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Vol. 22, No. 3, 2006
Issue release date: August 2006
Section title: Original Research Article
Free Access
Dement Geriatr Cogn Disord 2006;22:194–199
(DOI:10.1159/000094870)

MMSE Scores Decline at a Greater Rate in Frontotemporal Degeneration than in AD

Chow T.W.a · Hynan L.S.b-d · Lipton A.M.d, e
aRotman Research Institute of Baycrest, University of Toronto Department of Medicine, Division of Neurology and Department of Psychiatry, Division of Geriatric Psychiatry, Toronto, Canada; bUniversity of Texas Southwestern Medical CenterAlzheimer’s Disease Center and Departments of cClinical Sciences, dPsychiatry, and eNeurology, Presbyterian Hospital, Dallas, Tex., USA
email Corresponding Author

Abstract

The clinical diagnostic criteria for frontotemporal degeneration (FTD) include relative preservation of memory and visuospatial function, in contradistinction to characteristics of Alzheimer’s disease (AD). The Mini-Mental State Examination (MMSE) contains items to assess these areas of cognition. In a retrospective case-control study of participants at two institutionally-based AD centers, we determined whether total MMSE and MMSE subscores would reflect the disease progression projected by the clinical criteria of FTD vs. AD. Participants were 44 subjects with FTD (7 pathologically confirmed) and 45 with pathologically confirmed AD. Each subject had at least two MMSEs with minimum inter-test intervals of 9 months. We compared annualized rates of change for total MMSE scores and cognitive domain subscores over time and between groups by two independent samples t-tests and proportion tests. The total MMSE score (p = 0.03) and language subscore (p = 0.02) showed a greater rate of decline for the FTD group than the AD group, although the constructional praxis item declined less rapidly in the FTD group (p = 0.018). Changes in MMSE subscores paralleled the clinical diagnostic criteria for FTD. The more rapid progression on the language subscore was observed in both language and behavioral variants of FTD.

© 2006 S. Karger AG, Basel


  

Key Words

  • Alzheimer’s disease
  • Frontotemporal dementia
  • Frontotemporal degeneration
  • Mini-Mental State Examination

