Frontal Assessment Battery is a marker of dorsolateral and medial frontal functions: A SPECT study in frontotemporal dementia

Association Between Frontal Lobe Hemodynamics and Neurocognitive Dysfunction in Adults With Moyamoya Disease: Retrospective Cohort Analysis

BACKGROUND

Adult patients with moyamoya disease (MMD) may present with mild cognitive dysfunction, even those without evidence of conspicuous brain parenchymal damage. This cognitive dysfunction might be caused by local frontal lobe ischemia.

OBJECTIVE

To explore the relationship between frontal lobe hemodynamic insufficiency and cognitive dysfunction in patients with MMD.

METHODS

Thirty adult patients with MMD without conspicuous brain parenchymal damage were retrospectively examined. Patients with MMD with frontal lobe intracerebral steal phenomenon on single photon emission computed tomography were defined as group S (n = 13) and those without it were defined as group P (n = 17). A comparative group comprising patients with unruptured intracranial aneurysm was defined as group C (n = 30). The results of various cognitive and intelligence tests and a composite cognitive score were compared between groups.

RESULTS

The digit span test forward version ( P = .041), frontal assessment battery ( P = .022), and composite cognitive score ( P = .015) z-scores were significantly lower in group S than group C. Adjusting for sex and age, patients in group S had a significantly lower composite cognitive score compared with those in group C in multiple regression analysis ( P = .037). Executive dysfunction and working memory dysfunction may be involved in the cognitive decline observed in group S.

CONCLUSION

Mild cognitive dysfunction in MMD was associated with frontal lobe hemodynamic insufficiency. Future studies should examine whether revascularization can improve cerebral hypoperfusion and neurocognitive function in these patients.

Differentiation of the motor cost associated with cognitive tasks in Parkinson's disease: a dual-task study

Parkinson's disease is a neurodegenerative condition associated with motor and cognitive impairments. While the execution of dual cognitive-motor tasks imposes a cost on gait velocity, it has been barely determined if the gait deterioration depends on the specific cognitive domain involved in the dual-task. Twenty-four subjects (twelve patients with Parkinson's disease and twelve healthy subjects) carried out a single task (gait alone) and several dual tasks where the concurrent second task was the Trail Making Test (Part A) and the six tasks of the Frontal Assessment Battery. Gait variables were measured by accelerometry via smartphone. Data analysis included analysis of variance and exploratory factorial analysis. Both groups showed a similar gait performance, except for velocity, where patients exhibited a bradykinetic profile. The dual-task during the Trail Making Test showed the highest motor cost. Frontal Assessment Battery's tasks as conceptualization, mental flexibility, and motor programming showed a higher motor cost than the other tasks (sensibility to interference, inhibitory control, and environmental autonomy). The factorial analysis applied to the motor costs confirmed two profiles, grouping those related to the dorsolateral prefrontal cortex (mental flexibility and motor programming tasks) in an independent factor. Among cognitive functions, attention is critical for gait control in Parkinson's disease and healthy elderly people. The interference posed by several executive operations suggests a specific competition in prefrontal regions that support dual tasks. Moreover, the higher cost for Parkinson's disease patients emphasizes the cognitive decline and compensatory cognitive strategy for gait control related to attention and executive functions.

Revascularization to the ACA: effectiveness and variation of the STA-RAG-A3 bonnet bypass

BACKGROUND

The effectiveness of bypass surgery in patients with atherothrombotic ischemia in the anterior cerebral artery (ACA) domain remains unclear. In this study, three cases with ischemia in the ACA territory underwent revascularization surgery using superficial temporal artery (STA)-radial artery graft (RAG)-A3 (pericallosal artery) bonnet bypass. Herein, we discuss the effectiveness and variations of this approach.

METHODS

Among 182 consecutive patients with atherothrombotic ischemic stroke admitted to the NTT Medical Center, Tokyo, from April 2017 to May 2021, three patients with hemodynamic insufficiency in the extensive ACA territory beyond the recent infarct area were treated using STA-RAG-A3 bonnet bypass.

RESULTS

One patient with bilateral severe cerebral blood flow (CBF) deficiency required additional A3-A3 and STA-middle cerebral artery single bypass in conjunction with STA-RAG-A3 bypass. There were no complications associated with the surgical procedure. The patients' hemodynamic study results and neurocognitive performances improved dramatically after surgery.

CONCLUSION

Our results suggest the efficacy of STA-RAG-A3 bypass for atherothrombotic ACA ischemia. However, because the number of cases was too small to generalize our results, more cases and thorough pre- and postoperative hemodynamic studies are necessary to prove the validity of the approach.

Social Cognition Tests Can Discriminate Behavioral Variant Frontotemporal Dementia From Alzheimer's Disease Independently of Executive Functioning

OBJECTIVE

To investigate the accuracy of the Social and Emotional Assessment-short version (Mini-SEA) to differentiate subgroups of behavioral variant of frontotemporal dementia (bvFTD) and Alzheimer's disease (AD) defined according to executive performance.

METHODS

bvFTD (n = 21), AD (n = 20), and healthy controls (HC, n = 23) underwent the Mini-SEA, comprising the Facial Emotion Recognition Test (FERT) and the faux-pas test. AD and bvFTD patients were classified according to their performance in the Frontal Assessment Battery into dysexecutive and nondysexecutive subgroups.

RESULTS

The area under the curve (AUC) values for the faux-pas test were 0.87 (dysexecutive-bvFTD vs. dysexecutive-AD) and 0.96 (non-dysexecutive-bvFTD vs. nondysexecutive-AD). The AUC values for FERT were 0.99 (dysexecutive-bvFTD vs. dysexecutive-AD) and 0.65 (nondysexecutive-bvFTD vs. nondysexecutive-AD); the AUC values for the Mini-SEA (total-score) were 0.95 (dysexecutive-bvFTD vs. dysexecutive-AD) and 0.88 (nondysexecutive-bvFTD vs. nondysexecutive-AD).

DISCUSSION

Social Cognition tests accurately distinguish bvFTD from AD regardless of the executive profile.

Quantitative gait analysis of idiopathic normal pressure hydrocephalus using deep learning algorithms on monocular videos

A vision-based gait analysis method using monocular videos was proposed to estimate temporo-spatial gait parameters by leveraging deep learning algorithms. This study aimed to validate vision-based gait analysis using GAITRite as the reference system and analyze relationships between Frontal Assessment Battery (FAB) scores and gait variability measured by vision-based gait analysis in idiopathic normal pressure hydrocephalus (INPH) patients. Gait data from 46 patients were simultaneously collected from the vision-based system utilizing deep learning algorithms and the GAITRite system. There was a strong correlation in 11 gait parameters between our vision-based gait analysis method and the GAITRite gait analysis system. Our results also demonstrated excellent agreement between the two measurement systems for all parameters except stride time variability after the cerebrospinal fluid tap test. Our data showed that stride time and stride length variability measured by the vision-based gait analysis system were correlated with FAB scores. Vision-based gait analysis utilizing deep learning algorithms can provide comparable data to GAITRite when assessing gait dysfunction in INPH. Frontal lobe functions may be associated with gait variability measurements using vision-based gait analysis for INPH patients.

Strategy for screening cognitive impairment in Chinese patients with amyotrophic lateral sclerosis

BACKGROUND

It is an economical strategy to design a screening method to decide which patients with amyotrophic lateral sclerosis/ motor neuron disease (ALS/MND) should enter into the stage for further comprehensive neuropsychological investigation.

