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

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Abstract

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.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

References

  1. Dubois B, Slachevsky A, Litvan I, Pillon B (2000) The FAB: a frontal assessment battery at bedside. Neurology 55:1621–1626. https://doi.org/10.1212/wnl.55.11.1621

    Article  CAS  PubMed  Google Scholar 

  2. Iavarone A, Ronga B, Pellegrino L, Loré E, Vitaliano S, Galeone F, Carlomagno S (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 

  3. Kugo A, Terada S, Ata T et al (2007) Japanese version of the Frontal Assessment Battery for dementia. Psychiatry Res 153:69–75. https://doi.org/10.1016/j.psychres.2006.04.004

    Article  PubMed  Google Scholar 

  4. Shen D, Cui B, Liu M, Gao J, Liu C, Li X, Cui L (2020) Strategy for screening cognitive impairment in Chinese patients with amyotrophic lateral sclerosis. J Clin Neurosci 81:105–110. https://doi.org/10.1016/j.jocn.2020.09.016

    Article  PubMed  Google Scholar 

  5. Oguro H, Yamaguchi S, Abe S, Ishida Y, Bokura H, Kobayashi S (2006) Differentiating Alzheimer’s disease from subcortical vascular dementia with the FAB test. J Neurol 253:1490–1494. https://doi.org/10.1007/s00415-006-0251-7

    Article  PubMed  Google Scholar 

  6. Kim TH, Huh Y, Choe JY et al (2010) Korean version of frontal assessment battery: psychometric properties and normative data. Dement Geriatr Cogn Disord 29:363–370. https://doi.org/10.1159/000297523

    Article  PubMed  Google Scholar 

  7. Lima CF, Meireles LP, Fonseca R, Castro SL, Garrett C (2008) The Frontal Assessment Battery (FAB) in Parkinson’s disease and correlations with formal measures of executive functioning. J Neurol 255:1756–1761. https://doi.org/10.1007/s00415-008-0024-6

    Article  CAS  PubMed  Google Scholar 

  8. Asaadi S, Ashrafi F, Omidbeigi M, Nasiri Z, Pakdaman H, Amini-Harandi A (2016) Persian version of frontal assessment battery: correlations with formal measures of executive functioning and providing normative data for Persian population. Iran J Neurol 15:16–22

    PubMed  PubMed Central  Google Scholar 

  9. Hurtado-Pomares M, Terol-Cantero MC, Sánchez-Pérez A, Leiva-Santana C, Peral-Gómez P, Valera-Gran D, Navarrete-Muñoz EM (2018) Measuring executive dysfunction in Parkinson’s disease: reliability and validity of the Spanish version of Frontal Assessment Battery (FAB-E). PLoS ONE 13:e0207698. https://doi.org/10.1371/journal.pone.0207698

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Sitek EJ, Konkel A, Dąbrowska M, Sławek J (2015) Utility of Frontal Assessment Battery in detection of neuropsychological dysfunction in Richardson variant of progressive supranuclear palsy. Neurol Neurochir Pol 49:36–40. https://doi.org/10.1016/j.pjnns.2014.12.002

    Article  PubMed  Google Scholar 

  11. Rodrigues GR, Souza CP, Cetlin RS et al (2009) Use of the frontal assessment battery in evaluating executive dysfunction in patients with Huntington’s disease. J Neurol 256:1809–1815. https://doi.org/10.1007/s00415-009-5197-0

    Article  CAS  PubMed  Google Scholar 

  12. Yamao A, Nagata T, Shinagawa S, Nukariya K, Ochiai Y, Kasahara H, Nakayama K (2011) Differentiation between amnestic-mild cognitive impairment and early-stage Alzheimer’s disease using the Frontal Assessment Battery test. Psychogeriatrics 11:235–241. https://doi.org/10.1111/j.1479-8301.2011.00377.x

