The Modified Frontal Behavioral Inventory (FBI-mod) for Patients with Frontotemporal Lobar Degeneration, Alzheimer’s Disease, and Mild Cognitive Impairment

Article type: Research Article

Authors: Suhonen, Noora-Maria^{a; b} | Hallikainen, Ilona^c | Hänninen, Tuomo^d | Jokelainen, Jari^{e; f} | Krüger, Johanna^a | Hall, Anette^c | Pikkarainen, Maria^c | Soininen, Hilkka^{c; d} | Remes, Anne M.^{a; b; c; d; *}

Affiliations: [a] Medical Research Center, Oulu University Hospital, Oulu, Finland | [b] Research Unit of Clinical Neuroscience, University of Oulu, Oulu, Finland | [c] Institute of Clinical Medicine - Neurology, University of Eastern Finland, Kuopio, Finland | [d] Department of Neurology, Kuopio University Hospital, Kuopio, Finland | [e] Center for Life Course Health Research, University of Oulu, Oulu, Finland | [f] Unit of Primary Health Care, Oulu University Hospital, Oulu, Finland

Correspondence: [*] Correspondence to: Prof. Anne M. Remes, MD, PhD, Institute of Clinical Medicine, Neurology, University of Eastern Finland, P.O. Box 1627, 70211 Kuopio, Finland. Tel.: +358 44 7174655; Fax: +358 17 172305; E-mail: anne.remes@uef.fi.

Abstract: While behavioral symptoms are both early and prevalent features of behavioral variant frontotemporal dementia (bvFTD), they can be present in other types of dementia as well, including Alzheimer’s disease (AD) and even mild cognitive impairment (MCI). The Frontal Behavioral Inventory (FBI) was specifically developed to capture the behavioral and personality changes in bvFTD; it has also been modified into a self-administered caregiver questionnaire (FBI-mod). We examined the utility of the FBI-mod in differentiating bvFTD (n = 26), primary progressive aphasia (PPA) (n = 7), AD (n = 53), and MCI (n = 50) patients, and investigated how the FBI-mod may be associated with neuropsychological measures. The bvFTD patients scored significantly higher as compared to all other patient groups on the FBI-mod Total (p < 0.005), Negative (p < 0.005), and Positive (p < 0.01) scores. The cut-off point for the FBI-mod Total score that best discriminated the bvFTD and AD patients in our sample was 16, thus substantially lower than reported for the original FBI. For the bvFTD group, only mild correlations emerged between the FBI-mod and the cognitive measures. However, significant correlations between the FBI-mod and depressive symptoms as measured by the BDI-II were found for bvFTD. This suggests that while behavioral symptoms appear independent from cognitive deficits in bvFTD, they may nevertheless be interrelated with depressive symptoms. We conclude that the FBI-mod is an easily administered behavioral scale that can aid in differential diagnosis of bvFTD and should be used in clinical practice. The FBI-mod may further be considered as an outcome measure in clinical trials.

Keywords: Behavioral rating scale, behavioral symptoms, dementia, depressive symptoms, frontotemporal dementia, neuropsychological tests

DOI: 10.3233/JAD-160983

Journal: Journal of Alzheimer's Disease, vol. 56, no. 4, pp. 1241-1251, 2017