References

  1. Neary D, Snowden JS, Gustafson L, Passant U, Stuss D, Black S, Freedman M, Kertesz A, Robert PH, Albert M, Boone K, Miller BL, Cummings J, Benson DF: Frontotemporal lobar degeneration: a consensus on clinical diagnostic criteria. Neurology 1998;51:1546–1554.
  2. McKhann GM, Albert MS, Grossman M, Miller B, Dickson D, Trojanowski JQ: Clinical and pathological diagnosis of frontotemporal dementia: report of the Work Group on Frontotemporal Dementia and Pick’s Disease. Arch Neurol 2001;58:1803–1809.
  3. Chow TW, Miller BL, Boone K, Mishkin F, Cummings J: Frontotemporal dementia classification and neuropsychiatry. Neurologist 2002;8:263–269.
  4. Lipton AM, Benavides R, Hynan LS: Disease duration is shorter in frontotemporal dementia than in Alzheimer’s disease. Neurology 2003;60(suppl 1):A377.
  5. Hodges JR, Davies R, Xuereb J, Kril J, Halliday G: Survival in frontotemporal dementia. Neurology 2003;61:349–354.
  6. Folstein MF, Folstein SE, McHugh PR: ‘Mini-Mental State’: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12:189–198.
  7. Mendez MF, Cherrier M, Perryman KM, Pachana N, Miller BL, Cummings JL: Frontotemporal dementia versus Alzheimer’s disease: differential cognitive features. Neurology 1996;47:1189–1194.
  8. Miller BL, Cummings JL, Boone K, et al: Clinical and neurobehavioral characteristics of fronto-temporal dementia and Alzheimer disease. Neurology 1995;45:A318.
  9. Gregory CA, Orrell M, Sahakian B, Hodges JR: Can frontotemporal dementia and Alzheimer’s disease be differentiated using a brief battery of tests? Int J Geriatr Psychiatry 1997;12:375–383.
  10. Mathuranath PS, Nestor PJ, Berrios GE, Rakowicz W, Hodges JR: A brief cognitive test battery to differentiate Alzheimer’s disease and frontotemporal dementia. Neurology 2000;55:1613–1620.
  11. Perry RJ, Hodges JR: Differentiating frontal and temporal variant frontotemporal dementia from Alzheimer’s disease. Neurology 2000;54:2277–2284.
  12. Hodges JR, Patterson K, Ward R, Garrard P, Bak T, Perry R, Gregory C: The differentiation of semantic dementia and frontal lobe dementia (temporal and frontal variants of frontotemporal dementia) from early Alzheimer’s disease: a comparative neuropsychological study. Neuropsychology 1999;13:31–40.
  13. Lindau M, Jelic V, Johansson SE, Andersen C, Wahlund LO, Almkvist O: Quantitative EEG abnormalities and cognitive dysfunctions in frontotemporal dementia and Alzheimer’s disease. Dement Geriatr Cogn Disord 2003;15:106–114.
  14. Kramer JH, Jurik J, Sha SJ, Rankin KP, Rosen HJ, Johnson JK, Miller BL: Distinctive neuropsychological patterns in frontotemporal dementia, semantic dementia, and Alzheimer disease. Cogn Behav Neurol 2003;16:211–218.
  15. Razani J, Boone KB, Miller BL, Lee A, Sherman D: Neuropsychological performance of right- and left-frontotemporal dementia compared to Alzheimer’s disease. J Int Neuropsychol Soc 2001;7:468–480.
  16. Siri S, Benaglio I, Frigerio A, Binetti G, Cappa SF: A brief neuropsychological assessment for the differential diagnosis between frontotemporal dementia and Alzheimer’s disease. Eur J Neurol 2001;8:125–132.
  17. Weintraub S, Mesulam MM: Four neuropsychological profiles in dementia; in Boller F, Spinnler H (eds): Handbook of Neuropsychology. Amsterdam, Elsevier, 1985, pp 253–282.
  18. Perry RJ, Hodges JR: Differentiating frontal and temporal variant frontotemporal dementia from Alzheimer’s disease. Neurology 2000;54:2277–2284.
  19. Pachana N, Boone KB, Miller BL, Cummings JL, Berman N: Comparison of neuropsychological functioning in Alzheimer’s disease and frontotemporal dementia. J Int Neuropsychol Soc 1996;2:505–510.
  20. Glosser G, Gallo JL, Clark CM, Grossman M: Memory encoding and retrieval in frontotemporal dementia and Alzheimer’s disease. Neuropsychology 2002;16:190–196.
  21. Lipton A, Chow TW, Hynan LS: MMSE scores decline at a greater rate in frontotemporal lobar degeneration than in Alzheimer’s disease. Neurology 2003;60(suppl 1):A375.
  22. Rascovsky K, Salmon DP, Leverenz JB, DeCarli C, Clark CM, Mendez MF, Graff-Radford NR, Galasko D: Rate of progression differs in frontotemporal dementia and Alzheimer’s disease. Neurology 2004;62:A344.
  23. Pasquier F, Lebert F, Lavenu I, Guillaume B: The clinical picture of frontotemporal dementia: diagnosis and follow-up. Dement Geriatr Cogn Disord 1999;10(suppl 1):10–14.
  24. Pasquier F, Richard F, Lebert F: Natural history of frontotemporal dementia: comparison with Alzheimer’s disease. Dement Geriatr Cogn Disord 2004;17:253–257.
  25. Rascovsky K, Salmon DP, Lipton AM, Leverenz JB, DeCarli C, Jagust WJ, Clark CM, Mendez MF, Tang-Wai DF, Graff-Radford NR, Galasko D: Rate of progression differs in frontotemporal dementia and Alzheimer’s disease. Neurology 2005;65:397– 403.
  26. Rascovsky K, Salmon DP, Ho GJ, Galasko D, Peavy GM, Hansen LA, Thal LJ: Cognitive profiles differ in autopsy-confirmed frontotemporal dementia and AD. Neurology 2002;58:1801–1808.
  27. Bier JC, Ventura M, Donckels V, Van Eyll E, Claes T, Slama H, Fery P, Vokaer M, Pandolfo M: Is the Addenbrooke’s cognitive examination effective to detect frontotemporal dementia? J Neurol 2004;251:428–431.
  28. Newell KL, Hyman BT, Growdon JH, Hedley-Whyte ET: Application of the National Institute on Aging (NIA)-Reagan Institute criteria for the neuropathological diagnosis of Alzheimer disease. J Neuropathol Exp Neurol 1999;58:1147–1155.
  29. Mirra SS, Heyman A, McKeel D, et al: The consortium to establish a registry for Alzheimer’s disease (CERAD). II. Standardization of the neuropathologic assessment of Alzheimer’s disease. Neurology 1991;40:1–8.
  30. Littell RC, Milliken GA, Stroup WW, Wolfinger RD: SAS System for Mixed Models. Cary, SAS Institute Inc, 1996.
  31. Bigio EH, Lipton AM, Yen SH, Hutton ML, Baker M, Nacharaju P, White CL, Davies P, Lin W, Dickson DW: Frontal lobe dementia with novel tauopathy: sporadic multiple system tauopathy with dementia. J Neuropathol Exp Neurol 2001;60:328–341.
  32. Chow TW, Boone K, Mishkin F, Miller BL: Behavioral changes in subtypes of primary progressive aphasia and other frontotemporal dementias; in Rotman Institute Frontal Lobes Meeting, 2000. Toronto, Brain and Cognition, 2000.
  33. Kertesz A, Davidson W, McCabe P, Takagi K, Munoz D: Primary progressive aphasia: diagnosis, varieties, evolution. J Int Neuropsychol Soc 2003;9:710–719.
  34. Seeley WW, Bauer AM, Miller BL, Gorno-Tempini ML, Kramer JH, Weiner M, Rosen HJ: The natural history of temporal variant frontotemporal dementia. Neurology 2005;64:1384–1390.
  35. Pijnenburg YA, Gillissen F, Jonker C, Scheltens P: Initial complaints in frontotemporal lobar degeneration. Dement Geriatr Cogn Disord 2004;17:302–306.
  36. Kertesz A, Davidson W, McCabe P, Munoz D: Behavioral quantitation is more sensitive than cognitive testing in frontotemporal dementia. Alzheimer Dis Assoc Disord 2003;17:223–229.
  37. Diehl J, Kurz A: Frontotemporal dementia: patient characteristics, cognition, and behaviour. Int J Geriatr Psychiatry 2002;17:914–918.

