Frontal Assessment Battery (FAB)

The Frontal Assessment Battery (FAB) incorporates several clinical assessments to screen for frontotemporal dementia, including S-word generation, similarities, Luria's test, grasp reflex, and the Go-No-Go test. Patients with FTD will score lower on the FAB compared with healthy controls and even patients with Alzheimer's Disease (AD).

Download FAB

Although the FAB was designed for screening for frontotemporal dementia, it has also been used in other clinical settings, including frontal lobe dysfunction in schizophrenia,[1] executive dysfunction screen in Parkinson’s,[2] and executive cognitive dysfunction in substance dependence.[3] It can provide an objective measure to distinguish FTD from AD in mildly demented patients.[4]

Ask the patient “In what way are they alike?”:

  • A banana and an orange (answer: fruits)
  • A table and a chair (answer: furniture)
  • A tulip, a rose and a daisy (answer: flowers)

Abstract reasoning is impaired in frontal lobe disorders. Patients with frontal lobe dysfunction may be unable to establish an abstract link between similar items (i.e. - flowers). Instead, they may adhere only to the concrete aspects of objects (i.e. - saying “both are red,” or “one is round but the other is elongated”).

Scoring

If the patient says “they are not alike” (total failure) or “both have peels” (partial failure) help the patient with a prompt by saying: “both a banana and an orange are…” However, credit 0 points for the first item. Do not help the patient for the last two items after this.
  • Three correct: 3 points
  • Two correct: 2 points
  • One correct: 1 point
  • None correct: 0 points

Tell the patient: “Say as many words as you can beginning with the letter 'S,' any words except surnames or proper nouns.”

  • The time allowed is 60 seconds

Patients with frontal lobe lesions have difficulties navigating non-routine situations. Literal fluency tasks (like the naming words that begin with a letter) are unusual and require self-organized retrieval from semantic memory. Frontal lesions, regardless of side, tend to decrease verbal fluency. Left frontal lesions usually result in lower word production than right frontal lesions.

Scoring

If the patient gives no response during the first 5 seconds, say: “for instance, snake.” If the patient pauses for 10 seconds, prompt them by saying: “any word beginning with the letter 'S.'” Word repetitions or variations (i.e. - “shoe,” “shoemaker”), surnames, or proper nouns are not counted as correct responses.

  • More than nine words: 3
  • Six to nine words: 2
  • Three to five words: 1
  • Less than three words: 0

Tell the patient: “Look carefully at what I’m doing.”

  • The examiner, seated in front of the patient, performs alone three times using the left hand the series of Luria motions of “fist–edge-palm.”

Prompt the patient: “Now, with your right hand do the same series, first with me, then alone.”

  • The examiner performs the series three times in total with the patient

Now tell the patient: “Now, do it on your own.”

  • Observe the patient's actions

Patients with frontal lobe lesions are impaired in tasks that require temporal organization, maintenance, and execution of successive actions. Patients with some impairment will be unable to execute the “fist–palm–edge” series in the correct order. Patients who are severely impaired will be unable to learn the series at all. Patients may simplify the task (use two gestures instead of three) or show perseveration (repeating the same gesture).

Scoring

  • Patient performs six correct consecutive series alone: 3
  • Patient performs at least three correct consecutive series alone: 2
  • Patient fails alone, but performs three correct consecutive series with the examiner: 1
  • Patient cannot perform three correct consecutive series even with the examiner: 0

Tell the patient: “Tap twice when I tap once.”

  • To be sure that the patient has understood the instructions, do a series of three trials run first: 1-1-1

Tell the patient: “Tap once when I tap twice.”

  • To be sure that the patient has understood the instruction, do a series of three trials run first: 2-2-2

The examiner now performs the actual following series: 1-1-2-1-2-2-2-1-1-2

This is a task assesses a patient's sensitivity to interference. When the verbal commands (Being told to “tap twice when I tap once”) conflict with sensory information (seeing the examiner tap twice and not once), deficits in behavioural self-regulation can be seen in patients with frontal lobe dysfunction. This task is similar to the Stroop Test. Patients with a frontal lobe lesion will usually fail to obey the verbal command and instead execute the echopractic movements by imitating the examiner.

Scoring

  • No error: 3
  • One or two errors: 2
  • More than two errors: 1
  • Patient taps like the examiner at least four consecutive times: 0

Tell the patient: “Tap once when I tap once.”

  • To be sure that the patient has understood the instruction, do a series of three trials run first: 1-1-1

Tell the patient: “Do not tap when I tap twice.”

  • To be sure that the patient has understood the instruction, do a series of three trials run first: 2-2-2

The examiner now performs the actual following series: 1-1-2-1-2-2-2-1-1-2

This task measures the patient's inhibitory control. Withholding a response can be difficult for patients with damage to the ventral part of the frontal lobes. This difficulty in controlling impulsiveness can be assessed with the Go–No Go task, because the subjects must now inhibit the response (”Tap once when I tap twice.“) that they were previously given (in the Conflicting Instructions task), for the same stimulus (seeing the examiner tap twice). The patient must now inhibit a response that was previously given to the same stimulus (i.e. - not tapping at all when the examiner taps twice).

Scoring

  • No error: 3
  • One or two errors: 2
  • More than two errors: 1
  • Patient taps like the examiner at least four consecutive times: 0

Tell the patient: “Do not take my hands.”

  • The examiner is seated in front of the patient
  • Place the patient’s hands palm up on his/her knees. Without saying anything or looking at the patient, the examiner brings his/her hands close to the patient’s hands and touches the palms of both the patient’s hands, to see if he/she will spontaneously take them. If the patient takes the hands, the examiner will try again after asking him/her: “Now, do not take my hands.”

This task assesses for environmental autonomy. Patients with frontal lobe lesions can be overly dependent on environmental cues. Sensory stimuli can activate patterns of responses in these patients. These sensory stimuli and pattern of responses include: (1) seeing movement as an order to imitate (imitation behaviour), (2) seeing an object implies the order to use it (utilization behaviour), or (3) the sight or sensory perception of an examiner’s hands may compel the patient to take them (prehension behaviour). These abnormal behaviours (the spontaneous tendency to adhere to the environment) shows the lack of inhibition that is normally exerted by the prefrontal cortex.

Scoring

  • Patient does not take the examiner’s hands: 3
  • Patient hesitates and asks what he/she has to do: 2
  • Patient takes the hands without hesitation: 1
  • Patient takes the examiner’s hand even after he/she has been told not to do so: 0

Age and Education norms from an Italian population sample:[5]

Frontal Assessment Battery Average Scores: Age and Education Norms

Appollonio, I., et al. The Frontal Assessment Battery (FAB): normative values in an Italian population sample. Neurological Sciences 26.2 (2005): 108-116.
20-29 30-39 40-49 50-59 60-69 70-79 80-89 90-95 Total
1-3 years education - - - 18 14.5 14.0 13.5 - 14.6
4-5 years education - - 16.4 15.6 14.8 14.7 13.2 11.8 14.7
6-8 years education 15.9 16.2 16.7 16.6 16.2 15.4 12.0 14.7 15.8
9-13 years education 16.9 17.1 17.7 16.9 16.3 16.2 17.0 12.0 16.6
> 13 years education 17.9 17.6 17.7 17.5 17.1 15.9 16.0 15.0 17.2
Total 16.8 16.8 17.1 16.8 16 15.5 13.8 13.1 16.1
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