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Frontal Lobe Hypometabolism and Impaired Insight in Alzheimer Disease

Received July 14, 2004; revised January 23, 2005; accepted January 27, 2005. From the Neuropsychiatric Institute and Hospital, Dept. of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine at the Univ. of California at Los Angeles (DGH, DLS, DF, LM, EF), Mental Health Services, VA Greater Los Angeles Healthcare System, Los Angeles, CA (DGH, DLS, DF, LM, EF), the Nuclear Medicine Service, VA Greater Los Angeles Healthcare System, Los Angeles, CA (MAM), and the Dept. of Physics and Radiological Sciences, University of California at Irvine (MAM). Send correspondence and reprint requests to D.L. Sultzer, M.D., Psychiatry, 3-South, 116AF, West Los Angeles VA Healthcare Center, 11301 Wilshire Blvd., Los Angeles, CA 90073. e-mail: dsultzer{at}ucla.edu
© 2005 American Association for Geriatric Psychiatry

Objective: The authors examined the relationship between impaired insight regarding cognitive and functional deficits and frontal cortex hypometabolism in 41 patients with Alzheimer disease (AD). Methods: Regional cerebral glucose metabolism was determined with ^18Ffluorodeoxyglucose and positron emission tomography. Level of insight was measured with the clinician-rated Neurobehavioral Rating Scale, and severity of global cognitive impairment was determined with the Mini-Mental State Exam. Results: Inaccurate insight was correlated with glucose metabolic rate in the right lateral frontal cortex (Brodmann areas 6 and 45, and the lateral aspect of Brodmann areas 8 and 9) after controlling for global cognitive dysfunction. Conclusions: The findings from this study help to further elucidate the neurobiological mechanisms underlying impaired insight in AD, indicating a link between this important clinical phenomenon and dysmetabolism in a focal region of the right prefrontal cortex.

Key Words: Alzheimer Disease • PET • SPECT • Insight • Frontal Lobes

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