Accuracy of neuropsychological tests and the Neuropsychiatric Inventory in differential diagnosis between Frontotemporal dementia and Alzheimer's disease

Bahia, Valéria Santoro; Viana, Rene

doi:10.1590/S1980-57642009DN30400012

Abstract

The differential diagnosis between frontotemporal dementia (FTD) and Alzheimer's disease (AD) is sometimes difficult.

Objectives:

To verify the accuracy of neuropsychological tests and a behavioral disorders scale in the differential diagnosis between FTLD and AD.

Methods:

Retrospective data on 12 FTD patients and 12 probable AD patients were analyzed. The scores on neuropsychological tests (MMSE score, reverse digit span, delayed recall for drawings, semantic fluency of animals) and the Neuropsychiatric Inventory (NPI) in both groups were compared.

Results:

Both groups had similar performance on neuropsychological tests. All FTD patients and 50% of AD patients had neuropsychiatric abnormalities. The NPI score was 58.0±19.3 for the FTD patients, and 3.6±4.7 for the AD patients (p<0.01). Using a NPI cut-off score of 13, the sensitivity and specificity were 100% in this sample. The four most common neuropsychiatric disturbances in FTD patients were: apathy, aberrant motor behavior, disinhibition and eating abnormalities. Apathy and dysphoria/depression were the most common behavioral symptoms among the AD patients.

Conclusions:

In this study, NPI was found to be a useful tool for the differential diagnosis between FTD and AD. The neuropsychological tests commonly used in the medical office were unable to distinguish between the two groups.

Key words:
frontotemporal dementia; Alzheimer's disease; neuropsychiatric disturbances; differential diagnosis.

Resumo

O diagnóstico diferencial entre demência frontotemporal (DFT) e doença de Alzheimer (DA) pode ser difícil em alguns casos.

Objetivos:

Verificar a acurácia de testes neuropsicológicos e de escala de transtornos comportamentais no diagnóstico diferencial entre DFT e DA.

Métodos:

Foram analisados dados retrospectivos de 12 pacientes com o diagnóstico de DFT e de 12 pacientes com DA provável. Os escores dos testes neuropsicológicos (MEEM, extensão de dígitos em ordem inversa, memória tardia de figuras e fluência semântica de animais) e do Inventário Neuropsiquiátrico (INP) dos dois grupos foram comparados.

Resultados:

Os dois grupos apresentaram pontuação similar nos testes neuropsicológicos. Todos os pacientes com DFT e 50% dos pacientes com DA apresentavam alterações neuropsiquiátricas. O escore do INP foi 58,0±19,3 em pacientes com DFT e 3,6±4,7 em pacientes com DA provável (p<0.01). Com o escore de corte de 13 no NPI, a sensibilidade e a especificidade foram de 100%, nesta amostra. Os quatro sintomas neuropsiquiátricos mais comuns em pacientes com DFT foram: apatia, comportamento motor aberrante, desinibição e alteração do comportamento alimentar. Apatia e depressão foram os sintomas comportamentais mais frequentes em pacientes com DA.

Conclusões:

Neste estudo, mostramos que o INP é um instrumento útil no diagnóstico diferencial entre DFT e DA enquanto que testes neuropsicológicos geralmente utilizados em consultório não distinguiram os dois grupos.

Palavras-chave:
demência frontotemporal; doença de Alzheimer; transtornos neuropsiquiátricos; diagnóstico diferencial.