METHODS

59 patients (including 8 with frank dementia) were recruited. They underwent the extensive neuropsychological evaluation and short screening batteries, namely the Mini-Mental State Examination (MMSE), the Peking Union Medical College Hospital version of Montreal Cognitive Assessment (MoCA-P) and the Frontal Assessment Battery (FAB). Results of the extensive neuropsychological evaluation were set as the gold standard to diagnose cognitive impairment, and the effectiveness of screening tests were measured against them.

RESULTS

By comparing the sensitivity and specificity, we found that the combination of FAB plus both or either of the other 2 short batteries provided a satisfactorily high sensitivity, but none of these screening batteries was significantly associated with quantitative behavioral measurements among non-demented subjects, the Frontal Behavioral Inventory-ALS version (FBI-ALS).

CONCLUSIONS

The combination of the FBI-ALS, the FAB, and the MMSE or the MoCA-P or both could effectively screen comorbid dementia, cognitive and behavioral impairment in ALS but this implicates a limited specificity. And the FAB needed to be validated in large Chinese sample.

Common carotid flow velocity is associated with cognitive function after carotid endarterectomy

The relationship between ultrasonographic flow parameters and cognitive function has not been well studied. This study aimed to clarify associations between carotid flow velocity (FV) and cognitive function in patients with a history of carotid endarterectomy (CEA). Ninety-four patients who previously underwent CEA participated in this study. The Neurobehavioral Cognitive Status Examination (Cognistat) and Frontal Assessment Battery (FAB) were adopted to assess cognitive functions at a mean of 6.5 ± 3.2 years after CEA. End-diastolic flow velocity (EDV) of the left and right common carotid artery (CCA) was significantly associated with total Cognistat score (p < 0.001) and total FAB score (p < 0.05). Pulsatility index (PI) of the left CCA was significantly associated with total Cognistat score and total FAB score (p < 0.01). A cut-off right CCA EDV of 14.5 cm/s offered the most reliable predictor of the bottom 25th percentile of total Cognistat score (sensitivity 83.3%, specificity 61.0%, area under the curve (AUC) 0.731, p = 0.0060), while a cut-off left CCA PI of 1.83 was the most reliable predictor of the bottom 25th percentile of total FAB score (sensitivity 73.3%, specificity 60.0%, AUC 0.679, p = 0.0179). Left and right CCA EDV correlated with sub-components of comprehension, construction, judgment, programming (p < 0.01), and conceptualization (p < 0.05). Right CCA EDV correlated with similarity (p < 0.01), repetition, naming, and memory (p < 0.05). Left CCA PI correlated with attention, conceptualization (p < 0.01), repetition, construction, similarity, and mental flexibility (p < 0.05), while right CCA PI correlated with construction (p < 0.05). CCA FV may offer useful markers of cognitive functions in patients with a history of CEA.

Normative data for the Slovak version of the Frontal Assessment Battery (FAB)

The Frontal Assessment Battery (FAB) is a well-established screening measure of frontal lobe pathology. The aim of this study is the development of normative data for healthy Slovak adults. The final sample consisted of 487 healthy adults (54% of them female). The mean age in our sample was M = 55.29 (SD = 19.96). For the whole sample, the mean score on the FAB was 16.46 and the SD was 1.64. The mean score on the MMSE for the whole sample was 28.39 and the SD was 1.43. All participants underwent a complex neuropsychological examination spanning the relevant cognitive domains. FAB scores were found to be negatively associated with age (rs = -0.464, p < 0.001) and positively associated with years of education (rs = 0.199, p < 0.001). FAB scores positively correlated with the performance in MMSE (rs = 0.266, p < 0.001). Statistically significant and theoretically meaningful associations to other neuropsychological tests used in this study suggested the adequate convergent validity of the Slovak version of the FAB. The present study provided accurate normative FAB data, which can be used for clinical and research purposes.

Apathy in frontotemporal dementia is related to medial prefrontal atrophy and is independent of executive dysfunction

INTRODUCTION

Apathy is the most common neuropsychiatric syndrome in behavioral variant frontotemporal dementia (bvFTD), and encompasses cognitive, behavioral and affective symptoms. The neural basis of apathy in bvFTD is not completely understood. Previous neuroimaging studies have poorly considered executive impairment and dementia severity as possible confounding factors. Herein we investigated the neural basis of apathy in bvFTD through structural neuroimaging taking into account these factors.

METHODS

We included patients with probable bvFTD (n = 21) and cognitively healthy controls (HC, n = 22). Participants were matched for age, sex and schooling. All subjects underwent a thorough neuropsychological examination, including tests for executive functions and social cognition. Apathy was assessed with the Starkstein Apathy Scale (SAS). All subjects underwent 3T brain MRI. We investigated correlations between SAS scores and gray matter atrophy within the bvFTD group. Executive function (Frontal Assessment Battery) and disease severity were considered as covariates in neuroimaging analyses.

RESULTS

Compared to HC, bvFTD patients had lower scores on global cognitive efficiency, executive functions and social cognition. All bvFTD had clinically relevant apathy (scores greater than 14 in the SAS). Performance in executive function tests did not correlate with apathy scores. The severity of apathy was negatively correlated with gray matter volumes in midline prefrontal regions, namely orbitofrontal cortex and both anterior and dorsal regions of cingulate cortex.

CONCLUSIONS

Apathy in bvFTD is related to a specific network of prefrontal cortical areas critically involved in effort-based behavior for rewards and appears to be independent of executive dysfunction.

Quantitative Gait Analysis and Cerebrospinal Fluid Tap Test for Idiopathic Normal-pressure Hydrocephalus

We investigated gait performance utilizing a quantitative gait analysis for 2 groups: (1) idiopathic normal-pressure hydrocephalus (INPH) patients who had a positive response to the cerebrospinal fluid tap test (CSFTT) and (2) healthy controls. The aims of the study were (1) to analyze the characteristics of gait features, (2) to characterize changes in gait parameters before and after the CSFTT, and (3) to determine whether there was any relationship between stride time and stride length variability and Frontal Assessment Battery (FAB) scores in INPH patients. Twenty-three INPH patients and 17 healthy controls were included in this study. Compared with healthy controls, the gait of INPH patients was characterized by lower velocity, shorter stride length, and more broad-based gait. Patients with INPH had a longer stance phase with increased double-limb support. Variability in stride time and stride length was increased in INPH patients. Stride time and stride length variability were correlated with FAB score. After the CSFTT, gait velocity, stride length, and step width significantly improved. There were significant decreases in stride time and stride length variability. These results suggest that the CSFTT for INPH patients might improve the so-called balance-related gait parameter (ie, step width) as well. Stride time and stride length variability also responded to the CSFTT. Association between FAB scores and both stride time and stride length variability suggests involvement of similar circuits producing gait variability and frontal lobe functions in INPH patients.

Frontal Assessment Battery in Early Cognitive Impairment: Psychometric Property and Factor Structure

BACKGROUND

The Frontal Assessment Battery (FAB) is a reliable and valid bedside tool for testing executive function in dementia. Given the increasing interest in utility of FAB as a screening tool in early cognitive impairment (ECI), there is a surprising lack of studies evaluating its psychometric property and factor structure, nor the influence of factors such as age, education and gender, in ECI.

