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Diagnostic properties of the Frontal Assessment Battery (FAB) in Italian healthy adults

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Abstract

Background

Sub-clinical cognitive efficiency deficits of a dysexecutive nature are moderately prevalent in healthy older adults and negatively affect their functional outcomes. To screen for such dysfunctions, the Frontal Assessment Battery (FAB) provided promising evidence, although its diagnostic properties have not been tested to date. This study thus aimed at exploring the performance on the FAB of a large sample of Italian healthy adults and comparing it in individuals aged < 75 years vs. ≥ 75 years.

Methods

Four hundred and seventy-five healthy adults (169 males, 306 females, age: 61.1 ± 15.1; education 11.7 ± 4.6) were administered the FAB and the Montreal Cognitive Assessment (MoCA). Sensitivity, specificity, positive and negative predictive values and likelihood ratios were computed through receiver-operating characteristics analyses by addressing an above- vs. below-cutoff performance on the MoCA as the state variable (as including measures of executive functioning).

Results

The FAB overall showed good accuracy (AUC = 0.71–0.76), although higher for healthy older adults. A trend towards higher specificity (64.4–80.3%) than sensitivity (61.1–77.8%) was found, despite these metrics being comparable in healthy older adults. Negative predictive values (0.98–0.99) were systematically higher than positive predictive values (0.05–0.24), whereas consistent post-test probabilities were detected (positive likelihood ratios: 2.19–3.35; negative likelihood ratios: 0.28–0.48).

Discussion

The FAB is an accurate test for the first-level assessment of dysexecutive-related global cognitive inefficiency in the general population, despite being moderately conservative as far as both its pre- and post-test features are concerned. Its diagnostic value is more informative for individuals aged ≥ 75 years.

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Data availability

Data collected and used for the present study are retrievable at https://osf.io/pv6tw/.

References

  1. Yuan P, Raz N (2014) Prefrontal cortex and executive functions in healthy adults: a meta-analysis of structural neuroimaging studies. Neurosci Biobehav Rev 42:180–192

    Article  Google Scholar 

  2. Thornton WL, Deria S, Gelb S et al (2007) Neuropsychological mediators of the links among age, chronic illness, and everyday problem solving. Psychol Aging 22:470–481

    Article  Google Scholar 

  3. Royall DR, Chiodo LK, Polk MJ (2000) Correlates of disability among elderly retirees with “subclinical” cognitive impairment. J Gerontol A Biol Sci Med Sci 55:M541–M546

    Article  CAS  Google Scholar 

  4. McAlister C, Schmitter-Edgecombe M (2016) Executive function subcomponents and their relations to everyday functioning in healthy older adults. J Clin Exp Neuropsychol 38:925–940

    Article  Google Scholar 

  5. Libon DJ, Glosser G, Malamut BL et al (1994) Age, executive functions, and visuospatial functioning in healthy older adults. Neuropsychology 8:38–43

    Article  Google Scholar 

  6. Freitas S, Simoes MR, Marôco J et al (2012) Construct validity of the montreal cognitive assessment (MoCA). J Int Neuropsychol Soc 18:242–250

    Article  Google Scholar 

  7. Lam B, Middleton LE, Masellis M et al (2013) Criterion and convergent validity of the Montreal cognitive assessment with screening and standardized neuropsychological testing. J Am Geriatr Soc 61:2181–2185

    Article  Google Scholar 

  8. Iavarone A, Lorè E, De Falco C et al (2011) Dysexecutive performance of healthy oldest old subjects on the frontal assessment battery. Aging Clin Exp Res 23:351–356

    Article  Google Scholar 

  9. Coen RF, McCarroll K, Casey M et al (2016) The frontal assessment battery: normative performance in a large sample of older community-dwelling hospital outpatient or general practitioner attenders. J Geriatr Psychiatry Neurol 29:338–343

    Article  Google Scholar 

  10. Dubois B, Slachevsky A, Litvan I et al (2000) The FAB: a frontal assessment battery at bedside. Neurology 55:1621–1626

    Article  CAS  Google Scholar 

  11. Hurtado-Pomares M, Carmen Terol-Cantero M, Sánchez-Pérez A et al (2018) The frontal assessment battery in clinical practice: a systematic review. Int J Geriatr Psychiatry 33:237–251

    Article  Google Scholar 

  12. Pottie K, Rahal R, Jaramillo A et al (2016) Recommendations on screening for cognitive impairment in older adults. CMAJ 188:37–46

    Article  Google Scholar 

  13. Iavarone A, Ronga B, Pellegrino L et al (2004) The frontal assessment battery (FAB): normative data from an Italian sample and performances of patients with Alzheimer’s disease and frontotemporal dementia. Funct Neurol 19:191–195

    PubMed  Google Scholar 

  14. Appollonio I, Leone M, Isella V et al (2005) The frontal assessment battery (FAB): normative values in an Italian population sample. Neurol Sci 26:108–116

    Article  CAS  Google Scholar 

  15. Aiello EN, Esposito A, Gramegna C, et al (2021a) The frontal assessment battery (FAB) and its sub-scales: validation and updated normative data in an Italian population sample. Neurol Sci 1–6

  16. Ilardi CR, Chieffi S, Scuotto C, et al (2021) The frontal assessment battery 20 years later: normative data for a shortened version (FAB15). Neurol Sci 1–11

  17. Pirani A, Tulipani C, Neri M (2006) Italian montreal cognitive assessment (MoCA). http://www.mocatest.org

  18. Measso G, Cavarzeran F, Zappalà G et al (1993) The mini-mental state examination: normative study of an Italian random sample. Dev Neuropsychol 9:77–85

    Article  Google Scholar 

  19. Magni E, Binetti G, Bianchetti A et al (1996) Mini-mental state examination: a normative study in Italian elderly population. Eur J Neurol 3:198–202

    Article  CAS  Google Scholar 

  20. Aiello EN, Gramegna C, Esposito A, et al (2021b) The montreal cognitive assessment (MoCA): updated norms and psychometric insights into adaptive testing from healthy individuals in Northern Italy. Aging Clin Experiment Res 1–8.

