The INECO Frontal Screening tool differentiates behavioral variant - frontotemporal dementia (bv-FTD) from major depression

Fiorentino, Natalia; Gleichgerrcht, Ezequiel; Roca, María; Cetkovich, Marcelo; Manes, Facundo; Torralva, Teresa

doi:10.1590/S1980-57642013DN70100006

ABSTRACT

Executive dysfunction may result from prefrontal circuitry involvement occurring in both neurodegenerative diseases and psychiatric disorders. Moreover, multiple neuropsychiatric conditions, may present with overlapping behavioral and cognitive symptoms, making differential diagnosis challenging, especially during earlier stages. In this sense, cognitive assessment may contribute to the differential diagnosis by providing an objective and quantifiable set of measures that has the potential to distinguish clinical conditions otherwise perceived in everyday clinical settings as quite similar.

Objective:

The goal of this study was to investigate the utility of the INECO Frontal Screening (IFS) for differentiating bv-FTD patients from patients with Major Depression.

Methods:

We studied 49 patients with bv-FTD diagnosis and 30 patients diagnosed with unipolar depression compared to a control group of 26 healthy controls using the INECO Frontal Screening (IFS), the Mini Mental State Examination (MMSE) and the Addenbrooke's Cognitive Examination-Revised (ACE-R).

Results:

Patient groups differed significantly on the motor inhibitory control (U=437.0, p<0.01), verbal working memory (U=298.0, p<0.001), spatial working memory (U=300.5, p<0.001), proverbs (U=341.5, p<0.001) and verbal inhibitory control (U=316.0, p<0.001) subtests, with bv-FTD patients scoring significantly lower than patients with depression.

Conclusion:

Our results suggest the IFS can be considered a useful tool for detecting executive dysfunction in both depression and bv-FTD patients and, perhaps more importantly, that it has the potential to help differentiate these two conditions.

Key words:
frontotemporal dementia; major depression and executive dysfunction

RESUMO

A disfunção executiva pode resultar de envolvimento do circuito pré-frontal que ocorre em doenças neurodegenerativas e distúrbios psiquiátricos. Além disso, várias condições neuropsiquiátricas, podem apresentar sobreposição de sintomas comportamentais e cognitivos, tornando o diagnóstico diferencial um desafio, especialmente durante as fases iniciais. Neste sentido, a avaliação cognitiva pode contribuir para o diagnóstico diferencial, fornecendo um conjunto de medidas objetivas e quantificáveis com potencial para distinguir as condições clínicas percebidas em ambientes clínicos comuns como bastante similar.

Objetivo:

O objetivo deste estudo foi o de investigar a utilidade do Rastreio Frontal INECO (IFS) em diferenciar pacientes bv-FTD de pacientes com depressão maior.

Métodos:

Foram estudados 49 pacientes com diagnóstico de bv-FTD e 30 pacientes com diagnóstico de depressão unipolar, que foram comparados com um grupo controle de 26 controles saudáveis usando o IFS, o Mini Exame do Estado Mental (MMSE) e Exame Cognitivo de Addenbrooke-revisado (ACE-I).

Resultados:

Os grupos de pacientes diferiram significativamente no controle inibitório motor (U=437,0, p<0,01), memória de trabalho verbal (U=298,0, p<0,001), a memória de trabalho espacial (U=300,5, p<0,001), provérbios (U=341,5, p<0,001) e no controle inibitório verbal (U=316,0, p<0,001), com pacientes com bv-FTD tendo pontuação significativamente menor do que os pacientes com depressão.

Conclusão:

Nossos resultados sugerem que o IFS pode ser considerado uma ferramenta útil para detectar a disfunção executiva em depressão e pacientes bv-FTD e, talvez mais importante, que tem o potencial de ajudar na diferenciação dessas duas condições.