    Article  PubMed  Google Scholar 

  13. Hurtado-Pomares M, Carmen Terol-Cantero M, Sánchez-Pérez A, Peral-Gómez P, Valera-Gran D, Navarrete-Muñoz EM (2018) The frontal assessment battery in clinical practice: a systematic review. Int J Geriatr Psychiatry 33:237–251. https://doi.org/10.1002/gps.4751

    Article  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. https://doi.org/10.1007/s10072-005-0443-4

    Article  CAS  PubMed  Google Scholar 

  15. Mok VCT, Wong A, Yim P et al (2004) The validity and reliability of Chinese Frontal Assessment Battery in evaluating executive dysfunction among Chinese patients with small subcortical infarct. Alzheimer Dis Assoc Disord 18:68–74. https://doi.org/10.1097/01.wad.0000126617.54783.7

    Article  PubMed  Google Scholar 

  16. 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. https://doi.org/10.1007/BF03337760

    Article  PubMed  Google Scholar 

  17. Benke T, Karner E, Delazer M (2013) FAB-D: German version of the Frontal Assessment Battery. J Neurol 260:2066–2072. https://doi.org/10.1007/s00415-013-6929-8

    Article  PubMed  Google Scholar 

  18. Goh WY, Chan D, Ali NB, Chew AP, Chuo A, Chan M, Lim WS (2019) Frontal Assessment Battery in early cognitive impairment: psychometric property and factor structure. J Nutr Heal Aging 23:966–972. https://doi.org/10.1007/s12603-019-1248-0

    Article  CAS  Google Scholar 

  19. Abrahámová M, Smolejová E, Dančík D, Pribišová K, Heretik A, Hajdúk M (2020) Normative data for the Slovak version of the Frontal Assessment Battery (FAB). Appl Neuropsychol. https://doi.org/10.1080/23279095.2020.1748031

    Article  Google Scholar 

  20. Bezdicek O, Růžička F, Fendrych Mazancova A et al (2017) Frontal Assessment Battery in Parkinson’s disease: validity and morphological correlates. J Int Neuropsychol Soc 23:675–684. https://doi.org/10.1017/S1355617717000522

    Article  PubMed  Google Scholar 

  21. Kenangil G, Orken DN, Ur E, Forta H (2010) Frontal assessment battery in patients with Parkinson disease in a Turkish population. Cogn Behav Neurol 23:26–28. https://doi.org/10.1097/WNN.0b013e3181c5e2b0

    Article  PubMed  Google Scholar 

  22. Nakaaki S, Murata Y, Sato J, Shinagawa Y, Matsui T, Tatsumi H, Furukawa TA (2007) Reliability and validity of the Japanese version of the Frontal Assessment Battery in patients with the frontal variant of frontotemporal dementia. Psychiatry Clin Neurosci 61:78–83. https://doi.org/10.1111/j.1440-1819.2007.01614.x

    Article  PubMed  Google Scholar 

  23. Castiglioni S, Pelati O, Zuffi M, Somalvico F, Marino L, Tentorio T, Franceschi M (2006) The frontal assessment battery does not differentiate frontotemporal dementia from Alzheimer’s disease. Dement Geriatr Cogn Disord 22:125–131. https://doi.org/10.1159/000093665

    Article  PubMed  Google Scholar 

  24. Kopp B, Rösser N, Tabeling S, Stürenburg HJ, de Haan B, Karnath HO, Wessel K (2013) Performance on the Frontal Assessment Battery is sensitive to frontal lobe damage in stroke patients. BMC Neurol 13:179. https://doi.org/10.1186/1471-2377-13-179

    Article  PubMed  PubMed Central  Google Scholar 

  25. Stamelou M, Diehl-Schmid J, Hapfelmeier A et al (2015) The frontal assessment battery is not useful to discriminate progressive supranuclear palsy from frontotemporal dementias. Parkinsonism Relat Disord 21:1264–1268. https://doi.org/10.1016/j.parkreldis.2015.08.006

    Article  CAS  PubMed  Google Scholar 

  26. 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. https://doi.org/10.1080/87565649109540545

