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Differentiation between frontotemporal dementia and Alzheimer's disease using a brief neuropsychological screening battery
708
Abstracts /Archives of Clinical Neuropsychologv 15 (2000) 653-850
that of Gerstmann syndrome (agraphia, acalculia, right-left disorientation, and finger agnosia) which is attributed to lesions in the dominant parietal lobe affecting the angular gyrus. In addition to these focal deficits, our patient also demonstrated diffuse deficits in working memory, visuo-perceptual and visual-motor integrative abilities, speed of processing, perseveration, and mild emotional lability. Further laboratory studies of CSF confirmed the diagnosis of Creutzfeldt-Jakob disease. NP testing was attempted 6 months after the initial assessment to track cognitive changes. However, cognitive deficits were too severe and further formal testing was not possible. At this time, the patient appeared unable to communicate in English with both expressive and receptive deficits. However, his ability to communicate in Spanish was significantly less impaired. Nevertheless, significant word finding problems and dysarthria were noted when speaking Spanish. This case underscores the need for a multi-disciplinary approach when assessing complex cases, as well as the need for bilingual NP assessment when needed.
Rate of forgetting, intrusions and recognition indexed by the CVLT-Short Form Donnelly JF: Jurik J, Kramer JK, Miller BL.
in Alzheimer’s
and frontotemporal
dementia
as
Previous research has indicated that while patients with Alzheimer’s disease (AD) and frontotemporal dementia (FTD) have deficits in verbal memory, the specific nature of the deficit may vary. For example, both groups can show impaired free recall, but patients with AD may have more difficulty initially storing verbal information, while patients with FTD have more retrieval difficulty. Patients with AD have also been shown to offer more intrusions during delayed recall and demonstrate a more rapid rate of forgetting than patients with other dementing conditions, but these memory indices have not been compared in AD versus FTD. The current study compared AD (n = 3 1) and FTD patients (n= 12) on an abbreviated form of the California Verbal Learning Test (CVLT-Short Form), which included measures of free recall, intrusions, and recognition accuracy. AD patients were expected to demonstrate a greater rate of forgetting and more intrusions, and FTD patients were expected to benefit more from a recognition memory format. Diagnosis was determined by consensus of 2 behavioral neurologists and a neuropsychologist, and the groups did not differ on Mini Mental State Exam Total score. The CVLT-SF consists of 4 learning trials of a 9-item word list, followed by several delayed recall and recognition trials. In general, FTD patients showed better recall than the AD patients. A repeated measures ANOVA contrasting immediate and delayed recall also yielded a significant Diagnosis x Trial interaction (p
Differentiation between frontotemporal dementia neuropsychological screening battery Jurik J, Donnelly JF: Kramer JK, Miller BL.
and
Alzheimer’s
disease
using
a brief
This study evaluated how well a brief neuropsychological screening battery could differentiate between frontotemporal dementia (FTD) and Alzheimer’s disease (AD). Previous studies relying on comprehensive neuropsychological assessment have suggested that delayed recall, visuospatial construction, and
Abstracts /Archives
of Clinical Neuropsychologv
709
I5 (2000) 653450
category fluency are disproportionately impaired in AD, whereas executive abilities are more affected in FTD. Thirty-six patients served as subjects. Twenty-six patients had a diagnosis ofprobable AD, based on the NINCDS-ADRDA criteria, and 10 were diagnosed with the bifrontal variant of FTD, based on the Neary criteria and neuroimaging data. There were no differences between the groups in overall level of dementia, as measured by the Mini-Mental State Examination. Neuropsychological measures included the California Verbal Learning Test-Short Form, measures of letter and category fluency, and the Harbor/ UCLA versions of the Rey-Osterreith Complex Figure and Trail Making Test. Discriminant function analysis correctly classified 92% of the cases (x2 = 17.58, p < 0.004). Ninety-six percent of the AD cases and 80% of the FTD cases were classified correctly. The category-fluency (Animals) and letter-fluency (D-words) tasks, and a rate-of-forgetting measure from the CVLT-SF (i.e., long-delay recall minus trial 4 recall) were found to be the best discriminators in the model. Although cross-validation is necessary, these results demonstrate the diagnostic utility of a theoretically driven bedside screening battery that taps cognitive constructs known to be differentially affected in AD and FTD.
