Functional profile of patients with behavioral variant frontotemporal dementia (bvFTD) compared to patients with Alzheimer's disease and normal controls

Lima-Silva, Thais Bento; Bahia, Valéria Santoro; Carvalho, Viviane Amaral; Guimarães, Henrique Cerqueira; Caramelli, Paulo; Balthazar, Márcio; Damasceno, Benito; Bottino, Cássio Machado de Campos; Brucki, Sônia Maria Dozzi; Nitrini, Ricardo; Yassuda, Mônica Sanches

doi:10.1590/S1980-57642013DN70100015

ABSTRACT

There are few studies describing the functional changes in behavioral variant frontotemporal dementia (bvFTD) and it is not clear which aspects of functionality are affected by the disease.

Objective:

The aim of the present investigation was to characterize the functional profile of patients previously diagnosed with bvFTD.

Methods:

The sample consisted of 31 patients diagnosed with bvFTD, who were compared to patients with Alzheimer's disease (AD) (n=31) and to healthy control subjects (NC) (n=34), matched for schooling and age. bvFTD and AD patients were matched by severity of dementia. The protocol included the Mini-Mental State Examination (MMSE), Geriatric Depression Scale (GDS), Direct Assessment of Functional Status (DAFS-BR), Functional Activities Questionnaire (PFAQ), Disability Assessment for Dementia (DAD) and the Clinical Dementia Rating scale (CDR).

Results:

The group with bvFTD showed worse performance on Initiation and Planning/Organization in the DAD and on ability to feed oneself in the DAFS-BR, as well as higher scores on the PFAQ, suggesting greater dependence in the bvFTD group.

Conclusion:

The results suggest that individuals with bvFTD display greater functional impairment compared to AD patients with a similar degree of dementia severity and to healthy controls. Direct assessment of functionality proved unable to clearly differentiate between the dementia subtypes.

Key words:
behavioral variant frontotemporal dementia; functional status; dependence

RESUMO

Existem poucos estudos sobre alterações funcionais na variante comportamental da demência frontotemporal (DFTvc).

Objetivo:

Caracterizar o desempenho funcional de pacientes com diagnóstico prévio de DFTvc.

Métodos:

Trinta e um pacientes com DFTvc foram comparados a pacientes com doença de Alzheimer (DA) (n=31) e adultos saudáveis (NC) (n=34), pareados para idade e escolaridade. Os pacientes com DFTvc e DA foram pareados pela gravidade da demência. O protocolo incluiu o Mini Exame do Estado Mental, Escala de Depressão Geriátrica (GDS), Direct Assessment of Functional Status (DAFS-BR), Disability Assessment for Dementia (DAD), Functional Activities Questionnaire (PFAQ) e Clinical Dementia Rating scale (CDR).

Resultados:

O grupo com DFTvc apresentou pior desempenho em Iniciação e Planejamento/Organização na DAD, em Alimentação na DAFS-BR e pontuação mais elevada na PFAQ, sugerindo que a dependência na DFTvc é mais acentuada.

Conclusão:

Os resultados apresentados sugerem que indivíduos com DFTvc apresentam maior prejuízo funcional, quando comparados com participantes com DA com grau semelhante de gravidade e com adultos saudáveis. A avaliação direta da funcionalidade não ajudou a diferenciar os subtipos de demência de modo significativo.

