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cognitive-testing:fab [on March 23, 2020]
cognitive-testing:fab [on December 30, 2021] (current)
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 +~~META:
 +description abstract = The FAB is a brief battery of neuropsychological tasks designed to assess frontal lobe function and screens for frontotemporal dementia.
 +~~
 +
 ====== Frontal Assessment Battery (FAB) ====== ====== Frontal Assessment Battery (FAB) ======
 {{INLINETOC}} {{INLINETOC}}
 ===== Primer ===== ===== Primer =====
-<​WRAP ​right 400px+<​WRAP ​group> 
-<panel type="​info"​ title="​Download"​ no-body="​true">​ +<WRAP twothirds column>​ 
-| <button type="info" icon="​fa fa-file" size="​sm">​{{ :​the_fab-_a_frontal_assessment_battery_at_bedside.pdf |FAB Instructions}}</​button> ​ | <button type="​success"​ icon="​fa fa-download" size="​sm">​{{ :​frontal_fab_scale.pdf |Download ​FAB}}</​button> ​ |+The **Frontal Assessment Battery (FAB)** is a [[:​cognitive-testing|cognitive test]] that incorporates several clinical assessments to screen for [[geri:​dementia:​frontotemporal|frontotemporal dementia]] (FTD), including S-word generation, similarities,​ [[neurology:​neuro-exam:​luria|Luria'​s test]], grasp reflex, and the [[neurology:​neuro-exam:​go-no-go|Go-No-Go test]]. Patients with FTD typically score lower on the FAB compared with healthy controls and even patients with mild [[geri:​dementia:​alzheimers|]]. 
 + 
 +</​WRAP>​ 
 +<WRAP third column
 +<panel type="​info"​ title="​Download ​FAB" icon="​fa fa-download" no-body="​true">​ 
 +| <button type="primary"​ block="​true" icon="​fa fa-file">​{{:​the_fab-_a_frontal_assessment_battery_at_bedside.pdf|Instructions}}</​button> ​  | 
 +| <button type="​success" block="​true" icon="​fa fa-download">​{{:​frontal_fab_scale.pdf|FAB}}</​button> ​ |
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-The **Frontal Assessment Battery** (FAB) incorporates several clinical assessments to screen for [[geri:​dementia:​frontotemporal|frontotemporal dementia]], including S-word generation, similarities,​ [[neurology:​exam:​1-neuro-exam:​luria|Luria'​s test]], grasp reflex, and the [[neurology:​exam:​1-neuro-exam:​go-no-go|Go-No-Go test]]. Patients with FTD will score lower on the FAB compared with healthy controls and even patients with [[geri:​dementia:​alzheimers|]].+</​WRAP>​ 
 ==== Indications ==== ==== Indications ====
-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,​[([[https://​www.europsy-journal.com/​article/​S0924-9338(07)00425-7/​abstract|Nimatoudis,​ I., Spyridi, S., Kantartzis, S., Sokolaki, S., Panagiotidis,​ P., Nassika, Z., & Kaprinis, G. (2007). The frontal assessment battery at bedside (FAB) in patients with schizophrenia. European Psychiatry, 22, S128.]])] executive dysfunction screen in Parkinson’s,​[([[https://​www.ncbi.nlm.nih.gov/​pubmed/​18821046|Lima,​ C. F., Meireles, L. P., Fonseca, R., Castro, S. L., & Garrett, C. (2008). The Frontal Assessment Battery (FAB) in Parkinson’s disease and correlations with formal measures of executive functioning. Journal of neurology, 255(11), 1756-1761.]])] and executive cognitive dysfunction in substance dependence.[([[https://​www.ncbi.nlm.nih.gov/​pubmed/​20584570|Cunha,​ P. J., Nicastri, S., de Andrade, A. G., & Bolla, K. I. (2010). The frontal assessment battery (FAB) reveals neurocognitive dysfunction in substance-dependent individuals in distinct executive domains: Abstract reasoning, motor programming,​ and cognitive flexibility. Addictive behaviors, 35(10), 875-881.]])] It can provide an objective measure to distinguish FTD from AD in mildly demented ​patients.[([[http://​jamanetwork.com/​journals/​jamaneurology/​fullarticle/​786118|Slachevsky A, Villalpando JM, Sarazin M, Hahn-Barma V, Pillon B, Dubois B. Frontal Assessment Battery and Differential Diagnosis of Frontotemporal Dementia and Alzheimer Disease. Arch Neurol. 2004;​61(7):​1104–1107.]])]