  21. Kang JH, Kim YH, Choi YA (2021) Montreal cognitive assessment and frontal assessment battery test as a predictor of performance of unaffected hand function after subcortical stroke. Int J Rehabil Res 44:45–50

    Article  Google Scholar 

  22. IBM Corp. (2020). IBM SPSS Statistics for Windows, Version 27.0. IBM Corp.

  23. StataCorp (2019) Stata statistical software: release 16. StataCorp LLC

    Google Scholar 

  24. Roalf DR, Moberg PJ, Xie SX et al (2013) Comparative accuracies of two common screening instruments for classification of Alzheimer’s disease, mild cognitive impairment, and healthy aging. Alzheimers Dement 9:529–537

    Article  Google Scholar 

  25. Kim HY (2013) Statistical notes for clinical researchers: assessing normal distribution (2) using skewness and kurtosis. Restor Dent Endod 38:52–54

    Article  Google Scholar 

  26. Aiello EN, Depaoli EG, Gallucci M (2020) Usability of the negative binomial model for analyzing ceiling and highly-inter-individually-variable cognitive data. Neurol Sci 41:S273–S274

    Google Scholar 

  27. Payne EH, Gebregziabher M, Hardin JW et al (2018) An empirical approach to determine a threshold for assessing overdispersion in Poisson and negative binomial models for count data. Commun Statistics-Simul Comput 47:1722–1738

    Article  Google Scholar 

  28. Goksuluk D, Korkmaz S, Zararsiz G et al (2016) easyROC: an interactive web-tool for ROC curve analysis using R language environment. R Journal 8:213

    Article  Google Scholar 

  29. Obuchowski NA (1998) Sample size calculations in studies of test accuracy. Stat Methods Med Res 7:371–392

    Article  CAS  Google Scholar 

  30. Larner AJ (2019) New unitary metrics for dementia test accuracy studies. Prog Neurol Psychiatry 23:21–25

    Article  Google Scholar 

  31. Julayanont P, Nasreddine ZS (2017) Montreal cognitive assessment (MoCA): concept and clinical review. In: Larner AJ (ed) Cognitive screening Instruments. Springer, pp 139–195

    Chapter  Google Scholar 

  32. Aiello EN, Rimoldi S, Bolognini N, Appollonio I, Arcara G (2021) Psychometrics and diagnostics of Italian cognitive screening tests: a systematic review. Neurol:1–25

  33. Habibzadeh F, Habibzadeh P, Yadollahie M (2016) On determining the most appropriate test cut-off value: the case of tests with continuous results. Biochem Med 26:297–307

    Article  Google Scholar 

  34. Pedraza O, Mungas D (2008) Measurement in cross-cultural neuropsychology. Neuropsychol Rev 18:184–193

    Article  Google Scholar 

  35. Bruti G, Cavallucci E, Mancini M et al (2016) A systematic review of the quality of studies on dementia prevalence in Italy. BMC Health Serv Res 16:1–10

    Article  Google Scholar 

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Acknowledgements

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This work did not receive any specific funding.

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Authors and Affiliations

  1. PhD Program in Neuroscience, School of Medicine and Surgery, University of Milano-Bicocca, Via Cadore 48, 20900, Monza, Italy

    Edoardo Nicolò Aiello

  2. Department of Psychology, University of Milano-Bicocca, Milan, Italy

    Antonella Esposito & Nadia Bolognini

  3. Neurology Section, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy

    Ildebrando Appollonio

  4. Laboratory of Neuropsychology, IRCCS Istituto Auxologico Italiano, Milan, Italy

    Nadia Bolognini

Authors
  1. Edoardo Nicolò Aiello
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  2. Antonella Esposito
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  3. Ildebrando Appollonio
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  4. Nadia Bolognini
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Corresponding author

Correspondence to Edoardo Nicolò Aiello.

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Ethical standards

This study was approved on behalf of the Ethics Committee of the University of Milano-Bicocca (RM-2017-111; 16 November, 2017).

Statement of human and animal rights

All procedures performed in this study that involved human participants were in accordance with the ethical standards of the Ethics Committee of the University of Milano-Bicocca and with the 1964 Helsinki Delaration and its later amendments or comparable ethical standards.

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Participants provided written informed consent.

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Aiello, E.N., Esposito, A., Appollonio, I. et al. Diagnostic properties of the Frontal Assessment Battery (FAB) in Italian healthy adults. Aging Clin Exp Res 34, 1021–1026 (2022). https://doi.org/10.1007/s40520-021-02035-2

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  • DOI: https://doi.org/10.1007/s40520-021-02035-2

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