Diagnostic properties of the Frontal Assessment Battery (FAB) in Italian healthy adults

Abstract

Background Sub-clinical cognitive efficiency deficits of a dysexecutive nature are moderately prevalent in healthy older adults and negatively affect their functional outcomes. To screen for such dysfunctions, the Frontal Assessment Battery (FAB) provided promising evidence, although its diagnostic properties have not been tested to date. This study thus aimed at exploring the performance on the FAB of a large sample of Italian healthy adults and comparing it in individuals aged < 75 years vs. ≥ 75 years. Methods Four hundred and seventy-five healthy adults (169 males, 306 females, age: 61.1 ± 15.1; education 11.7 ± 4.6) were administered the FAB and the Montreal Cognitive Assessment (MoCA). Sensitivity, specificity, positive and negative predictive values and likelihood ratios were computed through receiver-operating characteristics analyses by addressing an above-vs. below-cutoff performance on the MoCA as the state variable (as including measures of executive functioning). ResultsThe FAB overall showed good accuracy (AUC = 0.71-0.76), although higher for healthy older adults. A trend towards higher specificity (64.4-80.3%) than sensitivity (61.1-77.8%) was found, despite these metrics being comparable in healthy older adults. Negative predictive values (0.98-0.99) were systematically higher than positive predictive values (0.05-0.24), whereas consistent post-test probabilities were detected (positive likelihood ratios: 2.19-3.35; negative likelihood ratios: 0.28-0.48). Discussion The FAB is an accurate test for the first-level assessment of dysexecutive-related global cognitive inefficiency in the general population, despite being moderately conservative as far as both its pre-and post-test features are concerned. Its diagnostic value is more informative for individuals aged ≥ 75 years.

Diagnostic properties of the Frontal Assessment Battery (FAB) in Huntington’s disease

“…In addition, one should bear in mind that the MoCA and the FAB do share some items (e.g., phonemic fluency and abstraction ones), this prompting future studies to focus on a reference measure that does not overlap with the FAB in any extent. However, in this respect, it should be noted that, within the present report, the MoCA yielded a prevalence of cognitive impairment that is consistent with previous epidemiological evidence in HD patients (Julayanont et al, 2020), as well as that the use of the MoCA as a reference for testing the diagnostics of the FAB has previously proved adequate in normotypical individuals (Aiello et al, 2022a)-both these elements supporting its adoption as an outcome variable within ROC analyses.…”

Telephone-based Frontal Assessment Battery (t-FAB): standardization for the Italian population and clinical usability in neurological diseases

“…Nevertheless, executive deficits feature a variety of neurological diseases affecting cortical and subcortical frontal circuitries [16] and convey relevant information towards differential diagnosis and prognosis [17]. Moreover, subclinical or mild dysexecutive features are highly prevalent in healthy elderlies due to the anatomo-functional changes of frontal networks resulting from physiological aging [18,19], which were shown to negatively impact on daily living functional outcomes [17]. Screening for executive dysfunctions is thus crucial in both neurology and geriatrics, and the availability of standardized TBCS tests for frontalexecutive dysfunctions should be part of telemedicine [14], especially when dealing with elderly clinical populations.…”

“…Among frontal-executive screeners, the in-person version of the Frontal Assessment Battery (FAB) [21] represent one of the most psychometrically and diagnostically sound tests worldwide [22]. In Italy, the FAB has been shown to come with optimal psychometrics, diagnostics and clinical usability evidence [18,19,23,24].…”

“…a backward digit span (BDS) task[32] (HP subsample of N = 270: 110 males, 160 females; age: 47.24 ± 18.33 years, 18-96; education: 13.67 ± 3.63 years,[4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22]…”

Optimal MoCA cutoffs for detecting biologically-defined patients with MCI and early dementia

“…Although the authors applied the propensity score matching procedure [12,17] in order to minimize the effects of sociodemographic variables on the diagnostic accuracy estimation of the MoCA, their study included only participants with poor education. Furthermore, using a state variable based on the MMSE cutoff may not be an acceptable solution when exploring the diagnostic properties of a cognitive tool since the outcome of a screening assessment may be not sufficient for properly characterizing a cognitive profile [18].…”