Behavioral and activities of daily living inventories in the diagnosis of frontotemporal lobar degeneration and Alzheimer's disease

Bahia, Valéria Santoro; Silva, Mari-Nilva Maia da; Viana, Rene; Smid, Jerusa; Damin, Antonio Eduardo; Radanovic, Márcia; Nitrini, Ricardo

doi:10.1590/S1980-57642009DN20200006

Abstract

The differential diagnosis between frontotemporal lobar degeneration (FTLD) and Alzheimer's disease (AD) is often challenging.

Objectives:

To verify the usefulness of behavioral and activities of daily living inventories in the differential diagnosis between FTLD and AD.

Methods:

Caregivers of 12 patients with FTLD (nine with frontotemporal dementia, two with semantic dementia and one with progressive non-fluent aphasia) and of 12 patients with probable AD were interviewed. The Brazilian version of the Frontal Behavioral Inventory (FBI) and Disability Assessment for Dementia (DAD ) were used.

Results:

The mean of the MMSE score was 12.4±10.7 for patients with FTLD and 11.9±6.2 for patients with AD (p=0.93). Mean scores on the DAD were 33.7±27.7 in patients with FTLD and 55.6±29.7 in patients with AD (p=0.06), while for the FBI they were 42.6±10.0 for FTLD and 16.7±11.7 for AD (p<0.01).

Conclusions:

In this study, FBI was found to be a helpful tool for the differential diagnosis between FTLD and AD. Although the DAD was not useful in differential diagnosis in our sample we believe it to be important for measuring the severity of the disease through quantitative and qualitative assessment of functional deficits of the patients.

Key words:
dementia; frontotemporal lobar degeneration; Alzheimer's disease; inventories; behavior; activities of daily living

Resumo

O diagnóstico diferencial entre degeneração lobar fronto-temporal (DLFT) e doença de Alzheimer (DA) pode ser difícil em alguns casos.

Objetivos:

Verificar a utilidade de inventários comportamentais e de vida diária no diagnóstico diferencial entre DLFT e DA.

Métodos:

Foram entrevistados os cuidadores de 12 pacientes com DLFT (nove com demência fronto-temporal, dois com demência semântica e um com afasia progressiva não fluente) e de 12 pacientes com DA provável. As versões brasileiras dos questionáros Frontal Behavioral Inventory (FBI) e o Disability Assessment for Dementia (DAD ).

Resultados:

A média da pontuação do MEEM foi 12,4±10,7 para pacientes com DLFT e 11,9±6,2 para pacientes com DA (p=0.93). A média dos escores do DAD foi de 33,7±27,7 para pacientes com DLFT e 55,6±29,7 para pacientes com DA (p=0.06), enquanto que com relação ao FBI a média da pontuação foi de 42,6±10,0 para pacientes com DLFT e 16,7±11,7 para pacientes com DA (p<0.01).

Conclusões:

Neste estudo, o FBI apresentou uma boa acurácia no diagnóstico diferencial entre DFT e DA. Embora o DAD não tenha se mostrado útil no diagnóstico diferencial em nossa amostra, acreditamos que essa escala seja importante para analisar qualitativamente e quantitativamente os déficits funcionais dos pacientes, auxiliando na avaliação da gravidade do quadro demencial.

Palavras-chave:
demência; degeneração lobar fronto-temporal; doença de Alzheimer; inventários; comportamento; atividades de vida diária

