REVIEW article
Front. Neurosci.
Sec. Decision Neuroscience
Volume 19 - 2025 | doi: 10.3389/fnins.2025.1632054
This article is part of the Research TopicDecision making and its pathologies: a translational animal-to-human overviewView all articles
Decision making in frontotemporal dementia: neuropsychological and neuroimaging assessment
Provisionally accepted
- University of Verona, Verona, Italy
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Frontotemporal dementia (FTD) is a neurodegenerative disorder primarily affecting the frontal and temporal lobes, leading to significant impairments in executive function, social behavior, and emotional regulation. FTD is clinically categorized into two variants, the behavioral (bvFTD) and the primary progressive aphasia (PPA). The bvFTD is the most common form of FTD, and, in these patients, impaired decision-making is the most prominent and clinically relevant cognitive deficit, often manifesting early and preceding more global cognitive decline. This narrative review explores the neuropsychological and neurobiological basis of decision-making deficits in FTD, with a focus on tasks such as the Moral Behavior Inventory (MBI), Iowa Gambling Task (IGT), Executive and Social Cognition Battery (ESCB), Addenbrooke's Cognitive Examination (ACE), and the Balloon Analog Risk Task (BART). Evidence from both case and cohort studies reveals that, although bvFTD patients have intact cognitive profiles, they show impaired performance on decision-making tasks, suggesting that these deficits may be an early and specific marker of the disease. In addition, according to neuroimaging studies, these impairments are associated with atrophy in a distributed network, including the ventromedial and orbitofrontal cortices, anterior cingulate, insula, and even cerebellar regions. Finally, impaired decision-making is a critical yet underrecognized marker for early detection and differentiation of FTD from other forms of dementia.
Keywords: Frontotemporal Dementia, Decision-making tasks, cognitive deficits, neuroimaging studies, brain lesions
Received: 20 May 2025; Accepted: 15 Jul 2025.
Copyright: © 2025 Tavakolian Haghighi, Bertasini, Picari and Paolone. 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) or licensor 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: Giovanna Paolone, University of Verona, Verona, Italy
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