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Apathy and Impulsivity in Frontotemporal Lobar Degeneration



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Coyle-Gilchrist, Ian Trevor Stuart 


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.





Rowe, James


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


Doctor of Philosophy (PhD)

Awarding Institution

University of Cambridge