Neuropsychological differences between frontotemporal lobar degeneration and Alzheimer's disease

Porto, Claudia Sellitto; Bahia, Valeria Santoro; Brucki, Sonia Maria Dozzi; Caramelli, Paulo; Nitrini, Ricardo

doi:10.1590/S1980-57642009DN20300011

Abstract

Memory impairment is the main clinical feature in Alzheimer disease (AD), whereas in frontotemporal lobar degeneration (FTLD) behavioral and language disorders predominate.

Objectives:

To investigate possible differences between the neuropsychological performance in FTLD and AD.

Methods:

Fifty-six AD patients (mean age=72.98±7.43; mean schooling=9.62±4.68; 35 women and 21 men), 17 FTLD patients (mean age=67.64±7.93; mean schooling=12.12±4.77; 9 women and 8 men), and 60 controls (mean age=68.90±7.48; mean schooling=10.72±4.74; 42 women and 18 men) were submitted to a Dementia Rating Scale (DRS) and a comprehensive neuropsychological evaluation composed of tasks assessing attention, visuoperceptual abilities, constructive abilities, executive functions, memory and language.

Results:

DRS total score and subscales were not able to differentiate FTLD from AD patients. However, FTLD and AD patients showed statistically significant differences in performance in tests of verbal (Logical Memory, Rey Auditory Verbal Learning Test) and visual (Visual Reproduction, recall of the Rey Complex Figure) episodic memory, verbal immediate memory (Logical Memory), attention with interference (Trail Making Test - Part B), verbal fluency (semantic and phonemic) and concept formation (WCST).

Conclusion:

Contrary to expectations, only a few tasks executive function tasks (Trail Making Test - Part B, F.A.S. and WCST) and two memory tests (verbal and visual episodic memory tests) were able to differentiate between FTLD and AD patients.

Key words:
neuropsychological assessment; memory; executive functions; Alzheimer disease; frontotemporal lobar degeneration.

Resumo

Comprometimento de memória é a principal característica clínica na doença de Alzheimer (DA), enquanto na degeneração lobar fronto-temporal (DLFT) alterações de linguagem e comportamentais são predominantes.

Objetivos:

Investigar possíveis diferenças entre o desempenho neuropsicológico de pacientes com DLFT e pacientes com DA.

Métodos:

56 pacientes com DA (média de idade=72,98±7,43; média de escolaridade=9,62±4,68; 35 mulheres e 21 homens), 17 pacientes com DLFT (média de idade=67,64±7,93; média de escolaridade=12,12±4,77; 9 mulheres e 8 homens) e 60 controles (média de idade=68,90±7,48; média de escolaridade=10,72±4,74; 42 mulheres e 18 homens) foram submetidos à Escala de Avaliação de Demência (Dementia Rating Scale - DRS) e à extensa avaliação neuropsicológica composta de tarefas que examinam atenção, habilidades visuais-perceptuais, habilidades construtivas, funções executivas, memória e linguagem.

Resultados:

O escore total e as subescalas da DRS não foram capazes de diferenciar pacientes com DA de DLFT. Pacientes com DLFT e DA demonstraram diferenças estatisticamente significativa em testes de memória episódica verbal (Memória Lógica, Teste de Aprendizagem Verbal Auditiva de Rey) e visual (Reprodução Visual e evocação da Figura Complexa de Rey), memória imediata verbal (Memória Lógica), atenção com interferência (Trail Making Test - Parte B) e fluência verbal (semântica e fonêmica).

Conclusão:

Ao contrário do esperado, somente algumas tarefas de função executiva (Trail Making Test - Parte B, F.A.S. e WCST) e dois testes de memória (testes de memória episódica verbal e visual) foram capazes de diferenciar pacientes com DLFT de pacientes com DA.

Palavras-chave:
avaliação neuropsicológica; memória; funções executivas; doença de Alzheimer; degeneração lobar frontotemporal.

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Full text available only in PDF format.