Palavras-chave:
demência frontotemporal variante comportamental; funcionalidade; prejuízo funcional; dependência

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REFERENCES

Josephs KA, Whitwell JL, Weigand SD, Senjem ML, Boeve BF. Predicting functional decline in behavioral variante frontotemporal dementia. Brain 2011;134:432-448.
Piguet O, Homberger M, Shely BP, Kipps CM, Hodges JR. Sensitivy of current criteria for the diagnosis of behavioral variant frontotemporal dementia. Neurology 2009;72:732-737.
Mendez MF, Shapira JS, McMurtray A, Licht E, Miller BL. Accuracy of the clinical evaluation for frontotemporal dementia. Arch Neurol 2007; 64:830-835.
Rascovsky K, Hodges JR, Knopman D, et al. Sensitivity of revised diagnostic criteria for the behavioural variant of frontotemporal dementia. Brain2011;134:2456-2477.
Hodges JR, Davies RR, Xuereb JH, et al. Clinicopathological correlates in frontotemporal dementia. Ann Neurol 2004;56:399-406.
Mendez MF, Perryman KM. Neuropsychiatric features of frontotemporal dementia: evaluation of consensus criteria and review. J Neuropsychiatry Clin Neurosci 2002;14:424-429.
Slachevsky A, Villalpando JM, Sarazin M, Hahn-Barma V, Pillon B, Dubois B. Frontal assessment battery and differential diagnosis of frontotemporal dementia and Alzheimer disease. Arch Neurol2004;61:1104-1107.
Caramelli P, Machado JC, Barbosa MT, Bahia VS. Demências degenerativas não-Alzheimer. In: Freitas EV, Py L, Cançado FAX, Doll J, Gorzoni ML. Tratado de Geriatria e Gerontologia. Rio de Janeiro: Guanabra Koogan; 2011:202-222.
Mioshi E, Kipps CM, Dawson K, Mitchell J, Graham A, Hodges JR. Activities of daily living in frontotemporal dementia and Alzheimer disease. Neurology2007;68:2077-2084.
Kipps CM, Mioshi E, Hodges JR. Emotion, social functioning and activities of daily living in frontotemporal dementia. Neurocase 2009;15:182-189.
Mioshi E, Hodges JR. Rate of change of functional abilities in frontotemporal dementia. Dement Geriatr Cogn Disord 2009;28:419-426.
Wicklund AH, Johnson N, Rademaker A, Weitner BB, Weintraub S. Profiles of decline in activities of daily living in non-Alzheimer dementia. Alzheimer Dis Assoc Disord 2007;21:8-13.
Neary D, Snowden JS, Gustafson L, et al. Frontotemporal lobar degeneration: a consensus on clinical diagnostic criteria. Neurology1998;51: 1546-1554.
Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), 1994.
McKhann G, Drachman D, Folstein MF, et al. 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. Neurology1984;34:939-944.
Almeida OP, Almeida SA. Confiabilidade da versão brasileira da escala de depressão em geriatria (GDS) versão reduzida. Arq Neuropsiquiatr 1998;57:421-426.
Paradela EMP, Lourenço RA, Veras RP. Validação da Escala de Depressão Geriátrica em um ambulatório geral. Rev Saúde Pública 2005; 39:918-923.
Brucki SMD, Nitrini R, Caramelli P, Bertolucci PHF, Okamoto IH. Sugestões para o uso do mini-exame do estado mental no Brasil. Arq Neuropsiquiatr2003;61:777-781.
Loewenstein AD, Amigo E, Duara R, et al. A new scale for the assessment of functional status in Alzheimer Disease and related disorders. J Gerontol 1989;44:114-121.
Pereira FS, Yassuda MS, Oliveira AM, Forlenza OV. Executive dysfunction correlates with impaired functional status in older adults with varying degrees of cognitive impairment. Int Psychogeriatr 2008;20:1104-1115.
Pfeffer RI, Kurosaki TT, Harrah CH et al. Mensurement of functional activities in older adults in the community. J Gerontology 1982;37: 323-329.
Gélinas I, Gauthier L, McIntyre M, et al. Development of a functional measure for persons with Alzheimer's disease: the disability assessment for dementia. Am J Occuo Ther 1999;53:471-481.
Bahia VS, Carthery-Goulart MT, Novelli MMPC, et al. Functional disability in Alzheimer disease: a validation study of the Brazilian version of the Disability Assessment for Dementia (DAD-Br). Alzheimer Dis Assoc Disord2010;24:291-295.
Morris JC. The Clinical Dementia Rating (CDR): current version and scoring rules. Neurology1993;43:2412-2414.
Morris JC. Clinical Dementia Rating: a reliable and valid diagnostic and staging measure for Dementia of the Alzheimer type. Int Psychogeriatr1997;9(Suppl 1):S173-S176.
Maia ALG, Godinho C, Ferreira ED, et al. Aplicação da versão brasileira da escala de avaliação clínica da demência (Clinical Dementia Rating - CDR) em amostras de pacientes com demência. Arq Neuropsiquiatr2006;64:485-489.
Mioshi E, Kipps CM, Hodges JR. Activities of Daily living in Behavioral Variant Frontotemporal Dementia, Alzheimer Dis Assoc Disord2009; 23:70-77.
Razani J, Casas R, Wong JT, Lu P, Alessi C, Josephson K. Relationship between executive functioning and activities of daily living in patients with relatively mild dementia. Appl Neuropsychol 2007;14:208-214.
Razani J, Kakos B, Orieta-Barbalace C, et al. Predicting caregiver burden from daily functional abilities of patients with mild dementia, J Am Geriatr Soc 2007;55:1415-1420.
Marra TA, Pereira LSM, Faria CDCM, Pereira DS, Martins MAA, Tirado MGA. Avaliação das atividades de vida diária de idosos com diferentes níveis de demência. Rev Bras Fisioter 2007;11:267-273.

