LETTERS Progressive Impairment of Decision-Making in Behavioral-Variant

frontotemporal dementia (bvFTD) is characterized by marked alterations in behavior, personality, and social conduct, related to metabolic alter-ations of the medial prefrontal cortex (mPFC).1 In early bvFTD, patients may show preserved performance in traditional executive tasks,2 while presenting early impaired perfor-mance on the Iowa Gambling Task, (IGT), which assesses decision-making under ambiguous condi-tions and taps mPFC functions.3 Although the progressive prefrontal neurodegeneration has been seen, no studies assessed the progression of decision-making impairment in bvFTD. We hypothesized that decision-making may worsen along the course of bvFTD, and, to test this hypothesis, we longitudinally assessed two bvFTD patients, matchedwith 10 healthy controls (HC). “MM ” was a 49-year-old woman, working as doorperson. She pre-sented a pattern of behavioral alter-ations (apathy, decline in personal hygiene, bizarre behaviors) and cognitive impairment involving executive functions and visuospatial functions. SPECT showed hypoper-fusion in the right fronto-parieto-temporal cortex and in the left superior gyrus; 18FFDG PET showed a bilateral extended reduc-tion of the glucose metabolism in the frontal, prefrontal, temporal, posterior parietal, and occipito-parietal areas. “MS ” was a 56-year-old engineer. He presented a pattern of behavioral alterations (marked apathy, difficul-ties at work, aggressiveness) and cognitive impairment involving executive functions and episodic memory. SPECT showed moderate hypoperfusion in the left temporal and parietal cortices; 18FDG-PET showed an extended area of hypometabolism in the left parieto-temporal cortex, extended to the insula and the hippocampus and in the left infero-mesial frontal gyrus. Patients MM and MS received a clinical diagnosis of bvFTD. Their executive functioning was followed longitudinally, including decision-making ability, with the IGT, whose quantitative parameter consists of the net number of advantageous choices computed for the whole set of 100 cards. Patients attained these IGT scores