Frontotemporal dementias looking like sociopaths — is it a protection against elder abuse?

Frontal release reflexes: when the frontal lobe degenerates and archiac reflexes rise to the surface: here, the “rooting reflex.”

Frontotemporal dementia basically makes people amoral, but that may be OK if your over-eager heirs are trying to rip you off. The Astor trial should be a case study in this.  Perhaps frontotemporal dementia serves an evolutionary function, albeit in a twisted way, where you can coldly look at your relative and refuse to sign the lawyer paper.

With frontotemporal dementia, the frontal lobes are targeted for degeneration. The upshot is that the “higher order” thinking — the inhibitions against acting as a purely reflexive being — fades away.

One group points out that FTD selectively targets  von Economo neurons *– neurons found in the frontal lobes of only apes and humans –

“. . . FTD was associated with early, severe, and selective VEN losses, including a 74% reduction in VENs per section compared with control subjects. VEN dropout was not attributable to general neuronal loss and was seen across FTD pathological subtypes. Surviving VENs were often dysmorphic, with pathological tau protein accumulation in Pick’s disease. In contrast, patients with Alzheimer’s disease showed normal VEN counts and morphology despite extensive local neurofibrillary pathology.

The removal of higher order thinking lets more archaic behavior come to the forefront. Here is a video of  “frontal release reflexes”.  We’re born with certain reflexes  such as those for breast feeding, as indelicate a topic as that may be to discuss among adults.  Rooting around, grasping — basic motor behavior hard wired in utero. As our brain develops, these basic reflexes are inhibited.  As the frontal lobe wiring degenerates, these reflexes come out again (hence the name “frontal release” indicating the frontal lobe is shot to he**).

In the video above, this primordial reflex is in pursing the lips in response to touch — the “rooting” reflex.  If this is the outward appearance of what it’s like without your frontal lobe functions, you can imagine the disordered thinking.

Frontotemporal dementia looks a lot like sociopathy at the beginning — empathy decreases, callousness increases, peculiarities in hygiene, preferred foods, and manner burst out in distorted fashions; there may be impulsivity and a disregard for morality — so there is shoplifting or sexual acting out.  There may be flat affect and apathy; combined with irritability and rage. This is similar to some of the lower functioning sociopaths I know (the ones in my orbit are not afflicted with impulsivity — they’re much smoother, and only rage in private).

According to a recent study, those with frontotemporal dementia were more likely to exhibit less “emotional”  moral judgments (when given hypotheticals involving moral decision making in a laboratory setting):

. . .METHODS: We administered an inventory of moral knowledge, five “reasoned” moral dilemmas, and five “emotional” moral dilemmas where subjects may cause direct harm to another through their own actions, to 21 patients with FTD compared to 21 comparably mildly impaired patients with Alzheimer’s disease (AD) and 21 normal controls. Among the FTD patients, the results were compared to findings on functional neuroimaging. RESULTS: All groups showed retention of knowledge for moral behaviour and the ability to make reasoned moral judgements. In contrast to the other groups, the FTD patients were altered in their ability to make emotional moral judgements. Among the FTD patients, the altered moral judgements corresponded to right hemisphere frontotemporal involvement. CONCLUSIONS: In FTD patients, these findings suggest a decreased emotional responsiveness to others and a tendency to respond to moral dilemmas in a calculated fashion. Such a disturbance may result from ventromedial frontal dysfunction in FTD and supports the presence of a “morality” network in the brain, predominantly in the right hemisphere.

Mendez MF, Shapira JS.   Altered emotional morality in frontotemporal dementia. Cogn Neuropsychiatry. 14: 165-79 (May 2009) DOI: 10.1080/13546800902924122

Seeley et al., “Early frontotemporal dementia targets neurons unique to apes and humans,” Annals of Neurology, 60: 660-667 DOI:10.1002/ana.21055 December 2006

* Constantin Von Economo, a neuroscientist and dashing aviator of the early 20th century.