Publication Dates

Publication in this collection
Jan-Mar 2013

History

Received
12 Dec 2012
Accepted
28 Feb 2013

This is an open-access article distributed under the terms of the Creative Commons Attribution License

[1] Josephs KA, Whitwell JL, Weigand SD, Senjem ML, Boeve BF. Predicting functional decline in behavioral variante frontotemporal dementia. Brain 2011;134:432-448.

[2] Piguet O, Homberger M, Shely BP, Kipps CM, Hodges JR. Sensitivy of current criteria for the diagnosis of behavioral variant frontotemporal dementia. Neurology 2009;72:732-737.

[3] Mendez MF, Shapira JS, McMurtray A, Licht E, Miller BL. Accuracy of the clinical evaluation for frontotemporal dementia. Arch Neurol 2007; 64:830-835.

[4] Rascovsky K, Hodges JR, Knopman D, et al. Sensitivity of revised diagnostic criteria for the behavioural variant of frontotemporal dementia. Brain2011;134:2456-2477.

[5] Hodges JR, Davies RR, Xuereb JH, et al. Clinicopathological correlates in frontotemporal dementia. Ann Neurol 2004;56:399-406.

[6] Mendez MF, Perryman KM. Neuropsychiatric features of frontotemporal dementia: evaluation of consensus criteria and review. J Neuropsychiatry Clin Neurosci 2002;14:424-429.

[7] Slachevsky A, Villalpando JM, Sarazin M, Hahn-Barma V, Pillon B, Dubois B. Frontal assessment battery and differential diagnosis of frontotemporal dementia and Alzheimer disease. Arch Neurol2004;61:1104-1107.

[8] Caramelli P, Machado JC, Barbosa MT, Bahia VS. Demências degenerativas não-Alzheimer. In: Freitas EV, Py L, Cançado FAX, Doll J, Gorzoni ML. Tratado de Geriatria e Gerontologia. Rio de Janeiro: Guanabra Koogan; 2011:202-222.

[9] Mioshi E, Kipps CM, Dawson K, Mitchell J, Graham A, Hodges JR. Activities of daily living in frontotemporal dementia and Alzheimer disease. Neurology2007;68:2077-2084.

[10] Kipps CM, Mioshi E, Hodges JR. Emotion, social functioning and activities of daily living in frontotemporal dementia. Neurocase 2009;15:182-189.

