The Frontal Assessment Battery 20 years later: normative data for a shortened version (FAB15).

OBJECTIVE: The Frontal Assessment Battery (FAB) is a neuropsychological tool largely used to assess executive functions. Prior studies found a marked ceiling effect for the prehension behavior subtest (PBT) in healthy and clinical populations. Aims of the present study were (i) to examine the psychometric properties of the FAB without the contribution of PBT and (ii) to provide normative data for a revised version of the FAB after exclusion of PBT (FAB15). METHODS: The normative sample included 1,187 healthy participants. PBT had near-zero variance, poor content validity, and no discrimination power. Internal consistency increased when PBT was excluded. We assessed the FAB15 factorial structure, interrater, and test-retest reliabilities. Normative data  for the FAB15 were extracted through a regression-based procedure according to sex, age, and education. RESULTS: The principal component analysis revealed a single "executive factor" or alternatively a bifactorial solution reflecting the different degree of discriminative capability vs. difficulty of the subtests. The FAB15 demonstrated excellent interrater and test-retest reliabilities. Regression analysis showed that sex (lowly educated women < lowly educated men), higher age, and lower education affected FAB15 score. Accordingly, three grids for adjustment of raw scores (men, women, and both) were constructed. The cut-off was fixed at the non-parametric outer tolerance limit on the fifth centile (9.36, 95% CI). CONCLUSION: The observation of a ceiling effect in healthy subjects makes PBT not suitable for inclusion in a neuropsychological battery. The FAB15 may successfully replace the conventional FAB as a more severe and valid short screening tool to assess executive functioning.

Italian version of the Starkstein Apathy Scale (SAS-I) and a shortened version (SAS-6) to assess "pure apathy" symptoms: normative study on 392 individuals.

OBJECTIVES: The present normative study aimed to (1) develop the Italian version of the Starkstein Apathy Scale (SAS-I) and (2) construct a shortened version including only the most sensitive items to "pure apathy" experiences. METHODS: The normative sample included 392 healthy subjects. A regression-based procedure was used to explore the effects of sex, age, and education on the raw SAS-I score. A correction grid was designed for adjusting raw scores by adding or subtracting the contribution of any significant variable and net of sociodemographic interindividual differences. Cutoff scores were also calculated and fixed at the external tolerance limit on the ninety-fifth centile. To obtain the shortened version, each SAS-I item was correlated with the Beck's Depression Inventory (BDI) score. The only items showing no correlation with BDI were implemented to bypass the well-known overlap between apathetic and depressive symptoms. RESULTS: The mean raw SAS-I score was 11.27 (SD = 4.42). A significant education effect was observed, with highly educated subjects obtaining lower scores than lowly educated ones. The proposed general cutoff score was 20.68. The SAS-I had fair internal consistency and discriminant validity. Internal consistency increased by removing item 3. The new SAS-6 included items 1, 2, 4, 10, 11, and 13 of the original scale. CONCLUSION: The SAS-I is a reliable assessment tool to support the diagnosis of apathy. The SAS-6, instead, is a brief questionnaire useful for quickly screening apathetic symptoms in outpatient practice, addressing or not the clinician to further investigations.

Anosognosia for memory deficit in amnestic mild cognitive impairment and Alzheimer's disease.

OBJECTIVE: to investigate patterns of anosognosia for memory deficit in subjects with amnestic mild cognitive impairment (MCI) and Alzheimer's disease (AD). METHODS: the study involved twenty-five subjects with MCI, 15 with mild AD and 21 normal controls (NC). Subjective rating of memory functioning was assessed with a six-items questionnaire that was administered before and after memory testing; an informant version from caregivers gave a discrepancy score (SRD). In the Objective Judgement (OJ) task, aiming to evaluate memory-monitoring abilities, subjects were requested three times to predict their memory performance in recalling words from a list of ten. Then they had to recall the words. Prediction accuracy was computed by subtracting the predicted performance from the actual performance. RESULTS: MCI and AD showed reduced awareness of memory difficulties at the SRD and did not change their rating of these difficulties after memory testing. At the OJ task, MCI and AD consistently overestimated their memory performances as compared with NC. The SRD and OJ measures were not correlated with some patients being impaired on only one measure. Only the OJ measure was significantly related to executive functioning. CONCLUSIONS: AD and MCI subjects show unawareness for memory deficit and significant memory-monitoring disorder. This confirms that anosognosia is an important symptom of MCI. Similarities of patterns of impaired awareness between AD and MCI supports the view of a continuum of the anosognosia phenomenon in MCI and AD.

Brief report: error pattern in an autistic savant calendar calculator.

Special ability in computing the day of the week from given dates was observed in a 18 years old male, L.E., suffering from autism. Neuropsychological testing revealed severe deficits in all cognitive domains and poor explicit knowledge of calendar structure. The subject scored well above the chance level on dates of the past and future decades. Error rate and response latency increased with temporal remoteness of dates. Most of errors were in indicating the weekday before or after that of date stimulus. The performance and error pattern suggest that L.E. used "encapsulated" computation algorithm(s) for the day of week task.

