Study on the Behavioural Assessment of the Dysexecutive Syndrome (BADS) performance in healthy individuals, Mild Cognitive Impairment and Alzheimer's disease: A preliminary study

Armentano, Cristiane Garcia da Costa; Porto, Cláudia Sellitto; Brucki, Sonia Maria Dozzi; Nitrini, Ricardo

doi:10.1590/S1980-57642009DN30200006

Abstract

Executive deficits as well as deficits in episodic memory characterize the initial phases of Alzheimer Disease (AD) and are clinically correlated to neuropsychiatric symptoms and functional loss. Patients with Mild Cognitive Impairment present more problems as to inhibitory response control, switching and cognitive flexibility.

Objective:

To compare performance on the BADS with performance on other executive functional tests among patients with mild Alzheimer's disease, Amnestic Mild Cognitive Impairment (aMCI) to performance of control individuals and to examine discriminative capacity of BADS among these groups.

Methods:

The BADS was performed by 35 healthy controls, 13 patients with aMCI, and 16 mild probable AD patients. Besides performing the BADS, subjects underwent neuropsychological evaluation which comprised: the Dementia Rating Scale (DRS), verbal fluency by phonemic categories (F.A.S) and Concentrated Attention Test (CA).

Results:

There were no differences among groups by educational level, but performance differed for age (p<0.01). No difference between healthy controls and aMCI patients was found on total scores or subitems of the BADS. A significant difference was observed between aMCI and AD patients (p<0.05) and between controls and AD patients (p<0.05) on total and standard scores.

Conclusions:

Performance on the BADS differed between healthy individuals and mild AD patients. The BADS proved to be a sensitive method for discriminating AD from aMCI.

Key words:
Mild cognitive impairment; Alzheimer's disease; executive functions; BADS; neuropsychological tests.

Resumo

Déficits executivos conjuntamente aos déficits de memória episódica caracterizam as fases iniciais da doença Alzheimer (DA) e se correlacionam clinicamente com sintomas neuropsiquiátricos e com prejuízo funcional. Pacientes com Comprometimento Cognitivo Leve apresentam mais problemas com controle inibitório de respostas, alternância e flexibilidade cognitiva.

Objetivo:

Comparar o desempenho na BADS e outros testes de funções executivas entre pacientes com demência Alzheimer de intensidade leve, comprometimento cognitivo leve tipo amnéstico (CCLa) e indivíduos controles e verificar a sensibilidade da BADS para discriminar CCL tipo amnéstico de DA .

Métodos:

A BADS foi administrada a 35 indivíduos saudáveis, 13 pacientes com CCL amnéstico, e 16 pacientes com DA provável de intensidade leve. A avaliação consistiu da BADS e por avaliação neuropsicológica composta por: Escala de Avaliação de Demência(DRS), fluência verbal por categorias fonêmicas (F.A.S.) e o Teste de Atenção Concentrada (AC).

Resultados:

Não houve diferença estatisticamente significativa entre os grupos quanto à escolaridade, mas houve diferença quanto à idade (p<0,01). Não houve diferença estatisticamente significativa entre indivíduos controles e pacientes com CCLa nos subtestes e nos escores totais da BADS. Houve diferença significativa entre pacientes com CCLa e pacientes com DA (p<0,05) e entre indivíduos controles e pacientes com DA (p<0,05) nos escores totais padronizados.

Conclusões:

Foram encontradas diferenças no desempenho na BADS entre indivíduos saudáveis e o grupo de pacientes com DA. A BADS mostrou-se sensível para discriminar diferenças de desempenho entre DA e CCLa.

Palavras-chave:
comprometimento cognitivo leve; doença Alzheimer; funções executivas; BADS; testes neuropsicológicos.

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Full text available only in PDF format.