OBJECTIVES

This study aims to investigate the psychometric properties and factor structure of FAB in older adults with ECI, as well as the influence of age, gender and education.

DESIGN, SETTING AND PARTICIPANTS

This is a retrospective, observational cross-sectional study with 300 community dwelling, predominantly Chinese older adults (14 normal, 130 mild cognitive impairment (MCI), and 156 mild dementia) who presented to Memory Clinic from January 2011 to December 2013. Measurements and Analysis: We collected data on demographic, cognitive, functional and behavioral evaluation. To examine the psychometric properties of FAB, we examined the concurrent, convergent, and discriminant validity; internal consistency by Cronbach's alpha; and factor structure by exploratory factor analysis. The influence of age, education and gender was examined using unadjusted and adjusted correlational analyses with CDR-SOB. We performed analysis for the whole group and for MCI subgroup.

RESULTS

FAB total score decreases significantly from normal to dementia group attesting to concurrent validity. It correlated significantly with digit span backwards and Chinese Mini Mental State Examination (r=0.38 and 0.47 respectively, p<0.01) and poorly with Neuropsychiatric Inventory-Questionnaire and depression (r=0.004 and -0.02 respectively), supporting its convergent and discriminant validity. Factor analysis yielded a single-factor solution for FAB with fair Internal consistency (alpha=0.610). FAB is relatively unaffected by age, gender and education level. These good psychometric properties extend to MCI, albeit with greater influence by education level. FAB items of conceptualization and mental flexibility have good discriminatory ability between MCI and normal subjects.

CONCLUSION

FAB has good concurrent, convergent and discriminant validity with fair internal consistency in ECI that is premised on a one-factor structure. It is relatively unaffected by age, gender or education. Taken together, FAB is a useful bedside screening tool for executive function in ECI.

Stereotypic behaviours in frontotemporal dementia and progressive supranuclear palsy

INTRODUCTION

The behavioural variant of frontotemporal dementia (bvFTD), and the Richardson variant of progressive supranuclear palsy (PSP-RS) share several clinical signs and symptoms. Since stereotypic behaviours are fairly common in bvFTD, and are also described in other degenerative dementias including Alzheimer's disease, and parkinsonisms with dementia, we aimed to examine the extent to which stereotypies also characterise PSP-RS.

METHODS

We compared 53 bvFTD patients with 40 demented PSP-RS patients, seen consecutively as outpatients at four Italian Hospitals. Patients were assessed by the Neuropsychiatric Inventory (NPI); Mini-Mental State Examination (MMSE) and Frontal Assessment Battery (FAB) for cognitive functions; Stereotypy Rating Inventory (SRI) for stereotypies; Unified Parkinson's Disease Rating Scale (UPDRS) for motor function; and Activities of Daily Living (ADL) to assess autonomy in daily life.

RESULTS

The groups did not differ for age, illness duration, cognitive functions or total NPI score; PSP-RS had significantly more depressive symptoms and greater motor and autonomy compromise than bvFTD. The groups did not differ significantly on total SRI score, but bvFTD had significantly more cooking and eating stereotypies. Twenty-three (57.5%) PSP-RS and 43 (81%) bvFTD patients had at least one stereotypy; 16/23 (69.5%) PSP-RS and 9/43 (20.9%) bvFTD patients appeared aware of their stereotypies.

CONCLUSION

Stereotypies were common in our demented PSP-RS patients. Further studies on earlier stage non-demented PSP patients are required to ascertain whether stereotypies are characteristic of PSP in general or are confined to PSP-RS, and whether they may be used to suggest a PSP diagnosis early in disease course.

Long-Term Neurocognitive Outcomes in Patients with Adult Moyamoya Disease

OBJECTIVE

Neurocognitive impairment is a frequent complication of moyamoya disease in adults, but the long-term outcomes of neurocognitive function remain unclear. We evaluated neurocognitive functions in a group of patients with a history of moyamoya disease and assessed the relationship between regional cerebral blood flow (rCBF) and neurocognitive functions.

METHODS

We studied 53 patients with a history of adult moyamoya disease. Neurocognitive functions were evaluated with the Neurobehavioral Cognitive Status Examination (Cognistat) and the Frontal Assessment Battery. The relationship between rCBF and neurocognitive functions were assessed in patients for whom rCBF was measured using single-photon emission computed tomography with ¹²³I-iodoamphetamine.

RESULTS

Patients had a history of moyamoya disease for an average of 10.6 years, with 23 patients managed conservatively and 30 managed using revascularization. Attention, memory, conceptualization, mental flexibility, and inhibitory control were impaired but with no significant difference between conservatively and surgically treated patients. Posterior cerebral artery involvement and frontal lobe infarction were not associated with neurocognitive examination scores in nonrevascularized or revascularized patients. Orientation, comprehension, calculation, conceptualization, and sensitivity to interference correlated with rCBF in the left ventral middle cerebral artery territory (P < 0.01), whereas memory correlated with rCBF in the right dorsal anterior cerebral artery territory (P < 0.01). Conceptualization also correlated with rCBF in the left dorsal anterior cerebral artery territory (P < 0.001).

CONCLUSIONS

Our findings indicate that long-standing hypoperfusion in specific brain regions can cause related neurocognitive dysfunction even in mild moyamoya disease managed conservatively.

Diagnostic accuracy of new and old cognitive screening tools for HIV-associated neurocognitive disorders

OBJECTIVES

Considering the similarities between HIV-associated neurocognitive disorders (HAND) and neurodegenerative dementias and the frequency of executive dysfunctions among HIV-positive patients, we evaluated the accuracy of the Frontal Assessment Battery and Clock-Drawing Test together with the Three Questions Test and International HIV Dementia Scale to screen for HAND.

METHODS

A cross-sectional monocentric study was conducted from 2010 to 2017. The index tests were represented by the four screening tools; the reference standard was represented by a comprehensive neurocognitive battery used to investigate 10 cognitive domains. Patients were screened by a trained infectious diseases physician and those showing International HIV Dementia Scale scores ≤ 10 and/or complaining of neurocognitive symptoms were then evaluated by a trained neuropsychologist.

RESULTS

A total of 650 patients were screened and 281 received the full neurocognitive evaluation. HAND was diagnosed in 140 individuals. The sensitivity, specificity, correct classification rate and area under the receiver operating characteristic curve (AUROC) were, respectively, as follows: Frontal Assessment Battery, 40.7%, 95.1%, 68.3% and 0.81; International HIV Dementia Scale, 74.4%, 56.8%, 65.4% and 0.73; Clock-Drawing Test, 30.9%, 73.4%, 53.8% and 0.56; and Three Questions Test, 37.3%, 54.1% and 45.7%. Raising the Frontal Assessment Battery's cut-off to ≤ 16 improved its sensitivity, specificity and correct classification rate to 78.0%, 63.9% and 70.8%, respectively.

CONCLUSIONS

We observed poor screening performances of the Three Questions and Clock-Drawing Tests. While the International HIV Dementia Scale showed a poor specificity, the Frontal Assessment Battery showed the highest correct classification rate and a promising performance at different exploratory cut-offs.

Left dorsolateral prefrontal cortex atrophy is associated with frontal lobe function in Alzheimer's disease and contributes to caregiver burden

OBJECTIVE

Caregivers of patients with dementia experience physical and mental deterioration. We have previously reported a correlation between caregiver burden and the Frontal Assessment Battery (FAB) total scores of patients with Alzheimer's disease (AD), especially regarding the dependency factor from the Zarit Burden Interview. The present study aimed to identify an objective biomarker for predicting caregiver burden.