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References

¹
Ratnavalli E, Brayne C, Dawson K, Hodges JR. The prevalence of frontotemporal dementia. Neurology 2002;58:1615-1621.
²
Johnson JK, Dichl J, Mendez MF, et al. Frontotemporal lobar degeneration. Demographic characteristics of 353 patients. Arch Neurol 2005;62:925-930.
³
Rosso SM, Kaat LD, Baks T, et al. Frontotemporal dementia in The Netherlands: patient characteristics and prevalence estimates from a population-based study. Brain 2003;126: 2016-2022.
⁴
Harvey RJ, Skelton-Robinson M, Rossor MN. The prevalence and causes of dementia in people under the age of 65 years. J Neurol Neurosurg Psychiatry 2003;74:1206-1209.
⁵
Takada LT, Caramelli P, Radanovic M, et al. Prevalence of potentially reversible dementias in a dementia outpatient clinic of a tertiary university-affiliated hospital in Brazil. Arq Neuropsiquiatr 2003;61:925-929.
⁶
Fujihara S, Brucki SM, Rocha MSG. Prevalence of presenile dementia in a tertiary outpatient clinic. Arq Neuropsiquiatr 2004;62:592-595.
⁷
Neary D, Snowden JS, Gustafson L, et al. Frontotemporal lobar degeneration. A consensus on clinical diagnostic criteria. Neurology 1998;51:1546-1554.
⁸
Herrera E Jr, Caramelli, Silveira AS, Nitrini R. Epidemiologic survey of dementia in a community-dwelling Brazilian population. Alzheimer Dis Assoc Disord 2002;16:103-108.
⁹
Qiu C, De Ronchi D, Fratiglioni L. The epidemiology of the dementias: an update. Curr Opin Psychiatry 2007;20: 380-385.
¹⁰
Kelley BJ, Petersen RC. Alzheimer's disease and mild cognitive impairment. Neurol Clin 2007;25:577-609.
¹¹
Bustamante SEZ, Bottino CMC, Lopes MA, et al. Instrumentos combinados na avaliação de demência em idosos. Arq Neuropsiquiatr 2003;61:601-606.
¹²
Shu GH, Ju YS, Yeon BK, Shah A. A longitudinal study of Alzheimer's disease: rates of cognitive and functional decline. Int J Geriatr Psichiatry 2004;19:817-824.
¹³
Mendez MF, Selwood A, Mastri AR, Frey WH. Pick's disease versus Alzheimer's disease: a comparison of clinical characteristics. Neurology 1993;43:289-292.
¹⁴
Pijinenburg YAL, Gillissen F, Jonker C, Scheltens P. Initial complaints in frontotemporal lobar degeneration. Dement Geriatr Cogn Disord 2004;17:302-306.
¹⁵
Bahia VS. Underdiagnosis of Frontotemporal Lobar Degeneration in Brazil. Dement Neuropsychol 2007;1: 361-365.
¹⁶
McKhann G, Drachman D and Folstein M. Clinical diagnosis of Alzheimer's disease: Report of the NINCDS/ADRDA workgroup under the auspices of the Department of Health and Human Services Task Force on Alzheimer's disease. Neurology 1984;34:939-944.
¹⁷
Nitrini R, Lefèvre BH, Mathias SC, et al. Testes neuropsicológicos de aplicação simples para o diagnóstico de demência. Arq Neuropsiquiatr 1994;52:457-465.
¹⁸
Nitrini R, Caramelli P, Porto CS, et al. Brief cognitive battery in the diagnosis of mild Alzheimer's disease in subjects with medium and high levels of education. Dement Neuropsychol 2007;1:32-36
¹⁹
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.
²⁰
Pfeffer RI, Kusosaki TT, Harrah Jr CH, et al. Measurement of functional activities in older adults in the community. J Gerontol 1982;37:323-9.
²¹
Cummings JL, Mega M, Gray K, et al. The Neuropsychiatric Inventory: comprehensive assessment of psychopathology in dementia. Neurology 1994;44:2308.
²²
Cummings JL. The Neuropsychiatric Inventory: assessing psychopathology in dementia patients. Neurology 1997; 48 (Suppl.6):S10-S16.
²³
Liscic RM, Storandt M, Cairns NJ, Morris JC. Clinical and psychometric distinction of Frontotemporal and Alzheimer dementias. Arch Neurol 2007;64:535-540.
²⁴
Rosen HJ, Hartikainen KM, Jagust W, et al. Utility of clinical criteria in differentiating frontotemporal lobar degeneration (FTLD) from AD. Neurology 2002;58:1608-1615.
²⁵
Bozeat S, Gregory CA, Lambon Ralph MA et al. Which neuropsychiatry and behavioural features distinguish frontal and temporal variants of frontotemporal dementia from Alzheimer's disease? J Neurol Neurosurg Psychiatry 2000;69:178-186.
²⁶
Caine D, Patterson K, Hodges JR, Heard R, Halliday G. Severe anterograde amnesia with extensive hippocampal degeneration in a case of rapidly progressive frontotemporal dementia. Neurocase 2001;7:57-64.
²⁷
Galton CJ, Patterson K, Graham K, et al. Differing patterns of temporal atrophy in Alzheimer's disease and semantic dementia. Neurology 2001;57:216-225.
²⁸
Graham A, Davies R, Xuereb J, et al. Pathologically proven frontotemporal dementia presenting with severe amnesia. Brain 2005;128: 597-605.
²⁹
Hutchinson AD, Mathias JL. Neuropsychological deficits in frontotemporal dementia and Alzheimer's disease: a meta-analytic review. J Neurol Neurosurg Psychiatry. 2007;78:917-928.
³⁰
Thompson JC, Stopford CL, Snowden JS, Neary D. Qualitative neuropsychological performance characteristics in frontotemporal dementia and Alzheimer's disease. J Neurol Neurosurg Psychiatry. 2005;76:920-927.
³¹
Caputo M, Monastero R , Mariani E et al. Neuropsychiatry symptoms in 921 elderly subjects with dementia: a comparison between vascular and neurodegenerative types. Acta Psychiatr Scand 2008;117:455-464.
³²
Kertesz A, Davidson W, Fox H. Frontal Behavioral Inventory: diagnostic criteria for frontal lobe dementia. Can J Neurol Sci 1997;24:29-36.
³³
Kertesz A, Davidson W, McCabe P, Munoz D. Behavioral quantitation is more sensitive than cognitive testing in frontotemporal dementia. Alzheimer Dis Assoc Disord 2003;17(4): 223-229.
³⁴
Bahia VS, Silva M-NM, Viana R, et al. Behavioral and activities of daily living inventories in the diagnosis of frontotemporal lobar degeneration and Alzheimer's disease. Dement Neuropsychol 2008;2:108-113.
³⁵
Kertesz A, Nadkarni N, Davidson W, Thomas AW. The Frontal Behavioral Inventory in the differential diagnosis of frontotemporal dementia. J Int Neuropsychol Soc 2000;6:460-468.
³⁶
Camozzato AL, Kochhnann R, Simeoni C et al. Reliability of the Brazilian Portuguese version of the Neuropsychiatric Inventory (NPI) for patients with Alzheimer's disease and their caregivers. Int Psychog 2008;20:383-393.

