Skip to main content
SpringerLink
Log in

Frontal Assessment Battery in Early Cognitive Impairment: Psychometric Property and Factor Structure

  • Published:
The journal of nutrition, health & aging

Abstract

Background

The Frontal Assessment Battery (FAB) is a reliable and valid bedside tool for testing executive function in dementia. Given the increasing interest in utility of FAB as a screening tool in early cognitive impairment (ECI), there is a surprising lack of studies evaluating its psychometric property and factor structure, nor the influence of factors such as age, education and gender, in ECI.

Objectives

This study aims to investigate the psychometric properties and factor structure of FAB in older adults with ECI, as well as the influence of age, gender and education.

Design, Setting and Participants

This is a retrospective, observational cross-sectional study with 300 community dwelling, predominantly Chinese older adults (14 normal, 130 mild cognitive impairment (MCI), and 156 mild dementia) who presented to Memory Clinic from January 2011 to December 2013.

Measurements and Analysis

We collected data on demographic, cognitive, functional and behavioral evaluation. To examine the psychometric properties of FAB, we examined the concurrent, convergent, and discriminant validity; internal consistency by Cronbach’s alpha; and factor structure by exploratory factor analysis. The influence of age, education and gender was examined using unadjusted and adjusted correlational analyses with CDR-SOB. We performed analysis for the whole group and for MCI subgroup.

Results

FAB total score decreases significantly from normal to dementia group attesting to concurrent validity. It correlated significantly with digit span backwards and Chinese Mini Mental State Examination (r=0.38 and 0.47 respectively, p<0.01) and poorly with Neuropsychiatric Inventory-Questionnaire and depression (r=0.004 and −0.02 respectively), supporting its convergent and discriminant validity. Factor analysis yielded a single-factor solution for FAB with fair Internal consistency (alpha=0.610). FAB is relatively unaffected by age, gender and education level. These good psychometric properties extend to MCI, albeit with greater influence by education level. FAB items of conceptualization and mental flexibility have good discriminatory ability between MCI and normal subjects.

Conclusion

FAB has good concurrent, convergent and discriminant validity with fair internal consistency in ECI that is premised on a one-factor structure. It is relatively unaffected by age, gender or education. Taken together, FAB is a useful bedside screening tool for executive function in ECI.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Dubois B, Slachesvsky A, Litvan I, et al: The FAB. A Frontal Assessment Battery at bedside. Neurology 2000; 55: 1621–1626.

    Article  CAS  Google Scholar 

  2. Guedj E, Allali G, Goetz C, et al. 2008. Frontal assessment battery is a marker of dorsolateral and medial frontal functions: a SPECT study in frontotemporal dementia. J Neurol Sci 273(1–2): 84–87.

    Article  Google Scholar 

  3. Lee JH, Byun MS, Sohn BK, et al. 2015. Functional neuroanatomical correlates of the frontal assessment battery performance in Alzheimer disease: a FDG-PET study. J Geriatr Psychiatry Neurol 28(3): 184–192.

    Article  Google Scholar 

  4. Castiglioni S, Pelati O, Zuffi M, et al. 2006. The frontal assessment battery does not differentiate frontotemporal dementia from Alzheimer’s disease. Dement Geriatr Cogn Disord 22(2): 125–131.

    Article  Google Scholar 

  5. Nagata T, Shinagawa S, Ochiai Y, et al. 2011. Association between executive dysfunction and hippocampal volume in Alzheimer’s disease. Int Psychogeriatr 23(5): 764–771.

    Article  Google Scholar 

  6. Matsui H, Udaka F, Miyoshi T, et al. 2006. Frontal assessment battery and brain perfusion image in Parkinson’s disease. J Geriatr Psychiatry Neurol 19(1): 41–45.

    Article  Google Scholar 

  7. Slachevsky A, Villalpando JM, Sarazin M, et al. 2004. Frontal assessment battery and differential diagnosis of frontotemporal dementia and Alzheimer disease. Arch Neurol 61(7): 1104–1107.

    Article  Google Scholar 

  8. Lipton AM, Ohman KA, Womack KB, et al. 2005. Subscores of the FAB differentiate frontotemporal lobar degeneration from AD. Neurology 65(5): 726–731.

    Article  CAS  Google Scholar 

  9. Paviour DC, Winterburn D, Simmonds S, et al. 2005. Can the frontal assessment battery (FAB) differentiate bradykinetic rigid syndromes? relation of the FAB to formal neuropsychological testing. Neurocase 11(4): 274–282.

