Portuguese version of the CDR plus NACC FTLD: Validation studies

Abstract

Introduction The CDR Dementia Staging Instrument PLUS National Alzheimer’s Coordinating Center (CDR plus NACC FTLD) was developed by adding to the standard CDR two extra domains focused on the main features of frontotemporal lobar degeneration (FTLD): language and behavior/personality. We intended to perform the validation studies for the European‐Portuguese population. Methods A total of 105 participants matched for age, education, and disease staging (35 bvFTD, 35 AD, and 35 controls) were included. A translated‐version of the CDR and the two added domains was administered by a neuropsychologist who was blinded to the diagnosis. Results The bvFTD group had higher baseline CDR plus NACC FTLD scores compared to the AD and controls. Only the sum‐of‐boxes (SB) score, the behavior/personality, and language domains were able to distinguish between clinical groups. Logistic regression analyses showed that adding the behavior/personality domain with or without language significantly enhanced the discriminating ability. Discussion Results show that the CDR plus NACC FTLD is a reliable tool in the diagnostic process of bvFTD patients and has an added value in distinguishing them from patients with AD.

Utility of the Japanese version of the Clinical Dementia Rating® plus National Alzheimer's Coordinating Centre Behaviour and Language Domains for sporadic cases of frontotemporal dementia in Japan

“…ROC curve analysis showed that the BEHAV and LANG domain of the CDR® plus NACC FTLD distinguished between patients with AD dementia and FTD better than the MEMORY domain of the CDR®. This result is consistent with those of previous studies 7,8,10 . Although the CDR® plus NACC FTLD was not developed to distinguish FTD from other types of dementia, it may be useful in distinguishing FTD from AD dementia.…”

“…This study had some limitations. First, the number of patients, particularly with PNFA, was less than that in previous studies 5–8,36 . However, 50 patients were sufficient to evaluate the inter‐ and intra‐rater reliability, validity, and responsiveness.…”

“…However, 50 patients were sufficient to evaluate the inter‐ and intra‐rater reliability, validity, and responsiveness. Second, this study included more patients who scored three (severely impaired) in BEHAV and/or LANG domains of the CDR® plus NACC FTLD than previous studies 6–8 . This may have resulted in significant differences in the correlation analysis.…”

“…Previous validation studies showed that the CDR ® plus NACC FTLD, which allows a more comprehensive description of the disease, enhances sensitivity to FTD and improves the discrimination between FTD and AD dementia. 7,8 Furthermore, the CDR ® plus NACC FTLD correlates well with reduced cerebral blood flow in the frontotemporal lobe typical of FTLD. 9 As a result, the CDR ® plus NACC FTLD has been used as the primary end point in the recently initiated FTD clinical trial.…”

“…The global rating and its scoring rules were developed with the transition from the FTLD‐CDR to the CDR® plus NACC FTLD. Previous validation studies showed that the CDR® plus NACC FTLD, which allows a more comprehensive description of the disease, enhances sensitivity to FTD and improves the discrimination between FTD and AD dementia 7,8 . Furthermore, the CDR® plus NACC FTLD correlates well with reduced cerebral blood flow in the frontotemporal lobe typical of FTLD 9 .…”