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Social cognition and behavioral changes in patients with posterior cortical atrophy

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Abstract

Posterior cortical atrophy (PCA) is a rare neurodegenerative condition characterized by progressive visual and visuospatial dysfunction. The consensus criteria state that patients should present “relatively spared behavior and personality” in early stages. However, limited research has focused on these symptoms in PCA. This study compared 157 patients with PCA in early stages of the disease with 352 healthy controls (HC), 202 typical AD (tAD), and 177 logopenic variant primary progressive aphasia (lvPPA) patients from the National Alzheimer's Coordinating Center (NACC) dataset. They were compared using clinician ratings of behavioral symptoms, informant- and clinician-filled questionnaires and patient-facing tests of behavior and social cognition. Results showed that PCA individuals exhibited many behavioral symptoms, the more frequently reported being anxiety, depression, apathy, and irritability. During cognitive testing, clinicians observed disorganized and reactive behaviors, but no insensitive behaviors. Informant reports indicated that PCA patients exhibited higher levels of inhibition and anxiety in response to stimuli associated with non-reward, novelty, and punishment. Social norms knowledge and empathy were overall preserved, although slight decreases in perspective-taking and socioemotional sensitivity were observed on informant-rated questionnaires. Except for more elevated neuropsychiatric symptoms in tAD, the three AD variants had similar profiles. Our findings provide insights into the social cognition and behavioral profiles of PCA, highlighting patterns of preservations and mild impairments, even in the early stages of the disease. These results contribute to a more complete understanding of non-visual symptoms in PCA and have implications for diagnostic and intervention strategies.

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Data availability

The data used in this study is from the National Alzheimer’s Coordinating Center (NACC). Data request can be made at https://naccdata.org/.

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Acknowledgements

The NACC database is funded by NIA/NIH Grant U24 AG072122. NACC data are contributed by the NIA-funded ADRCs: P30 AG062429 (PI James Brewer, MD, PhD), P30 AG066468 (PI Oscar Lopez, MD), P30 AG062421 (PI Bradley Hyman, MD, PhD), P30 AG066509 (PI Thomas Grabowski, MD), P30 AG066514 (PI Mary Sano, PhD), P30 AG066530 (PI Helena Chui, MD), P30 AG066507 (PI Marilyn Albert, PhD), P30 AG066444 (PI John Morris, MD), P30 AG066518 (PI Jeffrey Kaye, MD), P30 AG066512 (PI Thomas Wisniewski, MD), P30 AG066462 (PI Scott Small, MD), P30 AG072979 (PI David Wolk, MD), P30 AG072972 (PI Charles DeCarli, MD), P30 AG072976 (PI Andrew Saykin, PsyD), P30 AG072975 (PI David Bennett, MD), P30 AG072978 (PI Neil Kowall, MD), P30 AG072977 (PI Robert Vassar, PhD), P30 AG066519 (PI Frank LaFerla, PhD), P30 AG062677 (PI Ronald Petersen, MD, PhD), P30 AG079280 (PI Eric Reiman, MD), P30 AG062422 (PI Gil Rabinovici, MD), P30 AG066511 (PI Allan Levey, MD, PhD), P30 AG072946 (PI Linda Van Eldik, PhD), P30 AG062715 (PI Sanjay Asthana, MD, FRCP), P30 AG072973 (PI Russell Swerdlow, MD), P30 AG066506 (PI Todd Golde, MD, PhD), P30 AG066508 (PI Stephen Strittmatter, MD, PhD), P30 AG066515 (PI Victor Henderson, MD, MS), P30 AG072947 (PI Suzanne Craft, PhD), P30 AG072931 (PI Henry Paulson, MD, PhD), P30 AG066546 (PI Sudha Seshadri, MD), P20 AG068024 (PI Erik Roberson, MD, PhD), P20 AG068053 (PI Justin Miller, PhD), P20 AG068077 (PI Gary Rosenberg, MD), P20 AG068082 (PI Angela Jefferson, PhD), P30 AG072958 (PI Heather Whitson, MD), P30 AG072959 (PI James Leverenz, MD).

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The authors did not receive support from any organization for the submitted work.

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Authors and Affiliations

  1. Douglas Research Centre, Montréal, QC, H4H 1R3, Canada

    Marie-Anne St-Georges, Thomas Carrier & Maxime Montembeault

  2. Department of Psychology, McGill University, Montréal, QC, H3A 1G1, Canada

    Linshan Wang

  3. Memory & Aging Center, University of California in San Francisco, San Francisco, CA, 94158, USA

    Marianne Chapleau

  4. FrontLab, INSERM U1127, Institut du cerveau, Hôpital Pitié-Salpêtrière, Paris, France

    Raffaella Migliaccio

  5. Centre de Référence des Démences Rares ou Précoces, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France

    Raffaella Migliaccio

  6. Department of Neurology, Institute of Memory and Alzheimer’s Disease, Centre of Excellence of Neurodegenerative Disease, Hôpital Pitié-Salpêtrière, Assistance Publique-Hôpitaux de Paris, Paris, France

    Raffaella Migliaccio

  7. Département de Psychologie, Université du Québec à Montréal, Montréal, QC, H2X 3P2, Canada

    Thomas Carrier

  8. Department of Psychiatry, McGill University, Montréal, QC, H3A 1A1, Canada

    Maxime Montembeault

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  1. Marie-Anne St-Georges
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  2. Linshan Wang
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  3. Marianne Chapleau
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  4. Raffaella Migliaccio
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  5. Thomas Carrier
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  6. Maxime Montembeault
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Contributions

Conceptualization: M-AS-G and MM; Methodology: M-AS-G and MM; Software: M-AS-G, LW and TC; Formal analysis and investigation: M-AS-G and MM; Writing—original draft preparation: M-AS-G and MM; Writing—review and editing: LW, MC, RM, TC; Supervision: MM.

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Correspondence to Maxime Montembeault.

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St-Georges, MA., Wang, L., Chapleau, M. et al. Social cognition and behavioral changes in patients with posterior cortical atrophy. J Neurol 271, 1439–1450 (2024). https://doi.org/10.1007/s00415-023-12089-z

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  • DOI: https://doi.org/10.1007/s00415-023-12089-z

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