  

Author Contacts

Tiffany Chow, MD
Rotman Research Institute, 3560 Bathurst Street, 8th Floor Posluns Bldg
Toronto M6A 2E1 (Canada)
Tel. +1 416 785 2500/ext. 3459, Fax +1 416 785 2862
E-Mail tchow@rotman-baycrest.on.ca

  

Article Information

Accepted: February 9, 2006
Published online: August 7, 2006
Number of Print Pages : 6
Number of Figures : 1, Number of Tables : 1, Number of References : 37

  

Publication Details

Dementia and Geriatric Cognitive Disorders

Vol. 22, No. 3, Year 2006 (Cover Date: August 2006)

Journal Editor: Chan-Palay, V. (New York, N.Y.)
ISSN: 1420–8008 (print), 1421–9824 (Online)

For additional information: http://www.karger.com/DEM


Copyright / Drug Dosage / Disclaimer

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

Abstract

The clinical diagnostic criteria for frontotemporal degeneration (FTD) include relative preservation of memory and visuospatial function, in contradistinction to characteristics of Alzheimer’s disease (AD). The Mini-Mental State Examination (MMSE) contains items to assess these areas of cognition. In a retrospective case-control study of participants at two institutionally-based AD centers, we determined whether total MMSE and MMSE subscores would reflect the disease progression projected by the clinical criteria of FTD vs. AD. Participants were 44 subjects with FTD (7 pathologically confirmed) and 45 with pathologically confirmed AD. Each subject had at least two MMSEs with minimum inter-test intervals of 9 months. We compared annualized rates of change for total MMSE scores and cognitive domain subscores over time and between groups by two independent samples t-tests and proportion tests. The total MMSE score (p = 0.03) and language subscore (p = 0.02) showed a greater rate of decline for the FTD group than the AD group, although the constructional praxis item declined less rapidly in the FTD group (p = 0.018). Changes in MMSE subscores paralleled the clinical diagnostic criteria for FTD. The more rapid progression on the language subscore was observed in both language and behavioral variants of FTD.

© 2006 S. Karger AG, Basel


  

Author Contacts

Tiffany Chow, MD
Rotman Research Institute, 3560 Bathurst Street, 8th Floor Posluns Bldg
Toronto M6A 2E1 (Canada)
Tel. +1 416 785 2500/ext. 3459, Fax +1 416 785 2862
E-Mail tchow@rotman-baycrest.on.ca

  

Article Information

Accepted: February 9, 2006
Published online: August 7, 2006
Number of Print Pages : 6
Number of Figures : 1, Number of Tables : 1, Number of References : 37

  

Publication Details

Dementia and Geriatric Cognitive Disorders

Vol. 22, No. 3, Year 2006 (Cover Date: August 2006)

Journal Editor: Chan-Palay, V. (New York, N.Y.)
ISSN: 1420–8008 (print), 1421–9824 (Online)