+Although the FAB was designed for screening for frontotemporal dementia, it has also been used in other clinical settings, including frontal lobe dysfunction in [[psychosis:​schizophrenia-scz|schizophrenia]],​[([[https://​www.europsy-journal.com/​article/​S0924-9338(07)00425-7/​abstract|Nimatoudis,​ I., Spyridi, S., Kantartzis, S., Sokolaki, S., Panagiotidis,​ P., Nassika, Z., & Kaprinis, G. (2007). The frontal assessment battery at bedside (FAB) in patients with schizophrenia. European Psychiatry, 22, S128.]])] executive dysfunction screen in [[geri:​parkinsons|Parkinson’s]],​[([[https://​www.ncbi.nlm.nih.gov/​pubmed/​18821046|Lima,​ C. F., Meireles, L. P., Fonseca, R., Castro, S. L., & Garrett, C. (2008). The Frontal Assessment Battery (FAB) in Parkinson’s disease and correlations with formal measures of executive functioning. Journal of neurology, 255(11), 1756-1761.]])] and executive cognitive dysfunction in [[addictions:​home|substance dependence]].[([[https://​www.ncbi.nlm.nih.gov/​pubmed/​20584570|Cunha,​ P. J., Nicastri, S., de Andrade, A. G., & Bolla, K. I. (2010). The frontal assessment battery (FAB) reveals neurocognitive dysfunction in substance-dependent individuals in distinct executive domains: Abstract reasoning, motor programming,​ and cognitive flexibility. Addictive behaviors, 35(10), 875-881.]])] It can provide an objective measure to distinguish FTD from AD in patients ​with mild dementia.[([[http://​jamanetwork.com/​journals/​jamaneurology/​fullarticle/​786118|Slachevsky A, Villalpando JM, Sarazin M, Hahn-Barma V, Pillon B, Dubois B. Frontal Assessment Battery and Differential Diagnosis of Frontotemporal Dementia and Alzheimer Disease. Arch Neurol. 2004;​61(7):​1104–1107.]])]
  
  
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 <callout title="​Scoring">​ <callout title="​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. 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   * Three correct: 3 points
   * Two correct: 2 points   * Two correct: 2 points
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   * The time allowed is 60 seconds   * 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.+Patients with frontal lobe lesions have difficulties navigating non-routine situations. Frontal lesions, regardless of side, tend to decrease verbal fluency. Left frontal lesions usually result in lower word production than right frontal lesions. ​Although the lexical fluency test has relatively poor localizing value, significant impairment is lateralizing to the left frontal lobe.[([[https://​pubmed.ncbi.nlm.nih.gov/​11113214/​|Dubois,​ B., Slachevsky, A., Litvan, I., & Pillon, B. F. A. B. (2000). The FAB: a frontal assessment battery at bedside. Neurology, 55(11), 1621-1626.]])]
  
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 ==== Motor Series ("​Luria'​s Test") ==== ==== Motor Series ("​Luria'​s Test") ====
-<callout type="success">​{{fa>arrow-circle-right?color=green}} ​See main article: **[[neurology:​exam:1-neuro-exam:​luria|]]**</​callout> +<alert icon="​fa ​fa-arrow-circle-right ​fa-lg fa-fw" type="​success">​See main article: **[[neurology:​neuro-exam:​luria|]]**</​alert><​WRAP group>
-<WRAP group>+
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 **Tell the patient: "Look carefully at what I’m doing."​** **Tell the patient: "Look carefully at what I’m doing."​**
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-==== Go–No Go ==== +==== Go–No-Go ==== 
-<callout type="success">​{{fa>arrow-circle-right?color=green}} ​See main article: **[[neurology:​exam:1-neuro-exam:​go-no-go|]]**</​callout> +<alert icon="​fa ​fa-arrow-circle-right ​fa-lg fa-fw" type="​success">​See main article: **[[neurology:​neuro-exam:​go-no-go|]]**</​alert>
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-==== Prehension Behaviour ====+ 
 +==== Prehension Behaviour ​(Grasp Reflex) ​====
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   * 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."​   * 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.+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. This is called the grasp reflex, and is a type of [[:​neurology:​neuro-exam:​home#​primitive-reflexes|primitive reflex]].
