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Are we comparing frontotemporal dementia and Alzheimer disease patients with the right measures?

  • Mariel B. Deutsch (a1) (a2), Li-Jung Liang (a3), Elvira E. Jimenez (a1) (a2), Michelle J. Mather (a1) and Mario F. Mendez (a1) (a2) (a4)...



Clinical research studies of behavioral variant frontotemporal dementia (bvFTD) often use Alzheimer disease (AD) as a comparison group for control of dementia variables, using tests of cognitive function to match the groups. These two dementia syndromes, however, are very different in clinical manifestations, and the comparable severity of these dementias may not be reflected by commonly used cognitive scales such as the Mini-Mental State Examination (MMSE).


We evaluated different measures of dementia severity and symptoms among 20 people with bvFTD compared to 24 with early-onset AD.


Despite similar ages, disease-duration, education, and cognitive performance on two tests of cognitive function, the MMSE and the Montreal Cognitive Assessment (MoCA), the bvFTD participants, compared to the AD participants, were significantly more impaired on other measures of disease severity, including function (Functional Assessment Questionnaire (FAQ)), neuropsychiatric symptoms (Neuropsychiatric Inventory (NPI)), and global dementia stage (Clinical Dementia Rating Scales (CDRs)). However, when we adjusted for the frontotemporal lobar degeneration-CDR (FTLD-CDR) in the analyses, the two dementia groups were comparable across all measures despite significant differences on the cognitive scales.


We found tests of cognitive functions (MMSE and MoCA) to be insufficient measures for ensuring comparability between bvFTD and AD groups. In clinical studies, the FTLD-CDR, which includes additional language and behavior items, may be a better overall way to match bvFTD and AD groups on dementia severity.


Corresponding author

Correspondence should be addressed to: Mariel B. Deutsch, MD, Department of Neurology Icahn School of Medicine at Mount Sinai, 1 Gustave L. Levy Place, Box 1139 New York, NY 10029, USA. Phone: +(212)-241–7076; Fax: +(212)-241–9346. Email:


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Apostolova, L. G. and Cummings, J. L. (2008). Neuropsychiatric manifestations in mild cognitive impairment: a systematic review of the literature. Dementia and Geriatric Cognitive Disorders, 25, 115126. doi: 10.1159/000112509.
Cullen, B., O'Neill, B., Evans, J. J., Coen, R. F. and Lawlor, B. A. (2007). A review of screening tests for cognitive impairment. Journal of Neurology, Neurosurgery and Psychiatry, 78, 790799. doi: 10.1136/jnnp.2006.095414.
Cummings, J. L. (1997). The neuropsychiatric inventory: assessing psychopathology in dementia patients. Neurology, 48, S10–16. doi: 10.1212/WNL.48.5_Suppl_6.10S.
Desai, A. K., Grossberg, G. T. and Sheth, D. N. (2004). Activities of daily living in patients with dementia: clinical relevance, methods of assessment and effects of treatment. CNS Drugs, 18, 853875.
Folstein, M. F., Robins, L. N. and Helzer, J. E. (1983). The mini-mental state examination. Archives of General Psychiatry, 40, 812. doi: 10.1001/archpsyc.1983.01790060110016.
Freitas, S., Simoes, M. R., Alves, L., Duro, D. and Santana, I. (2012). Montreal cognitive assessment (MoCA): validation study for frontotemporal dementia. Journal of Geriatric Psychiatry and Neurology, 25, 146154. doi: 10.1177/0891988712455235.
Gregory, C. et al. (2002). Theory of mind in patients with frontal variant frontotemporal dementia and Alzheimer's disease: theoretical and practical implications. Brain : A Journal of Neurology, 125, 752764. doi: 10.1093/brain/awf079.
Kertesz, A., Davidson, W., McCabe, P. and Munoz, D. (2003). Behavioral quantitation is more sensitive than cognitive testing in frontotemporal dementia. Alzheimer Disease and Associated Disorders, 17, 223229. doi: 10.1097/00002093-200310000-00005.
Knopman, D. S. et al. (2008). Development of methodology for conducting clinical trials in frontotemporal lobar degeneration. Brain : A Journal of Neurology, 131, 29572968. doi: 10.1093/brain/awn234.
Knopman, D. S., Weintraub, S. and Pankratz, V. S. (2011). Language and behavior domains enhance the value of the clinical dementia rating scale. Alzheimer's & Dementia: The Journal of the Alzheimer's Association, 7, 293299. doi: 10.1016/j.jalz.2010.12.006.
Lima-Silva, T. B. et al. (2013). Functional profile of patients with behavioral variant frontotemporal dementia (bvFTD) compared to patients with Alzheimer's disease and normal controls. Dementia & Neuropsychologia, 7, 96103.
McKhann, G., Drachman, D., Folstein, M., Katzman, R., Price, D. and Stadlan, E. M. (1984). Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA work group under the auspices of department of health and human services task force on Alzheimer's disease. Neurology, 34, 939944. doi: 10.1212/WNL.34.7.939.
Pfeffer, R. I., Kurosaki, T. T., Harrah, C. H. Jr, Chance, J. M. and Filos, S. (1982). Measurement of functional activities in older adults in the community. Journal of Gerontology, 37, 323329. doi: 10.1093/geronj/37.3.323.
Rascovsky, K. et al. (2005). Rate of progression differs in frontotemporal dementia and Alzheimer disease. Neurology, 65, 397403. doi: 10.1212/01.wnl.0000171343.43314.6e.
Rascovsky, K. et al. (2011). Sensitivity of revised diagnostic criteria for the behavioural variant of frontotemporal dementia. Brain: A Journal of Neurology, 134, 24562477. doi: 10.1093/brain/awr179.
Rosen, H. J. et al. (2004). Neuropsychological and functional measures of severity in Alzheimer disease, frontotemporal dementia, and semantic dementia. Alzheimer Disease and Associated Disorders, 18, 202207.



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