For additional information: http://www.karger.com/DEM


Article / Publication Details

First-Page Preview
Abstract of Original Research Article

Received: 2/9/2006
Published online: 8/30/2006
Issue release date: August 2006

Number of Print Pages: 6
Number of Figures: 1
Number of Tables: 1

ISSN: 1420-8008 (Print)
eISSN: 1421-9824 (Online)

For additional information: http://www.karger.com/DEM


Copyright / Drug Dosage

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

References

  1. Neary D, Snowden JS, Gustafson L, Passant U, Stuss D, Black S, Freedman M, Kertesz A, Robert PH, Albert M, Boone K, Miller BL, Cummings J, Benson DF: Frontotemporal lobar degeneration: a consensus on clinical diagnostic criteria. Neurology 1998;51:1546–1554.
  2. McKhann GM, Albert MS, Grossman M, Miller B, Dickson D, Trojanowski JQ: Clinical and pathological diagnosis of frontotemporal dementia: report of the Work Group on Frontotemporal Dementia and Pick’s Disease. Arch Neurol 2001;58:1803–1809.
  3. Chow TW, Miller BL, Boone K, Mishkin F, Cummings J: Frontotemporal dementia classification and neuropsychiatry. Neurologist 2002;8:263–269.
  4. Lipton AM, Benavides R, Hynan LS: Disease duration is shorter in frontotemporal dementia than in Alzheimer’s disease. Neurology 2003;60(suppl 1):A377.
  5. Hodges JR, Davies R, Xuereb J, Kril J, Halliday G: Survival in frontotemporal dementia. Neurology 2003;61:349–354.
  6. Folstein MF, Folstein SE, McHugh PR: ‘Mini-Mental State’: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12:189–198.
  7. Mendez MF, Cherrier M, Perryman KM, Pachana N, Miller BL, Cummings JL: Frontotemporal dementia versus Alzheimer’s disease: differential cognitive features. Neurology 1996;47:1189–1194.
  8. Miller BL, Cummings JL, Boone K, et al: Clinical and neurobehavioral characteristics of fronto-temporal dementia and Alzheimer disease. Neurology 1995;45:A318.
  9. Gregory CA, Orrell M, Sahakian B, Hodges JR: Can frontotemporal dementia and Alzheimer’s disease be differentiated using a brief battery of tests? Int J Geriatr Psychiatry 1997;12:375–383.
  10. Mathuranath PS, Nestor PJ, Berrios GE, Rakowicz W, Hodges JR: A brief cognitive test battery to differentiate Alzheimer’s disease and frontotemporal dementia. Neurology 2000;55:1613–1620.
  11. Perry RJ, Hodges JR: Differentiating frontal and temporal variant frontotemporal dementia from Alzheimer’s disease. Neurology 2000;54:2277–2284.
  12. Hodges JR, Patterson K, Ward R, Garrard P, Bak T, Perry R, Gregory C: The differentiation of semantic dementia and frontal lobe dementia (temporal and frontal variants of frontotemporal dementia) from early Alzheimer’s disease: a comparative neuropsychological study. Neuropsychology 1999;13:31–40.
  13. Lindau M, Jelic V, Johansson SE, Andersen C, Wahlund LO, Almkvist O: Quantitative EEG abnormalities and cognitive dysfunctions in frontotemporal dementia and Alzheimer’s disease. Dement Geriatr Cogn Disord 2003;15:106–114.
  14. Kramer JH, Jurik J, Sha SJ, Rankin KP, Rosen HJ, Johnson JK, Miller BL: Distinctive neuropsychological patterns in frontotemporal dementia, semantic dementia, and Alzheimer disease. Cogn Behav Neurol 2003;16:211–218.
  15. Razani J, Boone KB, Miller BL, Lee A, Sherman D: Neuropsychological performance of right- and left-frontotemporal dementia compared to Alzheimer’s disease. J Int Neuropsychol Soc 2001;7:468–480.
  16. Siri S, Benaglio I, Frigerio A, Binetti G, Cappa SF: A brief neuropsychological assessment for the differential diagnosis between frontotemporal dementia and Alzheimer’s disease. Eur J Neurol 2001;8:125–132.
  17. Weintraub S, Mesulam MM: Four neuropsychological profiles in dementia; in Boller F, Spinnler H (eds): Handbook of Neuropsychology. Amsterdam, Elsevier, 1985, pp 253–282.
