Journal of the International Neuropsychological Society



The Frontal Behavioral Inventory in the differential diagnosis of frontotemporal dementia


ANDREW  KERTESZ a1c1, NEELESH  NADKARNI a1, WILDA  DAVIDSON a1 and ALEX W.  THOMAS a1
a1 Department of Cognitive Neurology, St. Joseph's Health Centre, London, Ontario, Canada

Abstract

A personality and behavioral disorder is an important and defining feature of frontal lobe dementia (FLD) or frontotemporal degeneration (FTD). The diagnosis usually depends on the progressive development of various behavioral symptoms rather than a set of neuropsychological measures. Quantification of the personality–behavior disorder is important for standardizing the diagnosis. An inventory was constructed to capture the major positive and negative behaviors and personality change, and it was administered prospectively to caregivers of 108 patients in a cognitive neurology clinic, at the time of first diagnostic assessment. The prevalence and extent of behavioral abnormality was quantitated in the clinic population of FLD, vascular dementia (VaD), Alzheimer's disease (AD), primary progressive aphasia (PPA), and depressive disorder (DD) patients. The mean scores of FLD patients were significantly above all other groups. Scores in VaD were also higher than in AD, PPA, and DD. Interrater reliability (Cohen's kappa of .90) and item consistency (a Cronbach alpha of .89) were both high. Perseveration, indifference, inattention, inappropriateness, and loss of insight rated highest in FLD, significantly different from all other groups. Apathy, aspontaneity, inflexibility, disorganization, impulsivity, personal neglect, and poor judgment were also significantly higher in FLD. Discriminant function correctly classified 92.7% versus all other patients (NON-FLD) in the study. A total of 18.8% of VaD patients were misclassified as FLD. Indifference, alien hand, and inappropriateness were the highest discriminant functions. Perseveration and verbal apraxia were important discriminatory items for FLD and PPA, respectively. The FBI is a standardized behavioral inventory useful to diagnose FLD, to differentiate it from other dementias, and to quantify the behavior disorder. (JINS, 2000, 6, 460–468.)

(Received March 12 1999)
(Revised July 21 1999)
(Accepted August 3 1999)


Key Words: Frontotemporal dementia; Pick's disease; Frontal Behavioral Inventory.

Correspondence:
c1 Reprint requests to: Dr. Andrew Kertesz, St. Joseph's Health Centre, Department of Neurology, 268 Grosvenor Street, London, ON N6A 4V2, Canada