Palavras-chave:
demência frontotemporal; depressão; disfunção executiva

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REFERENCES

Piguet O, Hornberger M, Mioshi E, et al. Behavioral - variant frontotemporal dementia: diagnosis, clinical staging, and management. Lancet Neurol 2011;10:162-172.
Mackenzie IR, Neumann M, Bigio EH, et al. Nomenclature and nosology for neuropathologic subtypes of frontotemporal lobar degeneration: an update. Acta Neuropathol 2010;119:1-4.
Kertesz CM, Davies RR, Mitchell J, et al. Clinical significance of lobar atrophy in frontotemporal dementia: application of an MRI visual rating scale. Dement Geriatr Cogn Disord 2007;23:334-342
Torralva T, Roca M, Gleichgerrcht E, Bekinschtein T, Manes F. A Neuropsychological battery to detect specific executive and social cognitive impairments in early frontotemporal dementia. Brain 2009;132:1299-1309.
Torralva T, Kipps C, Hodges J, et al. The relationship between affective decision-making and theory of mind in the frontal variant of fronto-temporal dementia. Neiropsychologia 2007;45:342-349.
Gleichgerrcht E, Torralva T, Roca M, Manes F. Utility of an abbreviated version of the executive and social cognition battery in the detection of executive deficits in early behavioral variant frontotemporal dementia patients. J Int Neuropsychol Soc 2010;16:687-694.
Hodges KR, Miller B. Classification, genetics and neuropathology of frontotemporal dementia. Introduction to the special topic paper, Part I [Review]. Neurocase 2001;7:31-35.
Gregory CA, Hodges JR. Frontotemporal dementia: use of consensus criteria and prevalence of psychiatric features. Neruopsychiatry Neuropsychol Behav Neurol 1996;9:145-153.
Walker AJ, Meares S, Sachdev PS, Brodaty H. The differentiation of mild frontotemporal dementia from Alzheirmer´s disease and healthy aging by neuropsychological tests. Int Psychogeriatr 2005;17:57-68.
Stuss DT, Alexander MP. Is there a dysexecutive syndrome? Philos Trans R Soc Lond B Biol Sci. 2007;362:901-915.
Bertoux M, Delavest M, Cruz de Souza L, et al. Social cognition and emocional assessment differentiates frontotemporal dementia from depression. J Neurol Neurosurg Psychiatry 2012;83:411-416.
Zamboni G, Huey ED, Krueger F, Nichelli PF, Grafman J. Apathy and disinhibition in frontotemporal dementia. Neurology 2008;71:736-742.
Eslinger PJ, Moore P, Antani S, Anderson, C, Grossman M. Apathy in frontotemporal dementia: Behavioral and neuroimaging correlates. Behavioral Neurology2012;25:127-136.
Deavies RR, Kipps CM, Mitchell J, Kril JJ, Halliday GM, Hodges JR. Progression in frontotemporal dementia: identifying a benign behavioral variant by magnetic resonance imaging. Arch Neurol 2006;63:1627-1631.
Kipps CM, Davies RR, Mitchell J, Kril JJ, Halliday GM, Hodges JR. Clinical significance of lobar atrophy in frontotemporal dementia: application of an MRI visual rating scale. Dement Geriatr Cogn Disord2007;23: 334-342.
Mendez MF, Shapira JS, McMurtray A, Licht E, Miller BL. Accuracy of the clinical evaluation for frontotemporal dementia. Arch Neurol2007; 64:830-835.
Rascovsky K, Hodges JR, Kipps CM, et al. Diagnostic criteria for the behavioral variant of frontotemporal dementia (bv-FTD): current limitations and future directions [Review]. Alzheimer Dis Assoc Disord 2007; 21:14-18.
Pose M, Cetkovich M, Gleichgerrcht E, Ibáñez A, Torralva T, Manes F. The overlap of symptomatic dimensions between behavioral variant Frontotemporal Dementia (bv-FTD) and several psychiatric disorders that appear in late adulthood. International Psychiatry Review (in press).
Torralva T, Roca M, Gleichgerrcht E, López P, Manes F. INECO Frontal screening (IFS): A brief, sensitive, and specific tool to assess executive functions in dementia. J Int Neuropsychol Soc2009;2009:1-10.
Rascovsky K, Hodges JR, Knopman D, et al. Sensitivity of revised diagnostic criteria for the behavioural variant of frontotemporal dementia. Brain2011;134:2456-2477.
Diagnostic and Statistical Manual of Mental Disorders, 4th ed. Washington DC: American Psychiatric Association, 1994.
Folstein MF, Folstein SE, McHugh PR. "Mini-mental". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12:189-198.
Mioshi E, Dawson K, Mitchell J, Arnold R, Hodges JR. The Addenbrookes's Cognitive Examination Revised (ACE-R): a brief cognitive test battery for dementia screening. Int J Geriatr Psychiatry 2004;21:1078-1085.
Luria AR. Higher cortical function in man. London: Tavistock, 1966
Dubois B, Slachevsky A, Litvan, I, Pillon B. The FAB: A frontal assessment battery at bedside. Neurology2000;55:1621-1626.
Hodges JR. Cognitive assessment for clinicians. Oxford: Oxford University Press, 1994.
Wechsler D. Wechsler Memory Scale-Revised. New York: Psychological Corporation, 1987.
Burguess PW, Shallice T. The Hayling and Brixton Tests. Thurston, Suffolk: Thames Valley Test Company, 1997
Abusamra V, Miranda MA, Ferreres A. Evaluación de la iniciación e inhibición verbal en espeñol. Adaptación y normal del test de hayling. Rev Argentina Neuropsicol 2007;9:19-32.
Neary D, Snowden JS, Gustafson L, et al. Frontotemporal lobar degeneration: a consensus on clinical diagnostic criteria. Neurology1998;51: 1546-1554.
Lockwood KA, Alexopoulos GS, Van Gorp WG. Executive dysfunction in geriatric depression. Am J Psychiatry 2002;159:1119-1126.
Karabekiroglu A, Topçuoglu V, Gimzal Gönentür A, Karabekiroglu K. Executive function differences between first episode and recurrent major depression patients. Turk Psikiyatri Derg. 2010;21:280-288.
Snyder HR. Major depressive disorder is associated with broad impairments on neuropsychological measures of executive function: A meta-analysis and review. Psychol Bull 2013;1:81-132.
Huey ED, Goveia EN, Paviol S, et al. Executive dysfunction in frontotemporal dementia and corticobasal syndrome. Neurology2009;72:453-459.
Hodges JR, Miller B. The neuropsychology of frontal variant frontotemporal dementia. Introduction to the special topic papers: Part II. Neurocase2001;7:113-121.
Gleichgerrcht E, Roca M, Manes F, Torralva T. Comparing the clinical usefulness of the Institute of Cognitive Neurology (INECO) Frontal Screening (IFS) and the Frontal Assessment Battery (FAB) in frontotemporal dementia. J Clin Exp Neuropsychol 2011;1:1-8.