  18. Perry RJ, Hodges JR: Differentiating frontal and temporal variant frontotemporal dementia from Alzheimer’s disease. Neurology 2000;54:2277–2284.
  19. Pachana N, Boone KB, Miller BL, Cummings JL, Berman N: Comparison of neuropsychological functioning in Alzheimer’s disease and frontotemporal dementia. J Int Neuropsychol Soc 1996;2:505–510.
  20. Glosser G, Gallo JL, Clark CM, Grossman M: Memory encoding and retrieval in frontotemporal dementia and Alzheimer’s disease. Neuropsychology 2002;16:190–196.
  21. Lipton A, Chow TW, Hynan LS: MMSE scores decline at a greater rate in frontotemporal lobar degeneration than in Alzheimer’s disease. Neurology 2003;60(suppl 1):A375.
  22. Rascovsky K, Salmon DP, Leverenz JB, DeCarli C, Clark CM, Mendez MF, Graff-Radford NR, Galasko D: Rate of progression differs in frontotemporal dementia and Alzheimer’s disease. Neurology 2004;62:A344.
  23. Pasquier F, Lebert F, Lavenu I, Guillaume B: The clinical picture of frontotemporal dementia: diagnosis and follow-up. Dement Geriatr Cogn Disord 1999;10(suppl 1):10–14.
  24. Pasquier F, Richard F, Lebert F: Natural history of frontotemporal dementia: comparison with Alzheimer’s disease. Dement Geriatr Cogn Disord 2004;17:253–257.
  25. Rascovsky K, Salmon DP, Lipton AM, Leverenz JB, DeCarli C, Jagust WJ, Clark CM, Mendez MF, Tang-Wai DF, Graff-Radford NR, Galasko D: Rate of progression differs in frontotemporal dementia and Alzheimer’s disease. Neurology 2005;65:397– 403.
  26. Rascovsky K, Salmon DP, Ho GJ, Galasko D, Peavy GM, Hansen LA, Thal LJ: Cognitive profiles differ in autopsy-confirmed frontotemporal dementia and AD. Neurology 2002;58:1801–1808.
  27. Bier JC, Ventura M, Donckels V, Van Eyll E, Claes T, Slama H, Fery P, Vokaer M, Pandolfo M: Is the Addenbrooke’s cognitive examination effective to detect frontotemporal dementia? J Neurol 2004;251:428–431.
  28. Newell KL, Hyman BT, Growdon JH, Hedley-Whyte ET: Application of the National Institute on Aging (NIA)-Reagan Institute criteria for the neuropathological diagnosis of Alzheimer disease. J Neuropathol Exp Neurol 1999;58:1147–1155.
  29. Mirra SS, Heyman A, McKeel D, et al: The consortium to establish a registry for Alzheimer’s disease (CERAD). II. Standardization of the neuropathologic assessment of Alzheimer’s disease. Neurology 1991;40:1–8.
  30. Littell RC, Milliken GA, Stroup WW, Wolfinger RD: SAS System for Mixed Models. Cary, SAS Institute Inc, 1996.
  31. Bigio EH, Lipton AM, Yen SH, Hutton ML, Baker M, Nacharaju P, White CL, Davies P, Lin W, Dickson DW: Frontal lobe dementia with novel tauopathy: sporadic multiple system tauopathy with dementia. J Neuropathol Exp Neurol 2001;60:328–341.
  32. Chow TW, Boone K, Mishkin F, Miller BL: Behavioral changes in subtypes of primary progressive aphasia and other frontotemporal dementias; in Rotman Institute Frontal Lobes Meeting, 2000. Toronto, Brain and Cognition, 2000.
  33. Kertesz A, Davidson W, McCabe P, Takagi K, Munoz D: Primary progressive aphasia: diagnosis, varieties, evolution. J Int Neuropsychol Soc 2003;9:710–719.
  34. Seeley WW, Bauer AM, Miller BL, Gorno-Tempini ML, Kramer JH, Weiner M, Rosen HJ: The natural history of temporal variant frontotemporal dementia. Neurology 2005;64:1384–1390.
  35. Pijnenburg YA, Gillissen F, Jonker C, Scheltens P: Initial complaints in frontotemporal lobar degeneration. Dement Geriatr Cogn Disord 2004;17:302–306.
  36. Kertesz A, Davidson W, McCabe P, Munoz D: Behavioral quantitation is more sensitive than cognitive testing in frontotemporal dementia. Alzheimer Dis Assoc Disord 2003;17:223–229.
  37. Diehl J, Kurz A: Frontotemporal dementia: patient characteristics, cognition, and behaviour. Int J Geriatr Psychiatry 2002;17:914–918.