title: Executive Abilities as Reflected by Clock Hand Placement: Frontotemporal Dementia Versus Early-Onset Alzheimer Disease.
abstract: The clock-drawing test (CDT) is widely used in clinical practice to diagnose and distinguish patients with dementia. It remains unclear, however, whether the CDT can distinguish among the early-onset dementias. Accordingly, we examined the ability of both quantitative and qualitative CDT analyses to distinguish behavioral variant frontotemporal dementia (bvFTD) and early-onset Alzheimer disease (eAD), the 2 most common neurodegenerative dementias with onset <65 years of age. We hypothesized that executive aspects of the CDT would discriminate between these 2 disorders. The study compared 15 patients with bvFTD and 16 patients with eAD on the CDT using 2 different scales and correlated the findings with neuropsychological testing and magnetic resonance imaging. The total CDT scores did not discriminate bvFTD and eAD; however, specific analysis of executive hand placement items successfully distinguished the groups, with eAD exhibiting greater errors than bvFTD. The performance on those executive hand placement items correlated with measures of naming as well as visuospatial and executive function. On tensor-based morphometry of the magnetic resonance images, executive hand placement correlated with right frontal volume. These findings suggest that lower performance on executive hand placement items occurs with involvement of the right dorsolateral frontal-parietal network for executive control in eAD, a network disproportionately affected in AD of early onset. Rather than the total performance on the clock task, the analysis of specific errors, such as executive hand placement, may be useful for early differentiation of eAD, bvFTD, and other conditions.
authors.affiliation: Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA Greater Los Angeles VA Healthcare System, West Los Angeles, CA, USA drbarrowsrobinjoyce@gmail.com.
authors.forename: Robin J
authors.initials: RJ
authors.lastname: Barrows
authors.affiliation: Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA Greater Los Angeles VA Healthcare System, West Los Angeles, CA, USA.
authors.forename: Joseph
authors.initials: J
authors.lastname: Barsuglia
authors.affiliation: Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA Greater Los Angeles VA Healthcare System, West Los Angeles, CA, USA Department of Psychiatry, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
authors.forename: Pongsatorn
authors.initials: P
authors.lastname: Paholpak
authors.affiliation: Greater Los Angeles VA Healthcare System, West Los Angeles, CA, USA Department of Psychiatry, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA.
authors.forename: Donald
authors.initials: D
authors.lastname: Eknoyan
authors.affiliation: Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA Greater Los Angeles VA Healthcare System, West Los Angeles, CA, USA.
authors.forename: Valeriy
authors.initials: V
authors.lastname: Sabodash
authors.affiliation: Department of Psychology, School of Behavioral Health, Loma Linda University, Loma Linda, CA, USA.
authors.forename: Grace J
authors.initials: GJ
authors.lastname: Lee
authors.affiliation: Department of Neurology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA Greater Los Angeles VA Healthcare System, West Los Angeles, CA, USA.
authors.forename: Mario F
authors.initials: MF
authors.lastname: Mendez
mesh_terms: D000544:Alzheimer Disease / Q000175:diagnosis* / Q000503:physiopathology / Q000523:psychology*; D056344:Executive Function; D005260:Female; D057180:Frontotemporal Dementia / Q000175:diagnosis* / Q000503:physiopathology / Q000523:psychology*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests
keywords: Alzheimer disease; executive functioning; frontotemporal dementia