Executive Dysfunction Detected with the Frontal Assessment Battery in Alzheimer’s Disease Versus Vascular Dementia

Article type: Research Article

Authors: D’Onofrio, Grazia^a | Panza, Francesco^{a; b; c; *} | Sancarlo, Daniele^a | Addante, Filomena^a | Solfrizzi, Vincenzo^d | Cantarini, Chiara^a | Mangiacotti, Antonio^a | Lauriola, Michele^a | Cascavilla, Leandro^a | Paris, Francesco^a | Lozupone, Madia^b | Daniele, Antonio^e | Greco, Antonio^a | Seripa, Davide^a

Affiliations: [a] Department of Medical Sciences, Geriatric Unit and Laboratory of Gerontology and Geriatrics, IRCCS “Casa Sollievo della Sofferenza”, San Giovanni Rotondo, Foggia, Italy | [b] Department of Basic Medicine, Neurodegenerative Disease Unit, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy | [c] Department of Clinical Research in Neurology, University of Bari Aldo Moro, “Pia Fondazione Cardinale G. Panico”, Tricase, Lecce, Italy | [d] Geriatric Medicine-Memory Unit and Rare Disease Centre, University of Bari ‘Aldo Moro’, Bari, Italy | [e] Institute of Neurology, Catholic University of Sacred Heart, Rome, Italy

Correspondence: [*] Correspondence to: Francesco Panza, Geriatric Unit and Gerontology-Geriatrics Research Laboratory, IRCCS Casa Sollievo della Sofferenza, Viale Cappuccini 1, 71013 San Giovanni Rotondo, Foggia, Italy. Tel./Fax: +39 0882 410271; E-mail: [email protected].

Abstract: Alzheimer’s disease (AD) and vascular dementia (VaD) lead to progressive decline in executive function. We estimated the prevalence of executive dysfunction in AD and VaD patients, investigating cognitive, functional, and clinical correlates and also using a multidimensional approach based on a standardized comprehensive geriatric assessment (CGA). We included 215 patients (115 AD patients and 100 VaD patients) consecutively evaluated with a complete cognitive and affective assessment, a CGA, and the Frontal Assessment Battery (FAB) with six subtests investigating conceptualization, mental flexibility, motor programming, sensitivity to interference, inhibitory control, and environmental autonomy. The prevalence of dysexecutive syndrome screened with a FAB score <12 points was high in both AD (97 patients) and VaD (77 patients) (84.3% versus 77.0%, p = 0.171). AD patients were significantly younger, with higher grade of cognitive impairment and less severe comorbidity and polypharmacy than VaD patients. AD patients showed a significantly higher impairment in FAB total score and five FAB subtests (conceptualization, motor programming, sensitivity to interference, inhibitory control, and environmental autonomy) than VaD patients. These findings were largely confirmed in a sub-analysis conducted subdividing the sample in mild and moderate-to-severe demented patients and suggesting that in moderate-to-severe AD there was higher impairment in FAB total score and four FAB subtests (conceptualization, sensitivity to interference, inhibitory control, and environmental autonomy). Executive dysfunction could be greater in AD patients with moderate-to-severe dementia compared to VaD patients, although our groups were also not matched for age, comorbidity or polypharmacy, which could also exert an effect.

Keywords: Alzheimer’s disease, comprehensive geriatric assessment, dementia, executive function, vascular dementia

DOI: 10.3233/JAD-170365

Journal: Journal of Alzheimer's Disease, vol. 62, no. 2, pp. 699-711, 2018