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 +
 +==== Total ====
 +The sum of the sub-scores from each of the six components are added up to generate total score out of 18.
 +
 ===== Norms ===== ===== Norms =====
-Age and Education ​norms from an Italian population sample:[([[https://​www.ncbi.nlm.nih.gov/​pubmed/​15995827|Appollonio,​ I., Leone, M., Isella, V., Piamarta, F., Consoli, T., Villa, M. L., ... & Nichelli, P. (2005). The Frontal Assessment Battery (FAB): normative values in an Italian population sample. Neurological Sciences, 26(2), 108-116.]])]+Using a cutoff score of 12/18 can reasonably differentiate FTD from mild [[geri:​dementia:​alzheimers|Alzheimer'​s]] (sensitivity of 77% and specificity of 87%).[([[https://​pubmed.ncbi.nlm.nih.gov/​15262742/​|Slachevsky,​ A., Villalpando,​ J. M., Sarazin, M., Hahn-Barma, V., Pillon, B., & Dubois, B. (2004). Frontal assessment battery and differential diagnosis of frontotemporal dementia and Alzheimer disease. Archives of neurology, 61(7), 1104-1107.]])] ​Age and education ​norms from an Italian population sample ​for normal scores are also available in the table below.[([[https://​www.ncbi.nlm.nih.gov/​pubmed/​15995827|Appollonio,​ I., Leone, M., Isella, V., Piamarta, F., Consoli, T., Villa, M. L., ... & Nichelli, P. (2005). The Frontal Assessment Battery (FAB): normative values in an Italian population sample. Neurological Sciences, 26(2), 108-116.]])] ​There is considerable variability based on education, with lower mean scores accepted as “normal” for those with less years of education.
  
 <panel type="​info"​ title="​Frontal Assessment Battery Average Scores: Age and Education Norms" no-body="​true"​ subtitle="​Appollonio,​ I., et al. The Frontal Assessment Battery (FAB): normative values in an Italian population sample. Neurological Sciences 26.2 (2005): 108-116.">​ <panel type="​info"​ title="​Frontal Assessment Battery Average Scores: Age and Education Norms" no-body="​true"​ subtitle="​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  ^+<​mobiletable 1> 
 +^                       ^ 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   | ^ 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   | ^ 4-5 years education ​  | -      | -      | 16.4   | 15.6   | 14.8   | 14.7   | 13.2   | 11.8   | 14.7   |
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 ^ > 13 years education ​ | 17.9   | 17.6   | 17.7   | 17.5   | 17.1   | 15.9   | 16.0   | 15.0   | 17.2   | ^ > 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   | ^ Total                 | 16.8   | 16.8   | 17.1   | 16.8   | 16     | 15.5   | 13.8   | 13.1   | 16.1   |
 +</​mobiletable>​
 </​panel>​ </​panel>​
  
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 == For Providers == == For Providers ==
   * [[https://​www.ncbi.nlm.nih.gov/​pubmed/​11113214|Dubois,​ B., Slachevsky, A., Litvan, I., & Pillon, B. F. A. B. (2000). The FAB: a frontal assessment battery at bedside. Neurology, 55(11), 1621-1626.]]   * [[https://​www.ncbi.nlm.nih.gov/​pubmed/​11113214|Dubois,​ B., Slachevsky, A., Litvan, I., & Pillon, B. F. A. B. (2000). The FAB: a frontal assessment battery at bedside. Neurology, 55(11), 1621-1626.]]
 +
 +{{tag>​cognitive-testing}}