METHODS

The participants were 26 pairs of caregivers and patients with AD and mild-to-moderate dementia. Correlations between regional gray matter volumes in the patients with AD and the FAB total scores were explored by using whole-brain voxel-based morphometric analysis. Path analysis was used to estimate the relationships between regional gray matter volumes, FAB total scores, and caregiver burden based on the Zarit Burden Interview.

RESULTS

The voxel-based morphometric revealed a significant positive correlation between the FAB total scores and the volume of the left dorsolateral prefrontal cortex. This positive correlation persisted after controlling for the effect of general cognitive dysfunction, which was assessed by using the Mini-Mental State Examination. Path analysis revealed that decreases in FAB scores, caused by reduced frontal lobe volumes, negatively affected caregiver burden.

CONCLUSIONS

The present study revealed that frontal lobe function, based on FAB scores, was affected by the volume of the left dorsolateral prefrontal cortex. Decreased scores were associated with greater caregiver burden, especially for the dependency factor. These findings may facilitate the development of an objective biomarker for predicting caregiver burden.

Sensitivity and specificity of Frontal Assessment Battery in newly diagnosed and untreated obstructive sleep apnea patients

BACKGROUND

Executive dysfunction (ED) is often observed in subjects diagnosed with obstructive sleep apnea (OSA), but their assessment requires facilities that are not always available. We aim to evaluate the extent to which Frontal Assessment Battery (FAB) discriminates ED in newly diagnosed, untreated, and without-comorbidity OSA patients.

METHODS

Sixty subjects participated in the study. Of these, 40 (31 males and 9 females) were newly diagnosed for OSA through full-night polysomnography (apnea/hypopnea index; M = 39.01, SD = 27.16), untreated, with a mean age of 54.50 years (SD = 8.90), while the remaining 20 (15 males and 5 females) had no symptoms of OSA (M = 51.60 years, SD = 10.70). The instruments used were the following: Questionnaire for Sleep Apnea Risk, Epworth Sleepiness Scale, Mini-Mental State Examination, and FAB.

RESULTS

The group with OSA exhibited significantly lower values in the FAB global score (p = 0.003) and in Conceptualization (p = 0.001) and Mental Flexibility (p = 0.009) subtests. ROC analysis showed adequate discriminative capacity for the FAB global score (AUC = 0.74) and for Conceptualization (AUC = 0.75) and Mental Flexibility (AUC = 0.70) scores.

CONCLUSIONS

The FAB is a short and no-time-consuming tool that can be used to investigate the presence of ED in untreated OSA patients with no comorbidities, providing clinicians with a simple and effective way of detecting the presence of this dysfunction and allowing a more informed decision for the need of a full neuropsychological assessment.

The frontal assessment battery in clinical practice: a systematic review

BACKGROUND

The frontal assessment battery (FAB) is a brief tool designed to evaluate executive function. Some studies have particularly focused on assessing its applicability addressing two issues: first, on detecting the brain regions responsible for the FAB performance, and second, on determining its capability for differential diagnosis. Our aim was to summarize and analyze critically the studies that assessed the neuroanatomical correspondence and the differential diagnostic value of the FAB in several study populations suffering from different pathologies.

METHODS

We completed a literature search in MEDLINE (via PubMed) database by using the term "frontal assessment battery" and the combination of this term with "applicability" or "use" or "usefulness". The search was limited to articles in English or Spanish languages, published between 1 September 2000 and 30 September 2016, human studies, and journal articles.

RESULTS

A total of 32 studies met inclusion criteria. Seventeen studies were aimed at identifying the brain regions or the neural substrates involved in executive functions measured by the FAB and 15 studies at verifying that the FAB was an appropriate tool for the differential diagnosis in neurological diseases.

CONCLUSION

Our study showed that the FAB may be an adequate assessment tool for executive function and may provide useful information for differential diagnosis in several diseases. Given that the FAB takes short time and is easy to administer, its usage may be of great interest as part of a full neuropsychological assessment in clinical settings. Copyright © 2017 John Wiley & Sons, Ltd.

Differences in the neural correlates of frontal lobe tests

BACKGROUND

The Executive Interview (EXIT25), the executive clock-drawing task (CLOX1), and the Frontal Assessment Battery (FAB) are used to assess executive function at the bedside. These tests assess distinct psychometric properties. The aim of this study was to examine differences in the neural correlates of the EXIT25, CLOX1, and FAB based on magnetic resonance imaging.

METHODS

Fifty-eight subjects (30 with Alzheimer's disease, 10 with mild cognitive impairment, and 18 healthy controls) participated in this study. Multiple regression analyses were performed to examine the brain regions correlated with the EXIT25, CLOX1, and FAB scores. Age, gender, and years of education were included as covariates. Statistical thresholds were set to uncorrected P-values of 0.001 at the voxel level and 0.05 at the cluster level.

RESULTS

The EXIT25 score correlated inversely with the regional grey matter volume in the left lateral frontal lobe (Brodmann areas 6, 9, 44, and 45). The CLOX1 score correlated positively with the regional grey matter volume in the right orbitofrontal cortex (Brodmann area 11) and the left supramarginal gyrus (Brodmann area 40). The FAB score correlated positively with the regional grey matter volume in the right precentral gyrus (Brodmann area 6). The left lateral frontal lobe (Brodmann area 9) and the right lateral frontal lobe (Brodmann area 46) were identified as common brain regions that showed association with EXIT25, CLOX1, and FAB based only a voxel-level threshold.

CONCLUSIONS

The results of this study suggest that the EXIT25, CLOX1, and FAB may be associated with the distinct neural correlates of the frontal cortex.

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

Executive function (EF) has been defined as a multifaceted construct that involves a variety of high-level cognitive abilities such as planning, working memory, mental flexibility, and inhibition. Being able to identify deficits in EF is important for the diagnosis and monitoring of several neurodegenerative disorders, and thus their assessment is a topic of much debate. In particular, there has been a growing interest in the development of neuropsychological screening tools that can potentially provide a reliable quick measure of EF. In this review, we critically discuss the four screening tools of EF currently available in the literature: Executive Interview-25 (EXIT 25), Frontal Assessment Battery (FAB), INECO Frontal Screening (IFS), and FRONTIER Executive Screen (FES). We first describe their features, and then evaluate their psychometric properties, the existing evidence on their neural correlates, and the empirical work that has been conducted in clinical populations. We conclude that the four screening tools generally present appropriate psychometric properties, and are sensitive to impairments in EF in several neurodegenerative conditions. However, more research will be needed mostly with respect to normative data and neural correlates, and to determine the extent to which these tools add specific information to the one provided by global cognition screening tests. More research directly comparing the available tools with each other will also be important to establish in which conditions each of them can be most useful.

Frontal Assessment Battery in Parkinson's Disease: Validity and Morphological Correlates

OBJECTIVES

Executive dysfunction is a common feature in Parkinson's disease (PD). However, there is a lack of brief validated instruments for executive dysfunction in PD.