Publication Dates

Publication in this collection
Jan-Mar 2013

History

Received
04 Dec 2012
Accepted
06 Feb 2013

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

[1] Piguet O, Hornberger M, Mioshi E, et al. Behavioral - variant frontotemporal dementia: diagnosis, clinical staging, and management. Lancet Neurol 2011;10:162-172.

[2] Mackenzie IR, Neumann M, Bigio EH, et al. Nomenclature and nosology for neuropathologic subtypes of frontotemporal lobar degeneration: an update. Acta Neuropathol 2010;119:1-4.

[3] Kertesz CM, Davies RR, Mitchell J, et al. Clinical significance of lobar atrophy in frontotemporal dementia: application of an MRI visual rating scale. Dement Geriatr Cogn Disord 2007;23:334-342

[4] Torralva T, Roca M, Gleichgerrcht E, Bekinschtein T, Manes F. A Neuropsychological battery to detect specific executive and social cognitive impairments in early frontotemporal dementia. Brain 2009;132:1299-1309.

[5] Torralva T, Kipps C, Hodges J, et al. The relationship between affective decision-making and theory of mind in the frontal variant of fronto-temporal dementia. Neiropsychologia 2007;45:342-349.

[6] Gleichgerrcht E, Torralva T, Roca M, Manes F. Utility of an abbreviated version of the executive and social cognition battery in the detection of executive deficits in early behavioral variant frontotemporal dementia patients. J Int Neuropsychol Soc 2010;16:687-694.

[7] Hodges KR, Miller B. Classification, genetics and neuropathology of frontotemporal dementia. Introduction to the special topic paper, Part I [Review]. Neurocase 2001;7:31-35.

[8] Gregory CA, Hodges JR. Frontotemporal dementia: use of consensus criteria and prevalence of psychiatric features. Neruopsychiatry Neuropsychol Behav Neurol 1996;9:145-153.

[9] Walker AJ, Meares S, Sachdev PS, Brodaty H. The differentiation of mild frontotemporal dementia from Alzheirmer´s disease and healthy aging by neuropsychological tests. Int Psychogeriatr 2005;17:57-68.

[10] Stuss DT, Alexander MP. Is there a dysexecutive syndrome? Philos Trans R Soc Lond B Biol Sci. 2007;362:901-915.

[11] Bertoux M, Delavest M, Cruz de Souza L, et al. Social cognition and emocional assessment differentiates frontotemporal dementia from depression. J Neurol Neurosurg Psychiatry 2012;83:411-416.

[12] Zamboni G, Huey ED, Krueger F, Nichelli PF, Grafman J. Apathy and disinhibition in frontotemporal dementia. Neurology 2008;71:736-742.

