Print version ISSN 0004-282X
Arq. Neuro-Psiquiatr. vol.59 no.2A São Paulo June 2001
NEUROBIOLOGY AND PHENOMENOLOGY OF DISTURBANCES OF SELF-CONSCIOUSNESS IN FRONTOTEMPORAL DEMENTIA AND ALZHEIMER'S DISEASE (ABSTRACT)*. THESIS. SÃO PAULO, 2000.
Consciousness, previously an exclusive philosophical matter, has awaked more and more psychopathologists and neuroscientists interested in the phenomenology of its disorders and in the associated neurobiological substrate. Degenerative brain process may represent an important resourse of discoveries in this field, since they can show self-consciousness disorders with a relatively well defined neuroanatomical basis, making easy the relationship between clinics and neurobiology.
Twenty patients with frontotemporal dementia (FTD) and 22 with Alzheimer's disease (AD) were evaluated in two dimentions of self-consciousness: insight and Theory of Mind. Cognitive, functional, psychopathological and neuroimaging (SPECT scans) measures were statisticaly analysed in association with measures of insight and Theory of Mind, making use of univariate analysis, Fisher Exact Test, student test. Insight and Theory of Mind deficits were invariably important and frequent in FTD, but more mild and variable in AD.
Insight and Theory of Mind deficits showed association with frontal damage. Insight was significantly associated with some variables (severity of ilness, functional adaptation, negative symptoms), but not with others (sex, age, duration of ilness, years of education) in a general form for FTD and AD groups. Mirror sign, phenomenum that indicates the presence of a severe Theory of Mind deficit, was observed in 40% of the FTD group and in 31,8% of the AD group and it was associated with the presence of confabulations, severity of the dementia process and frontal damage. Insight deficit seems to be more related to the topography of degenerative lesions than to the type of dementia and has predictive value to program more early and intensive actions in order to minimize socio-functional limitations related to deficits in insight. Insight and Theory of Mind deficits seem to constitute markers of the pathophisiological process involved in the deterioration of the frontal lobe executive functions.
Many of the more representative FTD behaviors (egocentrism, lackness of social tact, apathy, several language disorders, paranoid delusions) may be understood as phenomenological manifestations related to Theory of Mind and insight deficits.
KEY WORDS: dementia, Alzheimer's disease, frontotemporal dementia, self-consciousness disturbances.
*Neurobiologia e fenomenologia dos distúrbios de auto-consciência na demência frontotemporal e na doença de Alzheimer (Resumo). Tese de Doutorado, Faculdade de Mediciana da Universidade de São Paulo (Área: Neurologia). Orientador: Ricardo Nitrini.
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