Alzheimer’s Disease or Behavioral Variant Frontotemporal Dementia? Review of Key Points Toward an Accurate Clinical and Neuropsychological Diagnosis

Musa, Gada; Slachevsky, Andrea; Muñoz-Neira, Carlos; Méndez-Orellana, Carolina; Villagra, Roque; González-Billault, Christian; Ibáñez, Agustín; Hornberger, Michael; Lillo, Patricia

doi:10.3233/jad-190924

Cited by 39 publications

(42 citation statements)

References 120 publications

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“…A key goal of LAC-CD is to develop a regional, harmonized approach to dementia diagnosis in order to allow multi-country comparisons. We initially developed diagnostic recommendations [ 92 ], including relevant clinical, neuropsychological, and behavioral measures, for the identification and diagnosis of AD and FTD in Latin American individuals. We focused on specific aspects that would facilitate adequate diagnosis in settings where the resources needed for accurate classification of dementia syndromes are not always available.…”

Section: Regional Diagnosis Visibility and Capacity Buildingmentioning

confidence: 99%

The Latin America and the Caribbean Consortium on Dementia (LAC-CD): From Networking to Research to Implementation Science

Ibáñez

Parra

Butler

2021

JAD

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In comparison with other regions, dementia prevalence in Latin America is growing rapidly, along with the consequent clinical, social, and economic burden upon patients and their families. The combination of fragile health care systems, large social inequalities, and isolated clinical and research initiatives makes the coordination of efforts imperative. The Latin America and the Caribbean Consortium on Dementia (LAC-CD) is a regional organization overseeing and promoting clinical and research activities on dementia. Here, we first provide an overview of the consortium, highlighting the antecedents and current mission. Then, we present the consortium’s regional research, including the multi-partner consortium to expand dementia research in Latin America (ReDLat), which aims to identify the unique genetic, social, and economic factors that drive Alzheimer’s and frontotemporal dementia presentation in LAC relative to the US. We describe an extension of ReDLat which aims to develop affordable markers of disease subtype and severity using high density EEG. We introduce current initiatives promoting regional diagnosis, visibility, and capacity, including the forthcoming launch of the Latin American Brain Health Institute (BrainLat). We discuss LAC-CD-led advances in brain health diplomacy, including an assessment of responses to the impact of COVID-19 on people with dementia and examining the knowledge of public policies among experts in the region. Finally, we present the current knowledge-to-action framework, which paves the way for a future regional action plan. Coordinated actions are crucial to forging strong regional bonds, supporting the implementation of regional dementia plans, improving health systems, and expanding research collaborations across Latin America.

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Section: Regional Diagnosis Visibility and Capacity Buildingmentioning

confidence: 99%

The Latin America and the Caribbean Consortium on Dementia (LAC-CD): From Networking to Research to Implementation Science

Ibáñez

Parra

Butler

2021

JAD

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“…Remarkable change in personality with prominent apathy and disinhibition, accompanied by a lack of empathy and insight, stereotypical behaviors and changes in eating habits, obsessive-compulsive behaviors. Executive dysfunctions and altered social cognition are also observed yet with relative preservation of other cognitive areas such as visuospatial function and memory in the early stages (Musa et al, 2020).…”

Section: Ftd Variant Anatomical Alterations Cognitive and Behavioral Alterationsmentioning

confidence: 99%

Divergent Thinking Abilities in Frontotemporal Dementia: A Mini-Review

et al. 2021

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A large number of studies, including single case and case series studies, have shown that patients with different types of frontotemporal dementia (FTD) are characterized by the emergence of artistic abilities. This led to the hypothesis of enhanced creative thinking skills as a function of these pathological conditions. However, in the last years, it has been argued that these brain pathologies lead only to an augmented “drive to produce” rather than to the emergence of creativity. Moreover, only a few studies analyzed specific creative skills, such as divergent thinking (DT), by standardized tests. This Mini-Review aimed to examine the extent to which DT abilities are preserved in patients affected by FTD. Results showed that DT abilities (both verbal and figural) are altered in different ways according to the specific anatomical and functional changes associated with the diverse forms of FTD. On the one hand, patients affected by the behavioral form of FTD can produce many ideas because of unimpaired access to memory stores (i.e., episodic and semantic), but are not able to recombine flexibly the information to produce original ideas because of damages in the pre-frontal cortex. On the other hand, patients affected by the semantic variant are impaired also in terms of fluency because of the degradation of their semantic memory store. Potential implications, limitations, and future research directions are discussed.