Publication Dates

Publication in this collection
Oct-Dec 2009

History

Received
29 Aug 2009
Accepted
20 Oct 2009

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

[1] ¹
Ratnavalli E, Brayne C, Dawson K, Hodges JR. The prevalence of frontotemporal dementia. Neurology 2002;58:1615-1621.

[2] ²
Johnson JK, Dichl J, Mendez MF, et al. Frontotemporal lobar degeneration. Demographic characteristics of 353 patients. Arch Neurol 2005;62:925-930.

[3] ³
Rosso SM, Kaat LD, Baks T, et al. Frontotemporal dementia in The Netherlands: patient characteristics and prevalence estimates from a population-based study. Brain 2003;126: 2016-2022.

[4] ⁴
Harvey RJ, Skelton-Robinson M, Rossor MN. The prevalence and causes of dementia in people under the age of 65 years. J Neurol Neurosurg Psychiatry 2003;74:1206-1209.

[5] ⁵
Takada LT, Caramelli P, Radanovic M, et al. Prevalence of potentially reversible dementias in a dementia outpatient clinic of a tertiary university-affiliated hospital in Brazil. Arq Neuropsiquiatr 2003;61:925-929.

[6] ⁶
Fujihara S, Brucki SM, Rocha MSG. Prevalence of presenile dementia in a tertiary outpatient clinic. Arq Neuropsiquiatr 2004;62:592-595.

[7] ⁷
Neary D, Snowden JS, Gustafson L, et al. Frontotemporal lobar degeneration. A consensus on clinical diagnostic criteria. Neurology 1998;51:1546-1554.

[8] ⁸
Herrera E Jr, Caramelli, Silveira AS, Nitrini R. Epidemiologic survey of dementia in a community-dwelling Brazilian population. Alzheimer Dis Assoc Disord 2002;16:103-108.

[9] ⁹
Qiu C, De Ronchi D, Fratiglioni L. The epidemiology of the dementias: an update. Curr Opin Psychiatry 2007;20: 380-385.

[10] ¹⁰
Kelley BJ, Petersen RC. Alzheimer's disease and mild cognitive impairment. Neurol Clin 2007;25:577-609.

[11] ¹¹
Bustamante SEZ, Bottino CMC, Lopes MA, et al. Instrumentos combinados na avaliação de demência em idosos. Arq Neuropsiquiatr 2003;61:601-606.

[12] ¹²
Shu GH, Ju YS, Yeon BK, Shah A. A longitudinal study of Alzheimer's disease: rates of cognitive and functional decline. Int J Geriatr Psichiatry 2004;19:817-824.

[13] ¹³
Mendez MF, Selwood A, Mastri AR, Frey WH. Pick's disease versus Alzheimer's disease: a comparison of clinical characteristics. Neurology 1993;43:289-292.

[14] ¹⁴
Pijinenburg YAL, Gillissen F, Jonker C, Scheltens P. Initial complaints in frontotemporal lobar degeneration. Dement Geriatr Cogn Disord 2004;17:302-306.

[15] ¹⁵
Bahia VS. Underdiagnosis of Frontotemporal Lobar Degeneration in Brazil. Dement Neuropsychol 2007;1: 361-365.