METHODS

The aim of the present study was to assess the relation of Frontal Assessment Battery (FAB) scores to age and education, to verify the utility of FAB in the evaluation of executive dysfunction in PD and to differentiate between controls (n=41), PD patients with normal cognition (PD-NC; n=41; Hoehn and Yahr stages 2-3) and PD with mild cognitive impairment (PD-MCI; n=32; Hoehn and Yahr stages 2-3). In addition, we studied the relation between voxel-based morphometric (VBM) data and FAB results in PD.

RESULTS

We found that FAB scores are significantly related to age and education. The FAB has shown discriminative validity for the differentiation of PD-MCI from PD-NC and controls (area under the curve >.80). Also, the VBM analysis revealed lower FAB scores are specifically related to lower gray matter density in the right ventromedial prefrontal areas and precuneus.

CONCLUSIONS

The FAB can be recommended as a valid instrument for PD-MCI Level I screening. FAB is sensitive to frontal lobe involvement in PD as reflected by lower gray matter density in prefrontal areas. (JINS, 2017, 23, 675-684).

Frontal Assessment Battery and Cerebrospinal Fluid Tap Test in Idiopathic Normal-Pressure Hydrocephalus

BACKGROUND AND PURPOSE

Our aim in this study was to assess whether the frontal assessment battery (FAB) could contribute to the differential diagnosis of cerebrospinal fluid tap test (CSFTT) responders and nonresponders with the hypothesis that CSFTT nonresponders had greater frontal lobe dysfunction. We also explored whether a relationship exists between FAB scores and gait disturbance in idiopathic normal-pressure hydrocephalus (INPH) patients.

METHODS

INPH subjects were selected in a consecutive order from a prospectively enrolled INPH registry. Fifty-one INPH patients constituted the final sample for analysis.

RESULTS

Logistic regression analysis using the FAB score as independent variable showed a significant influence of the FAB on the differential diagnosis of CSFTT responders and nonresponders (p = 0.025; OR 1.186; 95% CI 1.022-1.377). The FAB scores were negatively correlated with the Timed Up and Go test score (r = -0.382; p = 0.007), 10-meter walking test score (r = -0.351; p = 0.014), Gait Status Scale score (r = -0.382; p = 0.007), and INPH Grading Scale gait score (r = -0.370; p = 0.009).

CONCLUSIONS

Our findings may indicate a possibility for considering FAB scores in patients with ventriculomegaly as potential cognitive markers for the prediction of CSFTT response. Association between gait function and FAB scores suggests the involvement of similar circuits producing gait symptom and frontal lobe functions in INPH.

Cognitive sequelae of methanol poisoning involve executive dysfunction and memory impairment in cross-sectional and long-term perspective

Methanol poisoning leads to lesions in the basal ganglia and subcortical white matter, as well as to demyelination and atrophy of the optic nerve. However, information regarding cognitive deficits in a large methanol sample is lacking. The principal aim of the present study was to identify the cognitive sequelae of methanol poisoning and their morphological correlates. A sample of 50 patients (METH; age 48 ± 13 years), 3-8 months after methanol poisoning, and 57 control subjects (CS; age 49 ± 13 years) were administered a neuropsychological battery. Forty-six patients were followed in 2 years' perspective. Patients additionally underwent 1.5T magnetic resonance imaging (MRI). Three biochemical and toxicological metabolic markers and a questionnaire regarding alcohol abuse facilitated the classification of 24 patients with methanol poisoning without alcohol abuse (METHna) and 22 patients with methanol poisoning and alcohol abuse (METHa). All groups were compared to a control group of similar size, and matched for age, education, premorbid intelligence level, global cognitive performance, and level of depressive symptoms. Using hierarchical multiple regression we found significant differences between METH and CS, especially in executive and memory domains. METHa showed a similar pattern of cognitive impairment with generally more severe executive dysfunction. Moreover, all METH patients with extensive involvement on brain MRI (lesions in ≥2 anatomical regions) had a more severe cognitive impairment. From a longitudinal perspective, we did not find any changes in their cognitive functioning after 2 years' follow-up. Our findings suggest that methanol poisoning is associated with executive dysfunction and explicit memory impairment, supposedly due to basal ganglia dysfunction and disruption of frontostriatal circuitry proportional to the number of brain lesions, and that these changes are persistent after 2 years' follow-up.

Frontal assessment battery: A tool for screening minimal hepatic encephalopathy?

AIM

To apply the Frontal Assessment Battery to cirrhotic patients with or without overt hepatic encephalopathy (OHE) and controls.

METHODS

The frontal assessment battery (FAB) was applied to 87 patients with liver cirrhosis (16 with and 71 without OHE) and 40 control subjects without cirrhosis treated at the alcohol and liver outpatient clinics and the gastroenterology ward of the Cassiano Antônio de Moraes University Hospital (Hospital Universitário Cassiano Antônio de Moraes - HUCAM), Espírito Santo, Brazil.

RESULTS

The average FAB score was lower for the cirrhotic than for the non-cirrhotic patients (10.6 ± 3.67 vs 12.25 ± 2.72, P = 0.015). The FAB score was lower for the cirrhotic patients with OHE than for the patients without OHE (8.25 ± 4.55 vs 11.14 ± 3.25, P = 0.027). The total FAB score was lower for the cirrhotic patients without OHE than for the non-cirrhotic patients, although this difference was not significant (11.14 ± 3.25 vs 12.25 ± 2.72, P = 0.067). Nevertheless, the difference in the scores on the subtest that assessed the ability to inhibit a response previously conditioned to a stimulus was significant (1.72 ± 0.93 vs 2.2 ± 0.85, P = 0.011).

CONCLUSION

The present study indicates that the FAB is a promising tool for outpatient minimal HE screening and the assessment of HE severity.

Excessive Daytime Sleepiness in Schizophrenia: A Naturalistic Clinical Study

INTRODUCTION

Excessive Daytime Sleepiness (EDS) and sleep problems are common in patients with schizophrenia. The symptom of EDS in schizophrenia can be attributed to various causes including neurobiological changes, sleep disorders, medication or as a symptom of schizophrenia itself. EDS as a symptom in schizophrenia has been understudied.

AIM

To assess the prevalence of EDS and to the study the same in patients with first episode and chronic schizophrenia.

MATERIALS AND METHODS

In this cross-sectional study 100 patients suffering from schizophrenia as per International Classification of Diseases (ICD-10) criteria were evaluated for sleep quality using the Pittsburgh Sleep Quality Index (PSQI) and EDS using the Epworth Sleepiness Scale (ESS). The severity of illness was assessed by Positive and Negative Symptom Scale for Schizophrenia (PANSS) while cognition was assessed using the Frontal Assessment Battery (FAB) and the Trail Making Test A and B. The data was statistically analysed.

RESULTS

A total of 100 patients (72 male and 28 female) aged 18 to 64years (mean age 30.63 years) were studied. Poor sleep quality (PSQI > 6) was exhibited by 83% of patients. Excessive daytime sleepiness (ESS > 7) was found in 32% of patients. There was no statistically significant difference in various parameters according to the age, duration of illness or gender. However, first episode patients differed in having better sleep quality than patients with chronic schizophrenia (p=0.0002). Cognition was not affected by sleep quality.

CONCLUSION

A high prevalence of sleepiness and poor sleep quality was noted in the entire sample but it did not have any correlation with age and gender. It also did not affect the cognitive test scores. Further research in this area is warranted.

