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Journal of Neurology, Neurosurgery, and Psychiatry logoLink to Journal of Neurology, Neurosurgery, and Psychiatry
. 2005 Jul;76(7):920–927. doi: 10.1136/jnnp.2003.033779

Qualitative neuropsychological performance characteristics in frontotemporal dementia and Alzheimer's disease

J Thompson 1, C Stopford 1, J Snowden 1, D Neary 1
PMCID: PMC1739700  PMID: 15965196

Abstract

Background: Frontotemporal dementia (FTD) and Alzheimer's disease are clinically distinct disorders, yet neuropsychological studies have had variable success in distinguishing them. A possible reason is that studies typically rely on overall accuracy scores, which may obscure differences in reasons for failure.

Objectives: To explore the hypothesis that analysis of qualitative performance characteristics and error types, in addition to overall numerical scores, would enhance the neuropsychological distinction between FTD and Alzheimer's disease.

Methods: 38 patients with FTD and 73 with Alzheimer's disease underwent assessment of language, visuospatial abilities, memory, and executive function, using a neuropsychological screening instrument and standard neuropsychological tests. In each of these cognitive domains, performance characteristics and error types were documented, in addition to numerical scores on tests.

Results: Whereas comparison of neuropsychological test scores revealed some group differences, these did not occur consistently across tests within cognitive domains. However, analysis of performance characteristics and error types revealed qualitative differences between the two groups. In particular, FTD patients displayed features associated with frontal lobe dysfunction, such as concrete thought, perseveration, confabulation, and poor organisation, which disrupted performance across the range of neuropsychological tests.

Conclusions: Numerical scores on neuropsychological tests alone are of limited value in differentiating FTD and Alzheimer's disease, but performance characteristics and error types enhance the distinction between the two disorders. FTD is associated with a profound behavioural syndrome that affects performance on cognitive assessment, obscuring group differences. Qualitative information should be included in neuropsychological research and clinical assessments.

