Differential Longitudinal Decline on the Mini-Mental State Examination in Frontotemporal Lobar Degeneration and Alzheimer Disease

Objective:To examine how phenotype affects longitudinal decline on the Mini-Mental State Examination (MMSE) in patients with frontotemporal lobar degeneration (FTLD) and Alzheimer disease (AD). Background:The MMSE is the most commonly administered assessment for dementia severity; however, the effects of phenotype on longitudinal MMSE performance in FTLD and AD have not been extensively studied. Methods:Data from 185 patients diagnosed with AD (n=106) and 3 FTLD (n=79) phenotypes [behavioral variant frontotemporal dementia (bvFTD), nonfluent agrammatic variant of primary progressive aphasia (nfaPPA), and semantic variant PPA (svPPA)] were collected for up to 52 months since initial evaluation. Results:Differential rates of decline were noted in that MMSE scores declined more precipitously for AD and svPPA compared with bvFTD and nfaPPA patients (P=0.001). The absolute 4-year MMSE decline given median baseline MMSE for bvFTD [14.67; 95% confidence interval (CI), 14.63-14.71] and nfaPPA (11.02; 95% CI, 10.98-11.06) were lower than svPPA (22.32; 95% CI, 22.29-22.34) or AD (22.24; 95% CI, 22.22-22.26). Conclusions:These data suggest that within-group AD and FTLD phenotypes present distinct patterns of longitudinal decline on the MMSE. MMSE may not be adequately sensitive to track disease progression in some phenotypes of FTLD.

[1]  Florence Pasquier,et al.  The Clinical Picture of Frontotemporal Dementia: Diagnosis and Follow-Up , 1999, Dementia and Geriatric Cognitive Disorders.

[2]  D. Salmon,et al.  Distinct cognitive profiles and rates of decline on the Mattis Dementia Rating Scale in autopsy-confirmed frontotemporal dementia and Alzheimer's disease , 2008, Journal of the International Neuropsychological Society.

[3]  M. Folstein,et al.  Clinical diagnosis of Alzheimer's disease: Report of the NINCDS—ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer's Disease , 2011, Neurology.

[4]  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.

[5]  J. Cummings,et al.  The Montreal Cognitive Assessment, MoCA: A Brief Screening Tool For Mild Cognitive Impairment , 2005, Journal of the American Geriatrics Society.

[6]  B. Miller,et al.  Classification of primary progressive aphasia and its variants , 2011, Neurology.

[7]  R. Faber,et al.  Frontotemporal lobar degeneration: a consensus on clinical diagnostic criteria. , 1999, Neurology.

[8]  E. Teng,et al.  The Cognitive Abilities Screening Instrument (CASI): A Practical Test for Cross-Cultural Epidemiological Studies of Dementia , 1994, International Psychogeriatrics.

[9]  S. Weintraub,et al.  The Mini-Mental State Examination in Behavioral Variant Frontotemporal Dementia and Primary Progressive Aphasia , 2008, American journal of Alzheimer's disease and other dementias.

[10]  Murray Grossman,et al.  The Philadelphia Brief Assessment of Cognition (PBAC): A Validated Screening Measure for Dementia , 2011, The Clinical neuropsychologist.

[11]  Nick C Fox,et al.  Sensitivity of revised diagnostic criteria for the behavioural variant of frontotemporal dementia. , 2011, Brain : a journal of neurology.

[12]  J. Hodges,et al.  Measuring progression in frontotemporal dementia , 2008, Neurology.

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

[14]  F. Pasquier,et al.  Natural History of Frontotemporal Dementia: Comparison with Alzheimer’s Disease , 2004, Dementia and Geriatric Cognitive Disorders.

[15]  J. Kramer,et al.  Neuropsychological and Functional Measures of Severity in Alzheimer Disease, Frontotemporal Dementia, and Semantic Dementia , 2004, Alzheimer disease and associated disorders.

[16]  C. DeCarli,et al.  Rate of progression differs in frontotemporal dementia and Alzheimer disease , 2005, Neurology.

[17]  Jennifer Farmer,et al.  Distinct antemortem profiles in patients with pathologically defined frontotemporal dementia. , 2007, Archives of neurology.

[18]  A. Larner,et al.  Addenbrooke's Cognitive Examination (ACE) for the diagnosis and differential diagnosis of dementia , 2007, Clinical Neurology and Neurosurgery.

[19]  Murray Grossman,et al.  Screening for Frontotemporal Dementias and Alzheimer’s Disease with the Philadelphia Brief Assessment of Cognition: A Preliminary Analysis , 2007, Dementia and Geriatric Cognitive Disorders.

[20]  R. Hales,et al.  J Neuropsychiatry Clin Neurosci , 1992 .

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

[22]  M. Kenward,et al.  Small sample inference for fixed effects from restricted maximum likelihood. , 1997, Biometrics.

[23]  X. Wang,et al.  Longitudinal decline in autopsy-defined frontotemporal lobar degeneration , 2008, Neurology.

[24]  H. Coslett,et al.  Longitudinal patterns of semantic and episodic memory in frontotemporal lobar degeneration and Alzheimer’s disease , 2009, Journal of the International Neuropsychological Society.

[25]  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.

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

[27]  B. L. Miller,et al.  Brain and ventricular volumetric changes in frontotemporal lobar degeneration over 1 year , 2009, Neurology.

[28]  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.

[29]  J. Ware,et al.  Random-effects models for longitudinal data. , 1982, Biometrics.

[30]  M. Hornberger,et al.  Clinical Staging and Disease Progression in Frontotemporal Dementia Supplemental Data at Www.neurology.org , 2022 .

[31]  Murray Grossman,et al.  Neuropsychological decline in frontotemporal lobar degeneration: a longitudinal analysis. , 2009, Neuropsychology.

[32]  Nick C Fox,et al.  Measuring disease progression in frontotemporal lobar degeneration , 2010, Neurology.

[33]  J. Haxby,et al.  Individual trajectories of cognitive decline in patients with dementia of the Alzheimer type. , 1992, Journal of clinical and experimental neuropsychology.

[34]  D P Salmon,et al.  The Mini-Mental State Examination in the early diagnosis of Alzheimer's disease. , 1990, Archives of neurology.

[35]  E. Kaplan,et al.  Errors Produced on the Mini-Mental State Examination and Neuropsychological Test Performance in Alzheimer's Disease, Ischemic Vascular Dementia, and Parkinson's Disease , 2002 .

[36]  Clinical and neuropathological criteria for frontotemporal dementia. The Lund and Manchester Groups. , 1994, Journal of neurology, neurosurgery, and psychiatry.