Brazilian version of the Frontal Assessment Battery (FAB): Preliminary data on administration to healthy elderly

Beato, Rogério Gomes; Nitrini, Ricardo; Formigoni, Ana Paula; Caramelli, Paulo

doi:10.1590/S1980-57642008DN10100010

Abstract

The Frontal Assessment Battery (FAB) has been proposed as a diagnostic tool for patients with frontal lobe syndrome.

Objectives:

To present the Brazilian version of the FAB and to show preliminary data on the performance of healthy elderly in the battery, correlating with age, education and scores in the MiniMental State Examination (MMSE).

Methods:

Forty-eight healthy elderly individuals (34 female/14 male) were evaluated, aged 69.3±6.1 years and with educational level=8.0±5.6 years. The subjects were submitted to the MMSE, the Cornell depression scale and the FAB, in which scores were determined for each item and for the total scale. All individuals had to attain above education adjusted cut-off scores in the MMSE and ≤7 points on the Cornell depression scale. Correlations were calculated between FAB total scores and age, educational level and MMSE scores, as well as between FAB items and education.

Results:

The mean score ±SD in the FAB was 13.0±2.3 (7 to 18). Total FAB scores correlated significantly with education (r=0.37; p=0.01) and MMSE scores (r=0.46; p=0.001). No correlation emerged between FAB scores and age. The mean score ±SD of the MMSE was 27.4 ± 1.8. Considering the six FAB items separately, two of them (similarities and conflicting instructions) correlated significantly with educational.

Conclusions:

In this group of healthy elderly, the Brazilian version of the FAB proved to be influenced by education, but not age.

Key words:
frontal lobe; prefrontal cortex; aging; education; neuropsychological tests.

Resumo

A Bateria de Avaliação Frontal (BAF) foi proposta recentemente como instrumento diagnóstico para pacientes com síndrome frontal.

Objetivos:

Apresentar a versão brasileira da BAF e dados preliminares do desempenho de idosos saudáveis na bateria, e sua correlação com a idade, nível educacional e escores no MiniExame do Estado Mental (MEEM).

Métodos:

Foram avaliados 48 idosos saudáveis (34 mulheres/14 homens), com idade média=69,3±6,1 anos e escolaridade média=8,0±5,6 anos. Todos foram submetidos ao MEEM, à escala de Depressão de Cornell e à BAF, com escores determinados para cada item e no total. Os participantes apresentaram desempenho acima de valores ajustados para a escolaridade no MEEM e ≤7 pontos na escala de Depressão de Cornell. Foram calculadas correlações entre o escore total da BAF e as variáveis idade, escolaridade e escore do MEEM, como também a correlação entre os itens da BAF e a escolaridade.

Resultados:

O escore médio ±DP na BAF foi 13,0±2,3 (7-18). Os escores totais da BAF se correlacionaram significativamente com a escolaridade (r=0,37; p=0,01) e com os escores do MEEM (r=0,46; p=0,001). Não foi observada correlação entre a BAF e a idade. O escore médio do MEEM foi 27,4 ± 1,8. A análise separada dos itens da BAF mostrou que dois deles (similaridades e instruções conflitantes) se correlacionaram significativamente com a escolaridade.

Conclusões:

Neste grupo de idosos saudáveis, a versão brasileira da BAF demonstrou ser influenciada pela escolaridade, mas não pela idade.

Palavras-chave:
lobo frontal; córtex pré-frontal; envelhecimento; educação; testes neuropsicológicos.