Olfactory functioning in Alzheimer’s Duf K, McCafiey RJ Solomon GS.
disease, vascular dementia,
and major depression
Recently, olfactory dysfunction has been reported in a number of different patient populations. Odor identification testing has also proved useful in discriminating between various patient and nonpatient samples. The present study was conducted to assess the utility of odor identification testing in discriminating between patients with Alzheimer’s disease (AD), vascular dementia (VaD), or major depression (MD). Sixty elderly patients meeting the DSM-IV criteria for either AD (n = 20), VaD (n= 20), or MD (n = 20) underwent assessment with the Pocket Smell Test (PST), a 3-item screening measure of odor identification, and the Mini-Mental State Examination (MMSE). Patients in the AD group scored significantly worse than the VaD and MD patients on the PST, even when covarying out the MMSE scores. Olfactory assessment continues to add to the diagnostic utility in the differential diagnosis of Alzheimer’s disease vs. vascular dementia vs. major depression in elderly patients.
Material-specific memory clinical significance Gleason CE.
changes
following
unilateral
temporal
lobectomy:
statistical
versus
Ninety-eight subjects from the Northern California Comprehensive Epilepsy Center were evaluated pre- and postunilateral temporal lobectomy. Patients’ verbal and nonverbal memory performance was examined for statistically and clinically significant postsurgery changes. Statistical differences between the groups were found on verbal memory measures only. The left temporal lobectomy group on average performed worse than the right temporal lobectomy group on verbal memory tests. An analysis of clinical significance was conducted on verbal memory findings. The majority of subjects (83.2%-100%) did not evidence clinically significant change on various verbal memory indices. Among the small number who showed clinically significant change, some patterns were evident: declines outnumbered improvements and left temporal lobectomy subjects were more likely than right temporal lobectomy subjects to demonstrate declines. Further analyses revealed that regression to the mean was a statistical artifact. Corrections were made and analysis of clinical significance reconducted. Failing to correct for this artifact appeared to inflate estimates
Abstracts /Archives of Clinical Neuropsychologv 15 (2000) 653-850
that of Gerstmann syndrome (agraphia, acalculia, right-left disorientation, and finger agnosia) which is attributed to lesions in the dominant parietal lobe affecting the angular gyrus. In addition to these focal deficits, our patient also demonstrated diffuse deficits in working memory, visuo-perceptual and visual-motor integrative abilities, speed of processing, perseveration, and mild emotional lability. Further laboratory studies of CSF confirmed the diagnosis of Creutzfeldt-Jakob disease. NP testing was attempted 6 months after the initial assessment to track cognitive changes. However, cognitive deficits were too severe and further formal testing was not possible. At this time, the patient appeared unable to communicate in English with both expressive and receptive deficits. However, his ability to communicate in Spanish was significantly less impaired. Nevertheless, significant word finding problems and dysarthria were noted when speaking Spanish. This case underscores the need for a multi-disciplinary approach when assessing complex cases, as well as the need for bilingual NP assessment when needed.
Rate of forgetting, intrusions and recognition indexed by the CVLT-Short Form Donnelly JF: Jurik J, Kramer JK, Miller BL.
in Alzheimer’s
and frontotemporal
dementia
as
Previous research has indicated that while patients with Alzheimer’s disease (AD) and frontotemporal dementia (FTD) have deficits in verbal memory, the specific nature of the deficit may vary. For example, both groups can show impaired free recall, but patients with AD may have more difficulty initially storing verbal information, while patients with FTD have more retrieval difficulty. Patients with AD have also been shown to offer more intrusions during delayed recall and demonstrate a more rapid rate of forgetting than patients with other dementing conditions, but these memory indices have not been compared in AD versus FTD. The current study compared AD (n = 3 1) and FTD patients (n= 12) on an abbreviated form of the California Verbal Learning Test (CVLT-Short Form), which included measures of free recall, intrusions, and recognition accuracy. AD patients were expected to demonstrate a greater rate of forgetting and more intrusions, and FTD patients were expected to benefit more from a recognition memory format. Diagnosis was determined by consensus of 2 behavioral neurologists and a neuropsychologist, and the groups did not differ on Mini Mental State Exam Total score. The CVLT-SF consists of 4 learning trials of a 9-item word list, followed by several delayed recall and recognition trials. In general, FTD patients showed better recall than the AD patients. A repeated measures ANOVA contrasting immediate and delayed recall also yielded a significant Diagnosis x Trial interaction (p
Differentiation between frontotemporal dementia neuropsychological screening battery Jurik J, Donnelly JF: Kramer JK, Miller BL.
