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Original Research ARTICLE Provisionally accepted The full-text will be published soon. Notify me

Front. Neurol. | doi: 10.3389/fneur.2019.00941

Exploration deficits under ecological conditions as a marker of apathy in frontotemporal dementia

  • 1INSERM U1127 Institut du Cerveau et de la Moelle épinière (ICM), France
  • 2Centre de Bioinformatique, Biostatistique et Biologie Intégrative, Institut Pasteur, France
  • 3Institut de la Mémoire et de la Maladie d’Alzheimer (IM2A), France
  • 4Unité de NeuroPsychiatrie Comportementale, Institut du Cerveau et de la Moelle épinière, 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.

Keywords: Apathy, Behavior, Prefronal cortex, disinhibition, Motivation, Executive Function, Dementia, Neuropsychology, Neurodegenarative diseases, Medical technical devices, Frontotemperal lobar degeneration

Received: 03 Feb 2019; Accepted: 14 Aug 2019.

Copyright: © 2019 Batrancourt, Lecouturier, Ferrand-Verdejo, Guillemot, Azuar, Bendetowicz, Migliaccio, Rametti-Lacroux, Dubois and Levy. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: PhD. Bénédicte M. Batrancourt, INSERM U1127 Institut du Cerveau et de la Moelle épinière (ICM), Paris, France, benedicte.batrancourt@upmc.fr