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“…Other recommendations include using validated visual atrophy rating scales and volumetric analyses of brain regions on MRI, 18F-fluorodeoxyglucose PET, neurofilament light chain in serum or cerebrospinal fluid (CSF), and screening for C9orf72 mutation in patients with prevalent psychiatric symptoms ( 6 ). However, these guidelines are not standards of care in most clinical settings worldwide and are reserved for research purposes or for cases in which the clinical diagnosis is unclear based on clinical presentation or neuropsychological testing ( 51 ). Despite the importance of these diagnostic modalities, there are significant logistical challenges in their practical application for the diagnosis of bvFTD across Latin America and throughout many low- and middle-income countries (LMIC) that have limited access to these resources.…”

Section: Discussionmentioning

confidence: 99%

Social Cognition and Behavioral Assessments Improve the Diagnosis of Behavioral Variant of Frontotemporal Dementia in Older Peruvians With Low Educational Levels

et al. 2021

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Background: The behavioral variant of frontotemporal dementia (bvFTD), characterized by early behavioral abnormalities and late memory impairment, is a neurodegenerative disorder with a detrimental impact on patients and their caregivers. bvFTD is often difficult to distinguish from other neurodegenerative diseases, such as Alzheimer's disease (AD), using brief cognitive tests. Combining brief socio-cognitive and behavioral evaluations with standard cognitive testing could better discriminate bvFTD from AD patients. We sought to evaluate the diagnostic accuracy of brief socio-cognitive tests that may differentiate bvFTD and AD patients with low educational levels.Methods: A prospective study was performed on 51 individuals over the age of 50 with low educational levels, with bvFTD or AD diagnosed using published criteria, and who were receiving neurological care at a multidisciplinary neurology clinic in Lima, Peru, between July 2017 and December 2020. All patients had a comprehensive neurological evaluation, including a full neurocognitive battery and brief tests of cognition (Addenbrooke's Cognitive Examination version III, ACE-III), social cognition (Mini-social Cognition and Emotional Assessment, Mini-SEA), and behavioral assessments (Frontal Behavioral Inventory, FBI; Interpersonal Reactivity Index—Emphatic Concern, IRI-EC; IRI—Perspective Taking, IRI-PT; and Self-Monitoring Scale—revised version, r-SMS). Receiver operating characteristic (ROC) analysis to calculate the area under the curve (AUC) was performed to compare the brief screening tests individually and combined to the gold standard of bvFTD and AD diagnoses.Results: The AD group was significantly older than the bvFTD group (p < 0.001). An analysis of the discriminatory ability of the ACE-III to distinguish between patients with AD and bvFTD (AUC = 0.85) and the INECO Frontal Screening (IFS; AUC = 0.78) shows that the former has greater discriminatory ability. Social and behavioral cognition tasks were able to appropriately discriminate bvFTD from AD. The Mini-SEA had high sensitivity and high moderate specificity (83%) for discriminating bvFTD from AD, which increased when combined with the brief screening tests ACE-III and IFS. The FBI was ideal with high sensitivity (83%), as well as the IRI-EC and IRI-PT that also were adequate for distinguishing bvFTD from AD.Conclusions: Our study supports the integration of socio-behavioral measures to the standard global cognitive and social cognition measures utilized for screening for bvFTD in a population with low levels of education.

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Alzheimer’s Disease or Behavioral Variant Frontotemporal Dementia? Review of Key Points Toward an Accurate Clinical and Neuropsychological Diagnosis

Cited by 39 publications

References 120 publications

The Latin America and the Caribbean Consortium on Dementia (LAC-CD): From Networking to Research to Implementation Science

The Latin America and the Caribbean Consortium on Dementia (LAC-CD): From Networking to Research to Implementation Science

Divergent Thinking Abilities in Frontotemporal Dementia: A Mini-Review

Social Cognition and Behavioral Assessments Improve the Diagnosis of Behavioral Variant of Frontotemporal Dementia in Older Peruvians With Low Educational Levels

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