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Case Report/Case Series |

Comparing Moral Judgments of Patients With Frontotemporal Dementia and Frontal Stroke

Sandra Baez, MS1,2,3,4; Blas Couto, MD, PhD1,2,3; Teresa Torralva, PsyD1,2; Luciano A. Sposato, MD, MBA1,5; David Huepe, PhD2,6; Patricia Montañes, PhD7,8; Pablo Reyes, MS7; Diana Matallana, PhD7; Nora S. Vigliecca, PhD3,9; Andrea Slachevsky, PhD10,11,12; Facundo Manes, MD, MS1,2,3,13; Agustin Ibanez, PhD1,2,3,13,14
[+] Author Affiliations
1Institute of Cognitive Neurology and Institute of Neuroscience, Favaloro University, Buenos Aires, Argentina
2UDP-INECO Foundation Core on Neuroscience, Diego Portales University, Santiago, Chile
3National Scientific and Technical Research Council, Buenos Aires, Argentina
4Pontifical Catholic University of Argentina, Buenos Aires, Argentina
5Department of Clinical Neurological Sciences, Western University, London, Canada
6Laboratory of Cognitive and Social Neuroscience, Universidad Diego Portales, Santiago, Chile
7Universidad Javeriana, Facultad de Medicina, Instituto de Envejecimiento, Departamento de Psiquiatría y Salud Mental, Centro de Memoria y Cognición, Hospital San Ignacio, Bogota, Colombia
8Universidad Nacional de Colombia, Bogota, Colombia
9Instituto de Humanidades de la Facultad de Filosofía y Humanidades, Universidad Nacional de Córdoba, Córdoba, Argentina
10Unidad de Neurología Cognitiva y Demencias, Servicio de Neurología, Hospital del Salvador, Santiago, Chile
11Facultad de Medicina y Centro de Investigación Avanzada en Educación, Universidad de Chile, Santiago, Chile
12Departamento de Neurología, Clínica Alemana, Santiago, Chile
13Australian Research Council Centre of Excellence in Cognition and Disorders, New South Wales, Australia
14Universidad Autonoma del Caribe, Barraquilla, Colombia
JAMA Neurol. 2014;71(9):1172-1176. doi:10.1001/jamaneurol.2014.347.
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Importance  Several clinical reports have stated that patients with prefrontal lesions or patients with the behavioral variant of frontotemporal dementia share social cognition impairments. Moral reasoning is impaired in both conditions but there have been few investigations that directly compare this domain in the 2 groups.

Observations  This work compared the moral judgments of these patient groups using a task designed to disentangle the contributions of intentions and outcomes in moral judgment. For both disorders, patients judged scenarios where the protagonists believed that they would cause harm but did not as being more permissible than the control group. Moreover, patients with frontotemporal dementia judged harmful outcomes in the absence of harmful intentions as less permissible than the control participants. There were no differences between the 2 conditions.

Conclusions and Relevance  Both disorders involved impairments in integrating intention and outcome information for moral judgment. This study was the first, to our knowledge, to directly compare a social cognition domain in 2 frontal pathologies with different etiology. Our results highlighted the importance of comparing patients with vascular lesions and patients with neurodegenerative diseases.

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Figure 1.
Lesions of Patients With Prefrontal Lesions

Left and right medial (top) and axial section (bottom) views. Each lesion is shown with a different color. L indicates left and R, right.

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Figure 2.
Lesions of Patients With and Without Involvement of the Ventromedial Prefrontal Cortex (VMPC)

Left and right brain medial views of patient lesions with (red) and without (green) VMPC damage. L indicates left and R, right.

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Figure 3.
Moral Judgments and Significant Differences Between Groups

Patients with prefrontal lesions (PFL) and patients with the behavioral variant of frontotemporal dementia (bvFTD) judged attempted harm as significantly more permissible than the control participants. Patients with bvFTD judged accidental harm as less permissible than the control participants.

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