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Regional Brain Atrophy and Impaired Decision Making on the Balloon Analog Risk Task in Behavioral Variant Frontotemporal Dementia

Strenziok, Maren PhD*; Pulaski, Sarah MA; Krueger, Frank PhD‡,§; Zamboni, Giovanna MD; Clawson, Deborah PhD; Grafman, Jordan PhD§,¶

Cognitive and Behavioral Neurology: June 2011 - Volume 24 - Issue 2 - p 59–67
doi: 10.1097/WNN.0b013e3182255a7c
Original Studies

Objective: The goal of this study was 2-fold, first, to compare decision making in behavioral variant frontotemporal dementia (bvFTD) patients and healthy adults using the Balloon Analog Risk Task (BART), and, second, to identify the regions of gray matter atrophy associated with bvFTD patients' BART performance.

Background: Stimulus-reinforcement learning is required to evaluate the results of previously chosen actions to improve future decisions. Although there is a well established literature suggesting altered decision making in FTD patients and data from lesion studies suggest orbitofrontal cortex (OFC) involvement in decision making, there is very little research looking at the brain correlates of decision making in FTD populations specifically.

Method: Twenty-seven bvFTD patients and 19 age-matched and education-matched normal controls completed the BART. Voxel-based morphometry analysis was performed on the magnetic resonance imaging scans of a subset of patients.

Results: Compared with healthy controls, the bvFTD patients did not learn and pumped less to inflate a balloon to receive a reward, indicating altered stimulus-reinforcement learning. The voxel-based morphometry analysis indicated that bvFTD patients' impaired BART performance was related to atrophy in the right lateral OFC.

Conclusions: The right lateral OFC is crucial for stimulus-reinforcement learning required for the adjustment of behavior under changing reward contingencies.

Supplemental Digital Content is available in the text.

Catholic University of America, Washington, DC

*George Mason University, Department of Psychology

Krasnow Institute for Advanced Study, George Mason University, Fairfax, VA

§Cognitive Neuroscience Section, National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD

Traumatic Brain Injury Research Laboratory, Kessler Foundation Research Center, West Orange, NJ

Experimental Medicine Division of NDM and FMRIB Centre, University of Oxford, OX3 9DU, UK

Maren Strenziok and Sarah Pulaski have contributed equally to the study.

Supported by the intramural research program of the National Institutes of Health, National Institute of Neurological Disorders and Stroke.

Disclosures: The authors have no conflicts of interest to disclose.

Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Website,

Reprints: Jordan Grafman, PhD, Traumatic Brain Injury Research Laboratory, Kessler Foundation Research Center, 1199 Pleasant Valley Way, West Orange, NJ 07052 (e-mail:

Received July 21, 2010

Accepted May 18, 2011

© 2011 Lippincott Williams & Wilkins, Inc.