Standardization and diagnostic utility of the Frontal Assessment Battery for healthy people and patients with dementia in the Chilean population

Abstract

ABSTRACT. The Frontal Assessment Battery (FAB) is a screening test that measures executive functions. Although this instrument has been validated in several countries, its diagnostic utility in a Chilean population has not been studied yet. Objectives: This study aimed to (1) adapt FAB in a Chilean population; (2) study the psychometric properties of the FAB in a Chilean population; (3) assess the sociodemographic influence in the performance of the FAB in a sample of healthy controls (HC); and (4) develop normative data for this healthy group. Methods: A HC (n=344) and a group of patients with dementia (n=156) were assessed with the Chilean version of FAB. Results: FAB showed good internal consistency (Cronbach's alpha=0.79) and acceptable validity based on the relationship with other variables. Factor analysis showed the unidimensionality of the instrument. Significant differences were found in the total FAB value between the HC and dementia groups. With the matched sample, the established cutoff point was 13.5, showing a sensitivity of 80.8% and a specificity of 90.4%. Regression analysis showed that education and age significantly predicted FAB performance in the healthy group. Finally, normative data are provided. Conclusions: This study shows that FAB is a useful tool to discriminate between healthy people and people with dementia. However, further studies are needed to explore the capacity of the instrument to characterize the dysexecutive syndrome in people with dementia in the Chilean population.

Validation of the Norma Latina Neuropsychological Assessment Battery in Patients with Alzheimer’s Disease in Mexico

“…The results of this study concur with those reported in previous studies in which neuropsychological test batteries are useful tools to discriminate between healthy people and people with neurodegenerative diseases [ 38 , 42 , 43 , 109 , 110 ]. Specifically, in this study the group of participants with AD presented significantly lower scores compared to the healthy group, a fact widely reported also by other studies [ 38 , 42 , 43 , 108 ].…”

“…The results of this study concur with those reported in previous studies in which neuropsychological test batteries are useful tools to discriminate between healthy people and people with neurodegenerative diseases [ 38 , 42 , 43 , 109 , 110 ]. Specifically, in this study the group of participants with AD presented significantly lower scores compared to the healthy group, a fact widely reported also by other studies [ 38 , 42 , 43 , 108 ]. In addition, the AUCs were moderate and large (AUC’s ≥ 0.78) when evaluating the degree of discrimination between the group of healthy participants and the AD group, aspects that have also been previously reported in the literature [ 42 , 108 ].…”

“…Currently, there are different studies that have been carried out with the purpose of validating and assessing different screening tests for people with dementia in the Spanish-speaking population [ 57 , 105 , 106 ]. However, very few studies to date have been carried out with the aim of validating neuropsychological assessment batteries in individuals with Alzheimer’s disease in Latin America [ 38 , 42 , 43 , 107 , 108 ].…”

“…For example: (1) Very few studies have been conducted with the aim of validating neuropsychological test batteries in people with dementia in Latin America [ 38 , 42 , 43 , 107 , 108 ]. Some of those that have been done combine patients with different types of dementia or have been done with Portuguese-speaking people [ 42 , 107 ]; (2) The total number of tests and scores is different between the studies, where in this study Norma Latina consists of nine tests and 24 test-scores, while in similar studies batteries made up of eight [ 38 ], seven (INECO Frontal Screening [IFS]) [ 108 ], or six (Frontal Assessment Battery [FAB]) [ 43 , 108 ] test-scores, except for the study by Porto et al [ 42 ] who studied 144 test-scores; (3) The sample size of the groups is different, especially in the AD group, where the present study has a sample of 117 participants with AD, while Custodio et al [ 108 ] analyzed 35 participants and Fonseca et al [ 107 ] 11, while Aguirre-Acevedo et al [ 38 ] and Grandi et al [ 43 ] studied 151 and 150 participants with AD, respectively; (4) The number of cognitive domains that the batteries evaluate vary, for example [ 43 , 108 ] present validation of IFS and FAB, these batteries specialize in measuring executive function, while Norma Latina Battery groups the 24 test-scores in four cognitive domains commonly used in the clinic (Executive Function, Attention and Processing Speed, Language and Learning and Memory) in a similar way as Porto et al [ 42 ] that groups by domains of Attention, Initiation/Perseveration, Construction, Conceptualization, and Memory; (5) In the present study, the estimation of the most used cut-off points in the clinic (25th, 16th, 10th, 5th, and 2nd) was carried out from a multivariate approach [ 98 ], which allowed adjusting each test-score to the demographic variables of the participants through the Multivariate base rates of low scores. However, studies such as those conducted by Custodio et al [ 108 ], Grandi et al [ 43 ], Porto et al [ 42 ] and Fonseca et al [ 107 ] did not make any type of adjustment, since they assumed that because there were no significant differences between the sociodemographic characteristics of the patients, the samples were paired, so eliminating this effect; (6) Another notable difference is the different statistics used to determine the optimal cut-off point from the ROC curve.…”

“…Finally, in Chile, Grandi et al conducted a study with the objectives of: (1) adapting The Frontal Assessment Battery (FAB); (2) analyzing its psychometric properties; (3) evaluating the sociodemographic influence on FAB performance in a sample of healthy controls; and (4) developing normative data in healthy population. This study found that the FAB is a useful tool to discriminate between healthy people and people with dementia [ 43 ]. It is important to have accurate and valid population-specific tests because biological [ 44 ] and cultural [ 45 ] differences have been documented across populations.…”