    Article  Google Scholar 

  27. Folstein MF, Folstein SE, McHugh PR (1975) “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12:189–198. https://doi.org/10.1016/0022-3956(75)90026-6

    Article  CAS  PubMed  Google Scholar 

  28. Lewis TJ, Trempe CL (2017) Diagnosis of Alzheimer’s—standard-of-care. In: Lewis TJ, Trempe CL (eds) The end of Alzheimer’s: the brain and beyond, 2nd edn. Academic Press, pp 66–69. https://doi.org/10.1016/B978-0-12-812112-2.00003-3

  29. Morgado J, Rocha CS, Maruta C, Guerreiro M, Martins IP (2010) Cut-off scores in MMSE: a moving target? Eur J Neurol 17:692–695. https://doi.org/10.1111/j.1468-1331.2009.02907.x

    Article  CAS  PubMed  Google Scholar 

  30. Carpinelli Mazzi M, Iavarone A, Russo G et al (2020) Mini-Mental State Examination: new normative values on subjects in Southern Italy. Aging Clin Exp Res 32:699–702. https://doi.org/10.1007/s40520-019-01250-2

    Article  PubMed  Google Scholar 

  31. 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. https://doi.org/10.1177/0891988716666381

    Article  PubMed  Google Scholar 

  32. Kim HY (2013) Statistical notes for clinical researchers: assessing normal distribution (2) using skewness and kurtosis. Restor Dent Endod 38:52–54. https://doi.org/10.5395/rde.2013.38.1.52

    Article  PubMed  PubMed Central  Google Scholar 

  33. Cohen JW (1988) Statistical power analysis for the behavioral sciences, 2nd edn. Lawrence Erlbaum Associates, New York

    Google Scholar 

  34. De Vaus D (2004) Surveys in social research. Routledge, London

    Google Scholar 

  35. Taber KS (2018) The use of Cronbach’s alpha when developing and reporting research instruments in science education. Res Sci Educ 48:1273–1296. https://doi.org/10.1007/s11165-016-9602-2

    Article  Google Scholar 

  36. Lindig A, Hahlweg P, Christalle E, Scholl I (2020) Translation and psychometric evaluation of the German version of the Organisational Readiness for Implementing Change measure (ORIC): a cross-sectional study. BMJ Open 10:e034380. https://doi.org/10.1136/bmjopen-2019-034380

    Article  PubMed  PubMed Central  Google Scholar 

  37. Pedersen KF, Alves G, Larsen JP, Tysnes OB, Møller SG, Brønnick K (2012) Psychometric properties of the Starkstein Apathy Scale in patients with early untreated Parkinson disease. Am J Geriatr Psychiatry 20:142–148. https://doi.org/10.1097/JGP.0b013e31823038f2

    Article  PubMed  Google Scholar 

  38. Shen L, Zeng H, Jin X, Yang J, Shang S, Zhang Y (2018) An innovative evaluation in fundamental nursing curriculum for novice nursing students: an observational research. J Prof Nurs 34:412–416. https://doi.org/10.1016/j.profnurs.2018.05.002

    Article  PubMed  Google Scholar 

  39. Spinnler H, Tognoni G (1987) Standardizzazione e Taratura Italiana di Test Neuropsicologici. Ital J Neurol Sci 1:8–120

    Google Scholar 

  40. Capitani R, Laiacona M (1988) Aging and psychometric diagnosis of intellectual impairment: some considerations on test scores and their use. Dev Neuropsychol 4:325–330. https://doi.org/10.1080/87565648809540416

    Article  Google Scholar 

  41. Capitani E (1997) Normative data and neuropsychological assessment. Common problems in clinical practice and research. Neuropsychol Rehabil 7:295–310. https://doi.org/10.1080/713755543

    Article  Google Scholar 

  42. Baylor C, Hula W, Donovan NJ, Doyle PJ, Kendall D, Yorkston K (2011) An introduction to item response theory and Rasch models for speech-language pathologists. Am J Speech Lang Pathol 20:243–259. https://doi.org/10.1044/1058-0360(2011/10-0079)