Longitudinal profile of iron accumulation in good-grade subarachnoid hemorrhage

OBJECTIVE

MRI parameters of iron concentration (R2*, transverse relaxation rate), microstructural integrity (mean diffusivity and fractional anisotropy), as well as gray and white matter volumes were analyzed in patients with subarachnoid hemorrhage (SAH) and uncomplicated clinical course to detect the evolution of brain tissue changes 3 weeks and 12 months after ictus.

METHODS

MRI scans of 14 SAH patients (aneurysm of the anterior communicating artery, n = 5; no aneurysm n = 9) were compared with 14 age-matched healthy control subjects. Statistical parametric mapping (SPM) was applied to objectively identify focal changes of MRI parameters throughout the entire brain and to correlate image parameters with neuropsychological measures.

RESULTS

SPM localized significant bilateral increases in R2* signal within the white matter compartment of the temporal and parietal lobe and the cingulate gyrus (P < 0.001) which did not change significantly at 12 months. Significant gray matter volume reduction of the left insula and superior temporal gyrus (P < 0.001), as well as decreases in fractional anisotropy of the cingulate gyrus (P < 0.01) were also evident at 12 months. Significant correlations were found between fractional anisotropy signal alterations adjacent to the left middle and superior frontal gyrus and cognitive parameters of executive dysfunction (P < 0.001).

INTERPRETATION

The study indicates that iron is trapped predominantly throughout large portions of the white matter compartment in SAH patients at 12 months postbleeding. Increased disintegration of fiber tracts colocalizing with iron overload and correlating with lower executive function performance suggests that the white matter compartment is primarily susceptible toward long-term damage in patients with good clinical grade SAH.

A systematic review of lessons learned from PET molecular imaging research in atypical parkinsonism

PURPOSE

To systematically review the previous studies and current status of positron emission tomography (PET) molecular imaging research in atypical parkinsonism.

METHODS

MEDLINE, ISI Web of Science, Cochrane Library, and Scopus electronic databases were searched for articles published until 29th March 2016 and included brain PET studies in progressive supranuclear palsy (PSP), multiple system atrophy (MSA), and corticobasal syndrome (CBS). Only articles published in English and in peer-reviewed journals were included in this review. Case-reports, reviews, and non-human studies were excluded.

RESULTS

Seventy-seven PET studies investigating the dopaminergic system, glucose metabolism, microglial activation, hyperphosphorilated tau, opioid receptors, the cholinergic system, and GABA_A receptors in PSP, MSA, and CBS patients were included in this review. Disease-specific patterns of reduced glucose metabolism have shown higher accuracy than dopaminergic imaging techniques to distinguish between parkinsonian syndromes. Microglial activation has been found in all forms of atypical parkinsonism and reflects the known distribution of neuropathologic changes in these disorders. Opioid receptors are decreased in the striatum of PSP and MSA patients. Subcortical cholinergic dysfunction was more severe in MSA and PSP than Parkinson's disease patients although no significant changes in cortical cholinergic receptors were seen in PSP with cognitive impairment. GABA_A receptors were decreased in metabolically affected cortical and subcortical regions in PSP patients.

CONCLUSIONS

PET molecular imaging has provided valuable insight for understanding the mechanisms underlying atypical parkinsonism. Changes at a molecular level occur early in the course of these neurodegenerative diseases and PET imaging provides the means to aid differential diagnosis, monitor disease progression, identify of novel targets for pharmacotherapy, and monitor response to new treatments.

Association of Motoric Cognitive Risk Syndrome With Brain Volumes: Results From the GAIT Study

BACKGROUND

The "motoric cognitive risk" (MCR) syndrome is a newly reported predementia syndrome combining cognitive complaint and slow gait speed. We hypothesized that individuals with MCR syndrome would have lower brain volumes compared with non-MCR individuals. This study aims (i) to compare the cognitive profile of nondemented older community-dwellers with and without MCR syndrome and (ii) to examine association of global and regional brain volumes with MCR syndrome.

METHODS

A total of 171 individuals (28 MCR and 143 non-MCR) were included in this cross-sectional study. Total white matter abnormalities, total white matter, total cortical and subcortical gray matters, hippocampus, motor cortex, premotor cortex, and prefrontal cortex were examined. Brain volumes were quantified from a three-dimensional T1-weighted magnetic resonance imaging using semi-automated software. Age, gender, education level, number of drugs taken daily, use of psychoactive drugs, and cognitive profile were also measured.

RESULTS

The distribution of cognitively healthy individuals and those with mild cognitive impairment was not different in participants with and without MCR. Multiple logistic regression models showed that smaller volumes of total gray matter (p = .016), total cortical gray matter (p = .010), premotor cortex (p = .018), prefrontal cortex (p = .026), and dorsolateral segment of prefrontal cortex (p = .032) were associated with MCR status. The premotor cortex presented the highest mean difference for brain regional volume between MCR and non-MCR participants (p = .03).

CONCLUSIONS

The findings revealed similar cognitive profile in MCR and non-MCR participants, and MCR-related smaller global and regional gray matter volumes involving premotor and prefrontal cortices, suggesting that the MCR syndrome may predict cortical neurodegenerative dementia more than subcortical dementia.

Functional Neuroanatomical Correlates of The Frontal Assessment Battery Performance in Alzheimer Disease: A FDG-PET Study

BACKGROUND/OBJECTIVES

We aimed to elucidate the functional neuroanatomical correlates of Frontal Assessment Battery (FAB) performances by applying [(18)F]fluorodeoxyglucose positron emission tomography (FDG-PET) to a large population of patients with Alzheimer disease (AD).

METHODS

The FAB was administered to 177 patients with AD, and regional cerebral glucose metabolism (rCMglc) was measured by FDG-PET scan. Correlations between FAB scores and rCMglc were explored using both region-of-interest-based (ROI-based) and voxel-based approaches.

RESULTS

The ROI-based analysis showed that FAB scores correlated with the rCMglc of the dorsolateral prefrontal cortices. Voxel-based approach revealed significant positive correlations between FAB scores and rCMglc which were in various cortical regions including the temporal and parietal cortices as well as frontal regions, independent of age, gender, and education. After controlling the effect of global disease severity with Mini-Mental State Examination score, significant positive correlation was found only in the bilateral prefrontal regions.

CONCLUSIONS

Although FAB scores are influenced by temporoparietal dysfunction due to the overall progression of AD, it likely reflects prefrontal dysfunction specifically regardless of global cognitive state or disease severity in patients with AD.

Performance on the Frontal Assessment Battery is sensitive to frontal lobe damage in stroke patients

Background

The Frontal Assessment Battery (FAB) is a brief battery of six neuropsychological tasks designed to assess frontal lobe function at bedside [Neurology 55:1621-1626, 2000]. The six FAB tasks explore cognitive and behavioral domains that are thought to be under the control of the frontal lobes, most notably conceptualization and abstract reasoning, lexical verbal fluency and mental flexibility, motor programming and executive control of action, self-regulation and resistance to interference, inhibitory control, and environmental autonomy.

Methods

We examined the sensitivity of performance on the FAB to frontal lobe damage in right-hemisphere-damaged first-ever stroke patients based on voxel-based lesion-behavior mapping.

Results

Voxel-based lesion-behavior mapping of FAB performance revealed that the integrity of the right anterior insula (BA13) is crucial for the FAB global composite score, for the FAB conceptualization score, as well as for the FAB inhibitory control score. Furthermore, the FAB conceptualization and mental flexibility scores were sensitive to damage of the right middle frontal gyrus (MFG; BA9). Finally, the FAB inhibitory control score was sensitive to damage of the right inferior frontal gyrus (IFG; BA44/45).

