Screening for Frontotemporal Dementias and Alzheimer’s Disease with the Philadelphia Brief Assessment of Cognition: A Preliminary Analysis

Background: A neuropsychological screening instrument sensitive to neuropsychological deficits associated with Alzheimer’s disease (AD) and patients with frontotemporal dementia (FTD) would be valuable for diagnostic evaluation. Methods: The Philadelphia Brief Assessment of Cognition (PBAC) assesses working memory/executive control, language, visuospatial operations, verbal/visual episodic memory, and behavior/social comportment and can be administered and scored in 15–20 min. Participants included 149 patients with AD and four groups of FTD patients – i.e., patients with a decline in social comportment, personality, and executive functioning (SOC/EXEC), semantic dementia (SemD), progressive nonfluent aphasia (PNFA), and corticobasal syndrome (CBS). Results: The total PBAC score correlated with the Mini-Mental State Examination. Between-group analysis of PBAC subscales and the results of logistic regression analyses produced substantial between-group differences, emphasizing the sensitivity of the test to differentiate dementia subtypes. AD patients were impaired on tests of episodic memory, SOC/EXEC patients were impaired on a measure of social comportment/behavioral disturbance, PNFA patients obtained low scores on tests of working memory/executive control, SemD patients obtained lower scores on language-mediated measures, and CBS patients were impaired on visuospatial/visual memory tests. Conclusion: These data support the usefulness of the PBAC as a relatively brief screening test of overall dementia severity across a wide range of dementia patients.

[1]  M. Charlton Aphasia: a review. , 1963, The American journal of psychiatry.

[2]  Howard J. Rosen,et al.  Distinctive Neuropsychological Patterns in Frontotemporal Dementia, Semantic Dementia, And Alzheimer Disease , 2003, Cognitive and behavioral neurology : official journal of the Society for Behavioral and Cognitive Neurology.

[3]  M. Freedman,et al.  Frontotemporal lobar degeneration , 1998, Neurology.

[4]  John R Hodges,et al.  The Addenbrooke's Cognitive Examination Revised (ACE‐R): a brief cognitive test battery for dementia screening , 2006, International journal of geriatric psychiatry.

[5]  L. Thal,et al.  Disparate letter and semantic category fluency deficits in autopsy-confirmed frontotemporal dementia and Alzheimer's disease. , 2007, Neuropsychology.

[6]  J. Trojanowski,et al.  Cognitive and motor assessment in autopsy-proven corticobasal degeneration , 2007, Neurology.

[7]  R. D. Norman A revised deterioration formula for the Wechsler Adult Intelligence Scale. , 1966, Journal of clinical psychology.

[8]  O. Selnes A Compendium of Neuropsychological Tests , 1991, Neurology.

[9]  Gerald L. Russell,et al.  The temporal variant of frontotemporal dementia. , 1997, Brain : a journal of neurology.

[10]  T. Rogers,et al.  Cognitive bedside assessment in atypical parkinsonian syndromes , 2005, Journal of Neurology, Neurosurgery & Psychiatry.

[11]  Jennifer Farmer,et al.  Frontotemporal dementia: Clinicopathological correlations , 2006, Annals of neurology.

[12]  Katy A. Cross,et al.  Patterns of neuropsychological impairment in frontotemporal dementia , 2007, Neurology.

[13]  John R Hodges,et al.  A Comparison of the Addenbrooke's Cognitive Examination (ACE), Conventional Neuropsychological Assessment, and Simple MRI-Based Medial Temporal Lobe Evaluation in the Early Diagnosis of Alzheimer's Disease , 2005, Cognitive and behavioral neurology : official journal of the Society for Behavioral and Cognitive Neurology.

[14]  D. Benson Posterior cortical atrophy , 1995 .

[15]  S. Folstein,et al.  "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. , 1975, Journal of psychiatric research.

[16]  I Litvan,et al.  The FAB: A frontal assessment battery at bedside , 2000, Neurology.

[17]  M. Folstein,et al.  Clinical diagnosis of Alzheimer's disease , 1984, Neurology.

[18]  J. Hodges,et al.  Clinicopathological correlates in frontotemporal dementia , 2004, Annals of neurology.

[19]  A. Brun,et al.  Neuropsychological tests as discriminators between dementia of alzheimer type and frontotemporal dementia , 1994 .

[20]  Julie S. Snowden,et al.  Fronto-Temporal Lobar Degeneration: Fronto-Temporal Dementia, Progressive Aphasia, Semantic Dementia , 1996 .

[21]  Benson Df,et al.  Posterior cortical atrophy. , 1988, Archives of neurology.

[22]  P. S. Mathuranath,et al.  A brief cognitive test battery to differentiate Alzheimer's disease and frontotemporal dementia , 2000, Neurology.

[23]  A. Kertesz,et al.  The Frontal Behavioral Inventory in the differential diagnosis of frontotemporal dementia , 2000, Journal of the International Neuropsychological Society.

[24]  M. Mega,et al.  The Neuropsychiatric Inventory , 1994, Neurology.

[25]  E. Kaplan,et al.  Different underlying mechanisms for deficits in concept formation in dementia. , 2001, Archives of clinical neuropsychology : the official journal of the National Academy of Neuropsychologists.

[26]  R. Petersen,et al.  Antemortem diagnosis of frontotemporal lobar degeneration , 2005, Annals of neurology.

[27]  B Miller,et al.  Clinical and pathological diagnosis of frontotemporal dementia: report of the Work Group on Frontotemporal Dementia and Pick's Disease. , 2001, Archives of neurology.

[28]  F. Pasquier,et al.  Verbal fluency in dementia of frontal lobe type and dementia of Alzheimer type. , 1995, Journal of neurology, neurosurgery, and psychiatry.

[29]  J L Mathias,et al.  Neuropsychological deficits in frontotemporal dementia and Alzheimer’s disease: a meta-analytic review , 2007, Journal of Neurology, Neurosurgery & Psychiatry.

[30]  M. Grossman,et al.  Primary Progressive Aphasia: A Review , 2004, Neurocase.

[31]  W. Sturm,et al.  Neuropsychological assessment , 2007, Journal of Neurology.

[32]  Murray Grossman,et al.  Frontotemporal dementia: A review , 2002, Journal of the International Neuropsychological Society.

[33]  John R. Hodges,et al.  Fronto-Temporal Lobar Degeneration: Fronto-Temporal Dementia, Progressive Aphasia, Semantic Dementia. , 1997 .

[34]  Guy B. Williams,et al.  Neural correlates of semantic and behavioural deficits in frontotemporal dementia , 2005, NeuroImage.