Can Frontotemporal Dementia and Alzheimer's Disease Be Differentiated Using a Brief Battery of Tests?

Gregory, Carol; Orrell, Martin; Sahakian, Barbara J.; Hodges, John R.

doi:10.1002/(sici)1099-1166(199703)12:3<375::aid-gps518>3.0.co;2-#

Cited by 90 publications

(86 citation statements)

References 27 publications

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“…Dado que o MMSE não foi considerado no estadiamento de gravidade podemos concluir que esta gradação de desempenhos é uma primeira evidência de que o MMSE tem um constructo (memória, linguagem e capacidade construtiva) mais vocacionado para detetar os défices típicos da DA e da DC Lewy, sendo menos sensível a situações caracterizadas por disfunção frontal como a DFT e a DV. 14,[49][50][51] No que respeita à influência das variáveis sociodemográficas no desempenho global do teste, confirmámos que a idade e a escolaridade contribuíram ambas para a predição dos resultados e, saliente-se, com um peso semelhante, conforme indicado pelo valor beta. O valor obtido de 10,4, tem menor magnitude que o apontado para outras provas de rastreio, nomeadamente para o MoCA, cuja predição era 49% para o conjunto destas variáveis, com um peso de 42% para a escolaridade e 7% para a Idade.…”

Section: Discussionunclassified

Mini-Mental State Examination: Avaliação dos Novos Dados Normativos no Rastreio e Diagnóstico do Défice Cognitivo

et al. 2016

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RESUMOIntrodução: O Mini-Mental State Examination é o teste de rastreio de défice cognitivo/demência mais difundido. No nosso país têm-se utilizado pontuações de corte definidas por grupos de literacia, mas existem novas propostas sustentadas por estudos mais representativos. Propomo-nos confirmar a influência da idade e da escolaridade no desempenho, avaliar a capacidade discriminativa dos novos dados normativos e testar a acuidade diagnóstica das pontuações de corte validadas para o défice cognitivo ligeiro e para as formas mais prevalentes de demência. The Mini-Mental State Examination is the most commonly used cognitive screening test. In Portugal, the cut-off scores are defined according to literacy groups, but different proposals have been recommended by more representative studies. We therefore propose to confirm the influence of demographical variables, such as age and education, in the subject's performance; evaluating the discriminant ability of the new normative data; and to further examine the diagnostic acuity of the validated cut-off scoring for mild cognitive impairment and for the most prevalent types of dementia. Material and Methods: Our study includes 1 441 educated subjects, divided into seven subgroups: Mild cognitive impairment, Alzheimer's disease, frontotemporal dementia, vascular dementia, dementia with Lewy bodies, community-controls and memory cliniccontrols. Results: Altogether age and education explain 10.4% of the Mini-Mental State Examination results variance, with both variables contributing significantly to the results' prediction. The diagnostic acuity based on the most recent normative data was always higher than the one obtained through the validation cut-off scoring, revealing an overall excellent specificity (superior to 90%) and different sensitivity values: excellent for mild Alzheimer's disease (91%), good for dementia with Lewy Bodies (78%) and low for mild cognitive impairment (65%), frontotemporal dementia and vascular dementia (55%). Discussion and Conclusions:The performance on the Mini-Mental State Examination is influenced by age and education, supporting the use of normative data that consider those variables. With this approach, the Mini-Mental State Examination could be a sensitive and specific instrument for the Alzheimer's disease screening among all healthcare levels. Nevertheless, its diagnostic acuity is limited in other conditions frequently seen in memory clinics, such as Mild Cognitive Impairment and other types of dementia.

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Section: Discussionunclassified

Mini-Mental State Examination: Avaliação dos Novos Dados Normativos no Rastreio e Diagnóstico do Défice Cognitivo

et al. 2016

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“…This conclusion is supported by several other studies using clinically diagnosed patients that found similar levels of discriminability when differentiating FTD from AD on the basis of tests of executive function, visuospatial abilities, and episodic memory (Elfgren et al 1994;Gregory et al 1997;Lipton et al 2005;Libon et al 2007). These differences are robust enough to be detected with relatively brief dementiascreening instruments that tap multiple cognitive functions (Mathuranath et al 2000;Bier et al 2004;Slachevsky et al 2004).…”