References

¹
Neary D, Snowden JS, Gustafson L, et al. Frontotemporal lobar degeneration. A consensus on clinical diagnostic criteria. Neurology 1998;51:1546-1554.
²
Mendez MF, Shapira JS, McMurtray A, Licht E, Miller B. Accuracy of the clinical evaluation for frontotemporal dementia. Arch Neurol 2007;64:830-835.
³
Bahia VS. Underdiagnosis of frontotemporal lobar degeneration in Brazil. Dement Neuropsychol 2007;1:361-365.
⁴
Liscic RM, Storandt M, Cairns NJ, Morris JC. Clinical and psychometric distinction of frontotemporal and Alzheimer dementias. Arch Neurol 2007;64:535-540.
⁵
Folstein MF, Folstein SE, McHugh PR. "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Research 1975;12:189-198.
⁶
Brucki SMD; Nitrini R; Bertolucci PHP; Caramelli P; Okamoto IH. Normas sugeridas para o uso do Mini-Exame do Estado Mental (MEEM) em nosso meio. Arq Neuropsiquiatr 2003;60:46-47.
⁷
Nitrini R, Caramelli P, Porto CS, et al. Avaliação Cognitiva Breve no diagnóstico de doença de Alzheimer leve. Arq Neuropsiquiatr 2005;63:27.
⁸
Pfeffer RI, Kusosaki TT, Harrah Jr CH, Chance JM, Filos S. Measurement of functional activities in older adults in the community. J Gerontol 1982;37:323-329.
⁹
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 3rd ed. Ver. Washington, DC:American Psychiatric Association, 1987.
¹⁰
McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM. 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. Neurology 1984;34:939-944.
¹¹
Mattos P, Lino V, Rizo L, et al. Memory complaints and test performance in health elderly persons. Arq Neuropsiquiatr 2003;61:920-924.
¹²
Jorm AF. A short-form of the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE): development and cross-validation. Psychological Medicine 1994; 24:145-153.
¹³
Bustamante SEZ, Bottino CMC, Lopes MA, et al. Instrumentos combinados na avaliação de demência de idosos. Arq Neuropsiquiatr 2003;61:601-606.
¹⁴
Mattis S. Mental Status Examination for Organic Mental Syndrome in the Elderly Patient. In: Bellak L, Karasu TB, editors. Geriatric Psychiatry. A Handbook for Psychiatrists and Primary Care Physicians. New York: Grune & Stratton;1976:77-121.
¹⁵
Mattis S. Dementia Rating Scale. Professional Manual. Florida: Psychological Assessment Resources, Inc; 1988.
¹⁶
Porto CS, Charchat-Fichman H, Caramelli P, Bahia VS, Nitrini R. Brazilian version of the Mattis Dementia Rating Scale. Diagnosis of mild dementia in Alzheimer's disease. Arq Neuropsiquiatr 2003;61:339-345.
¹⁷
Wechsler D. Wechsler Memory Scale. Manual The Psychological Corporation Harcourt Brace Jovanovich; 1987.
¹⁸
Rey A. Figuras Complexas de Rey. São Paulo: Casa do Psicólogo; 1998.
¹⁹
Diniz LFM, Cruz MF, Torres VM, Consenza RM. O teste de aprendizagem auditivo-verbal de Rey: normas para uma população brasileira. Rev Bras Neurol 2000;36:79-83.
²⁰
Wechsler D. Test de Inteligencia para adultos (WAIS). Manual. 2a Ed. Buenos Aires, Argentina: Editorial Paidos;1993.
²¹
Hooper Visual Organization Test (VOT) Manual. Western Psychological Services. 1983.
²²
Raven JC, Raven J, Court JH. Manual Matrizes Progressivas Coloridas. São Paulo: Casa do Psicólogo. Divisão Editorial; 1988.
²³
Radanovic M, Mansur LL, Scaff M. Normative data for the Brazilian population in the Boston Diagnostic Aphasia Examination: influence of schooling. Braz J Med Biol Res 2004;37:1731-1738.
²⁴
Spreen O, Strauss E. A Compendium of Neuropsychological Tests. Administration, Norms, and Commentary. Second Edition. Oxford University Press; 1998.
²⁵
Hodges JR, Patterson K, Ward R, et al. The differentiation of semantic dementia and frontal lobe dementia (temporal and frontal variants of frontotemporal dementia) from early Alzheimer's disease: a comparative neuropsychological study. Neuropsychology 1999;13:31-40.
²⁶
Wicklund AH, Johnson N, Rademaker A, Weitner BB, Weintraub S. Word list versus story memory in Alzheimer disease and frontotemporal dementia. Alzheimer Dis Assoc Disord 2006;20:86-92.
²⁷
Heidler-Gary J, Gottesman R, Newhart M, Chang S, Ken L, Hillis AE. Utility of behavioral versus cognitive measures in differentiating between subtypes of frontotemporal lobar degeneration and Alzheimer's disease. Dement Geriatr Cogn Disord. 2007;23:184-93.
²⁸
Caza N, Belleville S. Reduced short-term memory capacity in Alzheimer's disease: The role of phonological, lexical, and semantic processing. Memory 2008;16:341-50.
²⁹
Peters F, Majerus S, Olivier L, van der Linden M, Salmon E, Collette F. A multicomponent exploration of verbal short-term storage deficits in normal aging and Alzheimer's disease. J Clin Exp Neuropsychol. 2007;29:405-417.
³⁰
Lezak MD. Neuropsychological Assessment. 3a Edição. New York: Oxford University Press; 1995.
³¹
Alescio-Lautier B, Michel BF, Herrera C, et al. Visual and visuospatial short-term memory in mild cognitive impairment and Alzheimer disease: role of attention. Neuropsychologia. 2007;45:1948-1960.
³²
Belleville S, Cherkow H, Gauthier S. Working memory and control of attention in persons with Alzheimer's disease and mild cognitive impairment. Neuropsychologia. 2007;21:458-469.
³³
Rascovsky K, Salmon DP, Ho GJ, et al. Cognitive profiles differ in autopsy-confirmed frontotemporal dementia and AD. Neurology 2002;58:1801-1808.

