Dataset Information

Neural effects of oxytocin and mimicry in frontotemporal dementia: A randomized crossover study.

ABSTRACT:

Objective

To determine whether intranasal oxytocin, alone or in combination with instructed mimicry of facial expressions, would augment neural activity in patients with frontotemporal dementia (FTD) in brain regions associated with empathy, emotion processing, and the simulation network, as indexed by blood oxygen-level dependent (BOLD) signal during fMRI.

Methods

In a placebo-controlled, randomized crossover design, 28 patients with FTD received 72 IU intranasal oxytocin or placebo and then completed an fMRI facial expression mimicry task.

Results

Oxytocin alone and in combination with instructed mimicry increased activity in regions of the simulation network and in limbic regions associated with emotional expression processing.

Conclusions

The findings demonstrate latent capacity to augment neural activity in affected limbic and other frontal and temporal regions during social cognition in patients with FTD, and support the promise and need for further investigation of these interventions as therapeutics in FTD.

Clinicaltrialsgov identifier

NCT01937013.

Classification of evidence

This study provides Class III evidence that a single dose of 72 IU intranasal oxytocin augments BOLD signal in patients with FTD during viewing of emotional facial expressions.

SUBMITTER: Oliver LD

PROVIDER: S-EPMC7713736 | biostudies-literature | 2020 Nov

REPOSITORIES: biostudies-literature

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Publications

Neural effects of oxytocin and mimicry in frontotemporal dementia: A randomized crossover study.

Oliver Lindsay D LD Stewart Chloe C Coleman Kristy K Kryklywy James H JH Bartha Robert R Mitchell Derek G V DGV Finger Elizabeth C EC

Neurology 20200922 19

<h4>Objective</h4>To determine whether intranasal oxytocin, alone or in combination with instructed mimicry of facial expressions, would augment neural activity in patients with frontotemporal dementia (FTD) in brain regions associated with empathy, emotion processing, and the simulation network, as indexed by blood oxygen-level dependent (BOLD) signal during fMRI.<h4>Methods</h4>In a placebo-controlled, randomized crossover design, 28 patients with FTD received 72 IU intranasal oxytocin or plac ...[more]

PMID: 32963103

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Project description:Frontotemporal dementia (FTD) encompasses a spectrum of neurodegenerative diseases with heterogeneous clinical presentations and two predominant types of underlying neuropathology. FTD typically comprises three distinct clinical syndromes: behavioral variant frontotemporal dementia (bvFTD), semantic variant primary progressive aphasia (svPPA), and nonfluent variant primary progressive aphasia (nfvPPA). FTD also frequently overlaps both clinically and neuropathologically with three other neurodegenerative syndromes: corticobasal syndrome (CBS), progressive supranuclear palsy (PSP), and amyotrophic lateral sclerosis (ALS). Each syndrome can be associated with one or more underlying neuropathological diagnoses and are referred to as frontotemporal lobar degeneration (FTLD). Although the various FTD syndromes can substantially differ in terms of clinical symptoms and underlying pathology, the symptoms can be broadly categorized into behavioral, cognitive and motor domains. Currently there are no Food and Drug Administration (FDA) approved therapies for the above syndromes except riluzole for ALS. FTD treatment strategies generally rely on off-label use of medications for symptomatic management, and most therapies lack quality evidence from randomized, placebo-controlled clinical trials. For behavioral symptoms, selective serotonin reuptake inhibitors may be effective, while case reports hint at possible efficacy with antipsychotics or anti-epileptics, but use of these latter agents is limited due to concerns regarding side effects. There are no effective therapies for cognitive complaints in FTD, which frequently involve executive function, memory, and language. Motor difficulties associated with FTD may present with parkinsonian symptoms or motor neuron disease, for which riluzole is indicated as therapy. Compared to idiopathic Parkinson's disease, FTD-related atypical parkinsonism is generally not responsive to dopamine replacement therapies, but a small percentage of patients may experience improvement with a trial of carbidopa-levodopa. Physical and occupational therapy remain an important corner stone of motor symptom management in FTD. Speech therapy may also help patients manage symptoms associated with aphasia, apraxia, and dysarthria. Recent advances in the understanding of FTLD pathophysiology and genetics have led to development of potentially disease-modifying therapies as well as symptomatic therapies aimed at ameliorating social and behavioral deficits.

Project description:RationaleMusic therapy has been in practice for years. However, the mechanism of action of music or music therapy is not well understood. It is only recently that the neuroendocrinological basis of therapeutic relationships has become the subject of growing research interest. The aim of this pilot study (Clinical Trial No: DRKS00035174) is to investigate whether oxytocin is usable and feasible as a biomarker of attachment to demonstrate the development of therapeutic alliance between therapist and patient in a dyadic music therapy setting.MethodsIn a single-measure crossover design, children aged 6-12 years from a special school for social and emotional disorders, were randomly with either music therapy followed by a waiting list control group that performed silent work, or vice versa. The respective interventions were conducted on the school premises on different days over a period of 1 month. The primary outcome was salivary oxytocin, with tests performed immediately before and after each 30-min intervention.ResultsThirty-two children were included in the study, resulting in n = 16 children per allocation sequence. During the implementation of the study, difficulties were encountered with protocol adherence both in terms of the duration of the music therapy and the implementation of the silent work in the control group. There were no dropouts, however, only 28 children were included in the final data analysis as two participants in each group were excluded due to large fluctuations in oxytocin levels. Between-group comparison and within-group comparisons showed no significant changes in oxytocin levels. However, the music therapist showed a significant increase in oxytocin levels in the before after measurement. No side effects or adverse events were reported during the trial.ConclusionThe findings indicated a responsiveness of oxytocin to musical stimulation. Although feasibility of oxytocin measurement was clearly demonstrated, evaluation of the results is difficult against the background of many remaining questions regarding individual and contextual factors influencing the oxytocinergic system. Moreover, the clinical significance of changes in oxytocin levels remains a topic for further research to better understand the role of oxytocin in the attachment formation between therapist and patient in music therapy.

Dataset Information

Neural effects of oxytocin and mimicry in frontotemporal dementia: A randomized crossover study.

Objective

Methods

Results

Conclusions

Clinicaltrialsgov identifier

Classification of evidence

Publications

Neural effects of oxytocin and mimicry in frontotemporal dementia: A randomized crossover study.

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