    Article  PubMed  Google Scholar 

  43. Baker FB (2001) The basics of item response theory, 2nd edn. ERIC Clearinghouse on Assessment and Evaluation, College Park

    Google Scholar 

  44. Toland MD (2014) Practical guide to conducting an item response theory analysis. J Early Adolesc 34:120–151. https://doi.org/10.1177/0272431613511332

    Article  Google Scholar 

  45. Boccia M, Marin D, D’Antuono G et al (2017) The Tower of London (ToL) in Italy: standardization of the ToL test in an Italian population. Neurol Sci 38:1263–1270. https://doi.org/10.1007/s10072-017-2957-y

    Article  PubMed  Google Scholar 

  46. Llinàs-Reglà J, Vilalta-Franch J, López-Pousa S, Calvó-Perxas L, Torrents Rodas D, Garre-Olmo J (2017) The Trail Making Test: association with other neuropsychological measures and normative values for adults aged 55 years and older from a Spanish-speaking population-based Sample. Assessment 24:183–196. https://doi.org/10.1177/1073191115602552

    Article  PubMed  Google Scholar 

  47. Gonzalez R, Grant I, Miller SW et al (2006) Demographically adjusted normative standards for new indices of performance on the Paced Auditory Serial Addition Task (PASAT). Clin Neuropsychol 20:396–413. https://doi.org/10.1080/13854040590967559

    Article  PubMed  Google Scholar 

  48. Schweitzer JB, Hanford RB, Medoff DR (2006) Working memory deficits in adults with ADHD: is there evidence for subtype differences? Behav Brain Funct 2:43. https://doi.org/10.1186/1744-9081-2-43

    Article  PubMed  PubMed Central  Google Scholar 

  49. Burton LA, Henninger D, Hafetz J (2005) Gender differences in relations of mental rotation, verbal fluency, and SAT scores to finger length ratios as hormonal indexes. Dev Neuropsychol 28:493–505. https://doi.org/10.1207/s15326942dn2801_3

    Article  PubMed  Google Scholar 

  50. Italian National Institute of Statistics. Employment rate. http://dati.istat.it. Accessed 12 January 2021

  51. Baldivia B, Andrade VM, Bueno OFA (2008) Contribution of education, occupation and cognitively stimulating activities to the formation of cognitive reserve. Dement Neuropsychol 2:173–182. https://doi.org/10.1590/S1980-57642009DN20300003

    Article  PubMed  PubMed Central  Google Scholar 

  52. Darwish H, Farran N, Assaad S, Chaaya M (2018) Cognitive reserve factors in a developing country: education and occupational attainment lower the risk of dementia in a sample of Lebanese older adults. Front Aging Neurosci 10:277. https://doi.org/10.3389/fnagi.2018.00277

    Article  PubMed  PubMed Central  Google Scholar 

  53. Rusmaully J, Dugravot A, Moatti JP et al (2017) Contribution of cognitive performance and cognitive decline to associations between socioeconomic factors and dementia: a cohort study. PLoS Med 14:e1002334. https://doi.org/10.1371/journal.pmed.1002334

    Article  PubMed  PubMed Central  Google Scholar 

  54. Ford KJ, Leist AK (2021) Returns to educational and occupational attainment in cognitive performance for middle-aged South Korean men and women. Gerontol Geriatr Med 7:23337214211004370. https://doi.org/10.1177/23337214211004366

    Article  PubMed  PubMed Central  Google Scholar 

  55. Malpetti M, Ballarini T, Presotto L et al (2017) Gender differences in healthy aging and Alzheimer’s dementia: a 18 F-FDG-PET study of brain and cognitive reserve. Hum Brain Mapp 38:4212–4227. https://doi.org/10.1002/hbm.23659

    Article  PubMed  PubMed Central  Google Scholar 

  56. Lhermitte F (1983) “Utilization behaviour” and its relation to lesions of the frontal lobes. Brain 106:237–255. https://doi.org/10.1093/brain/106.2.237