Conclusions

These findings indicate that several FAB scores (including composite and item scores) provide valid measures of right hemispheric lateral frontal lobe dysfunction, specifically of focal lesions near the anterior insula, in the MFG and in the IFG.

Predictors of cognitive decline in the early stages of Parkinson's disease: a brief cognitive assessment longitudinal study

Our objectives were to perform a longitudinal assessment of mental status in early stage Parkinson's disease (PD) patients, with brief neuropsychological tests, in order to find predictive factors for cognitive decline. Sixty-one, early stage, and nondemented patients were assessed twice, over a 2-year interval, with a global cognitive test (mini-mental state examination (MMSE)) and a frontal function test (frontal assessment battery (FAB)) and motor function scales. Dementia and hallucinations were diagnosed according to the DSM-IV criteria. Cognitive function scores did not decrease significantly, except for FAB lexical fluency score. Four patients presented with dementia at followup. The MMSE score below cut-off, worse gait dysfunction, the nontremor motor subtype, and hallucinations were significantly related to dementia. Rigidity and speech dysfunction were related to dementia and a decrease in FAB scores. We can conclude that decline in the MMSE and FAB scores is small and heterogeneous in the early stages of PD. Scores below cut-off in the MMSE could be helpful to predict dementia. Nontremor motor deficits could be predictive factors for frontal cognitive decline and dementia.

Screening for frontal lobe and general cognitive impairment in patients with amyotrophic lateral sclerosis

OBJECTIVES

Cognitive impairment occurs in up to 50% of patients with amyotrophic lateral sclerosis (ALS). Simple tools are required to identify such individuals, as cognitive impairment adversely impacts quality of life and survival. Our objective was to determine the potential utility of the Frontal Assessment Battery (FAB) and the Montreal Cognitive Assessment (MoCA) in evaluating frontal lobe and general cognitive impairment, respectively. We also assessed the feasibility of screening for cognitive impairment in those patients with advanced physical disability by modifying selected FAB and MoCA subtasks.

METHODS

Fifty-four consecutive ALS patients were screened; 44 completed the FAB and 39 completed the MoCA. We administered modified tasks to patients with severe hand weakness or dysarthria. The patients were classified as cognitively impaired on each measure based on published cut-off scores of 14.11 on the FAB and 26 on the MoCA.

RESULTS

Twenty-one percent and 53% of patients were impaired on the FAB and the MoCA, respectively. Scores from patients receiving modified instructions did not differ from those completing standard versions. There were statistically significant correlations between the MoCA total scores and forced vital capacity (FVC) and ALSFRS-R scores. There was no correlation between these variables and the FAB.

CONCLUSIONS

Both the FAB and MoCA detected cognitive impairment in ALS patients. While the MoCA classified more patients as cognitively impaired than the FAB, the latter was more feasible for assessing patients with physical impairment. Simple task modifications proved effective in allowing patients with speech and motor impairments to undergo screening. Future studies are required to validate both measures, establish optimal cut-off scores, and validate modifications.

FAB-D: German version of the Frontal Assessment Battery

Executive dysfunction (ED) is a frequent consequence of neurological disorders, such as stroke, trauma or dementia, but also appears in normal aging. We developed a German version of the Frontal Assessment Battery (FAB-D), a short test which has previously been developed (Dubois et al., Neurology 55:1621-1626, 2000) to detect ED during bedside screening. A sample of 401 cognitively intact subjects aged 50-95 was tested with the FAB-D and several neuropsychological tests tapping executive functions, memory and calculation abilities. Aim of the study was to receive normative data for different age and educational groups, and to learn which tests predict performance on the FAB-D. We found clear effects of age and education; furthermore, FAB-D performance was predicted by other tests of executive functioning, but also by calculation and memory abilities. The present study reports data of healthy individuals and may be useful for comparing patients' performance with a normative sample.

Concrete behaviour and reappraisal deficits after a left frontal stroke: a case study

Concrete behaviour, the inability to disengage from immediate experience in order to manipulate ideas and thoughts, has long been understood to be a common problem after frontal lobe lesions. However, there has been little consideration of the impact that concreteness may have on emotional functioning, specifically in the use of thinking to manipulate emotional responses. One widely studied emotion regulation strategy is reappraisal, which depends on several frontal lobe related cognitive control processes. While there have been numerous neuroimaging findings on reappraisal, no study has used brain injured patients to investigate this issue. The present case study is the first to describe the capacity to generate reappraisals in a patient (Mrs M), whose behaviour became concrete after a left prefrontal stroke. Using a picture-based reappraisal paradigm, her performance was compared to non-concrete brain-lesioned patients, and neurologically healthy controls. Although Mrs M showed relatively preserved overall cognitive function, she was completely unable to spontaneously generate reappraisals. In striking contrast, once external support was offered, in the form of prompts, her capacity to reappraise dramatically improved. The results are analysed in terms of three neuropsychological capacities - all compromised in Mrs M - previously proposed as reappraisal components: response inhibition, abstraction, and verbal fluency. A number of implications for rehabilitation are discussed, including how the use of prompting may facilitate reappraisal capacity.

Impact of five SNPs in dopamine-related genes on executive function

OBJECTIVES

Dopamine neurotransmission is a critical factor for executive function, which is controlled by the prefrontal cortex in humans. Although the contribution of genetic factors to the regulation of brain dopaminergic activity is widely acknowledged, identification of a genotype-phenotype association has not yet been clearly established. In this study, we therefore evaluated the effects of five functional single-nucleotide polymorphisms (SNPs) in specific genes related to dopamine neurotransmission on executive function in a general population.

MATERIALS AND METHODS

Participants of the health examination at the Shimane Institute of Health Science were recruited for this study (n = 964). To evaluate executive function, the Frontal Assessment Battery (FAB) was administered. SNPs were genotyped using the TaqMan method.

RESULTS

A significant association was found between an SNP in the catechol-O-methyltransferase (COMT) gene (rs4680) encoding the low-activity Met allele and FAB score (P = 0.003). Of note, the flexibility subset of the FAB was associated with the SNP in COMT (P = 0.003) after adjustment for confounding factors. The generalized multifactor dimensionality reduction method identified that the combination of two SNPs in the COMT gene (rs4680) and the dopamine D4 receptor gene (rs1800955) had a significant effect on FAB score.

CONCLUSIONS

Our study indicates a contribution of rs4680 in the COMT gene to the variability in executive function, as assessed by the FAB. In addition, we have indicated that a complex gene-gene interaction between SNPs in the genes related to dopamine neurotransmission may influence executive function in a general population.

Cognitive and affective theory of mind in patients with essential tremor

The theory of mind (ToM) is the ability to attribute mental states to oneself and others and to understand that others have beliefs, desires and intentions different from one's own. The aim of the present study was to explore the neuropsychological correlates of cognitive and affective ToM in patients affected by essential tremor (ET). Thirty consecutive ET outpatients and 30 healthy age-, sex- and education-matched control subjects underwent tasks assessing short-term memory, verbal learning and executive functions, as well as tasks assessing "cognitive" and "affective" ToM; questionnaires evaluating behavioral disorders and quality of life were also administered. Although the two groups did not differ on demographic variables, ET patients scored worse on memory tasks, and showed more apathy and worse quality of life than controls. After covarying for mnestic, behavioral and quality of life scores, ET patients achieved significantly lower scores than controls on task assessing cognitive ToM, whereas no difference was found between the two groups on task assessing affective ToM. In ET, "Cognitive" ToM was significantly associated with frontal tasks, whereas "Affective" ToM was not correlated with cognitive, behavioral or quality of life scales. Our results indicate that cognitive aspects of ToM may be selectively impaired in ET. Possible underlying neural mechanisms of the deficits are discussed.