Publication Dates

Publication in this collection
Jul-Sep 2008

History

Received
07 July 2008
Accepted
20 Aug 2008

This is an open-access article distributed under the terms of the Creative Commons Attribution License

[1] ¹
Neary D, Snowden JS, Gustafson L, et al. Frontotemporal lobar degeneration. A consensus on clinical diagnostic criteria. Neurology 1998;51:1546-1554.

[2] ²
Mendez MF, Shapira JS, McMurtray A, Licht E, Miller B. Accuracy of the clinical evaluation for frontotemporal dementia. Arch Neurol 2007;64:830-835.

[3] ³
Bahia VS. Underdiagnosis of frontotemporal lobar degeneration in Brazil. Dement Neuropsychol 2007;1:361-365.

[4] ⁴
Liscic RM, Storandt M, Cairns NJ, Morris JC. Clinical and psychometric distinction of frontotemporal and Alzheimer dementias. Arch Neurol 2007;64:535-540.

[5] ⁵
Folstein MF, Folstein SE, McHugh PR. "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Research 1975;12:189-198.

[6] ⁶
Brucki SMD; Nitrini R; Bertolucci PHP; Caramelli P; Okamoto IH. Normas sugeridas para o uso do Mini-Exame do Estado Mental (MEEM) em nosso meio. Arq Neuropsiquiatr 2003;60:46-47.

[7] ⁷
Nitrini R, Caramelli P, Porto CS, et al. Avaliação Cognitiva Breve no diagnóstico de doença de Alzheimer leve. Arq Neuropsiquiatr 2005;63:27.

[8] ⁸
Pfeffer RI, Kusosaki TT, Harrah Jr CH, Chance JM, Filos S. Measurement of functional activities in older adults in the community. J Gerontol 1982;37:323-329.

[9] ⁹
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 3rd ed. Ver. Washington, DC:American Psychiatric Association, 1987.

[10] ¹⁰
McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM. 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. Neurology 1984;34:939-944.

[11] ¹¹
Mattos P, Lino V, Rizo L, et al. Memory complaints and test performance in health elderly persons. Arq Neuropsiquiatr 2003;61:920-924.

[12] ¹²
Jorm AF. A short-form of the Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE): development and cross-validation. Psychological Medicine 1994; 24:145-153.

[13] ¹³
Bustamante SEZ, Bottino CMC, Lopes MA, et al. Instrumentos combinados na avaliação de demência de idosos. Arq Neuropsiquiatr 2003;61:601-606.