Section: Behavioral Variant Frontotemporal Dementiamentioning

confidence: 99%

The Neuropsychological Profile of Alzheimer Disease

Weıntraub

Wicklund²,

Salmon³

2012

Cold Spring Harbor Perspectives in Medicine

467

282

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Neuropsychological assessment has featured prominently over the past 30 years in the characterization of dementia associated with Alzheimer disease (AD). Clinical neuropsychological methods have identified the earliest, most definitive cognitive and behavioral symptoms of illness, contributing to the identification, staging, and tracking of disease. With increasing public awareness of dementia, disease detection has moved to earlier stages of illness, at a time when deficits are both behaviorally and pathologically selective. For reasons that are not well understood, early AD pathology frequently targets large-scale neuroanatomical networks for episodic memory before other networks that subserve language, attention, executive functions, and visuospatial abilities. This chapter reviews the pathognomonic neuropsychological features of AD dementia and how these differ from "normal," age-related cognitive decline and from other neurodegenerative diseases that cause dementia, including cortical Lewy body disease, frontotemporal lobar degeneration, and cerebrovascular disease.O ver the past 30 years, neuropsychological assessment has featured centrally in characterizing the dementia associated with Alzheimer disease (AD), identifying the most salient and earliest cognitive and behavioral symptoms and contributing to the staging and tracking of disease (Flicker et al. 1984;Morris et al. 1989;Storandt and Hill 1989;Storandt 1991;Welsh et al. 1991Welsh et al. , 1992Locascio et al. 1995;Albert 1996;Storandt et al. 1998; see also Salmon and Bondi 2009). As research has increasingly focused on earlier stages of illness, it has become clear that biological markers of AD can precede cognitive and behavioral symptoms by years. It has also become clear that the early symptoms of AD represent the selective targeting by disease of specific, "largescale" neuroanatomical networks, with clinical deficits consistent with the anatomical locus of impact (Weintraub and Mesulam 1993Seeley et al. 2009). In the usual case, AD pathology is initially selective for limbic regions that subserve episodic memory, which leads to a circumscribed memory deficit in the early stages of the disease (Braak and Braak 1991;Jack et al. 1997; de ToledoMorrell et al. 2000). It is only as pathology progresses to other neocortical regions over time (Braak and Braak 1996a,b;Braak et al. 1999;Jack et al. 2000) that additional cognitive symptoms emerge and the full dementia syndrome becomes apparent.These discoveries have prompted a revision of the established research diagnostic criteria for AD dementia that had served so well since 1984 (McKhann et al. 1984). The new criteria define not only the dementia of AD (McKhann et al. 2011) but also incorporate a fuller spectrum of cognitive aging, including an intermediate stage of mild cognitive impairment (MCI) that precedes the dementia (Albert et al. 2011). A third, even earlier, stage of "preclinical AD" has also been identified (Sperling et al. 2011). This prodromal period is characterized by the presence of bi...

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“…Some other brief batteries have found moderate success in differentiating early FTLD patients, as a general syndromic group, from early AD patients by focusing on language impairments. However, the language impairments are commonly seen in the aphasic PPA subtypes of FTLD but not in the behavioral variant, therefore, the specificity of the brief batteries is lacking for the former group (Gregory, Orrell, Sahakian, & Hodges, 1997;Liscic, Storandt, Cairns, & Morris, 2007;Mathuranath, Nestor, Berrios, Rakowicz, & Hodges, 2000). These batteries have not been successful at identifying specific objective achievement measures on which early FTD patients perform more poorly than and can be easily discriminated from early AD patients.…”

Section: Differentiation Of Ftd From Admentioning

confidence: 99%

“…The most common behavioral changes include apathy, disinhibition, and inappropriate social conduct. Some studies have shown that the caretaker report of behavioral change is often the best way to differentiate between FTD and AD (Binetti, Locascio, Corkin, Vonsattel, & Growdon, 2000;Gregory et al, 1997). The hallmarked behavioral and functional changes are identified by the caretakers and quantified through their responses on measures like the NPI, Interpersonal Reactivity Index (IRI), Interpersonal Adjectives Scales, and Clinical Dementia Rating Scale (CDR).…”

Section: Differentiation Of Ftd From Admentioning

confidence: 99%

The Early Neuropsychological and Behavioral Characteristics of Frontotemporal Dementia

et al. 2008

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Frontotemporal lobe dementias (FTLD) represent a constellation of disorders that may be overlooked or misdiagnosed, despite being a fairly common presenile neurodegenerative diseases. Although the cognitive disorder can be difficult to document, particularly early in the dementia course, neuropsychological evaluation can assist in the diagnosis. Neuropsychologists are in an excellent position to draw from related disciplines like personality theory and social psychology to better assess the types of changes that characterize the prodromal and early phases of the disease. This review summarizes the current state of the field in the diagnosis of FTLD and discusses the emerging role of neuropsychology in elucidating the brain organization of complex processes including empathy, behavioral control and inhibition, reward systems, appetitive behaviors, emotional regulation, and goal-orientation. As this review underscores, FTD remains a powerful model for studying brain-behavior relationships.Frontotemporal lobar degeneration (FTLD) refers to a set of neurodegenerative disorders arising from relatively circumscribed frontal and temporal lobar atrophy. Characterized by troubling and progressive changes in behavior, personality, judgment, language, and cognition, the disorder compromises individuals while still in their productive years and may initially be mistaken as a psychiatric disorder. As with other degenerative dementias, a goal is to identify these disorders early with the intent of intervening before the disease has fully expressed in brain. Although no pharmacological treatments are yet available to prevent the disease progression, there are treatments that help alleviate symptoms and nonpharmacological interventions to deal with problem behaviors, coping, and adjustment. From a cognitive neuroscience perspective, the FTLD dementias with their effects on some of the core features of human personality and cognition offer an opportunity to better understand how these fundamental processes of human existence are functionally organized, both the processes involved as well as the brain systems that mediate them. This review article discusses the clinical presentation of the FTLD dementias with an emphasis on its early expression. We propose that by applying a theoretical framework of human behavior from social psychology and constructs from personality theory to the study of FTLD, neuropsychology is ideally positioned to elucidate some of the brain mechanisms underlying a range of complex human behaviors, emotions, and social cognition. Clinical and Neuropathological Expression of FTLDThe first mention of FTLD as a syndrome was in 1892 when Arnold Pick, a neurologist at the University of Prague, described the clinical and pathological features of one of his patients. He reported an aphasic presentation that progressed over three years in a 71-yearold individual. Upon autopsy, there was found to be significant frontal and temporal lobe atrophy in the diseased brain. Pick's clinical description of his patien...

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Can Frontotemporal Dementia and Alzheimer's Disease Be Differentiated Using a Brief Battery of Tests?

Cited by 90 publications

References 27 publications

Mini-Mental State Examination: Avaliação dos Novos Dados Normativos no Rastreio e Diagnóstico do Défice Cognitivo

Mini-Mental State Examination: Avaliação dos Novos Dados Normativos no Rastreio e Diagnóstico do Défice Cognitivo

The Neuropsychological Profile of Alzheimer Disease

The Early Neuropsychological and Behavioral Characteristics of Frontotemporal Dementia

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