The Frontal Assessment Battery and Differential Diagnosis of Dementia: A Meta-Analysis

Rebecca Richards (2010)

An aging global population predicts a dramatic increase in dementia diagnoses during the next 20-40 years, with Alzheimer's disease (AD) accounting for the majority of cases. Accurate diagnosis of AD requires that it be distinguished from frontotemporal dementia (FTD), a syndrome with similar clinical and cognitive features but different underlying neuropathology, prognosis, and treatment protocols. This study is a meta-analysis examining the utility of the Frontal Assessment Battery for differentiating AD and FTD patient groups. Nine studies involving 558 participants were selected based on two inclusion criteria: a diagnosis of AD or FTD and the provision of FAB composite and subtest score data. Weighted effect sizes were calculated for all composite score comparisons and seven subtest comparisons. Degree of cognitive impairment was used as a moderator to control for heterogeneity of composite score effects, resulting in two homogeneous and one heterogeneous subgroup of studies from which averaged effects were drawn (Group 1, d = -1.77; Group 3, d = -0.21). Subtest analyses resulted in two homogeneous effects (Similarities, d = -0.51 and Lexical Fluency, d = -0.36, respectively). Overall, results of composite and subtest analyses suggest that the FAB is inconsistent in its ability to detect meaningful differences in performance between AD and FTD patient groups, and therefore, its routine use in clinical practice for this purpose is not recommended.