The Middelheim Frontality Score: a behavioural assessment scale that discriminates frontotemporal dementia from Alzheimer's disease.
BACKGROUND
Despite striking neuropsychological and behavioural differences between Alzheimer's disease (AD) and frontotemporal dementia (FTD), clinical diagnostic criteria failed to discriminate FTD from AD patients. We therefore developed the Middelheim Frontality Score (MFS), a disease-long clinical and behavioural assessment tool that measures frontal lobe features, and set up this prospective study in clinically diagnosed AD and FTD patients to assess discriminatory power and intra- and inter-rater variability.


METHODS
Patients with probable AD (n = 400) and FTD (n = 62) were included. The MFS was obtained by summating the scores obtained in a standardized fashion on ten items yielding a total maximal score of 10. Information was obtained through an interview of the patient and her/his caregiver, clinical files and behavioural observation.


RESULTS
Comparing mean total MFS scores, FTD patients (6.3 +/- 1.8) had significantly higher scores than AD patients (3.1 +/- 1.8) (p < 0.001). Distribution of scores on individual MFS items was significantly different between both disease groups (chi(2) = 76.2; p < 0.001). A moderately positive and highly significant correlation was shown between the total MFS score and diagnosis FTD (r = 0.478; p < 0.0001). Applying a total MFS score of 5 as discriminatory cut-off, a specificity of 89.0% and a sensitivity of 88.7% were achieved. Intra- and inter-rater variability was calculated in a different study population by means of retest correlation, revealing moderate to strong positive correlations of high statistical significance.


CONCLUSIONS
The MFS is a clinical and behavioural assessment scale that measures frontal lobe features and that was shown to reliably discriminate FTD from AD patients.
De Deyn
Peter Paul
PP
Department of Neurology and Memory Clinic, Middelheim General Hospital, ZNA, 2610 Antwerp, Belgium. peter.dedeyn@ua.ac.be
Engelborghs
Sebastiaan
S
Saerens
Jos
J
Goeman
Johan
J
Mariën
Peter
P
Maertens
Karen
K
Nagels
Guy
G
Martin
Jean-Jacques
JJ
Pickut
Barbara Anne
BA
D000367:Age Factors; D000368:Aged; D000544:Alzheimer Disease / Q000175:diagnosis / Q000473:pathology / Q000523:psychology; D003704:Dementia / Q000175:diagnosis* / Q000473:pathology / Q000523:psychology; D003937:Diagnosis, Differential; D005260:Female; D005625:Frontal Lobe / Q000473:pathology*; D015577:Geriatric Assessment / Q000379:methods; D006801:Humans; D008297:Male; D009483:Neuropsychological Tests; D011446:Prospective Studies; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D012737:Sex Factors