A Spanish Neuropsychological Battery Discriminates Between the Behavioral Variant of Frontotemporal Dementia and Primary Progressive Aphasia in a Colombian Sample

Abstract

The differential diagnosis among the behavioral variant of frontotemporal dementia FTD (bvFTD) and the linguist one primary progressive aphasia (PPA) is challenging. Presentations of dementia type or variants dominated by personality change or aphasia are frequently misinterpreted as psychiatric illness, stroke, or other conditions. Therefore, it is important to identify cognitive tests that can distinguish the distinct FTD variants to reduce misdiagnosis and best tailor interventions. We aim to examine the discriminative capacity of the most frequently used cognitive tests in their Spanish version for the context of dementia evaluation as well as the qualitative aspects of the neuropsychological performance such as the frequency and type of errors, perseverations, and false positives that can best discriminate between bvFTD and PPA. We also described mood and behavioral profiles of participants with mild to moderate probable bvFTD and PPA. A total of 55 subjects were included in this cross-sectional study: 20 with PPA and 35 with bvFTD. All participants underwent standard dementia screening that included a medical history and physical examination, brain MRI, a semistructured caregiver interview, and neuropsychological testing. We found that bvFTD patients had worse performance in executive function tests, and the PPA presented with the lower performance in language tests and the global score of Mini-Mental State Examination (MMSE). After running the linear discriminant model, we found three functions of cognitive test and subtests combination and three functions made by the Montreal Cognitive Assessment (MoCA) language subtest and performance errors that predicted group belonging. Those functions were more capable to classify bvFTD cases rather than PPA. In conclusion, our study supports that the combination of an individual test of executive function and language, MoCA's subtest, and performance errors as well have good accuracy to discriminate between bvFTD and PPA.

A systematic review of cognitive and behavioral tools to differentiate behavioral variant frontotemporal dementia from other conditions

“…The remaining 91 studies were rated low quality according to the QUADAS-2 appraisal. [15][16][17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50]52,[54][55][56][57][58][59][60][61][62][63][64][102][103][104][105][106]…”

“…The titles and abstracts were reviewed, with 633 articles identified that potentially met inclusion criteria. These articles were then reviewed in full, yielding 96 articles that met eligibility criteria 15–110 (Figure 1).…”

“…The remaining 91 studies were rated low quality according to the QUADAS‐2 appraisal 15–34,36–50,52,54–64,66–100,102–110,127–129 . These studies assessed (a) neuropsychological tests, (b) cognitive batteries, (c) behavioral tools, and (d) other clinical tools.…”

Gaps in clinical research in frontotemporal dementia: A call for diversity and disparities–focused research

“…In Colombia, caregivers felt stigmatized by their role, in that they thought they were less worthy, which predicted increased caregiver burden, greater depression, and reduced QoL 205 . In China, Chao et al 15 .…”

“…In Colombia, caregivers felt stigmatized by their role, in that they thought they were less worthy, which predicted increased caregiver burden, greater depression, and reduced QoL. 205 In China, Chao et al 15 reported that there was often confusion and disagreement about various symptoms, for example, motor or cognitive symptoms being attributed to "normal aging," thereby delaying the seeking of medical attention. Given the stigma surrounding mental illness in China, psychiatric or behavioral symptoms are generally not openly discussed and may not be disclosed on direct questioning.…”