[14] ¹⁴
Mattis S. Mental Status Examination for Organic Mental Syndrome in the Elderly Patient. In: Bellak L, Karasu TB, editors. Geriatric Psychiatry. A Handbook for Psychiatrists and Primary Care Physicians. New York: Grune & Stratton;1976:77-121.

[15] ¹⁵
Mattis S. Dementia Rating Scale. Professional Manual. Florida: Psychological Assessment Resources, Inc; 1988.

[16] ¹⁶
Porto CS, Charchat-Fichman H, Caramelli P, Bahia VS, Nitrini R. Brazilian version of the Mattis Dementia Rating Scale. Diagnosis of mild dementia in Alzheimer's disease. Arq Neuropsiquiatr 2003;61:339-345.

[17] ¹⁷
Wechsler D. Wechsler Memory Scale. Manual The Psychological Corporation Harcourt Brace Jovanovich; 1987.

[18] ¹⁸
Rey A. Figuras Complexas de Rey. São Paulo: Casa do Psicólogo; 1998.

[19] ¹⁹
Diniz LFM, Cruz MF, Torres VM, Consenza RM. O teste de aprendizagem auditivo-verbal de Rey: normas para uma população brasileira. Rev Bras Neurol 2000;36:79-83.

[20] ²⁰
Wechsler D. Test de Inteligencia para adultos (WAIS). Manual. 2a Ed. Buenos Aires, Argentina: Editorial Paidos;1993.

[21] ²¹
Hooper Visual Organization Test (VOT) Manual. Western Psychological Services. 1983.

[22] ²²
Raven JC, Raven J, Court JH. Manual Matrizes Progressivas Coloridas. São Paulo: Casa do Psicólogo. Divisão Editorial; 1988.

[23] ²³
Radanovic M, Mansur LL, Scaff M. Normative data for the Brazilian population in the Boston Diagnostic Aphasia Examination: influence of schooling. Braz J Med Biol Res 2004;37:1731-1738.

[24] ²⁴
Spreen O, Strauss E. A Compendium of Neuropsychological Tests. Administration, Norms, and Commentary. Second Edition. Oxford University Press; 1998.

[25] ²⁵
Hodges JR, Patterson K, Ward R, et al. The differentiation of semantic dementia and frontal lobe dementia (temporal and frontal variants of frontotemporal dementia) from early Alzheimer's disease: a comparative neuropsychological study. Neuropsychology 1999;13:31-40.

[26] ²⁶
Wicklund AH, Johnson N, Rademaker A, Weitner BB, Weintraub S. Word list versus story memory in Alzheimer disease and frontotemporal dementia. Alzheimer Dis Assoc Disord 2006;20:86-92.

[27] ²⁷
Heidler-Gary J, Gottesman R, Newhart M, Chang S, Ken L, Hillis AE. Utility of behavioral versus cognitive measures in differentiating between subtypes of frontotemporal lobar degeneration and Alzheimer's disease. Dement Geriatr Cogn Disord. 2007;23:184-93.

[28] ²⁸
Caza N, Belleville S. Reduced short-term memory capacity in Alzheimer's disease: The role of phonological, lexical, and semantic processing. Memory 2008;16:341-50.

[29] ²⁹
Peters F, Majerus S, Olivier L, van der Linden M, Salmon E, Collette F. A multicomponent exploration of verbal short-term storage deficits in normal aging and Alzheimer's disease. J Clin Exp Neuropsychol. 2007;29:405-417.

[30] ³⁰
Lezak MD. Neuropsychological Assessment. 3a Edição. New York: Oxford University Press; 1995.

[31] ³¹
Alescio-Lautier B, Michel BF, Herrera C, et al. Visual and visuospatial short-term memory in mild cognitive impairment and Alzheimer disease: role of attention. Neuropsychologia. 2007;45:1948-1960.

[32] ³²
Belleville S, Cherkow H, Gauthier S. Working memory and control of attention in persons with Alzheimer's disease and mild cognitive impairment. Neuropsychologia. 2007;21:458-469.

[33] ³³
Rascovsky K, Salmon DP, Ho GJ, et al. Cognitive profiles differ in autopsy-confirmed frontotemporal dementia and AD. Neurology 2002;58:1801-1808.

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