HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

Correspondence to:

ARTICLES: E. Mioshi, C. M. Kipps, K. Dawson, J. Mitchell, A. Graham, and J. R. Hodges Activities of daily living in frontotemporal dementia and Alzheimer disease Neurology 2007; 68: 2077-2084 [Abstract] [Full text] [PDF]

Correspondence: Submit a response to this article

Correspondence published:

Activities of daily living in frontotemporal dementia and Alzheimer disease

Andrew J. Larner, Pavla Hancock, Brooker Centre, Runcorn UK   (2 October 2007)

Activities of daily living assessment in Frontotemporal Dementia

Barbara Borroni, Alessandro Padovani   (30 July 2007)

Reply from the authors

Eneida Mioshi, John R. Hodges   (30 July 2007)

Activities of daily living in frontotemporal dementia and Alzheimer disease 2 October 2007
Andrew J. Larner, Cognitive Function Clinic, Walton Centre for Neurology and Neurosurgery Lower Lane, Liverpool, L9 7LJ, UK, Pavla Hancock, Brooker Centre, Runcorn UK Send Correspondence to journal: Re: Activities of daily living in frontotemporal dementia and Alzheimer disease a.larner{at}thewaltoncentre.nhs.uk Andrew J. Larner, et al.	We read the article by Mioshi et al with interest. [1] We recently completed a two-year study examining the utility of an Activities of Daily Living (ADL) scale in the diagnosis of the dementia syndrome. [2] Mioshi et al reported a greater impact on ADL as measured by the Disability Assessment for Dementia (DAD) of behavioral variant frontotemporal dementia (bvFTD) than Alzheimer disease (AD). This prompted a re-analysis of the data from our study. Of 296 consecutive patients and caregivers administered the Instrumental Activities of Daily Living (IADL) Scale of Lawton and Brody (score range = 0-14) [3], 154 were clinically diagnosed with dementia. Of those, 122 had AD and 11 FTD (9 bvFTD, 2 semantic dementia). Mean (+/- SD) IADL Scale score for the AD patients was 9.7 (+/- 3.4) and for the FTD patients was 10.5 (+/- 4.4). The null hypothesis that scores were not different between the two groups was not rejected (t = 0.65, p > 0.5). Likewise, using the 4-IADL score (score range = 0-4), reported to be a predictor of dementia in epidemiological studies [4], the mean scores (AD 2.8 +/- 1.2; FTD 3.0 +/- 1.3) were not significantly different (t = 0.47, p > 0.5). Factors that may account for the discrepancy of these results with those of Mioshi et al include different setting (regional clinic vs. University Hospital clinic), methodology (consecutive vs. selected cohort), case mix (lower proportion of FTD cases), and instrument used (IADL vs. DAD). While we agree that bvFTD may sometimes have a catastrophic effect on ADL, which may not be reflected in cognitive test scores, our data do not suggest that this is necessarily a reliable indicator in the differential diagnosis of dementia. References 1. Mioshi E, Kipps CM, Dawson K, Mithcell J, Graham A, Hodges JR. Activities of daily living in frontotemporal dementia and Alzheimer disease. Neurology 2007; 68: 2077-2084. 2. Hancock P, Larner AJ. The diagnosis of dementia: diagnostic accuracy of an instrument measuring activities of daily living in a clinic-based population. Dement Geriatr Cogn Disord 2007; 23: 133-139. 3. Lawton MP, Brody EM. Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist 1969; 9: 179-186. 4. Barberger-Gateau P, Commenges D, Gagnon M, Letenneur L, Sauvel C, Dartigues JF. Instrumental activities of daily living as a screening tool for cognitive impairment and dementia in elderly community dwellers. J Am Geriatr Soc 1992; 40: 1129-1134. The authors were provided the opportunity to respond but declined. Disclosure: The authors report no conflicts of interest.
Activities of daily living assessment in Frontotemporal Dementia 30 July 2007