The Frontal Assessment Battery (FAB): normative data from an Italian sample and performances of patients with Alzheimer's disease and frontotemporal dementia.

The Frontal Assessment Battery (FAB) is a short neuropsychological tool aiming to assess executive functions at the bedside. Two-hundred and thirty-six normal controls were administered the FAB and three other tasks assessing attentional and executive functions. The FAB was also administered to 28 patients suffering from mild Alzheimer's disease (AD, n. 15 subjects) or frontotemporal dementia (FTD, n. 13 subjects). The FAB showed good concurrent and discriminant validity and high internal consistency. Test-retest and inter-rater reliability were fairly good. A multiple regression analysis showed a significant positive effect of education and a negative effect of age. Cut-off values of non-parametric distribution were computed. A difference on FAB scores within dementia patients was observed, with subjects with FTD performing worse than patients suffering from AD.

Dysexecutive performance of healthy oldest old subjects on the Frontal Assessment Battery.

BACKGROUND AND AIMS: Frontal lobes and executive functions appear to be more vulnerable to normal aging than other cerebral regions and domains. The aim of the study was to evaluate executive functions by the Frontal Assessment Battery (FAB) in healthy oldest old subjects free of dementia. METHODS: Thirty-two healthy oldest old subjects (age range 85-97 yrs) and 32 young old subjects (aged 61-74 yrs) were studied. All subjects were living with their families or alone and were considered normal, since they were fully independent in their activities of daily living and without signs or symptoms characteristic of any type of dementia. Mental status was assessed by the Mini- Mental State Examination (MMSE) and executive functions by the FAB. RESULTS: Mean MMSE scores were 23.12 ± 4.68 in oldest old and 26.78 ± 2.60 in young old subjects (p<0.005). Delayed recall was the most impaired domain, followed by executive (Serial 7). Mean FAB scores were 9.37 ± 4.14 in the oldest old and 13.53 ± 2.12 in the young old (p<0.0001). Among the FAB subtests, conceptualization was the most impaired in both groups, with sensitivity to interference and inhibitory control exhibiting higher discrimination between the oldest old and young old. Education influenced performance on MMSE and FAB in both groups. CONCLUSIONS: On the FAB test, healthy oldest old subjects showed executive impairment with respect to the young olds, due to the involvement of functions depending on activities of different regions of the frontal lobes. FAB results were consistent with the hypothesis that frontal lobes have a high vulnerability to normal aging. Short composite batteries like the FAB are suitable for rapid and reliable description of patterns of executive functioning in the oldest old.

Episodic future thinking in amnesic mild cognitive impairment.

Results from behavioral studies of amnesic patients and neuroimaging studies of individuals with intact memory suggest that a brain system involving direct contributions from the medial temporal lobes supports both remembering the past and imagining the future (Episodic Future Thinking). In the present study, we investigated whether amnesic Mild Cognitive Impairment (aMCI) affects EFT. Amnesic MCI is a high-risk factor for Alzheimer's disease and is characterized by a selective impairment of episodic memory, likely reflecting hippocampal malfunctioning. The present study assessed, for the first time, whether the reduction of episodic specificity for past events, evident in aMCI patients, extends also to future events. We present data on 14 aMCI patients and 14 healthy controls, who mentally re-experienced and pre-experienced autobiographical episodes. Transcriptions were segmented into distinct details that were classified as either internal (episodic) or external (semantic). Results revealed that aMCI patients produced fewer episodic, event-specific details, and an increased number of semantic details for both past and future events, as compared to controls. These results are discussed with respect to the constructive episodic simulation hypothesis, which suggests that reminiscence and future thinking are the expression of the same neurocognitive system.

Effects of demographic and environmental variables on cognitive performance in a rural community sample of elderly people living in Southern Italy.

BACKGROUND AND AIMS: The aim of our study was to understand how demographic and environmental factors may be associated with cognitive functions in a rural population of Southern Italy, with a very high percentage of elderly persons with little formal education. MATERIALS AND METHODS: From the population registry of San Marcellino (province of Caserta), out of 1089 persons aged over 60 years, a random sample of 300 residents received a door-to-door visit. Two hundred and twenty-six subjects were judged as not having significant cognitive impairment, on the basis of their personal history and Clinical Dementia Rating score (< 1). They were administered the Mini Mental State Examination (MMSE). RESULTS: A positive statistically significant correlation was observed between MMSE score and education, but not between MMSE score, age and gender. Normative data showed that 90% of the normal population from this area had an adjusted MMSE score of more than 16.20, a value far below the traditional cut-off score of 23/24 for diagnosis of dementia. Subjects living with their families showed better performance than persons living alone or only with spouses. CONCLUSIONS: This finding is consistent with other epidemiologic surveys, and suggests the possible role of ecological and environmental factors in preventing or compensating cognitive decline, at least in persons coming from homogeneous rural areas. Low social demands in a protective family environment do not stimulate high intellectual performance, and signs of dementia may not be recognized by persons living in this context until the patient reaches a severe stage of disease.