References

¹
Herrera E, Carameli P, Nitrini R. Estudo epidemiológico populacional de demência na cidade de Catanduva, Estado de São Paulo, Brasil. Rev Psiquiatr Clin 1998;25:70-3
²
Mesulan M-M (Ed). Principles of Behavioral and Cognitive Neurology. Second Edition. New York: Oxford University Press, 2000.
³
Silveri MC, Reali G, Jenner C, Puopolo M. Attention and Memory in the Preclinical Stage of Dementia. J Geriatr Psychiatry Neurol 2007;20:67-75.
⁴
Baudic S, Barba GD, Thibaudet MC, Smagghe A, Remy P, Traycov L. Executive function deficits in early Alzheimer's disease and their relations with episodic memory. Arch Clin Neuropsychol 2006;1:15-21.
⁵
Traykov L, Rigaud AS, Cesaro P, Boller F. Neuropsychological impairment in the early Alzheimer's disease. Encephale. 2007;33:310-316
⁶
Chen ST, Sultzer DL, Hinkin CH, Mahler ME, Cummings JL. Executive Dysfunction in Alzheimer's Disease Association With Neuropsychiatric Symptoms and Functional Impairment. J Neuropsychiatry Clin Neurosci 1998;10:426-432.
⁷
Swanberg MM, Tractenberg RE, Mohs R, Thal LJ, Cummings JL. Executive dysfunction in Alzheimer disease. Arch Neurol 2004;61:556-560.
⁸
Petersen RC, Smith GE, Waring SC, Ivnik RJ, Tangalos EG, Kokmen E. Mild cognitive impairment. Clinical characterization and outcome. Arch Neurol 1999; 56:303-308.
⁹
Petersen RC, Stevens JC, Ganguli M, et al. Practice parameter: Early detection of dementia: Mild cognitive impairment (an evidence-based review). Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2001;56:1133-1142.
¹⁰
Portet F, Ousset PJ, Visser PJ, et al. Mild cognitive impairment in medical practice: critical review of the concept and new diagnostic procedure. Report of the MCI working group of the European Consortium on Alzheimer's disease (EADC). J Neurol Neurosurg Psychiatry published online. 2006. doi:10.1136/jnnp2005.085332.
¹¹
Ganguli M, Dogge HH, Shen C, DeKosky ST. Mild cognitive impairment, amnestic type: an epidemiologic study. Neurology 2004;63:115-121.
¹²
Arndiz E, Almkvist O. Neuropsychological features of mild cognitive impairment and preclinical Alzheimer's disease. Acta Neurol Scand 2003;107(suppl. 179): 34-41.
¹³
Rozzini L, Chilovi BV, Conti M, et al. Conversion of amnestic Mild Cognitive Impairment to dementia of Alzheimer type is independent to memory deterioration. Int J Geriatr psychiatry 2007;22:1217-1222.
¹⁴
Pereira FS, Yassuda MS, Oliveira AM, Forlenza OV. Executive dysfunction correlates with impairment functional status in older adults with varying degrees of cognitive impairment. Int Psychogeriatr. 2008; 20:1104-1115.
¹⁵
Woodruff-Pak DS (Ed). The Neuropsychology of aging. Malden: Blackwell Publishers.1997.
¹⁶
Jacobson MW, Delis DC, Bondi MW, Salmon DP. Do Neuropsychological Tests detect preclinical Alzheimer's disease: individual-test versus cognitive-discrepancy score analyses. Am Psychol Assoc 2002:16:132-139.
¹⁷
Wilson BA, Alderman N, Burguess PW, Emslie H, Evans JJ. Behavioural Assessment of the Dysexecutive Syndrome (BADS). Bury St Edmunds, U.K.: Thames Valley Test Company 1996.
¹⁸
Mckann G, Drachman D, Folstein M, Katzman R, Prince D, Staklan EM. Clinical diagnosis of Alzheimer's Disease: report of the NINCDS-ADRDA work group under the auspices of department of health and human services force on Alzheimer's Disease. Neurology 1984;34:939-944.
¹⁹
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 3 ed. Ver Washington, DC: American Psychiatric Association; 1987.
²⁰
Brucki SMD, Nitrini R, Caramelli P, Bertolucci PHF, Okamoto IH. Suggestions of utilization of the Mini-mental state examination in Brazil. Arq Neuropsiquiatr 2003; 61:777-781.
²¹
Nitrini R, Caramelli P, Bottino CMC, Damasceno BP, Brucki SMD, Anghinah R. Diagnóstico de doença de Alzheimer no Brasil: avaliação cognitiva e funcional. Recomendações do Departamento Científico de Neurologia Cognitiva e do Envelhecimento da Academia Brasileira de Neurologia. Arq Neuropsiquiatr 2005;63: 720-727.
²²
Nitrini R, Lefèvre BH, Mathias SC, et al. Neuropsychological tests of simple application for diagnosing dementia. Arq Neuropsiquiatr 1994;52:457-465.
²³
