Differential Longitudinal Decline on the Mini-Mental State Examination in Frontotemporal Lobar Degeneration and Alzheimer Disease

Abstract

Objective To examine how phenotype affects longitudinal decline on the Mini-Mental State Examination (MMSE) in patients with frontotemporal lobar degeneration (FTLD) and Alzheimer's disease (AD) Background The MMSE is the most commonly administered assessment for dementia severity; however, the effects of phenotype on longitudinal MMSE performance in FTLD and AD have not been extensively studied. Methods Data from 185 patients diagnosed with AD (n=106) and three FTLD (n=79) phenotypes (behavioral variant frontotemporal dementia [bvFTD], nonfluent agrammatic variant of primary progressive aphasia [nfaPPA], and semantic variant PPA [svPPA]) were collected for up to 52 months since initial evaluation. Results Differential rates of decline were noted in that MMSE scores declined more precipitously for AD and svPPA compared to bvFTD and nfaPPA patients (p=0.001). The absolute 4-year MMSE decline given median baseline MMSE for bvFTD (14.67, 95% confidence interval [CI]: 14.63-14.71) and nfaPPA (11.02, 95% CI: 10.98-11.06) were lower than svPPA (22.32, 95% CI: 22.29-22.34) or AD (22.24, 95% CI: 22.22-22.26). Conclusions These data suggest that within-group AD and FTLD phenotypes present distinct patterns of longitudinal decline on the MMSE. MMSE may not be adequately sensitive to track disease progression in some phenotypes of FTLD.

Apraxia profile differentiates behavioural variant frontotemporal from Alzheimer's dementia in mild disease stages

“…Patients with AD presented with lower MMSE scores than patients with bvFTD (bvFTD: 25.4, AD: 22.4, p=0.009). Owing to its disproportionately high weighting of memory, verbal and visuoperceptual functions, the MMSE has been shown to be insensitive for the core behavioural and cognitive deficits in bvFTD especially in mild disease stages when apathy and mutism are less pronounced 22 23. Disease duration was longer for patients with bvFTD compared with patients with AD in our sample, t(32)=2.58, p<0.05.…”

A multivariate metabolic imaging marker for behavioral variant frontotemporal dementia

“…Moreover, in the absence of standardized clinical rating scales for bvFTD [29], most previous studies [27,28,30] have used general dementia rating scales (such as MMSE) to determine early or mild stages of bvFTD. However, these measures, commonly used for AD, do not consistently correlate with disease progression and the associated deterioration of social and behavioral symptoms in bvFTD, thus often underrating its severity [29,31,32].…”

“…Moreover, in the absence of standardized clinical rating scales for bvFTD [29], most previous studies [27,28,30] have used general dementia rating scales (such as MMSE) to determine early or mild stages of bvFTD. However, these measures, commonly used for AD, do not consistently correlate with disease progression and the associated deterioration of social and behavioral symptoms in bvFTD, thus often underrating its severity [29,31,32]. To overcome this limitation, we used symptom duration as the main metric to identify subjects at the early stage of dementia [29]; and general cognitive measures were only used to exclude subjects with early presentation of marked cognitive or functional impairment [29].…”

The epidemiology of frontotemporal dementia

“…Folstein, Folstein, & McHugh, 1975) and the Clinical Dementia Rating (CDR) (Hughes, Berg, Danziger, Coben, & Martin, 1982), both developed for measurement of AD. Recent data indicate FTD and AD differ in the profile and tempo of decay in MMSE scores (Tan, Libon, Rascovsky, Grossman, & Xie, 2013). This may result from the MMSE not measuring the asocial or behavioral aspects of the FTD phenotype, or to focal decline in language (Chow, Hynan, & Lipton, 2006).…”