Barbara Borroni, Department of Neurology, University of Brescia Piazza Spedali Civili 1, 25125 Brescia Italy, Alessandro Padovani Send Correspondence to journal: Re: Activities of daily living assessment in Frontotemporal Dementia bborroni{at}inwind.it Barbara Borroni, et al.	We read the article by Mioshi et al who described the devastating effect that behavioral variant of Frontotemporal Dementia (bvFTD) has on activities of daily living. [1] This aspect is not captured by bedside evaluation and is crucial in clinical practice.[1] We are currently studying a consecutive series of 88 bvFTD [2] (mean age±SD, years=67.4±7.1), 12 semantic dementia [3] (SD, age=69.5±7.9), 20 progressive non fluent aphasia [3] (PNFA, age=65.0±7.7), and 100 Alzheimer Disease [4] (AD, age=67.0±7.2) patients. AD patients were randomly selected from more than 500 AD patients and matched for age, education, and age at onset with FTD groups. bvFTD, SD, and AD were comparable in terms of global cognitive impairment (Mini-Mental State Examination, overall=20.8±6.7), but PNFA patients were more compromised than the other groups (13.9±8.7, P<.0001). We also considered the degree of behavioral disturbances which was similar in FTD (Neuropsychiatry Inventory=20.8±14.0), AD (18.5±14.2) and PNFA (15.5±15.9), and less prevalent in SD (10.0±8.4, FTD vs. SD, P<0.02; AD vs. SD, P<0.05). Interestingly, FTD patients showed a greater impairment in the number of lost Basic Activities of Daily Living (BADLs, 0.87±1.5), compared to AD patients (0.35±0.85, One-Way ANOVA and Bonferroni post-hoc analysis, P<.004), SD (0.17±0.57, P<.05), and PNFA (0.20±0.52, P<.03). In our sample, no significant differences in instrumental activities of daily living (IADLs) were found. These results indicated that a specific pattern of activities of daily living impairment emerged in bvFTD. BvFTD showed worse BADLs, even if global cognitive performances were comparable to AD and SD and were better than PNFA, and no significant differences in degree of behavioral disturbances were found compared to AD and PNFA. These findings confirm the data by Mioshi et al demonstrating differences in BADLs in FTD even after controlling for age, education, age at disease onset, global cognitive impairment and degree of behavioral disturbances (P<.008). The predictors of activities of daily living performances (i.e., specific patterns of cognition and behavior) would be further analyzed in FTD and compared to those of other neurodegenerative diseases. Understanding the inter-relationship among functional, cognitive and behavioral aspects in FTD will help to establish which parameters should be used to measure and define not only dementia severity but also disease prognosis. References 1. Mioshi E, Kipps CM, Dawson K, Mitchell J, Graham A, Hodges JR. Activities of daily living in frontotemporal dementia and Alzheimer Disease. Neurology 2007; 68:2077-2084. 2. Neary D, Snowden JS, Gustafson L, et al. Frontotemporal lobar degeneration: a consensus on clinical diagnostic criteria. Neurology 1998; 51:1546-1554. 3. Bozeat S, Gregory CA, Ralph MA, Hodges JR. Which neuropsychiatric and behavioural features distinguish frontal and temporal variants of frontotemporal dementia from Alzheimer’s disease? J Neurol Neurosurg Psychiatry 2000; 69:178-186. 4. McKhann G, Drachman D, Folstein M, et al. Clinical diagnosis of Alzheimer’s disease: report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer’s Disease. Neurology 1984; 34: 939–944. Disclosure: The authors report no conflicts of interest.
Reply from the authors 30 July 2007
Eneida Mioshi, MRC - Cognition and Brain Sciences Unit 15 Chaucer Road, Cambridge, United Kingdom, CB2 7EF, John R. Hodges Send Correspondence to journal: Re: Reply from the authors eneida.mioshi{at}mrc-cbu.cam.ac.uk Eneida Mioshi, et al.	This is an active area of research worldwide and we are delighted that Borroni and Padovani’s findings corroborate our results. Disclosure: The authors report no conflicts of interest.