Bustamante SEZ, Bottino CMC, Lopes MA, ET AL. Instrumentos combinados na avaliacao de demencia de idosos. Arq Neuropsiquiatr 2003; 61: 601-606.
²⁴
Jorm AF. The Epidemiology of Alzheimer's Disease and Related Disorders. London: Chapman and Hill; 1990.
²⁵
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.
²⁶
Xavier FMF, Ferraz MPT, Trentini CM, Freitas NK, Moriguchi EH. Bereavement-related cognitive impairment in a oldest-old community-dwelling Brazilian sample. J Clin Exp Neuropsychol 2002;24:294-301.
²⁷
Mattos P, Lino V, Rizo L, Alfano A, et al. Memory complaints and test performance in health elderly persons. Arq Neuropsiquiatr 2003;61:920-924.
²⁸
Mattis S. Mental Status Examination for Organic Mental Syndrome in the Elderly Patient. In: Bellak L, Karasu TB (Eds). Geriatric Psychiatry. A Handbook for Psychiatrists and Primary Care Physicians. New York. Grune & Stratton; 1976: 77-121.
²⁹
Mattis S. Dementia Rating Scale. Professional Manual. Florida: Psychological Assessment Resources, Inc; 1988.
³⁰
Porto CS, Charchat Fichman H, Carameli 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.
³¹
Spreen O, Strauss E (Eds). A Compendium of Neuropsychological Tests. Administration, Norms, and Commentary. Second Edition. Oxford University Press; 1998.
³²
Cambraia SV. Teste de Atenção Concentrada. São Paulo: Vetor Editora Psicopedagógica Ltda, 2004.
³³
Grady CL, Craik FIM. Changes in memory with age. Current Opinion in Neurobiology 2000;10:224-231.
³⁴
Green J. Neuropsychological evaluation of the older adult: a clinician's guidebook. San Diego: Academic; 2000.
³⁵
Stebbins GT, Carrillo MC, Dorfman J, et al. Aging effects on memory encoding in the frontal lobes. Psychol Aging 2002; 17:44-55.
³⁶
West RL. An application of prefrontal cortex function theory to cognitive aging. Psychol Bulletin 1996;120:272-292.
³⁷
Salthouse TA, Ferrer-Caja E. What needs to be explained to account for age-related effects on multiple cognitive variables? Psychol Aging 2003;18:91-110.
³⁸
Wecker NS, Hallam JK, Delis DC. Mental flexibility: age effects on switching. Neuropsychology 2005;19:345-352.
³⁹
Souza RO, Ignácio FA, Cunha FCR, Oliveira DLG, Moll J. Contribuição a neuropsicologia do comportamento executivo: torre de Londres e teste de Wisconsin em indivíduos normais. Arq Neuropsiquiatr 2001;59:526-531.
⁴⁰
Perry RJ, Hodges JR. Attention and executive deficits in Alzheimer's disease: a critical review. Brain 1999;122:383-404.
⁴¹
Rizzo M, Anderson SW, Dawson J, Myers R, Ball K. Visual attention impairments in Alzheimer's disease. Neurology 2000; 54: 1954-1959.
⁴²
Rapp MA, Reischies FM. Attention and executive control predict Alzheimer disease in later life. Results from the Berlin aging study. Am J Geriatr Psychiatry 2005;13:134-141.
⁴³
Amieva H, Rouch-Leroyer I, Letenneur L, Dartigues JF, Fabrigoule C. Cognitive slowing and learning of target detection skills in pre-demented subjects. Brain Cogn 2004;54:212-214.
⁴⁴
Traykov L, Raoux N, Latour F, et al. Executive Functions Deficit in Mild Cognitive Impairment. Cog Behav Neurol 2007;20: 219-224.
⁴⁵
Perry R J, Hodges JR. Dissociation between top-down attentional control and the time course of visual attention as measured by attentional dwell time in patients with mild cognitive impairment. Eur J Neurosc 2003:18:221-226.
⁴⁶
Petersen RC. Conceptual overview. In: Petersen RC (Ed). Mild cognitive impairment. Aging to Alzheimer's disease. New York: Oxford University Press; 2003; 1:14.
⁴⁷
Canali F, Brucki SMD, Bueno OFA. Behavioural assessment of the dysexecutive syndrome (BADS) in healthy elders and Alzheimer's disease patients Preliminary study. Dement Neuropsychol 2007;2:153-159.
⁴⁸
Espinosa A, Alegret M, Boada M, Tarraga L, Peña-Casanova J. Ecological assessment of the executive functions in mild cognitive impairment and Alzheimer's disease Alzheimer's & Dementia. J Alz Assoc 2006;2:S286.
⁴⁹
Gouveia PAR, Brucki SMD, Malheiros SMF, Bueno OFA. Disorders in planning and strategy application in frontal lobe lesion patients. Brain Cog 2007;63:240-246.
⁵⁰
Allain P, Nicoleau S, Pinon K, et al. Executive functioning in normal aging: A study of action planning using the Zoo Map Test. Brain Cog 2005;57:4-7.