[16] ¹⁶
McKhann G, Drachman D and Folstein M. Clinical diagnosis of Alzheimer's disease: Report of the NINCDS/ADRDA workgroup under the auspices of the Department of Health and Human Services Task Force on Alzheimer's disease. Neurology 1984;34:939-944.

[17] ¹⁷
Nitrini R, Lefèvre BH, Mathias SC, et al. Testes neuropsicológicos de aplicação simples para o diagnóstico de demência. Arq Neuropsiquiatr 1994;52:457-465.

[18] ¹⁸
Nitrini R, Caramelli P, Porto CS, et al. Brief cognitive battery in the diagnosis of mild Alzheimer's disease in subjects with medium and high levels of education. Dement Neuropsychol 2007;1:32-36

[19] ¹⁹
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.

[20] ²⁰
Pfeffer RI, Kusosaki TT, Harrah Jr CH, et al. Measurement of functional activities in older adults in the community. J Gerontol 1982;37:323-9.

[21] ²¹
Cummings JL, Mega M, Gray K, et al. The Neuropsychiatric Inventory: comprehensive assessment of psychopathology in dementia. Neurology 1994;44:2308.

[22] ²²
Cummings JL. The Neuropsychiatric Inventory: assessing psychopathology in dementia patients. Neurology 1997; 48 (Suppl.6):S10-S16.

[23] ²³
Liscic RM, Storandt M, Cairns NJ, Morris JC. Clinical and psychometric distinction of Frontotemporal and Alzheimer dementias. Arch Neurol 2007;64:535-540.

[24] ²⁴
Rosen HJ, Hartikainen KM, Jagust W, et al. Utility of clinical criteria in differentiating frontotemporal lobar degeneration (FTLD) from AD. Neurology 2002;58:1608-1615.

[25] ²⁵
Bozeat S, Gregory CA, Lambon Ralph MA et al. Which neuropsychiatry and behavioural features distinguish frontal and temporal variants of frontotemporal dementia from Alzheimer's disease? J Neurol Neurosurg Psychiatry 2000;69:178-186.

[26] ²⁶
Caine D, Patterson K, Hodges JR, Heard R, Halliday G. Severe anterograde amnesia with extensive hippocampal degeneration in a case of rapidly progressive frontotemporal dementia. Neurocase 2001;7:57-64.

[27] ²⁷
Galton CJ, Patterson K, Graham K, et al. Differing patterns of temporal atrophy in Alzheimer's disease and semantic dementia. Neurology 2001;57:216-225.

[28] ²⁸
Graham A, Davies R, Xuereb J, et al. Pathologically proven frontotemporal dementia presenting with severe amnesia. Brain 2005;128: 597-605.

[29] ²⁹
Hutchinson AD, Mathias JL. Neuropsychological deficits in frontotemporal dementia and Alzheimer's disease: a meta-analytic review. J Neurol Neurosurg Psychiatry. 2007;78:917-928.

[30] ³⁰
Thompson JC, Stopford CL, Snowden JS, Neary D. Qualitative neuropsychological performance characteristics in frontotemporal dementia and Alzheimer's disease. J Neurol Neurosurg Psychiatry. 2005;76:920-927.

[31] ³¹
Caputo M, Monastero R , Mariani E et al. Neuropsychiatry symptoms in 921 elderly subjects with dementia: a comparison between vascular and neurodegenerative types. Acta Psychiatr Scand 2008;117:455-464.

[32] ³²
Kertesz A, Davidson W, Fox H. Frontal Behavioral Inventory: diagnostic criteria for frontal lobe dementia. Can J Neurol Sci 1997;24:29-36.

[33] ³³
Kertesz A, Davidson W, McCabe P, Munoz D. Behavioral quantitation is more sensitive than cognitive testing in frontotemporal dementia. Alzheimer Dis Assoc Disord 2003;17(4): 223-229.

[34] ³⁴
Bahia VS, Silva M-NM, Viana R, et al. Behavioral and activities of daily living inventories in the diagnosis of frontotemporal lobar degeneration and Alzheimer's disease. Dement Neuropsychol 2008;2:108-113.

[35] ³⁵
Kertesz A, Nadkarni N, Davidson W, Thomas AW. The Frontal Behavioral Inventory in the differential diagnosis of frontotemporal dementia. J Int Neuropsychol Soc 2000;6:460-468.

[36] ³⁶
Camozzato AL, Kochhnann R, Simeoni C et al. Reliability of the Brazilian Portuguese version of the Neuropsychiatric Inventory (NPI) for patients with Alzheimer's disease and their caregivers. Int Psychog 2008;20:383-393.

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