    Article  PubMed  Google Scholar 

  57. Goldberg G, Bloom KK (1990) The alien hand sign. Localization, lateralization and recovery. Am J Phys Med Rehabil 69:228–238. https://doi.org/10.1097/00002060-199010000-00002

    Article  CAS  PubMed  Google Scholar 

  58. Archibald SJ, Mateer CA, Kerns KA (2001) Utilization behavior: clinical manifestations and neurological mechanisms. Neuropsychol Rev 11:117–130. https://doi.org/10.1023/a:1016673807158

    Article  CAS  PubMed  Google Scholar 

  59. Schott JM, Rossor MN (2003) The grasp and other primitive reflexes. J Neurol Neurosurg Psychiatry 74:558–560. https://doi.org/10.1136/jnnp.74.5.558

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  60. Mendez MF, McMurtray AM, Licht EA, Saul RE (2009) Frontal-executive versus posterior-perceptual mental status deficits in early-onset dementias. Am J Alzheimers Dis Other Demen 24:220–227. https://doi.org/10.1177/1533317509332626

    Article  PubMed  Google Scholar 

  61. De Renzi E, Barbieri C (1992) The incidence of the grasp reflex following hemispheric lesion and its relation to frontal damage. Brain 115:293–313. https://doi.org/10.1093/brain/115.1.293

    Article  PubMed  Google Scholar 

  62. Mestre T, Lang AE (2010) The grasp reflex: a symptom in need of treatment. Mov Disord 25:2479–2485. https://doi.org/10.1002/mds.23059

    Article  PubMed  Google Scholar 

  63. Hogan DB, Ebly EM (1995) Primitive reflexes and dementia: results from the Canadian Study of Health and Aging. Age Ageing 24:375–381. https://doi.org/10.1093/ageing/24.5.375

    Article  CAS  PubMed  Google Scholar 

  64. Borroni B, Broli M, Costanzi C, Gipponi S, Gilberti N, Agosti C, Padovani A (2006) Primitive reflex evaluation in the clinical assessment of extrapyramidal syndromes. Eur J Neurol 13:1026–1028. https://doi.org/10.1111/j.1468-1331.2006.01404.x

    Article  CAS  PubMed  Google Scholar 

  65. Slachevsky A, Villalpando JM, Sarazin M, Hahn-Barma V, Pillon B, Dubois B (2004) Frontal assessment battery and differential diagnosis of frontotemporal dementia and Alzheimer disease. Arch Neurol 61:1104–1107. https://doi.org/10.1001/archneur.61.7.1104

    Article  PubMed  Google Scholar 

  66. Besnard J, Allain P, Aubin G, Chauviré V, Etcharry-Bouyx F, Le Gall D (2011) A contribution to the study of environmental dependency phenomena: the social hypothesis. Neuropsychologia 49:3279–3294. https://doi.org/10.1016/j.neuropsychologia.2011.08.001

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Psychology, University of Campania “Luigi Vanvitelli”, Caserta, Italy

    Ciro Rosario Ilardi & Chiara Scuotto

  2. Department of Experimental Medicine, University of Campania “Luigi Vanvitelli”, Naples, Italy

    Sergio Chieffi & Marco La Marra

  3. Laboratory of Experimental Psychology, Suor Orsola Benincasa University, Naples, Italy

    Nadia Gamboz

  4. Frailty Unit, ASL Napoli 1 Centro, Naples, Italy

    Filomena Galeone

  5. Neurological Unit, CTO Hospital, AORN “Ospedali Dei Colli”, Viale Colli Aminei 21, 80131, Naples, Italy

    Maria Sannino, Elisabetta Garofalo, Bruno Ronga & Alessandro Iavarone

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  1. Ciro Rosario Ilardi
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Ilardi, C.R., Chieffi, S., Scuotto, C. et al. The Frontal Assessment Battery 20 years later: normative data for a shortened version (FAB15). Neurol Sci 43, 1709–1719 (2022). https://doi.org/10.1007/s10072-021-05544-0

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