Publication Dates

Publication in this collection
Apr-Jun 2009

History

Received
16 Feb 2009
Accepted
18 May 2009

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

[1] ¹
Herrera E, Carameli P, Nitrini R. Estudo epidemiológico populacional de demência na cidade de Catanduva, Estado de São Paulo, Brasil. Rev Psiquiatr Clin 1998;25:70-3

[2] ²
Mesulan M-M (Ed). Principles of Behavioral and Cognitive Neurology. Second Edition. New York: Oxford University Press, 2000.

[3] ³
Silveri MC, Reali G, Jenner C, Puopolo M. Attention and Memory in the Preclinical Stage of Dementia. J Geriatr Psychiatry Neurol 2007;20:67-75.

[4] ⁴
Baudic S, Barba GD, Thibaudet MC, Smagghe A, Remy P, Traycov L. Executive function deficits in early Alzheimer's disease and their relations with episodic memory. Arch Clin Neuropsychol 2006;1:15-21.

[5] ⁵
Traykov L, Rigaud AS, Cesaro P, Boller F. Neuropsychological impairment in the early Alzheimer's disease. Encephale. 2007;33:310-316

[6] ⁶
Chen ST, Sultzer DL, Hinkin CH, Mahler ME, Cummings JL. Executive Dysfunction in Alzheimer's Disease Association With Neuropsychiatric Symptoms and Functional Impairment. J Neuropsychiatry Clin Neurosci 1998;10:426-432.

[7] ⁷
Swanberg MM, Tractenberg RE, Mohs R, Thal LJ, Cummings JL. Executive dysfunction in Alzheimer disease. Arch Neurol 2004;61:556-560.

[8] ⁸
Petersen RC, Smith GE, Waring SC, Ivnik RJ, Tangalos EG, Kokmen E. Mild cognitive impairment. Clinical characterization and outcome. Arch Neurol 1999; 56:303-308.

[9] ⁹
Petersen RC, Stevens JC, Ganguli M, et al. Practice parameter: Early detection of dementia: Mild cognitive impairment (an evidence-based review). Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology 2001;56:1133-1142.

[10] ¹⁰
Portet F, Ousset PJ, Visser PJ, et al. Mild cognitive impairment in medical practice: critical review of the concept and new diagnostic procedure. Report of the MCI working group of the European Consortium on Alzheimer's disease (EADC). J Neurol Neurosurg Psychiatry published online. 2006. doi:10.1136/jnnp2005.085332.

