Examining Executive Dysfunction with the Institute of Cognitive Neurology (INECO) Frontal Screening (IFS): Normative Values from a Healthy Sample and Clinical Utility in Alzheimer's Disease

Abstract

Age and education should be taken into account when interpreting performance on the IFS. The IFS is useful to detect executive dysfunction in AD, showing good discriminant and concurrent validities.

Assessing Executive Dysfunction in Neurodegenerative Disorders: A Critical Review of Brief Neuropsychological Tools

“…Comparisons between IFS and FAB were undertaken, and these have shown that IFS is more sensitive and specific in differentiating bvFTD from AD (Gleichgerrcht et al, 2011 ; Custodio et al, 2016 ), and it also correlates more strongly with standard executive tasks (e.g., TMT-B, WCST, Gleichgerrcht et al, 2011 ). Nonetheless, the advantage of IFS over FAB remains to be established: in a study with AD patients, they showed similar diagnostic accuracy (0.88 and 0.87, respectively) and similar correlations with other measures of EF (Moreira et al, 2014 ). IFS scores also correlate with MMSE scores (Torralva et al, 2009 ; Ihnen et al, 2013 ; Moreira et al, 2014 ) and are influenced by age (Moreira et al, 2014 ) and education (Ihnen et al, 2013 ; Moreira et al, 2014 ), reinforcing the need of normative data to take these variables into account.…”

“…Concerning byFTD and AD patients, although bvFTD presented lower scores in some studies (Iavarone et al, 2004 ; Slachevsky et al, 2004 ; Nakaaki et al, 2007 ), in other studies differences were not significant (Castiglioni et al, 2006 ; Gleichgerrcht et al, 2011 ). Additionally, some of its subtests have been shown to have poor sensitivity (e.g., Prehension Behaviour and Letter Fluency; Lima et al, 2008 ; Moreira et al, 2014 ). Age (Iavarone et al, 2004 ; Appollonio et al, 2005 ; Lima et al, 2008 ) and education (Iavarone et al, 2004 ; Appollonio et al, 2005 ; Rodrigues et al, 2009 ) should be considered when interpreting FAB scores, since they are predictors of performance, with advanced age and less years of education predicting lower scores.…”

“…Additionally, associations with functional measures have been found, such as the Activities of Daily Living Scale (Ihnen et al, 2013 ). The IFS discriminate between healthy controls and patients with bvFTD (Torralva et al, 2009 ; Gleichgerrcht et al, 2011 ; Fiorentino et al, 2013 ; Custodio et al, 2016 ), AD (Torralva et al, 2009 ; Gleichgerrcht et al, 2011 ; Moreira et al, 2014 ; Custodio et al, 2016 ), relapsing–remitting multiple sclerosis (Bruno et al, 2015 ), bipolar disorder and ADHD (Baez et al, 2014 ), as well as between clinical conditions, with bvFTD patients scoring lower than those with major depression (Fiorentino et al, 2013 ) and AD (Torralva et al, 2009 ; Custodio et al, 2016 ). Cut-offs have been presented throughout the studies, with overall values of sensitivity and specificity above 70%: 23.5 (Custodio et al, 2016 ) and 25 (Torralva et al, 2009 ) for the detection of dementia, and 17.5 (Custodio et al, 2016 ) and 19 (Torralva et al, 2009 ) for the discrimination between bvFTD and AD patients.…”

“…Cut-offs have been presented throughout the studies, with overall values of sensitivity and specificity above 70%: 23.5 (Custodio et al, 2016 ) and 25 (Torralva et al, 2009 ) for the detection of dementia, and 17.5 (Custodio et al, 2016 ) and 19 (Torralva et al, 2009 ) for the discrimination between bvFTD and AD patients. In a sample with lower education, Moreira et al ( 2014 ) showed that an optimal cut-off of 17 discriminated between healthy controls from AD patients. Only one study explored the neural correlates of IFS, finding that total scores were associated with atrophy in the amygdala, the hippocampus, the parahippocampal gyrus, the fusiform gyrus, and the orbitofrontal cortex in bvFTD patients (Baez et al, 2017 ).…”

FRONTIER Executive Screen: a brief executive battery to differentiate frontotemporal dementia and Alzheimer's disease

“…While brief executive screening tests have been developed to address this issue, many existing tools were not specifically designed for use within dementia populations,14 show limited discrimination between bvFTD and AD,15 include items that are vulnerable to misinterpretation16 or items which fail to exclusively tap executive functions 17. Tools focusing on executive function to assist with differential dementia diagnosis already exist (eg, INECO Frontal Screen;18 Frontal Assessment Battery19), but these are not without limitations, which include inconsistent patient differentiation across subtests,20 need for training in scoring responses and inclusion of items vulnerable to educational achievement 21. While the Addenbrooke's Cognitive Examination,22 a broad cognitive screening tool, is also often thought to assist with differential diagnosis, this was not its intended design and an acknowledged caveat of the test is its limited capacity to assess executive functions.…”