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References

¹
Lezak MD. Executive functions and motor performance. In: Lezak MD, Howieson DB, Loring DW, editors. Neuropsychological Assessment. 4th ed. New York: Oxford University Press; 2004:611-646.
²
Dubois B, Slachevsky A, Litvan I, Pillon B. The FAB: AFrontal Assessment Battery at bedside. Neurology 2000;55: 1621-1626.
³
Slachevsky A, Villalpando JM, Sarazin M, Hahn-Barma V,Pillon B, Dubois B. Frontal assessment battery and differential diagnosis of frontotemporal dementia and Alzheimer disease. Arch Neurol 2004;61:1104-1107.
⁴
Castiglioni S, Pelati O, Zuffi M, et al. The Frontal Assessment Battery Does Not Differentiate Frontotemporal Dementia from Alzheimer's Disease. Dement Geriatr Cogn Disord 2006;22:125-131.
⁵
Matsui H, Udaka F, Miyoshi T, et al. Frontal assessment battery and brain perfusion image in Parkinson's disease. J Geriatr Psychiatry Neurol 2006;19:41-45.
⁶
Paviour DC, Winterburn D, Simmonds S, et al. Can thefrontal assessment battery (FAB) differentiate bradykinetic rigid syndromes? Relation of the FAB to formal neuropsychological testing. Neurocase 2005;11:274-282.
⁷
Mok VC, Wong A, Yim P et al. The validity and reliability ofchinese frontal assessment battery in evaluating executive dysfunction among Chinese patients with small subcortical infarct. Alzheimer Dis Assoc Disord 2004;18:68-74.
⁸
Nitrini R, Caramelli P. Demências. In Nitrini R, BacheschiLA, editors. A neurologia que todo médico deve saber. 2ª ed. São Paulo: Atheneu; 2003:323-334.
⁹
Alexopoulos GS, Abrams RC, Young RC, Shamoian CA. Useof the Cornell scale in nondemented patients. J Am Geriatr Soc 1988;36:230-236.
¹⁰
Reverberi C, D'Agostini S, Skrap M, Shallice T. Generationand recognition of abstract rules in different frontal lobe subgroups. Neuropsychologia 2005;43:1924-1937.
¹¹
Green AE, Fugelsang JA, Kraemer DJ, Shamosh NA, DunbarKN. Frontopolar cortex mediates abstract integration in analogy. Brain Res 2006;1096:125-137.
¹²
Lhermitte F, Derouesné J, Signoret JL. Neuropsychologicalanalysis of the frontal syndrome. Rev Neurol (Paris) 1972; 127: 415-440.
¹³
Andrewes D. Executive dysfunction. In: Andrewes D, editor.Neuropsychology - from theory to practice. New York: Psychology Press, 2001:85-137.
¹⁴
Benton A. Differential behavior effects in frontal lobe disease. Neuropsychologia 1968;6:53-60.
¹⁵
Stuss DT, Alexander MP, Hamer L, et al. The effects of focalanterior and posterior brain lesions on verbal fluency. J Int Neuropsychol Soc 1998; 4:265-278.
¹⁶
Baldo JV, Shimamura AP. Letter and category fluency in patients with frontal lobe lesions. Neuropsychology 1998;12: 259-267.
¹⁷
Henry JD, Crawford JR. A meta-analytic review of verbalfluency performance following focal cortical lesions. Neuropsychology 2004;18:284-295.
¹⁸
Luria AR. Investigating of Motor Functions. In: Luria AR,editor. Higher Cortical Functions in Man. 2nd Edition. New York: Basic Books Publishers; 1980:414-435.
¹⁹
Truelle JL, Le Gall D, Joseph PA, et al. Movement disturbances following frontal lobe lesions. Neuropsychiatry Neuropsychol Behav Neurol 1995;8:14-19.
²⁰
Rousseaux M, Godefroy O, Cabaret M, Bernati T. Dysexecutive syndrome and disorders of motor control in prefrontal mediobasal and cingulate lesions. Rev Neurol (Paris) 1996;152:517-527.