and
Alzheimer’s
disease
using
a brief
This study evaluated how well a brief neuropsychological screening battery could differentiate between frontotemporal dementia (FTD) and Alzheimer’s disease (AD). Previous studies relying on comprehensive neuropsychological assessment have suggested that delayed recall, visuospatial construction, and
Abstracts /Archives
of Clinical Neuropsychologv
709
I5 (2000) 653450
category fluency are disproportionately impaired in AD, whereas executive abilities are more affected in FTD. Thirty-six patients served as subjects. Twenty-six patients had a diagnosis ofprobable AD, based on the NINCDS-ADRDA criteria, and 10 were diagnosed with the bifrontal variant of FTD, based on the Neary criteria and neuroimaging data. There were no differences between the groups in overall level of dementia, as measured by the Mini-Mental State Examination. Neuropsychological measures included the California Verbal Learning Test-Short Form, measures of letter and category fluency, and the Harbor/ UCLA versions of the Rey-Osterreith Complex Figure and Trail Making Test. Discriminant function analysis correctly classified 92% of the cases (x2 = 17.58, p < 0.004). Ninety-six percent of the AD cases and 80% of the FTD cases were classified correctly. The category-fluency (Animals) and letter-fluency (D-words) tasks, and a rate-of-forgetting measure from the CVLT-SF (i.e., long-delay recall minus trial 4 recall) were found to be the best discriminators in the model. Although cross-validation is necessary, these results demonstrate the diagnostic utility of a theoretically driven bedside screening battery that taps cognitive constructs known to be differentially affected in AD and FTD.
Olfactory functioning in Alzheimer’s Duf K, McCafiey RJ Solomon GS.
disease, vascular dementia,
and major depression
Recently, olfactory dysfunction has been reported in a number of different patient populations. Odor identification testing has also proved useful in discriminating between various patient and nonpatient samples. The present study was conducted to assess the utility of odor identification testing in discriminating between patients with Alzheimer’s disease (AD), vascular dementia (VaD), or major depression (MD). Sixty elderly patients meeting the DSM-IV criteria for either AD (n = 20), VaD (n= 20), or MD (n = 20) underwent assessment with the Pocket Smell Test (PST), a 3-item screening measure of odor identification, and the Mini-Mental State Examination (MMSE). Patients in the AD group scored significantly worse than the VaD and MD patients on the PST, even when covarying out the MMSE scores. Olfactory assessment continues to add to the diagnostic utility in the differential diagnosis of Alzheimer’s disease vs. vascular dementia vs. major depression in elderly patients.
Material-specific memory clinical significance Gleason CE.
changes
following
unilateral
temporal
lobectomy:
statistical
versus
Ninety-eight subjects from the Northern California Comprehensive Epilepsy Center were evaluated pre- and postunilateral temporal lobectomy. Patients’ verbal and nonverbal memory performance was examined for statistically and clinically significant postsurgery changes. Statistical differences between the groups were found on verbal memory measures only. The left temporal lobectomy group on average performed worse than the right temporal lobectomy group on verbal memory tests. An analysis of clinical significance was conducted on verbal memory findings. The majority of subjects (83.2%-100%) did not evidence clinically significant change on various verbal memory indices. Among the small number who showed clinically significant change, some patterns were evident: declines outnumbered improvements and left temporal lobectomy subjects were more likely than right temporal lobectomy subjects to demonstrate declines. Further analyses revealed that regression to the mean was a statistical artifact. Corrections were made and analysis of clinical significance reconducted. Failing to correct for this artifact appeared to inflate estimates