Clinical usefulness of the Frontal Assessment Battery at bedside (FAB) for elderly cancer patients

BACKGROUND

The number of elderly cancer patients has been rising in recent years, and decreases in cognitive function are reportedly seen in 25-50% of these patients. However, no validated and practical tests are available for the assessment of cognitive function in cancer patients. Age and the effects of cancer treatment have been pointed out as possible causes of these decreases in cognitive function; in both instances, a strong possibility of a decrease in frontal lobe function exists.

METHODS

We administered the Frontal Assessment Battery at bedside (FAB), the Mini-Mental State Examination (MMSE), the Barthel Index, and the Instrumental Activities of Daily Living (IADL) to 54 cancer patients who were 65 years of age or older and assessed the clinical usefulness of the FAB.

RESULTS

The results showed that the FAB scores were significantly correlated with the MMSE and IADL scores and were unaffected by the number of years of education. Moreover, when the subjects were divided into two groups according to whether their total FAB score was less than 16 points or 16 points or more, significant differences in the total MMSE scores and the total IADL scores were observed.

CONCLUSIONS

Based on these findings and because the FAB sensitively detected decreases in cognitive function, accurately reflected the status of everyday life, and could be performed conveniently and in a short time, we concluded that the FAB may be very useful clinically as a means of evaluating the cognitive function of elderly cancer patients.

Frontal assessment battery and brain perfusion imaging in Alzheimer's disease

BACKGROUND

The frontal assessment battery (FAB) is reported to be a useful tool for assessing frontal dysfunction. However, the neural substrates involved in patients with Alzheimer's disease (AD) remain to be elucidated. The aim of the present study was to identify the regional perfusion patterns of the brain associated with performance scores on the FAB of patients with AD using brain perfusion assessed by single photon emission computed tomography (SPECT).

METHODS

Twenty-four AD patients with high scores and 24 age- and sex-matched AD patients with low scores on the FAB were selected from 470 consecutive Japanese patients of the Memory Clinic of Okayama University Hospital. All 48 participants underwent brain SPECT with 99mTc-ethylcysteinate dimer, and the SPECT images were analyzed by statistical parametric mapping.

RESULTS

No significant differences were found between high and low FAB scoring groups with respect to Addenbrooke's Cognitive Examination scores, Mini-Mental State Examination scores, or the depression score of the Neuropsychiatric Inventory subscale. Compared with patients with high scores on the FAB, AD patients with low scores showed significant hypoperfusion in the left middle frontal gyrus (MFG) and the right superior frontal gyrus (SFG) extending to the left SFG.

CONCLUSION

Our results suggest that functional activity of the SFG and MFG is closely related to the FAB score. The FAB might be a promising strategy to detect early stages of AD with low SFG and MFG function.

Frontal assessment battery in a Brazilian sample of healthy controls: normative data

OBJECTIVE

To show data on the performance of healthy subjects in the Frontal Assessment Battery (FAB), correlating with gender, age, education, and scores in the Mini-Mental State Examination (MMSE).

METHODS

Two hundred and seventy-five healthy individuals with mean age of 66.4 ± 10.6 years-old were evaluated. Mean total FAB scores were established according to the educational level.

RESULTS

Mean total FAB scores according to the educational level were 10.9 ± 2.3, for one to three years; 12.8 ± 2.7, for four to seven years; 13.8 ± 2.2, for eight to 11 years; and 15.3 ± 2.3, for 12 or more years. Total FAB scores correlated significantly with education (r=0.47; p<0.0001) and MMSE scores (r=0.39; p<0.0001). No correlation emerged between FAB scores, age, and gender.

CONCLUSION

In this group of healthy subjects, the Brazilian version of the FAB proved to be influenced by the education level, but not by age and gender.

Executive deficits are related to the inferior frontal junction in early dementia

Executive functions describe a wide variety of higher order cognitive processes that allow the flexible modification of thought and behaviour in response to changing cognitive or environmental contexts. Their impairment is common in neurodegenerative disorders. Executive deficits negatively affect everyday activities and hamper the ability to cope with other deficits, such as memory impairment in Alzheimer's disease or behavioural disorders in frontotemporal lobar degeneration. Our study aimed to characterize the neural correlates of executive functions by relating respective deficits to regional hypometabolism in early dementia. Executive functions were assessed with two classical tests, the Stroop and semantic fluency test and various subtests of the behavioural assessment of the dysexecutive syndrome test battery capturing essential aspects of executive abilities relevant to daily living. Impairments in executive functions were correlated with reductions in brain glucose utilization as measured by [(18)F]fluorodeoxyglucose positron emission tomography and analysed voxelwise using statistical parametric mapping in 54 subjects with early dementia, mainly Alzheimer's disease and frontotemporal lobar degeneration, and its prodromal stages: subjective and mild cognitive impairment. Although the analysis revealed task-specific frontoparietal networks, it consistently showed that hypometabolism in one region in the left lateral prefrontal cortex-the inferior frontal junction area-was related to performance in the various neuropsychological tests. This brain region has recently been related to the three component processes of cognitive control-working memory, task switching and inhibitory control. Group comparisons additionally showed hypometabolism in this area in Alzheimer's disease and frontotemporal lobar degeneration. Our study underlines the importance of the inferior frontal junction area for cognitive control in general and for executive deficits in early dementia.

Frontal assessment battery scores and non-motor symptoms in parkinsonian disorders

Using data from the PRIAMO study, we investigated non-motor symptoms (NMS) versus frontal lobe dysfunction in patients with idiopathic Parkinson disease (PD); 808 patients with PD and 118 with atypical parkinsonisms (AP) were consecutively enrolled at 55 Centers in Italy. Twelve categories of NMS were investigated. Cognitive impairment was defined as a Mini-Mental Status Evaluation score ≤ 23.8 and frontal lobe dysfunction as a Frontal Assessment Battery (FAB) score ≤ 3.48. Multivariable logistic regression was used to identify predictor of frontal lobe dysfunction in 524 PD patients, and a generalized linear model was used for each of the six FAB items. Not only the total FAB scores but also the single FAB items were lower in AP versus PD (p ≤ 0.005). Age (OR = 1.05), cognitive impairment (OR = 9.54), lack of cardiovascular symptoms (OR = 3.25), attention or memory problems (OR = 0.59) and treatment with L: -DOPA (OR = 5.58) were predictors of frontal lobe dysfunction. MMSE was negatively associated with all FAB items (β ≤ -0.16) and age with all FAB items but prehension behavior (β ≤ -0.01). Previous use of L: -DOPA was negatively associated with verbal fluency (β = -0.32) possibly acting as surrogate marker of disease duration. Cognitive impairment is a predictor of frontal lobe dysfunction. Among NMS, lack of attention or memory problems were negatively associated with frontal impairment. Further studies are nonetheless needed to better identify the predictors of frontal impairment in PD patients.