2022•CortexOpen access
Behavioural disinhibition in frontotemporal dementia investigated within an ecological framework
Delphine Tanguy, Armelle Rametti‐Lacroux, Arabella Bouzigues, Dario Saracino, Isabelle Le Ber, Valérie Godefroy, Xavier Morandi, Pierre Jannin, Richard Lévy, Bénédicte Batrancourt, Bénédicte Batrancourt, Raffaella Migliaccio, Bénédicte Batrancourt, Bénédicte Batrancourt, Carole Azuar, Bruno Dubois, Karen Lecouturier, Carlos Eduardo Vasconcelos de Araújo, Estelle Janvier, Aline Jourdain, Armelle Rametti‐Lacroux, Sophie Coriou, Vanessa Brochard, Cécile Gaudebout, Johan Ferrand-Verdejo, Louis Bonnefous, Flore Pochan-Leva, Lucie Jeanne, Mathilde Joulié, Myriam Provost, Rozenn Renaud, Sarah Hachemi, Vincent Guillemot, David Bendetowicz, Guilhem Carle, Julie Socha, Fanny Pineau, Frédéric Marin, Yongjian Liu, Pierre Mullot, Aymen Mousli, Armelle Blossier, Giulia Visentin, Delphine Tanguy, Valérie Godefroy, Idil Sezer, Mathilde Boucly, Blandine Cabrol-Douat, Raphaëlle Odobez, Constance Marque, Daphné Tessereau-Barbot, Anaïs Raud, Aurélie Funkiewiez, Céline Chamayou, Emmanuel Cognat, Manon Le Bozec, Arabella Bouzigues, Vincent Le Du, Stéphanie Bombois, Camille Simard, Paolo Fulcheri, Hortense Guitton, Caroline Peltier, François‐Xavier Lejeune, Lars Jorgensen, Louise‐Laure Mariani, Jean‐Christophe Corvol, Antoni Valero‐Cabré, Béatrice Garcin, Emmanuelle Volle, Isabelle Le Ber, Raffaella Migliaccio, Richard Lévy
Abstract
Disinhibition is a core symptom in behavioural variant frontotemporal dementia (bvFTD) particularly affecting the daily lives of both patients and caregivers. Yet, characterisation of inhibition disorders is still unclear and management options of these disorders are limited. Questionnaires currently used to investigate behavioural disinhibition do not differentiate between several subtypes of disinhibition, encompass observation biases and lack of ecological validity. In the present work, we explored disinhibition in an original semi-ecological situation, by distinguishing three categories of disinhibition: compulsivity, impulsivity and social disinhibition. First, we measured prevalence and frequency of these disorders in 23 bvFTD patients and 24 healthy controls (HC) in order to identify the phenotypical heterogeneity of disinhibition. Then, we examined the relationships between these metrics, the neuropsychological scores and the behavioural states to propose a more comprehensive view of these neuropsychiatric manifestations. Finally, we studied the context of occurrence of these disorders by investigating environmental factors potentially promoting or reducing them. As expected, we found that patients were more compulsive, impulsive and socially disinhibited than HC. We found that 48% of patients presented compulsivity (e.g., repetitive actions), 48% impulsivity (e.g., oral production) and 100% of the patients group showed social disinhibition (e.g., disregards for rules or investigator). Compulsivity was negatively related with emotions recognition. BvFTD patients were less active if not encouraged in an activity, and their social disinhibition decreased as activity increased. Finally, impulsivity and social disinhibition decreased when patients were asked to focus on a task. Summarising, this study underlines the importance to differentiate subtypes of disinhibition as well as the setting in which they are exhibited, and points to stimulating area for non-pharmacological management.