Can a personality trait predict function in frontotemporal dementia?

Clinical takeaway: Consider asking caregivers about changes in conscientiousness, including organization, reliability, planning, and follow-through, when assessing patients with early behavioral variant frontotemporal dementia (bvFTD). Marked declines in these traits may signal greater difficulty with instrumental activities of daily living and help identify patients who could benefit from earlier caregiver support and environmental interventions.

Functional decline often appears early in bvFTD and can be disproportionately severe relative to cognitive test performance. Clinicians have long recognized personality change as a hallmark of the disease, but its relationship to everyday functioning has remained unclear.

Researchers found that current personality traits explained nearly 40% of the variation in functional status among patients with early-stage bvFTD. In contrast, personality traits before disease onset showed no meaningful relationship with patients' ability to manage daily activities.

The study identified conscientiousness as the only personality trait independently associated with everyday functioning. Patients with lower levels of conscientiousness had greater difficulty managing complex tasks such as finances, shopping, meal preparation, appointments, and travel. Adding current personality measures increased explained variation in functional scores from about 3% to nearly 40%.

Substantial personality changes were observed after disease onset. Conscientiousness showed the largest decline, followed by openness, extraversion, and agreeableness, while neuroticism increased. Family members rated current conscientiousness scores roughly 39% lower than premorbid scores.

The retrospective study included 111 patients with early-stage bvFTD (mean age 63 years) evaluated at the University of California, San Francisco memory center. Caregivers completed Big Five personality assessments for current and premorbid traits and rated patients' functional abilities using the Functional Activities Questionnaire, which served as the primary outcome measure.

The authors suggest that personality assessment may complement traditional cognitive and severity measures when evaluating bvFTD. Future longitudinal studies will examine whether changes in conscientiousness track functional decline over time and explore the neurocognitive and neurobiological mechanisms linking personality change to disability.

“Changes in personality can be among the most challenging symptoms of frontotemporal dementia for individuals and their families,” said study author Katherine P. Rankin, PhD. “These findings may help predict who may have problems with functioning, which could allow doctors and caregivers to implement strategies to support people's daily functioning.”

Source: Chatzidimitriou E, et al. (2026 Nov 10) Neurology. Personality Correlates of Functional Status in Patients With Early-Stage Behavioral Variant Frontotemporal Dementia