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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;74:1206-209.
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
Fulihara 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
Gorno-Tempini ML, Dronkers NF, Rankin KP, et al. Cognition and anatomy in three variants of primary progressive aphasia. Ann Neurol 2004;55:335-346.
⁹
Herrera E Jr, Caramelli P, Silveira AS, Nitrini R. Epidemiologic survey of dementia in a community-dwelling Brazilian population. Alzheimer Dis Assoc Disord 2002;16:103-108.
¹⁰
Qiu C, De Ronchi D, Fratiglioni L. The epidemiology of the dementias: an update. Curr Opin Psychiatry 2007;20:380-385.
¹¹
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.
¹²
Kelley BJ, Petersen RC. Alzheimer's disease and mild cognitive impairment. Neurol Clin 2007;25:577-609.
¹³
Bustamante SEZ, Bottino CMC, Lopes MA, et al. Instrumentos combinados na avaliação de demência em idosos. Arq Neuropsiquiatr 2003;61:601-606.
¹⁴
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.
¹⁵
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.
¹⁶
Pijinenburg YAL, Gillissen F, Jonker C, Scheltens P. Initial complaints in frontotemporal lobar degeneration. Dement Geriatr Cogn Disord 2004;17:302-306.
¹⁷
Bahia VS. Underdiagnosis of Frontotemporal Lobar Degeneration in Brazil. Dement Neuropsychol 2007;1:361-365.
¹⁸
Liscic RM, Storandt M, Cairns NJ, Morris JC. Clinical and psychometric distinction of Frontotemporal and Alzheimer dementias. Arch Neurol 2007;64:535-540.
¹⁹
Kertesz A, Davidson W, McCabe P, Munoz D. Behavioral quantification is more sensitive than cognitive testing in frontotemporal dementia. Alzheimer Dis Assoc Disord 2003;17: 223-229
²⁰
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.
²¹
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSMIV. 4th ed. Washington DC: American Psychiatric Association, 1984:139-143.
²²
Marra TA, Pereira LSM, Faria CDCM, et al. Avaliação das atividades de vida diária de idosos com diferentes níveis de demência. Rev Bras Fisiot (São Carlos) 2007;11:267-273.
²³
Mioshi E, Kipps CM, Dawson K, Mitchell J, Graham A, Hodges JR. Activities of daily living in frontotemporal dementia and Alzheimer disease. Neurology 2007;68:2077-2084.
²⁴
McKhann G, Drachman D, 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.
²⁵
Nitrini R, Lefèvre BH, Mathias SC, et al. Testes neuropsicológicos de aplicação simples para o diagnóstico de demência. Arq Neuropsiquiatr 1994;52:457-465.
²⁶
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
²⁷
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.
²⁸
Pfeffer RI, Kusosaki TT, Harrah Jr CH, et al. Measurement of functional activities in older adults in the community. J Gerontol 1982;37:323-329.
²⁹
Gélinas I, Gauthier L, McIntyre M, Gauthier S. Development of a functional measure for persons with Alzheimer's disease: the disability assessment for dementia. Am J Occup Ther 1999;53:471-481.
³⁰
Carthery-Goulart MT, Areza-Fegyveres R, Schultz RR, et al. Adaptação transcultural da Escala de Avaliação de Incapacidade em Demência (Disability Assessment for Dementia - DAD) Arq Neuropsiquiatr 2007;65:916-919.
³¹
Kertesz A, Davidson W, Fox H. Frontal Behavioral Inventory: diagnostic criteria for frontal lobe dementia. Can J Neurol Sci 1997;24:29-36.
³²
Cummings JL, Mega MS, Gray K et al. The neuropsychiatry Inventory: comprehensive assessment of psychopathology in dementia. Neurology 1994;44:2308-2314.
³³
Blair M, Davis-Faroque N, Hsiung GYR, et al. Behavioural measures in frontotemporal degeneration and other dementias: the utility of the Frontal Behavioural Inventory in a national cohort study. Dement Geriatr Cogn Disord 2007;23: 406-415.
³⁴
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.
³⁵
Alberici A, Geroldi C, Cotelli M, et al. The Frontal Behavioral Inventory (Italian version) differentiates frontotemporal lobar degeneration variants from Alzheimer's disease. Neurol Sci 2007;28:80-86.
³⁶
Caixeta LF. Neurobiologia e fenomenologia dos distúrbios da auto-consciência na demência fronto-temporal e na doença de Alzheimer. Tese. São Paulo: Universidade de São Paulo, 2001.
³⁷
Peres K, Helmer C, Amieva H, et al. Natural History of decline in instrumental activities of daily living performance over the 10 years preceding the clinical diagnosis of dementia: a prospective population-based study. J Am Geriatr Soc 2008; 56:37-44.

Publication Dates

Publication in this collection
Apr-Jun 2008

History

Received
09 Apr 2008
Accepted
21 May 2008

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;74:1206-209.

[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
Fulihara 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
Gorno-Tempini ML, Dronkers NF, Rankin KP, et al. Cognition and anatomy in three variants of primary progressive aphasia. Ann Neurol 2004;55:335-346.

[9] ⁹
Herrera E Jr, Caramelli P, Silveira AS, Nitrini R. Epidemiologic survey of dementia in a community-dwelling Brazilian population. Alzheimer Dis Assoc Disord 2002;16:103-108.