[11] ¹¹
Ganguli M, Dogge HH, Shen C, DeKosky ST. Mild cognitive impairment, amnestic type: an epidemiologic study. Neurology 2004;63:115-121.

[12] ¹²
Arndiz E, Almkvist O. Neuropsychological features of mild cognitive impairment and preclinical Alzheimer's disease. Acta Neurol Scand 2003;107(suppl. 179): 34-41.

[13] ¹³
Rozzini L, Chilovi BV, Conti M, et al. Conversion of amnestic Mild Cognitive Impairment to dementia of Alzheimer type is independent to memory deterioration. Int J Geriatr psychiatry 2007;22:1217-1222.

[14] ¹⁴
Pereira FS, Yassuda MS, Oliveira AM, Forlenza OV. Executive dysfunction correlates with impairment functional status in older adults with varying degrees of cognitive impairment. Int Psychogeriatr. 2008; 20:1104-1115.

[15] ¹⁵
Woodruff-Pak DS (Ed). The Neuropsychology of aging. Malden: Blackwell Publishers.1997.

[16] ¹⁶
Jacobson MW, Delis DC, Bondi MW, Salmon DP. Do Neuropsychological Tests detect preclinical Alzheimer's disease: individual-test versus cognitive-discrepancy score analyses. Am Psychol Assoc 2002:16:132-139.

[17] ¹⁷
Wilson BA, Alderman N, Burguess PW, Emslie H, Evans JJ. Behavioural Assessment of the Dysexecutive Syndrome (BADS). Bury St Edmunds, U.K.: Thames Valley Test Company 1996.

[18] ¹⁸
Mckann G, Drachman D, Folstein M, Katzman R, Prince D, Staklan EM. Clinical diagnosis of Alzheimer's Disease: report of the NINCDS-ADRDA work group under the auspices of department of health and human services force on Alzheimer's Disease. Neurology 1984;34:939-944.

[19] ¹⁹
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 3 ed. Ver Washington, DC: American Psychiatric Association; 1987.

[20] ²⁰
Brucki SMD, Nitrini R, Caramelli P, Bertolucci PHF, Okamoto IH. Suggestions of utilization of the Mini-mental state examination in Brazil. Arq Neuropsiquiatr 2003; 61:777-781.

[21] ²¹
Nitrini R, Caramelli P, Bottino CMC, Damasceno BP, Brucki SMD, Anghinah R. Diagnóstico de doença de Alzheimer no Brasil: avaliação cognitiva e funcional. Recomendações do Departamento Científico de Neurologia Cognitiva e do Envelhecimento da Academia Brasileira de Neurologia. Arq Neuropsiquiatr 2005;63: 720-727.

[22] ²²
Nitrini R, Lefèvre BH, Mathias SC, et al. Neuropsychological tests of simple application for diagnosing dementia. Arq Neuropsiquiatr 1994;52:457-465.

[23] ²³
Bustamante SEZ, Bottino CMC, Lopes MA, ET AL. Instrumentos combinados na avaliacao de demencia de idosos. Arq Neuropsiquiatr 2003; 61: 601-606.

[24] ²⁴
Jorm AF. The Epidemiology of Alzheimer's Disease and Related Disorders. London: Chapman and Hill; 1990.

[25] ²⁵
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.

[26] ²⁶
Xavier FMF, Ferraz MPT, Trentini CM, Freitas NK, Moriguchi EH. Bereavement-related cognitive impairment in a oldest-old community-dwelling Brazilian sample. J Clin Exp Neuropsychol 2002;24:294-301.

[27] ²⁷
Mattos P, Lino V, Rizo L, Alfano A, et al. Memory complaints and test performance in health elderly persons. Arq Neuropsiquiatr 2003;61:920-924.

[28] ²⁸
Mattis S. Mental Status Examination for Organic Mental Syndrome in the Elderly Patient. In: Bellak L, Karasu TB (Eds). Geriatric Psychiatry. A Handbook for Psychiatrists and Primary Care Physicians. New York. Grune & Stratton; 1976: 77-121.

[29] ²⁹
Mattis S. Dementia Rating Scale. Professional Manual. Florida: Psychological Assessment Resources, Inc; 1988.

