Olivier Piguet

We thank Drs Saputra and Lidyawati for their interest in our study [1]. We are pleased that our study has sparked interest and discussion in the field of cross-cultural neuropsychology, particularly concerning the impact of linguistic and sociocultural factors on the cognitive profiles of individuals with primary progressive aphasia (PPA).

Background: Appropriately balancing potential risks versus rewards is important for affective decision-making in everyday life. Impaired affective decision-making on risk-taking tasks has been reported in individuals with dementia, but the neural correlates of such deficits, and whether they relate to neuropsychiatric symptoms, such as disinhibition and apathy, have not been directly examined. Methods: Forty-one behavioural-variant frontotemporal dementia (bvFTD), 28 Alzheimer's disease (AD) patients and 42 healthy controls completed the Balloon Analogue Risk Task (BART), which assessed their ability to weigh risks versus rewards to maximise monetary earnings. Informant-reported measures of disinhibition and apathy were completed. All participants underwent structural magnetic resonance imaging brain scans. Results: While bvFTD and AD patients showed some impairments on the BART relative to controls, a high degree of variability was observed within patient groups. Poorer BART performance was associated with bilateral medial prefrontal and orbitofrontal cortex atrophy. A hierarchical cluster analysis revealed four groups of patients, with distinct patterns of BART performance, varying levels of disinhibition and apathy, and divergent patterns of brain atrophy. The group that showed the worst performance on the BART (i.e., collected the least money and popped the most balloons) showed the greatest disinhibition and orbitofrontal cortex atrophy. Conclusions: Our findings highlight the heterogeneous nature of affective decision-making deficits in dementia and uncover important links between BART performance, symptoms of disinhibition and apathy, and orbitofrontal cortex atrophy. Greater understanding of these symptom profiles and underlying neurocognitive mechanisms may help to inform potential management strategies for impaired affective decision-making in dementia.

March 04, 2025

Harmonized neuropsychological assessment for neurocognitive disorders (NCDs) is an urgent priority in clinics. Neuropsychology assessments in NCDs seldom include tests exploring social cognitive skills. In 2022, we launched the SIGNATURE initiative to optimize socio-cognitive assessment in NCDs. Here, we report findings from the first initiative phase, including consortium creation and evaluation of the state of the art in socio-cognitive assessment in memory clinics. We developed an ad hoc online survey to explore practices and measures, relevance, and obstacles preventing the use of socio-cognitive testing in clinics. The survey was distributed within the SIGNATURE network. National coordinators were identified to disseminate the survey to local collaborators and scientific societies active in the field of dementia and/or neuropsychology. Data were analysed in aggregate form and stratified by geographical area and variables of interest. Four hundred and thirteen (413) responses from 10 European and Latin American geographical regions were recorded. Responders were balanced between physicians and psychologists. Seventy-eight (78) % of respondents reported no/limited experience with socio-cognitive measures; more than 85% agreed on their relevance in clinics. Ekman-60 faces was the most well-known and/or used task, followed by the Faux-Pas and Reading-the-Mind-in-the-Eyes tests. Lack of clinical measures, assessment time, guidelines, and education/training were reported as main obstacles. Real-life barriers prevent the adoption of socio-cognitive testing in clinics. Bidirectional collaboration between clinicians and researchers is required to address clinical needs and constraints and facilitate consistent socio-cognitive assessment.

Sporadic behavioural variant frontotemporal dementia (bvFTD) is often misdiagnosed as late-onset primary psychiatric disorder (PPD) due to overlapping symptoms and lack of biomarkers. We aimed to identify clinical features that distinguish sporadic bvFTD from PPD. Multi-centre baseline data were retrospectively retrieved and categorized into neuropsychological domains. Logistic regression models and receiver operating characteristic curves were conducted to determine discriminators. Data from 508 sporadic bvFTD and 152 PPD cases were included. Higher scores in cognitive screening [odds ratio (OR): 1.23], facial emotion processing (OR: 1.69), episodic memory (OR: 1.09), animal fluency (OR: 1.17), working memory (OR: 1.18), letter fluency (OR: 1.17) and depressive symptoms (OR: 7.41) were significantly associated with PPD (all Ps ≤ 0.010). Within a combined model, higher scores of letter fluency (OR: 1.47), cognitive screening (OR: 1.72) and lower attention (OR: 0.77) were significantly (all Ps ≤ 0.05) associated with PPD (area under the curve = 0.771). Neuropsychological measurements-letter fluency, cognitive screening and attention-can help distinguish sporadic bvFTD from late-onset PPD. Depressive symptoms and facial emotion processing emerged as potential discriminators, warranting further exploration.