[10] ¹⁰
Qiu C, De Ronchi D, Fratiglioni L. The epidemiology of the dementias: an update. Curr Opin Psychiatry 2007;20:380-385.

[11] ¹¹
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.

[12] ¹²
Kelley BJ, Petersen RC. Alzheimer's disease and mild cognitive impairment. Neurol Clin 2007;25:577-609.

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

[14] ¹⁴
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.

[15] ¹⁵
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.

[16] ¹⁶
Pijinenburg YAL, Gillissen F, Jonker C, Scheltens P. Initial complaints in frontotemporal lobar degeneration. Dement Geriatr Cogn Disord 2004;17:302-306.

[17] ¹⁷
Bahia VS. Underdiagnosis of Frontotemporal Lobar Degeneration in Brazil. Dement Neuropsychol 2007;1:361-365.

[18] ¹⁸
Liscic RM, Storandt M, Cairns NJ, Morris JC. Clinical and psychometric distinction of Frontotemporal and Alzheimer dementias. Arch Neurol 2007;64:535-540.

[19] ¹⁹
Kertesz A, Davidson W, McCabe P, Munoz D. Behavioral quantification is more sensitive than cognitive testing in frontotemporal dementia. Alzheimer Dis Assoc Disord 2003;17: 223-229

[20] ²⁰
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.

[21] ²¹
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders: DSMIV. 4th ed. Washington DC: American Psychiatric Association, 1984:139-143.

[22] ²²
Marra TA, Pereira LSM, Faria CDCM, et al. Avaliação das atividades de vida diária de idosos com diferentes níveis de demência. Rev Bras Fisiot (São Carlos) 2007;11:267-273.

[23] ²³
Mioshi E, Kipps CM, Dawson K, Mitchell J, Graham A, Hodges JR. Activities of daily living in frontotemporal dementia and Alzheimer disease. Neurology 2007;68:2077-2084.

[24] ²⁴
McKhann G, Drachman D, 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.

[25] ²⁵
Nitrini R, Lefèvre BH, Mathias SC, et al. Testes neuropsicológicos de aplicação simples para o diagnóstico de demência. Arq Neuropsiquiatr 1994;52:457-465.

[26] ²⁶
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

[27] ²⁷
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.

[28] ²⁸
Pfeffer RI, Kusosaki TT, Harrah Jr CH, et al. Measurement of functional activities in older adults in the community. J Gerontol 1982;37:323-329.

[29] ²⁹
Gélinas I, Gauthier L, McIntyre M, Gauthier S. Development of a functional measure for persons with Alzheimer's disease: the disability assessment for dementia. Am J Occup Ther 1999;53:471-481.

[30] ³⁰
Carthery-Goulart MT, Areza-Fegyveres R, Schultz RR, et al. Adaptação transcultural da Escala de Avaliação de Incapacidade em Demência (Disability Assessment for Dementia - DAD) Arq Neuropsiquiatr 2007;65:916-919.

[31] ³¹
Kertesz A, Davidson W, Fox H. Frontal Behavioral Inventory: diagnostic criteria for frontal lobe dementia. Can J Neurol Sci 1997;24:29-36.

[32] ³²
Cummings JL, Mega MS, Gray K et al. The neuropsychiatry Inventory: comprehensive assessment of psychopathology in dementia. Neurology 1994;44:2308-2314.

[33] ³³
Blair M, Davis-Faroque N, Hsiung GYR, et al. Behavioural measures in frontotemporal degeneration and other dementias: the utility of the Frontal Behavioural Inventory in a national cohort study. Dement Geriatr Cogn Disord 2007;23: 406-415.

[34] ³⁴
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.

[35] ³⁵
Alberici A, Geroldi C, Cotelli M, et al. The Frontal Behavioral Inventory (Italian version) differentiates frontotemporal lobar degeneration variants from Alzheimer's disease. Neurol Sci 2007;28:80-86.

[36] ³⁶
Caixeta LF. Neurobiologia e fenomenologia dos distúrbios da auto-consciência na demência fronto-temporal e na doença de Alzheimer. Tese. São Paulo: Universidade de São Paulo, 2001.

[37] ³⁷
Peres K, Helmer C, Amieva H, et al. Natural History of decline in instrumental activities of daily living performance over the 10 years preceding the clinical diagnosis of dementia: a prospective population-based study. J Am Geriatr Soc 2008; 56:37-44.

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