The Tower of London Test: Different Scoring Criteria for Diagnosing Alzheimer's Disease and Mild Cognitive Impairment

Abstract

The Tower of London (TOL) is used for evaluating planning skills, which is a component of the executive functions. Different versions and scoring criteria were developed for this task, and some of them present with different psychometrical properties. This study aimed to evaluate two specific scoring methods of the TOL in diagnosing Mild Cognitive Impairment and probable Alzheimer's disease. The TOL total scores from 60 patients of each diagnosis were compared with the performance of 60 healthy-aged controls using receiver operating characteristics analysis and multinomial logistic regression. Krikorian method better diagnosed Alzheimer's disease, while Portellas's was better at discriminating healthy controls from Mild Cognitive Impairment, but were not efficient at comparing this last group with Alzheimer's patients. Regression analysis indicates that in addition to screening tests, TOL improves the classification of the three groups. The results suggest the two scoring methods used for this task may be useful for different diagnostic purposes.

Screening for Executive Dysfunction with the Frontal Assessment Battery: Psychometric Properties Analysis and Representative Normative Data for Brazilian Older Adults

“…Those with only few years of formal education (1 to 4) are usually classified as functional illiterate (they can sign their own name but cannot fully read and comprehend a simple text). In the past years, some effort has been done for improving the assessment of executive functions in this population, using neuropsychological tests less influenced by formal education (de Paula et al, 2011;2012a;2012b) or improving normative data for more traditional tests (Machado et al, 2009;Beato et al, 2012). The current study, adopting a populational representative methodology and including older adults with very low or even non-formal education, may contribute for this issue, establishing normative values for the FAB and testing its criterion related validity for AD.…”

“…This cognitive process involves the inhibition of a prominent, intuitive and automatic cognitive process in favor of a more controlled one. This might be an earlier marker of cognitive dysfunction in AD, even in its prodromal states (Balota et al, 2010;de Paula et al, 2011;2012a;2012b) and is closely related to the anterior cingulated cortex activity (Hayward, Goodwin & Harmer, 2004), an area which is also affected by AD pathology in its earlier stages (Schroeter et al, 2009).…”

“…After the exclusion of review papers, case reports and studies published in languages different from English or Portuguese, the review showed that the test was applied in the assessment of Parkinson's and Huntington's disease, alcohol and cocaine users and other neurological patients. Only four Brazilian studies found in this review used the FAB in AD patients (Pedroso et al, 2012;de Paula et al, 2012a;de Paula, Miranda, Moraes & Malloy-Diniz, in press;de Paula & Malloy-Diniz, 2013). Only two studies aimed at the performance of healthy older adults in (Beato et al, 2007;2012).…”

Comparison between Conventional Statistic Approach and Modelling Based on Artificial Neural Network in Differentiating Fronto-Temporal Dementia from Alzheimer's Disease with the Tower of London Test

“…Recently the use of Krikorian's ToL has been recommended in clinical practice [5] and as good method to diagnose AD [6] in comparison with non-demented elderly subjects [7].…”

Assessing planning skills and executive functions in the elderly: preliminary normative data for the Tower of London Test

“…The development of adequate normative data is essential for cognitive assessment in clinical setting. When a precise characterization of executive/planning performance is necessary, as in the assessment of different conditions like dementia, neuropsychiatry disorders, and mild cognitive impairment, stratified data for sociodemographic factors as age and education allow a more accurate interpretation of test performance and neuropsychological hypothesis testing in the clinical setting 5 .…”