²¹
Demakis GJ. Frontal lobe damage and tests of executive processing: a meta-analysis of the category test, stroop test, and trail-making test. J Clin Exp Neuropsychol 2004;26:441-450.
²²
Alvarez JA, Emory E. Executive function and the frontallobes: a meta-analytic review. Neuropsychol Rev 2006;16:1742.
²³
Stuss DT, Benson DF. The frontal lobes. New York: RavenPress; 1986.
²⁴
Malloy PF, Richardson ED. Assessment of frontal lobe functions. In: Salloway SP, Malloy PF, Duffy JD, editors. The frontal lobes and neuropsychiatric illness. Washington: American Psychiatric Publishing; 2001:125-137.
²⁵
Rolls ET, Hornak J, Wade D, McGraph J. Emotion-relatedlearning in patients with social and emotional changes associated with frontal lobe damage. J Neurol Neurosurg Psychiatry 1994;57:1518-1524.
²⁶
Godefroy O, Lhullier C, Rousseaux M. Non-spatial attentiondisorders in patients with frontal or posterior brain damage. Brain 1996;119:191-202.
²⁷
Picton TW, Stuss DT, Alexander MP, Shallice T, Binns MA,Gillingham S. Effects of focal frontal lesions on response inhibition. Cereb Cortex (in press).
²⁸
Schott JM, Rosor MN. The grasp and other primitive reflexes. J Neurol Neurosurg Psychiatry 2003;74:558-560.
²⁹
Lhermitte F, Pillon B, Serdaru M. Human autonomy and thefrontal lobes. Imitation and utilization behavior: a neuropsychological study of 75 patients.Ann Neurol 1986;19: 326-334.
³⁰
De Renzi E, Barbieri C. The incidence of the grasp reflex following hemispheric lesion and its relation to frontal damage. Brain 1992;115:293-313.
³¹
Etcharry-Bouyx F, Le Gall D, Allain P, Mercier P, Aubin G,Emile J. Incidence of grasping and its relationship to cerebral lesions. Rev Neurol (Paris) 2000;156: 977-983.
³²
Guillemin F, Bombardier C, Beaton D. Cross-cultural adaptation of health-related quality of life measures: literature review and proposed guidelines. J Clin Epidemiol 1993;46: 1417-1432.
³³
Kaufman AS, McLean JE, Reynolds CR. Sex, race, residence,region, and education differences on the 11 WAIS-R subtests. J Clin Psychol 1988;44:231-248.
³⁴
Malec JF, IvniK RJ, Smith GE et al. Mayo`s older Americannormative studies; utility of corrections for age and education for the WAIS-R. Clin Neuropsychol 1992;6(Suppl): 31-47.
³⁵
Anstey KJ, Matters B, Brown AK, Lord SR. Normative dataon neuropsychological tests for very old adults living in retirement villages and hostels. Clin Neuropsychol 2000; 14:309-17.
³⁶
Van der Elst W, Van Boxtel MP, Van Breukelen GJ, Jolles J.The Stroop color-word test: influence of age, sex, and education; and normative data for a large sample across the adult age range. Assessment 2006;13:62-79.
³⁷
Brucki SM, Rocha MS. Category fluency test: effects of age,gender and education on total scores, clustering and switching in Brazilian Portuguese-speaking subjects. Braz J Med Biol Res 2004;37:1771-1777.
³⁸
Caramelli P, Carthery-Goulart MT, Porto CS, CharchatFichman H, Nitrini R. Category fluency as screening test for Alzheimer disease in illiterate and literate patients. Alzheimer Dis Assoc Disord (in press).
³⁹
Nitrini R, Caramelli P, Herrera Jr. E, Charchat-Fichman H,Porto CS. Performance in Luria's fist-edge-palm test according to educational level. Cogn Behav Neurol 2005;18:211-214.

