiety. Here, bvFTD patients (n = 14) were compared to healthy participants (n
= 14) during the very first minutes of the scenario, when the participants
discovered the room and were encouraged to explore it. We showed that, in the
context of facing a new environment, healthy participants first explored it and
then engaged in sustained activities. By contrast, bvFTD patients were mostly
inactive and eventually explored this new place, but in a more irregular and
less efficient mode than normal subjects. This exploration deficit was
correlated with apathy, disinhibition and cognitive and behavioral dysexecutive
syndromes. These findings led us to discuss the presumed underlying mechanisms
responsible for the exploration deficit (an inability to self-initiate actions,
to integrate reward valuation and to inhibit involuntary behavior). Altogether,
these results pave the way for simple and objective assessment of behavioral
changes that represents a critical step for the evaluation of disease
progression and efficacy of treatment in bvFTD.
DOI: 10.3389/fneur.2019.00941
PMCID: PMC6736613
PMID: 31551908