Apathy and Impulsivity in Frontotemporal Lobar Degeneration

Apathy and Impulsivity in Frontotemporal Lobar Degeneration Ian Coyle-Gilchrist Frontotemporal Lobar Degeneration (FTLD) is pathologically heterogeneous group of degenerative diseases of the brain. While there are distinct and highly recognisable clinical syndromes associated with FTLD there is also a wider and more diverse spectrum of progressive changes in movement, coordination, language and behaviour. Correlation between clinical syndrome and pathology is variable. Furthermore, over the course of an individual’s illness their syndrome may change, or they may present with features of more than one syndrome at a given time. Apathy and Impulsivity are common, distressing and disabling across the entire spectrum of FTLD and may be particularly prominent compared to other neurodegenerative diseases. In this thesis I outline the current classification of syndromes associated with FTLD and how this has undergone expansion, refinement and fragmentation over time. Despite changes in nosology and advances in understanding of pathological heterogeneity, I argue that the clinical syndrome of FTLD is highly recognisable and has been described for centuries. I suggest that a more unifying transdiagnostic approach to FTLD may provide useful insights into an increasingly fragmented spectrum of disease. Using this approach I conducted a large epidemiological study of FTLD and report prevalence, incidence and lifetime risk estimates. From this cohort of recruits I then surveyed patients and their carers and used a range of assessments of cognition and behaviour. I showed that while reports of apathy and impulsivity are common in FTLD, patient and carer based reports do not correlate well with each other or predict performance on a range of behavioural measures of decision making or goal directed cognition. I conclude that in FTLD, apathy and impulsivity are overlapping and multidimensional constructs and that no single testing modality used in isolation represents them completely, hence a multimodal approach to their assessment is required.

Name dc:type.qualificationname

Doctor of Philosophy (PhD)

Level dc:type.qualificationlevel

Doctoral

Grantor dc:publisher.institution

University of Cambridge

Year dc:date.issued

2020

Author dc:creator

• Coyle-Gilchrist, Ian Trevor Stuart

Advisor dc:contributor.advisor

• Rowe, James

• Dementia
• Frontotemporal
• Apathy
• Impulsivity
• PSP
• Supranuclear
• CBD
• Corticobasal
• FTD
• Epidemiology

Statement dc:rights

• This thesis contains National Statistics and Ordinance survey Data (© Crown copyright and database right, 2013). Under the terms of the Open Government Licence and UK Government Licensing Framework (launched 30 September 2010), permission is granted to use or re-use ONS material, whether commercially or privately, and to do so freely without a specific application for a licence, subject to the conditions of the Open Government Licence and the Framework. No other copyright material is in this thesis.

Licence

• https://apollo8-f-pro.lib.cam.ac.uk/bitstreams/b0b7727b-994f-45f3-b730-d4daef9bc101/download
• https://www.rioxx.net/licenses/all-rights-reserved/

Language dc:language

en

DOI dc:identifier.doi

https://doi.org/10.17863/CAM.49834

OAI identifier oai:identifier

oai:www.repository.cam.ac.uk:1810/302762