Activities of daily living in frontotemporal dementia and Alzheimer disease
Mioshi E, Kipps CM, Dawson K, Mitchell J, Graham A, Hodges JR;
Commented by , 10 Jul 2007
Aim of the study
To evaluate activities of daily living (ADL) in 3 variants of frontotemporal dementia (FTD) and Alzheimer's disease (AD) and their relationship to cognitive dysfunction.
Method
Data was collected from 15 patients with the behavioral variant of FTD (bv-FTD), 10 with progressive non-fluent aphasia (PNFA), 15 with semantic dementia (SD) and 19 with AD. ADL were assessed using the Disability Assessment in Dementia (DAD), global staging using the Clinical Dementia Rating (CDR), cognition using the Addenbrooke's Cognitive Examination Revised (ACE-R), which incorporates the Mini Mental State Examination (MMSE).
Results
The 4 groups were well matched for age, years of education, disease duration. The MMSE scores ranged from 20.5 to 26/30 and CDR 0.5 to 1.0/3.0, indicating mild stage of dementia on these measures. Using the DAD, the impairment was bv-FTD > AD > PNFA > SD, with a significant group difference using ANOVA (χ2 =7.812; df = 3, p = 0.05).
The opposite pattern was seen on the ACE-R, e.g. the bv-FTD group had the highest scores on cognitive measures. Scores on the DAD did not correlate with cognitive measures, CDR or disease duration. The bv-FTD showed a unique pattern of impairment of initiation > planning > execution of basic ADL.
Professor Gauthier's comments
The bv-FTD group of patients showed to worse impairment in ADL, including basic ADL, although performing relatively well on cognitive tests. Although not used in this study, the NeuroPsychiatric Inventory would have also demonstrated higher impairment in this group of patients compared to the other types of FTD and mild AD.
In other words the non-cognitive (ADL and behavior) domains are more significantly impaired in some types of dementia, and clinicians must go beyond the traditional MMSE to assess current levels of clinical impairment. This is particularly true of the ability to drive, which is impaired in bv-FTD even with high MMSE scores. This is an excellent study of functional disability across dementia types.