[13] Eslinger PJ, Moore P, Antani S, Anderson, C, Grossman M. Apathy in frontotemporal dementia: Behavioral and neuroimaging correlates. Behavioral Neurology2012;25:127-136.

[14] Deavies RR, Kipps CM, Mitchell J, Kril JJ, Halliday GM, Hodges JR. Progression in frontotemporal dementia: identifying a benign behavioral variant by magnetic resonance imaging. Arch Neurol 2006;63:1627-1631.

[15] Kipps CM, Davies RR, Mitchell J, Kril JJ, Halliday GM, Hodges JR. Clinical significance of lobar atrophy in frontotemporal dementia: application of an MRI visual rating scale. Dement Geriatr Cogn Disord2007;23: 334-342.

[16] Mendez MF, Shapira JS, McMurtray A, Licht E, Miller BL. Accuracy of the clinical evaluation for frontotemporal dementia. Arch Neurol2007; 64:830-835.

[17] Rascovsky K, Hodges JR, Kipps CM, et al. Diagnostic criteria for the behavioral variant of frontotemporal dementia (bv-FTD): current limitations and future directions [Review]. Alzheimer Dis Assoc Disord 2007; 21:14-18.

[18] Pose M, Cetkovich M, Gleichgerrcht E, Ibáñez A, Torralva T, Manes F. The overlap of symptomatic dimensions between behavioral variant Frontotemporal Dementia (bv-FTD) and several psychiatric disorders that appear in late adulthood. International Psychiatry Review (in press).

[19] Torralva T, Roca M, Gleichgerrcht E, López P, Manes F. INECO Frontal screening (IFS): A brief, sensitive, and specific tool to assess executive functions in dementia. J Int Neuropsychol Soc2009;2009:1-10.

[20] Rascovsky K, Hodges JR, Knopman D, et al. Sensitivity of revised diagnostic criteria for the behavioural variant of frontotemporal dementia. Brain2011;134:2456-2477.

[21] Diagnostic and Statistical Manual of Mental Disorders, 4th ed. Washington DC: American Psychiatric Association, 1994.

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

[23] Mioshi E, Dawson K, Mitchell J, Arnold R, Hodges JR. The Addenbrookes's Cognitive Examination Revised (ACE-R): a brief cognitive test battery for dementia screening. Int J Geriatr Psychiatry 2004;21:1078-1085.

[24] Luria AR. Higher cortical function in man. London: Tavistock, 1966

[25] Dubois B, Slachevsky A, Litvan, I, Pillon B. The FAB: A frontal assessment battery at bedside. Neurology2000;55:1621-1626.

[26] Hodges JR. Cognitive assessment for clinicians. Oxford: Oxford University Press, 1994.

[27] Wechsler D. Wechsler Memory Scale-Revised. New York: Psychological Corporation, 1987.

[28] Burguess PW, Shallice T. The Hayling and Brixton Tests. Thurston, Suffolk: Thames Valley Test Company, 1997

[29] Abusamra V, Miranda MA, Ferreres A. Evaluación de la iniciación e inhibición verbal en espeñol. Adaptación y normal del test de hayling. Rev Argentina Neuropsicol 2007;9:19-32.

[30] Neary D, Snowden JS, Gustafson L, et al. Frontotemporal lobar degeneration: a consensus on clinical diagnostic criteria. Neurology1998;51: 1546-1554.

[31] Lockwood KA, Alexopoulos GS, Van Gorp WG. Executive dysfunction in geriatric depression. Am J Psychiatry 2002;159:1119-1126.

[32] Karabekiroglu A, Topçuoglu V, Gimzal Gönentür A, Karabekiroglu K. Executive function differences between first episode and recurrent major depression patients. Turk Psikiyatri Derg. 2010;21:280-288.

[33] Snyder HR. Major depressive disorder is associated with broad impairments on neuropsychological measures of executive function: A meta-analysis and review. Psychol Bull 2013;1:81-132.

[34] Huey ED, Goveia EN, Paviol S, et al. Executive dysfunction in frontotemporal dementia and corticobasal syndrome. Neurology2009;72:453-459.

[35] Hodges JR, Miller B. The neuropsychology of frontal variant frontotemporal dementia. Introduction to the special topic papers: Part II. Neurocase2001;7:113-121.

[36] Gleichgerrcht E, Roca M, Manes F, Torralva T. Comparing the clinical usefulness of the Institute of Cognitive Neurology (INECO) Frontal Screening (IFS) and the Frontal Assessment Battery (FAB) in frontotemporal dementia. J Clin Exp Neuropsychol 2011;1:1-8.

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