[11] Mioshi E, Hodges JR. Rate of change of functional abilities in frontotemporal dementia. Dement Geriatr Cogn Disord 2009;28:419-426.

[12] Wicklund AH, Johnson N, Rademaker A, Weitner BB, Weintraub S. Profiles of decline in activities of daily living in non-Alzheimer dementia. Alzheimer Dis Assoc Disord 2007;21:8-13.

[13] Neary D, Snowden JS, Gustafson L, et al. Frontotemporal lobar degeneration: a consensus on clinical diagnostic criteria. Neurology1998;51: 1546-1554.

[14] Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), 1994.

[15] McKhann G, Drachman D, Folstein MF, et al. 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. Neurology1984;34:939-944.

[16] Almeida OP, Almeida SA. Confiabilidade da versão brasileira da escala de depressão em geriatria (GDS) versão reduzida. Arq Neuropsiquiatr 1998;57:421-426.

[17] Paradela EMP, Lourenço RA, Veras RP. Validação da Escala de Depressão Geriátrica em um ambulatório geral. Rev Saúde Pública 2005; 39:918-923.

[18] Brucki SMD, Nitrini R, Caramelli P, Bertolucci PHF, Okamoto IH. Sugestões para o uso do mini-exame do estado mental no Brasil. Arq Neuropsiquiatr2003;61:777-781.

[19] Loewenstein AD, Amigo E, Duara R, et al. A new scale for the assessment of functional status in Alzheimer Disease and related disorders. J Gerontol 1989;44:114-121.

[20] Pereira FS, Yassuda MS, Oliveira AM, Forlenza OV. Executive dysfunction correlates with impaired functional status in older adults with varying degrees of cognitive impairment. Int Psychogeriatr 2008;20:1104-1115.

[21] Pfeffer RI, Kurosaki TT, Harrah CH et al. Mensurement of functional activities in older adults in the community. J Gerontology 1982;37: 323-329.

[22] Gélinas I, Gauthier L, McIntyre M, et al. Development of a functional measure for persons with Alzheimer's disease: the disability assessment for dementia. Am J Occuo Ther 1999;53:471-481.

[23] Bahia VS, Carthery-Goulart MT, Novelli MMPC, et al. Functional disability in Alzheimer disease: a validation study of the Brazilian version of the Disability Assessment for Dementia (DAD-Br). Alzheimer Dis Assoc Disord2010;24:291-295.

[24] Morris JC. The Clinical Dementia Rating (CDR): current version and scoring rules. Neurology1993;43:2412-2414.

[25] Morris JC. Clinical Dementia Rating: a reliable and valid diagnostic and staging measure for Dementia of the Alzheimer type. Int Psychogeriatr1997;9(Suppl 1):S173-S176.

[26] Maia ALG, Godinho C, Ferreira ED, et al. Aplicação da versão brasileira da escala de avaliação clínica da demência (Clinical Dementia Rating - CDR) em amostras de pacientes com demência. Arq Neuropsiquiatr2006;64:485-489.

[27] Mioshi E, Kipps CM, Hodges JR. Activities of Daily living in Behavioral Variant Frontotemporal Dementia, Alzheimer Dis Assoc Disord2009; 23:70-77.

[28] Razani J, Casas R, Wong JT, Lu P, Alessi C, Josephson K. Relationship between executive functioning and activities of daily living in patients with relatively mild dementia. Appl Neuropsychol 2007;14:208-214.

[29] Razani J, Kakos B, Orieta-Barbalace C, et al. Predicting caregiver burden from daily functional abilities of patients with mild dementia, J Am Geriatr Soc 2007;55:1415-1420.

[30] Marra TA, Pereira LSM, Faria CDCM, Pereira DS, Martins MAA, Tirado MGA. Avaliação das atividades de vida diária de idosos com diferentes níveis de demência. Rev Bras Fisioter 2007;11:267-273.

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