Hostname: page-component-5c6d5d7d68-wpx84 Total loading time: 0 Render date: 2024-08-17T17:46:23.844Z Has data issue: false hasContentIssue false

Living in squalor: neuropsychological function, emotional processing and squalor perception in patients found living in squalor

Published online by Cambridge University Press:  25 November 2010

Carol Gregory
Affiliation:
Greater Western Area Health Service, NSW, Australia
Graeme Halliday
Affiliation:
Concord Hospital, Sydney, Australia
John Hodges*
Affiliation:
Neuroscience Research Australia, Sydney, Australia
John Snowdon
Affiliation:
Concord Hospital and University of Sydney, Australia
*
Correspondence should be addressed to: Professor John Hodges, Neuroscience Research Australia, PO Box 1165, Randwick NSW 2031, Australia. Phone: +61 (2) 9399 1132; Fax: +61 (2) 9399 1047. Email: j.hodges@neura.edu.au.

Abstract

Background: Patients living in squalor have a wide range of psychiatric diagnoses, but these may have a common neural basis involving frontal systems. This study investigated frontal executive function, theory of mind, emotional processing including disgust, and appreciation of squalor in elderly patients found living in squalor.

Methods: Six patients referred to an old age psychiatry service underwent a battery of neuropsychological tests, assessment of living conditions and awareness of self and others’ squalor.

Results: All six patients showed impairment in frontal executive function, typically accompanied by amnesic deficits. Theory of mind and emotional processing were surprisingly preserved. While five of the patients could recognize severely unclean or cluttered living conditions in newspaper photographs, more than half did not appreciate that their own living conditions were squalid.

Conclusion: Deficits in frontal executive function appear important in the genesis of squalor although functions linked to orbito-frontal ability appear preserved.

Type
Research Article
Copyright
Copyright © International Psychogeriatric Association 2010

