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The frontotemporal dementias (FTD) are a heterogeneous group of neurodegenerative diseases that cause variable profiles of fronto-insulo-temporal network disintegration. Loss of empathy and dysfunctional social interaction are a leading features of FTD and major determinants of care burden, but remain poorly understood and difficult to measure with conventional neuropsychological instruments. Building on a large body of work in the healthy brain showing that embodied responses are important components of emotional responses and empathy, I performed a series of experiments to examine the extent to which the induction and decoding of somatic physiological responses to the emotions of others are degraded in FTD, and to define the underlying neuroanatomical changes responsible for these deficits. I systematically studied a range of modalities across the entire syndromic spectrum of FTD, including daily life emotional sensitivity, the cognitive categorisation of emotions, interoceptive accuracy, automatic facial mimicry, autonomic responses, and structural and functional neuroanatomy to deconstruct aberrant emotional reactivity in these diseases. My results provide proof of principle for the utility of physiological measures in deconstructing complex socioemotional symptoms and suggest that these warrant further investigation as clinical biomarkers in FTD. Chapter 3: Using a heartbeat counting task, I found that interoceptive accuracy is impaired in semantic variant primary progressive aphasia, but correlates with sensitivity to the emotions of others across FTD syndromes. Voxel based morphometry demonstrated that impaired interoceptive accuracy correlates with grey matter volume in anterior cingulate, insula and amygdala. Chapter 4: Using facial electromyography to index automatic imitation, I showed that mimicry of emotional facial expressions is impaired in the behavioural and right temporal variants of FTD. Automatic imitation predicted correct identification of facial emotions in healthy controls and syndromes focussed on the frontal lobes and insula, but not in syndromes focussed on the temporal lobes, suggesting that automatic imitation aids emotion recognition only when social concepts and semantic stores are intact. Voxel based morphometry replicated previously identified neuroanatomical correlates of emotion identification ability, while automatic imitation was associated with grey matter volume in a visuomotor network including primary visual and motor cortices, visual motion area (MT/V5) and supplementary motor cortex. Chapter 5: By recording heart rate during viewing of facial emotions, I showed that the normal cardiac reactivity to emotion is impaired in FTD syndromes with fronto-insular atrophy (behavioural variant FTD and nonfluent variant primary progressive aphasia) but not in syndromes focussed on the temporal lobes (right temporal variant FTD and semantic variant primary progressive aphasia). Unlike automatic imitation, cardiac reactivity dissociated from emotion identification ability. Voxel based morphometry revealed grey matter correlates of cardiac reactivity in anterior cingulate, insula and orbitofrontal cortex. Chapter 6: Subjects viewed videos of facial emotions during fMRI scanning, with concomitant recording of heart rate and pupil size. I identified syndromic profiles of reduced activity in posterior face responsive regions including posterior superior temporal sulcus and fusiform face area. Emotion identification ability was predicted by activity in more anterior areas including anterior cingulate, insula, inferior frontal gyrus and temporal pole. Autonomic reactivity related to activity in both components of the central autonomic control network and regions responsible for processing the sensory properties of the stimuli. |