    Article  CAS  Google Scholar 

  10. Oguro H, Yamaguchi S, Abe S, et al. 2006. Differentiating Alzheimer’s disease from subcortical vascular dementia with the FAB test. J Neurol 253(11): 1490–1494.

    Article  Google Scholar 

  11. Kawai Y, Miura R, Tsujimoto M, et al. 2013. Neuropsychological differentiation between Alzheimer’s disease and dementia with Lewy bodies in a memory clinic. Psychogeriatrics 13(3): 157–163.

    Article  Google Scholar 

  12. Hurtado-Pomares M, Carmen Terol-Cantero M, Sánchez-Pérez A, Peral-Gómez P, Valera-Gran D, Navarrete-Muñoz EM. The frontal assessment battery in clinical practice: a systematic review. International journal of geriatric psychiatry. 2018 Feb;33(2):237–51.

    Article  Google Scholar 

  13. Moreira HS, Costa AS, Castro SL, Lima CF, Vicente SG. Assessing Executive Dysfunction in Neurodegenerative Disorders: A Critical Review of Brief Neuropsychological Tools. Frontiers in aging neuroscience. 2017 Nov 9;9:369.

    Article  Google Scholar 

  14. Chong MS, Lim WS, Chan SP, Feng L, Niti M, Yap P, Yeo D, Ng TP. Diagnostic performance of the Chinese Frontal Assessment Battery in early cognitive impairment in an Asian population. Dementia and geriatric cognitive disorders. 2010;30(6):525–32

    Article  CAS  Google Scholar 

  15. Kim JW, Lee DY, Seo EH, Sohn BK, Park SY, Choo IL, Youn JC, Jhoo JH, Kim KW, Woo JI. Improvement of dementia screening accuracy of mini-mental state examination by education-adjustment and supplementation of frontal assessment battery performance. Journal of Korean medical science. 2013 Oct 1;28(10):1522–8.

    Article  Google Scholar 

  16. Hsu YH, Huang CF, Lo CP, Wang TL, Yang CC, Tu MC. Frontal assessment battery as a useful tool to differentiate mild cognitive impairment due to subcortical ischemic vascular disease from Alzheimer disease. Dementia and geriatric cognitive disorders. 2016;42(5–6):331–41.

    Article  Google Scholar 

  17. Hanyu H, Sato T, Takasaki A, Akai T, Iwamoto T. Frontal lobe dysfunctions in subjects with mild cognitive impairment. Journal of neurology. 2009 Sep 1;256(9):1570–1.

    Article  Google Scholar 

  18. Zhang Y, Han B, Verhaeghen P, Nilsson LG. Executive functioning in older adults with mild cognitive impairment: MCI has effects on planning, but not on inhibition. Aging, Neuropsychology, and Cognition. 2007 Nov 14;14(6):557–70.

    Article  Google Scholar 

  19. Wang TL, Hung YH, Yang CC. Psychometric properties of the Taiwanese (traditional Chinese) version of the Frontal Assessment Battery: a preliminary study. Applied Neuropsychology: Adult. 2016 Jan 2;23(1):11–20.

    Article  CAS  Google Scholar 

  20. Norman, D. A., & Shallice, T. (1986). Attention to action: Willed and automatic control of behavior. In R. J. Davidson, G. E. Schwartz, & D. Shapiro (Eds.), Consciousness and self-regulation (pp. 1–18). New York, NY: Plenum.

    Google Scholar 

  21. L Tay, WS Lim, M Chan Mark, N Ali, S Mahanum, P Chew, J Lim, MS Chong (2015). The new DSM-5 neurocognitive disorders criteria and its impact on prevalence of mild cognitive impairment and dementia in a memory clinic setting. Am J Geriatr Psychiatry, 23(8):768–779.

    Article  Google Scholar 

  22. Chan M, Tay L, Chong MS. Amnestic mild cognitive impairment and early Alzheimer’s disease in an Asian memory clinic-evidence for a clinical spectrum. Dement Geriatr Cogn Dis Extra (2011)

    Google Scholar 

  23. WS Lim, JJ Chin, CK Lam, PPJ Lim, S Sahadevan (2005). Clinical Dementia Rating: Experience of a multi-racial Asian Population. Alzheimer Disease and Associated Disorders, 19(3):135–142.

    Article  Google Scholar 

  24. WS Lim, MS Chong, Sahadevan S (2007). Utility of the Clinical Dementia Rating in Asian populations. Clinical Medicine and Research, 5(1): 61–70.

    Article  Google Scholar 

  25. Collin C, Wade DT, Davies S, Horne V. The Barthel ADL Index: a reliability study. International disability studies. 1988 Jan 1;10(2):61–3.