[30] ³⁰
Porto CS, Charchat Fichman H, Carameli 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.

[31] ³¹
Spreen O, Strauss E (Eds). A Compendium of Neuropsychological Tests. Administration, Norms, and Commentary. Second Edition. Oxford University Press; 1998.

[32] ³²
Cambraia SV. Teste de Atenção Concentrada. São Paulo: Vetor Editora Psicopedagógica Ltda, 2004.

[33] ³³
Grady CL, Craik FIM. Changes in memory with age. Current Opinion in Neurobiology 2000;10:224-231.

[34] ³⁴
Green J. Neuropsychological evaluation of the older adult: a clinician's guidebook. San Diego: Academic; 2000.

[35] ³⁵
Stebbins GT, Carrillo MC, Dorfman J, et al. Aging effects on memory encoding in the frontal lobes. Psychol Aging 2002; 17:44-55.

[36] ³⁶
West RL. An application of prefrontal cortex function theory to cognitive aging. Psychol Bulletin 1996;120:272-292.

[37] ³⁷
Salthouse TA, Ferrer-Caja E. What needs to be explained to account for age-related effects on multiple cognitive variables? Psychol Aging 2003;18:91-110.

[38] ³⁸
Wecker NS, Hallam JK, Delis DC. Mental flexibility: age effects on switching. Neuropsychology 2005;19:345-352.

[39] ³⁹
Souza RO, Ignácio FA, Cunha FCR, Oliveira DLG, Moll J. Contribuição a neuropsicologia do comportamento executivo: torre de Londres e teste de Wisconsin em indivíduos normais. Arq Neuropsiquiatr 2001;59:526-531.

[40] ⁴⁰
Perry RJ, Hodges JR. Attention and executive deficits in Alzheimer's disease: a critical review. Brain 1999;122:383-404.

[41] ⁴¹
Rizzo M, Anderson SW, Dawson J, Myers R, Ball K. Visual attention impairments in Alzheimer's disease. Neurology 2000; 54: 1954-1959.

[42] ⁴²
Rapp MA, Reischies FM. Attention and executive control predict Alzheimer disease in later life. Results from the Berlin aging study. Am J Geriatr Psychiatry 2005;13:134-141.

[43] ⁴³
Amieva H, Rouch-Leroyer I, Letenneur L, Dartigues JF, Fabrigoule C. Cognitive slowing and learning of target detection skills in pre-demented subjects. Brain Cogn 2004;54:212-214.

[44] ⁴⁴
Traykov L, Raoux N, Latour F, et al. Executive Functions Deficit in Mild Cognitive Impairment. Cog Behav Neurol 2007;20: 219-224.

[45] ⁴⁵
Perry R J, Hodges JR. Dissociation between top-down attentional control and the time course of visual attention as measured by attentional dwell time in patients with mild cognitive impairment. Eur J Neurosc 2003:18:221-226.

[46] ⁴⁶
Petersen RC. Conceptual overview. In: Petersen RC (Ed). Mild cognitive impairment. Aging to Alzheimer's disease. New York: Oxford University Press; 2003; 1:14.

[47] ⁴⁷
Canali F, Brucki SMD, Bueno OFA. Behavioural assessment of the dysexecutive syndrome (BADS) in healthy elders and Alzheimer's disease patients Preliminary study. Dement Neuropsychol 2007;2:153-159.

[48] ⁴⁸
Espinosa A, Alegret M, Boada M, Tarraga L, Peña-Casanova J. Ecological assessment of the executive functions in mild cognitive impairment and Alzheimer's disease Alzheimer's & Dementia. J Alz Assoc 2006;2:S286.

[49] ⁴⁹
Gouveia PAR, Brucki SMD, Malheiros SMF, Bueno OFA. Disorders in planning and strategy application in frontal lobe lesion patients. Brain Cog 2007;63:240-246.

[50] ⁵⁰
Allain P, Nicoleau S, Pinon K, et al. Executive functioning in normal aging: A study of action planning using the Zoo Map Test. Brain Cog 2005;57:4-7.

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