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Selected References

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  1. Bathgate D., Snowden J. S., Varma A., Blackshaw A., Neary D. Behaviour in frontotemporal dementia, Alzheimer's disease and vascular dementia. Acta Neurol Scand. 2001 Jun;103(6):367–378. doi: 10.1034/j.1600-0404.2001.2000236.x. [DOI] [PubMed] [Google Scholar]
  2. Biassou N., Grossman M., Onishi K., Mickanin J., Hughes E., Robinson K. M., D'Esposito M. Phonologic processing deficits in Alzheimer's disease. Neurology. 1995 Dec;45(12):2165–2169. doi: 10.1212/wnl.45.12.2165. [DOI] [PubMed] [Google Scholar]
  3. Blanken G., Dittmann J., Haas J. C., Wallesch C. W. Spontaneous speech in senile dementia and aphasia: implications for a neurolinguistic model of language production. Cognition. 1987 Dec;27(3):247–274. doi: 10.1016/s0010-0277(87)80011-2. [DOI] [PubMed] [Google Scholar]
  4. Glosser G., Friedman R. B., Kohn S. E., Sands L., Grugan P. Cognitive mechanisms for processing nonwords: evidence from Alzheimer's disease. Brain Lang. 1998 Jun 1;63(1):32–49. doi: 10.1006/brln.1997.1924. [DOI] [PubMed] [Google Scholar]
  5. Glosser G., Kohn S. E., Friedman R. B., Sands L., Grugan P. Repetition of single words and nonwords in Alzheimer's disease. Cortex. 1997 Dec;33(4):653–666. doi: 10.1016/s0010-9452(08)70723-8. [DOI] [PubMed] [Google Scholar]
  6. Gregory C. A., Orrell M., Sahakian B., Hodges J. R. Can frontotemporal dementia and Alzheimer's disease be differentiated using a brief battery of tests? Int J Geriatr Psychiatry. 1997 Mar;12(3):375–383. doi: 10.1002/(sici)1099-1166(199703)12:3<375::aid-gps518>3.0.co;2-#. [DOI] [PubMed] [Google Scholar]
  7. Grossi Dario, Fragassi Nina Antonetta, Chiacchio Laura, Valoroso Luigi, Tuccillo Rosaria, Perrotta Concetta, Rapone Paola, Conchiglia Giovanna, Trojano Luigi. Do visuospatial and constructional disturbances differentiate frontal variant of frontotemporal dementia and Alzheimer's disease? an experimental study of a clinical belief. Int J Geriatr Psychiatry. 2002 Jul;17(7):641–648. doi: 10.1002/gps.654. [DOI] [PubMed] [Google Scholar]
  8. Hodges J. R., Patterson K., Ward R., Garrard P., Bak T., Perry R., Gregory C. The differentiation of semantic dementia and frontal lobe dementia (temporal and frontal variants of frontotemporal dementia) from early Alzheimer's disease: a comparative neuropsychological study. Neuropsychology. 1999 Jan;13(1):31–40. doi: 10.1037//0894-4105.13.1.31. [DOI] [PubMed] [Google Scholar]
  9. Kumar A., Schapiro M. B., Haxby J. V., Grady C. L., Friedland R. P. Cerebral metabolic and cognitive studies in dementia with frontal lobe behavioral features. J Psychiatr Res. 1990;24(2):97–109. doi: 10.1016/0022-3956(90)90050-z. [DOI] [PubMed] [Google Scholar]
  10. Lindau M., Almkvist O., Johansson S. E., Wahlund L. O. Cognitive and behavioral differentiation of frontal lobe degeneration of the non-Alzheimer type and Alzheimer's disease. Dement Geriatr Cogn Disord. 1998 Jul-Aug;9(4):205–213. doi: 10.1159/000017048. [DOI] [PubMed] [Google Scholar]
  11. Mathuranath P. S., Nestor P. J., Berrios G. E., Rakowicz W., Hodges J. R. A brief cognitive test battery to differentiate Alzheimer's disease and frontotemporal dementia. Neurology. 2000 Dec 12;55(11):1613–1620. doi: 10.1212/01.wnl.0000434309.85312.19. [DOI] [PubMed] [Google Scholar]
  12. McKhann G., Drachman D., Folstein M., Katzman R., Price D., Stadlan E. M. Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer's Disease. Neurology. 1984 Jul;34(7):939–944. doi: 10.1212/wnl.34.7.939. [DOI] [PubMed] [Google Scholar]
  13. Mendez M. F., Cherrier M., Perryman K. M., Pachana N., Miller B. L., Cummings J. L. Frontotemporal dementia versus Alzheimer's disease: differential cognitive features. Neurology. 1996 Nov;47(5):1189–1194. doi: 10.1212/wnl.47.5.1189. [DOI] [PubMed] [Google Scholar]
  14. Neary D., Snowden J. S., Gustafson L., Passant U., Stuss D., Black S., Freedman M., Kertesz A., Robert P. H., Albert M. Frontotemporal lobar degeneration: a consensus on clinical diagnostic criteria. Neurology. 1998 Dec;51(6):1546–1554. doi: 10.1212/wnl.51.6.1546. [DOI] [PubMed] [Google Scholar]
  15. Neary D., Snowden J. S., Shields R. A., Burjan A. W., Northen B., MacDermott N., Prescott M. C., Testa H. J. Single photon emission tomography using 99mTc-HM-PAO in the investigation of dementia. J Neurol Neurosurg Psychiatry. 1987 Sep;50(9):1101–1109. doi: 10.1136/jnnp.50.9.1101. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Pachana N. A., Boone K. B., Miller B. L., Cummings J. L., Berman N. Comparison of neuropsychological functioning in Alzheimer's disease and frontotemporal dementia. J Int Neuropsychol Soc. 1996 Nov;2(6):505–510. doi: 10.1017/s1355617700001673. [DOI] [PubMed] [Google Scholar]
  17. Perry R. J., Hodges J. R. Differentiating frontal and temporal variant frontotemporal dementia from Alzheimer's disease. Neurology. 2000 Jun 27;54(12):2277–2284. doi: 10.1212/wnl.54.12.2277. [DOI] [PubMed] [Google Scholar]
  18. Rascovsky K., Salmon D. P., Ho G. J., Galasko D., Peavy G. M., Hansen L. A., Thal L. J. Cognitive profiles differ in autopsy-confirmed frontotemporal dementia and AD. Neurology. 2002 Jun 25;58(12):1801–1808. doi: 10.1212/wnl.58.12.1801. [DOI] [PubMed] [Google Scholar]
  19. Razani J., Boone K. B., Miller B. L., Lee A., Sherman D. Neuropsychological performance of right- and left-frontotemporal dementia compared to Alzheimer's disease. J Int Neuropsychol Soc. 2001 May;7(4):468–480. doi: 10.1017/s1355617701744037. [DOI] [PubMed] [Google Scholar]
  20. Snowden J. S., Mann D. M. A., Neary D. Distinct neuropsychological characteristics in Creutzfeldt-Jakob disease. J Neurol Neurosurg Psychiatry. 2002 Dec;73(6):686–694. doi: 10.1136/jnnp.73.6.686. [DOI] [PMC free article] [PubMed] [Google Scholar]
  21. Talbot P. R., Lloyd J. J., Snowden J. S., Neary D., Testa H. J. A clinical role for 99mTc-HMPAO SPECT in the investigation of dementia? J Neurol Neurosurg Psychiatry. 1998 Mar;64(3):306–313. doi: 10.1136/jnnp.64.3.306. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Talbot P. R., Snowden J. S., Lloyd J. J., Neary D., Testa H. J. The contribution of single photon emission tomography to the clinical differentiation of degenerative cortical brain disorders. J Neurol. 1995 Sep;242(9):579–586. doi: 10.1007/BF00868810. [DOI] [PubMed] [Google Scholar]

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