    Article  CAS  Google Scholar 

  26. Lawton MP, Brody EM. Assessment of older people: self-maintaining and instrumental activities of daily living. The gerontologist. 1969 Oct 1;9(3_Part_1):179–86.

    Article  CAS  Google Scholar 

  27. Sahadevan S, Tan NJ, Tan T, Tan S: Cognitive testing of elderly Chinese people in Singapore: influence of education and age on normative scores. Age Ageing 1997; 26: 481–486

    Article  CAS  Google Scholar 

  28. American Psychiatric Associatin. Diagnostic and Statistical Manual of Mental Disorder, Fourth Edition. Washington DC; American Psychiatric Association; 1994.

    Google Scholar 

  29. Kaufer DI, Cummings JL, Ketchel P, Smith V, MacMillan A, Shelley T, Lopez OL, DeKosky ST. Validation of the NPI-Q, a brief clinical form of the Neuropsychiatric Inventory. The Journal of neuropsychiatry and clinical neurosciences. 2000 May;12(2):233–9.

    Article  CAS  Google Scholar 

  30. Sahadevan S, Lim JP, Tan NJ, Chan SP: Psychometric identification of early Alzheimer disease in an elderly Chinese population with differing educational levels. Alzheimer Dis Assoc Disord 2002; 16: 65–72.

    Article  Google Scholar 

  31. Horn, J.L. (1965). A rationale and test for the number of factors in factor analysis. Psychometrika, 30, 179–185.

    Article  CAS  Google Scholar 

  32. Osborne JW, Costello AB, Kellow JT. Best practices in exploratory factor analysis. Best practices in quantitative methods. 2008:86–99.

    Book  Google Scholar 

  33. Kim TH, Huh Y, Choe JY, Jeong JW, Park JH, Lee SB, Lee JJ, Jhoo JH, Lee DY, Woo JI, Kim KW. Korean version of frontal assessment battery: psychometric properties and normative data. Dementia and geriatric cognitive disorders. 2010;29(4):363–70.

    Article  Google Scholar 

  34. Mok VCT, Wong A, Yim P, et al: The validity and reliability of Chinese Frontal Assessment Battery in evaluating executive dysfunction among Chinese patients with small subcortical infarct. Alz Dis Assoc Disord 2004; 18: 68–74.

    Article  Google Scholar 

  35. Ladera V, Sargento P, Perea V, Faria M, Garcia R. Sensitivity and specificity of Frontal Assessment Battery in newly diagnosed and untreated obstructive sleep apnea patients. Sleep medicine. 2018 Feb 1;42:1–6.

    Article  Google Scholar 

  36. LA Munang, M Chan, WS Lim (2010). Clock Drawing Test: Diagnostic performance using a pre-drawn circle in early dementia. Asian J Gerontol Geriatr 2010; 5: 54–6.

    Google Scholar 

Download references

Acknowledgements

We would like to thank the doctors and nurse clinicians of the Cognition and Memory Disorders Service, Department of Geriatric Medicine, Tan Tock Seng Hospital, and research assistants from the Institute of Geriatrics and Active Aging, Tan Tock Seng Hospital, for their substantial contribution to data acquisition and other aspects of the study.

Funding

Funding: None. All the authors have read the papers, fulfilled the criteria for authorship and have agreed to be listed as authors.

Author information

Authors and Affiliations

  1. Department of Geriatric Medicine, Institute of Geriatrics and Active Aging, Tan Tock Seng Hospital, Annex, Level 2, 11 Jalan Tan Tock Seng, Novena, Singapore, 308433, Singapore

    Wen Yang Goh, N. B. Ali, A. P. Chew, M. Chan & W. S. Lim

  2. Clinical Research and Innovation Office, Tan Tock Seng Hospital, Singapore, Singapore

    D. Chan

  3. Department of Geriatric Medicine, Seng Kang Hospital, Singapore, Singapore

    A. Chuo

Authors
  1. Wen Yang Goh
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. D. Chan
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. N. B. Ali
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. A. P. Chew
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. A. Chuo
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. M. Chan
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. W. S. Lim
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Wen Yang Goh.

Ethics declarations

Conflict of interests: None.

Ethical Standards: This study was approved by the National Healthcare Group Domain Specific Review Board.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Goh, W.Y., Chan, D., Ali, N.B. et al. Frontal Assessment Battery in Early Cognitive Impairment: Psychometric Property and Factor Structure. J Nutr Health Aging 23, 966–972 (2019). https://doi.org/10.1007/s12603-019-1248-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12603-019-1248-0

Key word

Search

Navigation