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Adolphs, R., Damasio, H. and Tranel, D. (2002). Neural systems for recognition of emotional prosody: a 3-D lesion study. Emotion, 2, 2351.Google Scholar
Baron-Cohen, S., Leslie, A. M. and Frith, U. (1985). Does the autistic child have a theory of mind? Cognition, 21, 3746.Google Scholar
Bedoin, N., Thomas-Anterion, C., Dorey, J. M. and Lebert, F. (2009). Implicit sensitivity to disgust-inducing stimuli in self-neglect FTD patients. Cognitive and Behavioral Neurology, 22, 236241.CrossRefGoogle ScholarPubMed
Burgess, P. and Shallice, T. (1997). Hayling and Brixton Tests. Thurston, Suffolk: Harcourt Assessment Incorporated.Google Scholar
Clark, A. N., Mankikar, G.D. and Gray, I. (1975). Diogenes syndrome: a clinical study of gross neglect in old age. Lancet, 1, 366368.CrossRefGoogle ScholarPubMed
Diehl-Schmid, J., Pohl, C., Ruprecht, C., Wagenpfeil, S., Foerstl, H. and Kurz, A. (2007). The Ekman 60 Faces Test as a diagnostic instrument in frontotemporal dementia. Archives of Clinical Neuropsychology, 22, 459464.Google Scholar
Ekman, P. and Friesen, W. (1976). Pictures of Facial Affect. Palo Alto, CA: Consulting Psychologists Press.Google Scholar
Folstein, M. F., Folstein, S.E. and McHugh, P.R. (1975). “Mini-mental state”: a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189198.CrossRefGoogle ScholarPubMed
Funayama, M., Mimura, M., Koshibe, Y. and Kato, Y. (2010). Squalor syndrome after focal orbitofrontal damage. Cognitive and Behavioral Neurology, 23, 135139.Google Scholar
Gregory, C. A. et al. (2002). Theory of mind in patients with frontal variant frontotemporal dementia and Alzheimer's disease: theoretical and practical implications. Brain, 125, 752764.Google Scholar
Halliday, G. and Snowdon, J. (2009). The Environmental Cleanliness and Clutter Scale (ECCS). International Psychogeriatrics, 21, 10411050.Google Scholar
Halliday, G., Banerjee, S., Philpot, M. and Macdonald, A. (2000). Community study of people who live in squalor. Lancet, 355, 882886.Google Scholar
Hornberger, M., Piguet, O., Kipps, C. and Hodges, J. R. (2008). Executive function in progressive and nonprogressive behavioral variant frontotemporal dementia. Neurology, 71, 14811488.Google Scholar
Kipps, C. M., Nestor, P. J., Acosta-Cabronero, J., Arnold, R. and Hodges, J. R. (2009). Understanding social dysfunction in the behavioural variant of frontotemporal dementia: the role of emotion and sarcasm processing. Brain, 132, 592603.CrossRefGoogle ScholarPubMed
Kril, J. J., Macdonald, V., Patel, S., Png, F. and Halliday, G. M. (2005). Distribution of brain atrophy in behavioral variant frontotemporal dementia. Journal of the Neurological Sciences, 232, 8390.Google Scholar
Lebert, F. (2005). Diogenes syndrome: a clinical presentation of fronto-temporal dementia or not? International Journal of Geriatric Psychiatry, 20, 12031204.Google Scholar
Lough, S., Kipps, C. M., Treise, C., Watson, P., Blair, J. R. and Hodges, J. R. (2006). Social reasoning, emotion and empathy in frontotemporal dementia. Neuropsychologia, 44, 950958.Google Scholar
Macmillan, D. and Shaw, P. (1966). Senile breakdown in standards of personal and environmental cleanliness. British Medical Journal, 2, 10321037.Google Scholar
Mioshi, E., Kipps, C. M., Dawson, K., Mitchell, J., Graham, A. and Hodges, J. R. (2007). Activities of daily living in frontotemporal dementia and Alzheimer disease. Neurology, 68, 20772084.CrossRefGoogle ScholarPubMed
Nelson, H. E. and O'Connell, A. (1978). Dementia: the estimation of premorbid intelligence levels using the new adult reading test. Cortex, 14, 234244.Google Scholar
Orrell, M. W. and Sahakian, B. J. (1991). Dementia of frontal lobe type. Psychological Medicine, 21, 553556.Google Scholar
Orrell, M. W., Sahakian, B. J. and Bergmann, K. (1989). Self-neglect and frontal lobe dysfunction. British Journal of Psychiatry, 155, 101105.Google Scholar
Perry, R. J. and Hodges, J. R. (1999). Attention and executive deficits in Alzheimer's disease: a critical review. Brain, 122, 383404.Google Scholar
Pike, K. E. et al. (2007). Beta-amyloid imaging and memory in non-demented individuals: evidence for preclinical Alzheimer's disease. Brain, 130, 28372844.Google Scholar
Post, F. (1982). The Psychiatry of Late Life. Oxford: Blackwell Scientific Publications.Google Scholar
Rascovsky, K. et al. (2007). Diagnostic criteria for the behavioral variant of frontotemporal dementia (bvFTD): current limitations and future directions. Alzheimer Disease and Associated Disorders, 21, S1418.CrossRefGoogle ScholarPubMed
Rosen, H. J. et al. (2002). Patterns of brain atrophy in frontotemporal dementia and semantic dementia. Neurology, 58, 198208.Google Scholar
Schillerstrom, J. E., Salazar, R., Regwan, H., Bonugli, R. J. and Royall, D. R. (2009). Executive function in self-neglecting adult protective services referrals compared with elder psychiatric outpatients. American Journal of Geriatric Psychiatry, 17, 907910.Google Scholar
Snowdon, J., Shah, A. and Halliday, G. (2007). Severe domestic squalor: a review International Psychogeriatrics, 19, 3751.CrossRefGoogle ScholarPubMed
Stone, V. E., Baron-Cohen, S. and Knight, R. T. (1998). Frontal lobe contributions to theory of mind. Journal of Cognitive Neuroscience, 10, 640656.Google Scholar
Torralva, T. et al. (2007). The relationship between affective decision-making and theory of mind in the frontal variant of fronto-temporal dementia. Neuropsychologia, 45, 342349.CrossRefGoogle ScholarPubMed
Wechsler, D. A. (1987). Wechsler Memory Scale – Revised. San Antonio, TX: Psychological Corporation.Google Scholar
Wrigley, M. and Cooney, C. (1992). Diogenes syndrome: an Irish series. British Journal of Psychiatry, 9, 3741.Google Scholar