Publication Dates

Publication in this collection
Jan-Mar 2007

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

[1] ¹
Lezak MD. Executive functions and motor performance. In: Lezak MD, Howieson DB, Loring DW, editors. Neuropsychological Assessment. 4th ed. New York: Oxford University Press; 2004:611-646.

[2] ²
Dubois B, Slachevsky A, Litvan I, Pillon B. The FAB: AFrontal Assessment Battery at bedside. Neurology 2000;55: 1621-1626.

[3] ³
Slachevsky A, Villalpando JM, Sarazin M, Hahn-Barma V,Pillon B, Dubois B. Frontal assessment battery and differential diagnosis of frontotemporal dementia and Alzheimer disease. Arch Neurol 2004;61:1104-1107.

[4] ⁴
Castiglioni S, Pelati O, Zuffi M, et al. The Frontal Assessment Battery Does Not Differentiate Frontotemporal Dementia from Alzheimer's Disease. Dement Geriatr Cogn Disord 2006;22:125-131.

[5] ⁵
Matsui H, Udaka F, Miyoshi T, et al. Frontal assessment battery and brain perfusion image in Parkinson's disease. J Geriatr Psychiatry Neurol 2006;19:41-45.

[6] ⁶
Paviour DC, Winterburn D, Simmonds S, et al. Can thefrontal assessment battery (FAB) differentiate bradykinetic rigid syndromes? Relation of the FAB to formal neuropsychological testing. Neurocase 2005;11:274-282.

[7] ⁷
Mok VC, Wong A, Yim P et al. The validity and reliability ofchinese frontal assessment battery in evaluating executive dysfunction among Chinese patients with small subcortical infarct. Alzheimer Dis Assoc Disord 2004;18:68-74.

[8] ⁸
Nitrini R, Caramelli P. Demências. In Nitrini R, BacheschiLA, editors. A neurologia que todo médico deve saber. 2ª ed. São Paulo: Atheneu; 2003:323-334.

[9] ⁹
Alexopoulos GS, Abrams RC, Young RC, Shamoian CA. Useof the Cornell scale in nondemented patients. J Am Geriatr Soc 1988;36:230-236.

[10] ¹⁰
Reverberi C, D'Agostini S, Skrap M, Shallice T. Generationand recognition of abstract rules in different frontal lobe subgroups. Neuropsychologia 2005;43:1924-1937.

[11] ¹¹
Green AE, Fugelsang JA, Kraemer DJ, Shamosh NA, DunbarKN. Frontopolar cortex mediates abstract integration in analogy. Brain Res 2006;1096:125-137.

[12] ¹²
Lhermitte F, Derouesné J, Signoret JL. Neuropsychologicalanalysis of the frontal syndrome. Rev Neurol (Paris) 1972; 127: 415-440.

[13] ¹³
Andrewes D. Executive dysfunction. In: Andrewes D, editor.Neuropsychology - from theory to practice. New York: Psychology Press, 2001:85-137.

[14] ¹⁴
Benton A. Differential behavior effects in frontal lobe disease. Neuropsychologia 1968;6:53-60.

[15] ¹⁵
Stuss DT, Alexander MP, Hamer L, et al. The effects of focalanterior and posterior brain lesions on verbal fluency. J Int Neuropsychol Soc 1998; 4:265-278.

[16] ¹⁶
Baldo JV, Shimamura AP. Letter and category fluency in patients with frontal lobe lesions. Neuropsychology 1998;12: 259-267.

[17] ¹⁷
Henry JD, Crawford JR. A meta-analytic review of verbalfluency performance following focal cortical lesions. Neuropsychology 2004;18:284-295.

[18] ¹⁸
Luria AR. Investigating of Motor Functions. In: Luria AR,editor. Higher Cortical Functions in Man. 2nd Edition. New York: Basic Books Publishers; 1980:414-435.

[19] ¹⁹
Truelle JL, Le Gall D, Joseph PA, et al. Movement disturbances following frontal lobe lesions. Neuropsychiatry Neuropsychol Behav Neurol 1995;8:14-19.

[20] ²⁰
Rousseaux M, Godefroy O, Cabaret M, Bernati T. Dysexecutive syndrome and disorders of motor control in prefrontal mediobasal and cingulate lesions. Rev Neurol (Paris) 1996;152:517-527.

