Executive Dysfunction in the FTD Spectrum

NATALIA FIORENTINO; EZEQUIEL GLEICHGERRCHT; NATALIA SIERRA; MARÍA ROCA; FACUNDO MANES; TERESA TORRALVA

San Diego

Congreso; Annual Meeting of the American Academy of Neurology; 2013

American Academy of Neurology

OBJECTIVE: To examine the sensitivity and specificity of the INECO Frontal Screening (IFS) for the detection of executive dysfunction in pathologies comprised by the spectrum of frontotemporal dementia (FTD). BACKGROUND: The FTD spectrum features at least three main, distinct clinical variants: behavioral variant FTD (bv-FTD), temporal variant FTD (tv-FTD): semantic dementia (SD) and progresive non-fluent aphasia (PNFA), as well as a motor variant (mv-FTD): progressive supranuclear palsy (PSP), amyotrophic lateral sclerosis (ALS) and corticobasal dementia (CBD). Executive dysfunction is one aspect of growing recognition for the diagnosis and treatment of patients with pathologies of the FTD spectrum. However, its assessment in daily clinical practice is still very limited. DESIGN/METHODS: The INECO Frontal Screening (IFS) and the Addenbrook's cognitive examination (ACE) were apllied to 48 patients with bv-FTD, 47 patients with tv-FTD (23 patients with PNFA and 21 patients with SD), 7 patients with PSP, 16 patients with ALS and 9 patients with CBD. IFS scores were compared across groups and with a healthy control group (n = 28). RESULTS: IFS total scores differed between the groups, with controls exhibiting significantly higher scores than all dementia groups, except for patients with ALS, who performed at at intermediate level between controls and the rest of the clinical groups. With a cut-off score of 25/30, sensitivity to detect any dementia within the FTD spectrum was 100% and specificity was 90%. The same sensitivity and specificity was found for the ACE-R with a cut-off score of 89/100. In all cases, the IFS demonstrated superior discriminatory accuracy to detect specific types of FTD spectrum dementias. CONCLUSIONS: The IFS is a brief screening tool for bedside assessment of executive functions. Because this cognitive domain appears to be primarily affected in FTD spectrum dementias, the IFS constitutes a valuable tool to contribute to the detection of FTD dementias in the early stages.