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Objective: Impaired empathy is a diagnostic feature of behavioral variant frontotemporal dementia (bvFTD), but it is not clear whether it is caused by a primary impairment in empathy or by general emotional blunting., Methods: Patients with bvFTD who met criteria for loss of empathy (N=10) and patients with Alzheimer's disease (N=15) were assessed with a measure for empathy (Socioemotional Dysfunction Scale [SDS]) and a measure for general emotion (Scale for Emotional Blunting [SEB]). All patients underwent neuroimaging. Both patient groups and a healthy control group (N=18) were evaluated by using autonomic responses (skin conductance responses [SCR]) to pictures from the Internal Affective Picture System (IAPS) (presence or absence of empathy stimuli and high versus low emotion)., Results: All participants reported understanding the content and others' perspectives on the empathy pictures; however, only patients with bvFTD showed impaired empathic behavior on the SDS, which persisted after adjusting for measures from the emotion scale (SEB). Patients with bvFTD had significantly lower SCR for all the IAPS stimuli, including for empathy pictures, which also persisted after adjusting for emotional content. On MRI analysis, SCR across groups significantly correlated with the volume of the dorsal anterior cingulate gyrus (dACC)., Conclusions: These results indicate that patients with bvFTD have decreased empathic behavior with or without emotional blunting, and they exhibit decreased psychophysiological responses to empathy stimuli, independent of general emotion. These preliminary findings suggest a specific impairment in emotional empathy, possibly related to impairment of the emotional appraisal role of the dACC.

Impaired attribution of animacy (state of living or being sentient) and of agency (capability of intrinsically-driven action) may underlie social behavior disturbances in behavioral variant frontotemporal dementia (bvFTD). We presented the Heider and Simmel film of moving geometric shapes to 11 bvFTD patients, 11 Alzheimer's disease (AD) patients, and 12 healthy controls (HCs) and rated their recorded verbal responses for animacy attribution and agency attribution. All participants had skin conductance (SC) continuously recorded while viewing the film, and all dementia participants underwent magnetic resonance imaging (MRI) for regions of interest. The bvFTD patients, but not the AD patients, were impaired in animacy attribution, compared to the HCs. In contrast, both bvFTD and AD groups were impaired in agency attribution, compared to the HCs, and only the HCs had increasing SC responsiveness during viewing of the film. On MRI analysis of cortical thicknesses, animacy scores significantly correlated across groups with the right pars orbitalis and opercularis; agency scores with the left inferior and superior parietal cortices and the supramarginal gyrus; and both scores with the left cingulate isthmus involved in visuospatial context. These findings suggest that bvFTD is specifically associated with impaired animacy attribution from right inferior frontal atrophy. In contrast, both dementias may have impaired agency attribution from left parietal cortical atrophy and absent SC increases during the film, a sympathetic indicator of attribution of a social "story" to the moving shapes. These findings clarify disease-related changes in social attribution and corroborate the neuroanatomical origins of animacy and agency., (Copyright © 2017 Elsevier Ltd. All rights reserved.)