Rebekah M Ahmed1,2, Zoë-Lee Goldberg3, Cassandra Kaizik4,5, Matthew C Kiernan4,5, John R Hodges4,6, Olivier Piguet3,6, Muireann Irish3,6. 1. ForeFront Clinic, Sydney Medical School, Brain and Mind Centre, The University of Sydney, 94 Mallett St Camperdown, Sydney, NSW, 2050, Australia. rebekah.ahmed@sydney.edu.au. 2. Memory and Cognition Clinic, Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Sydney, Australia. rebekah.ahmed@sydney.edu.au. 3. School of Psychology and Brain and Mind Centre, The University of Sydney, Sydney, Australia. 4. ForeFront Clinic, Sydney Medical School, Brain and Mind Centre, The University of Sydney, 94 Mallett St Camperdown, Sydney, NSW, 2050, Australia. 5. Memory and Cognition Clinic, Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Sydney, Australia. 6. ARC Centre of Excellence in Cognition and its Disorders, Sydney, Australia.
Abstract
BACKGROUND: Frontotemporal dementia (FTD) is characterised by changes in behaviour including alterations in sexual function. While hypersexual behaviour is commonly thought to predominate, emerging evidence suggests that hyposexual behaviour is in fact most prevalent. The underlying mechanisms driving these behavioural changes remain unclear; however, likely reflect interactions between cognitive, emotional, reward processing and physiological functioning. We aimed to systematically quantify changes in sexual behaviour in behavioural variant FTD (bvFTD) and semantic dementia (SD) in contrast with Alzheimer's disease (AD) and to elucidate the neural correlates of these changes using whole-brain voxel-based morphometry. METHODS: Carers of 62 dementia patients (30 bvFTD, 12 SD, 20 AD) were interviewed using the Sexual Behaviour and Intimacy Questionnaire, which assesses changes in sexual function. Voxel-based morphometry analysis of structural MRI brain scans was used to determine the association between changes in grey matter intensity and the presence of hyposexual, hypersexual, and inappropriate sexual behaviour across groups. RESULTS: Widespread attenuation of sexual drive, intimacy and the display of affection were evident irrespective of dementia subtype. In contrast, hypersexual and inappropriate sexual behaviour was present in only a small proportion of patients. Neuroimaging analyses revealed an association between hyposexual behaviour and atrophy of the right supramarginal gyrus, middle frontal gyrus and thalamus, whilst hypersexual behaviour was associated with cerebellar atrophy. CONCLUSION: Counter to the prevailing view, younger-onset dementia syndromes predominantly display an attenuation in sexual drive. Changes in sexual function likely reflect the degeneration of cortical and subcortical neural circuits implicated in reward, autonomic function, empathy, and emotional processing.
BACKGROUND: Frontotemporal dementia (FTD) is characterised by changes in behaviour including alterations in sexual function. While hypersexual behaviour is commonly thought to predominate, emerging evidence suggests that hyposexual behaviour is in fact most prevalent. The underlying mechanisms driving these behavioural changes remain unclear; however, likely reflect interactions between cognitive, emotional, reward processing and physiological functioning. We aimed to systematically quantify changes in sexual behaviour in behavioural variant FTD (bvFTD) and semantic dementia (SD) in contrast with Alzheimer's disease (AD) and to elucidate the neural correlates of these changes using whole-brain voxel-based morphometry. METHODS: Carers of 62 dementiapatients (30 bvFTD, 12 SD, 20 AD) were interviewed using the Sexual Behaviour and Intimacy Questionnaire, which assesses changes in sexual function. Voxel-based morphometry analysis of structural MRI brain scans was used to determine the association between changes in grey matter intensity and the presence of hyposexual, hypersexual, and inappropriate sexual behaviour across groups. RESULTS: Widespread attenuation of sexual drive, intimacy and the display of affection were evident irrespective of dementia subtype. In contrast, hypersexual and inappropriate sexual behaviour was present in only a small proportion of patients. Neuroimaging analyses revealed an association between hyposexual behaviour and atrophy of the right supramarginal gyrus, middle frontal gyrus and thalamus, whilst hypersexual behaviour was associated with cerebellar atrophy. CONCLUSION: Counter to the prevailing view, younger-onset dementia syndromes predominantly display an attenuation in sexual drive. Changes in sexual function likely reflect the degeneration of cortical and subcortical neural circuits implicated in reward, autonomic function, empathy, and emotional processing.
Entities:
Keywords:
Alzheimer’s disease; Frontotemporal dementia; Hypothalamus; Neurodegeneration; Neuroendocrine; Physiology; Reward; Sexual function
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