[21] ²¹
Demakis GJ. Frontal lobe damage and tests of executive processing: a meta-analysis of the category test, stroop test, and trail-making test. J Clin Exp Neuropsychol 2004;26:441-450.

[22] ²²
Alvarez JA, Emory E. Executive function and the frontallobes: a meta-analytic review. Neuropsychol Rev 2006;16:1742.

[23] ²³
Stuss DT, Benson DF. The frontal lobes. New York: RavenPress; 1986.

[24] ²⁴
Malloy PF, Richardson ED. Assessment of frontal lobe functions. In: Salloway SP, Malloy PF, Duffy JD, editors. The frontal lobes and neuropsychiatric illness. Washington: American Psychiatric Publishing; 2001:125-137.

[25] ²⁵
Rolls ET, Hornak J, Wade D, McGraph J. Emotion-relatedlearning in patients with social and emotional changes associated with frontal lobe damage. J Neurol Neurosurg Psychiatry 1994;57:1518-1524.

[26] ²⁶
Godefroy O, Lhullier C, Rousseaux M. Non-spatial attentiondisorders in patients with frontal or posterior brain damage. Brain 1996;119:191-202.

[27] ²⁷
Picton TW, Stuss DT, Alexander MP, Shallice T, Binns MA,Gillingham S. Effects of focal frontal lesions on response inhibition. Cereb Cortex (in press).

[28] ²⁸
Schott JM, Rosor MN. The grasp and other primitive reflexes. J Neurol Neurosurg Psychiatry 2003;74:558-560.

[29] ²⁹
Lhermitte F, Pillon B, Serdaru M. Human autonomy and thefrontal lobes. Imitation and utilization behavior: a neuropsychological study of 75 patients.Ann Neurol 1986;19: 326-334.

[30] ³⁰
De Renzi E, Barbieri C. The incidence of the grasp reflex following hemispheric lesion and its relation to frontal damage. Brain 1992;115:293-313.

[31] ³¹
Etcharry-Bouyx F, Le Gall D, Allain P, Mercier P, Aubin G,Emile J. Incidence of grasping and its relationship to cerebral lesions. Rev Neurol (Paris) 2000;156: 977-983.

[32] ³²
Guillemin F, Bombardier C, Beaton D. Cross-cultural adaptation of health-related quality of life measures: literature review and proposed guidelines. J Clin Epidemiol 1993;46: 1417-1432.

[33] ³³
Kaufman AS, McLean JE, Reynolds CR. Sex, race, residence,region, and education differences on the 11 WAIS-R subtests. J Clin Psychol 1988;44:231-248.

[34] ³⁴
Malec JF, IvniK RJ, Smith GE et al. Mayo`s older Americannormative studies; utility of corrections for age and education for the WAIS-R. Clin Neuropsychol 1992;6(Suppl): 31-47.

[35] ³⁵
Anstey KJ, Matters B, Brown AK, Lord SR. Normative dataon neuropsychological tests for very old adults living in retirement villages and hostels. Clin Neuropsychol 2000; 14:309-17.

[36] ³⁶
Van der Elst W, Van Boxtel MP, Van Breukelen GJ, Jolles J.The Stroop color-word test: influence of age, sex, and education; and normative data for a large sample across the adult age range. Assessment 2006;13:62-79.

[37] ³⁷
Brucki SM, Rocha MS. Category fluency test: effects of age,gender and education on total scores, clustering and switching in Brazilian Portuguese-speaking subjects. Braz J Med Biol Res 2004;37:1771-1777.

[38] ³⁸
Caramelli P, Carthery-Goulart MT, Porto CS, CharchatFichman H, Nitrini R. Category fluency as screening test for Alzheimer disease in illiterate and literate patients. Alzheimer Dis Assoc Disord (in press).

[39] ³⁹
Nitrini R, Caramelli P, Herrera Jr. E, Charchat-Fichman H,Porto CS. Performance in Luria's fist-edge-palm test according to educational level. Cogn Behav Neurol 2005;18:211-214.

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