Hostname: page-component-586b7cd67f-gb8f7 Total loading time: 0 Render date: 2024-11-22T23:05:39.997Z Has data issue: false hasContentIssue false

Relationship of frontal lobe dysfunction and aberrant motor behaviors in patients with Alzheimer's disease

Published online by Cambridge University Press:  15 December 2009

Tomoyuki Nagata*
Affiliation:
Department of Psychiatry, Jikei University School of Medicine, Kashiwa Hospital, Chiba, Japan
Shunichiro Shinagawa
Affiliation:
Department of Psychiatry, Jikei University School of Medicine, Tokyo, Japan
Yusuke Ochiai
Affiliation:
Department of Psychiatry, Jikei University School of Medicine, Kashiwa Hospital, Chiba, Japan
Hirohide Kada
Affiliation:
Department of Psychiatry, Jikei University School of Medicine, Kashiwa Hospital, Chiba, Japan
Hiroo Kasahara
Affiliation:
Department of Psychiatry, Jikei University School of Medicine, Kashiwa Hospital, Chiba, Japan
Kazutaka Nukariya
Affiliation:
Department of Psychiatry, Jikei University School of Medicine, Kashiwa Hospital, Chiba, Japan
Kazuhiko Nakayama
Affiliation:
Department of Psychiatry, Jikei University School of Medicine, Tokyo, Japan
*
Correspondence should be addressed to: Tomoyuki Nagata, Department of Psychiatry, Jikei University School of Medicine, Kashiwa Hospital, 163–1 Kashiwashita, Kashiwa, Chiba 277–8567, Japan. Phone: +81-4-7164-1111; Fax: +81-4-7164-9374. Email: [email protected].

Abstract

Background: In order to address the neuropsychological pathogenesis of aberrant motor behaviors in Alzheimer's disease (AD), we used a cross-sectional study design to investigate the association between frontal lobe function, including executive function, and activity disturbances (wandering, purposeless activities and inappropriate activities).

Methods: Among 75 consecutive outpatients with AD, 50 subjects with a Clinical Dementia Rating (CDR) score of 1 or 2 were selected and divided into two groups based on data obtained from interviews with their caregivers: an aberrant motor behaviors (AMB) group (n = 22), and a non-aberrant motor behaviors (NAMB) group (n = 28). Aberrant motor behavior was defined according to whether the “activity disturbance” score (ranging from 0 to 9) of the Behavioral Pathology in Alzheimer Disease (Behave-AD) scale was 0 or ≥1. The total and subtest scores of the Frontal Assessment Battery (FAB) were then compared between the two groups.

Results: Significant differences were found between the FAB total (P < 0.05) and the subtest scores (lexical fluency, conflicting instructions; P < 0.05) in the two groups. The FAB score was significantly associated with the activity disturbance score (r = −0.49; P<0.001). A stepwise multiple regression analysis showed that only the FAB score significantly influenced the activity disturbance score (P < 0.001).

Conclusions: This finding suggested that in addition to episodic memory disturbance, frontal lobe dysfunctions might lead patients with AD to develop aberrant motor behavior.

Type
Research Article
Copyright
Copyright © International Psychogeriatric Association 2009

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Baudic, S. et al. (2006). Executive function deficit in early Alzheimer's disease and their relations with episodic memory. Archives of Clinical Neuropsychology, 21, 1521.CrossRefGoogle ScholarPubMed
Bench, C. J. et al. (1993). Investigations of functional anatomy of attention using the Stroop test. Neuropsychologia, 31, 907922.Google Scholar
Chiu, M. J., Chen, T. F., Yip, P. K., Hua, M. S. and Tang, L. Y. (2006). Behavioral and psychologic symptoms in different types of dementia. Journal of the Formosan Medical Association, 105, 556562.CrossRefGoogle ScholarPubMed
Chiu, Y. C. et al. (2004). Getting lost: directed attention and executive function in early Alzheimer's disease patients. Dementia and Geriatric Cognitive Disorders, 17, 174180.CrossRefGoogle ScholarPubMed
Crosson, B. et al. (1999). Activity in the paracingulate and cingulated sulci during word generation: an fMRI study of functional anatomy. Cerebral Cortex, 9, 307316.Google Scholar
Devanand, D. P. et al. (1997). The course of psychopathologic features in mild to moderate Alzheimer disease. Archives of General Psychiatry, 54, 257263.Google Scholar
Donaldson, C., Tarrier, N. and Burns, A. (1997). The impact of the symptoms of dementia on caregivers. British Journal of Psychiatry, 170, 6268.CrossRefGoogle ScholarPubMed
Dubois, B., Slachevsky, A., Litvan, I. and Pillon, B. (2000). The FAB: a Frontal Assessment Battery at bedside. Neurology, 55, 16211626.Google Scholar
Engelborghs, S. et al. (2006). Behavioral and neuropsychological correlates of frontal lobe features in dementia. Psychological Medicine, 36, 11731182.Google Scholar
Folstein, M. F., Folstein, S. E. and McHugh, P. R. (1975). “Mini-mental state”: a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189198.CrossRefGoogle ScholarPubMed
Harwood, D. G., Barker, W. W., Ownby, R. L. and Duara, R. (2000). Relationship of behavioral and psychological symptoms to cognitive impairments and functional status in Alzheimer's disease. International Journal Geriatric Psychiatry, 15, 393400.3.0.CO;2-O>CrossRefGoogle ScholarPubMed
Hughes, C. P., Berg, L., Danziger, W. L., Coben, L. A. and Martin, R. L. (1982). A new clinical scale for the staging of dementia. British Journal of Psychiatry, 140, 566572.Google Scholar
Lipton, A. M. et al. (2005). Subscores of the FAB differentiate frontotemporal lobe degeneration from AD. Neurology, 65, 726731.CrossRefGoogle ScholarPubMed
Liu, W. et al. (2004). Behavioral disorders in the frontal and temporal variant of frontotemporal dementia. Neurology, 62, 742748.CrossRefGoogle Scholar
McKhann, G. et al. (1984). Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer's Disease. Neurology, 34, 939944.CrossRefGoogle ScholarPubMed
Mega, M. S., Cummings, J. L., Fiorello, T. and Gornbein, J. (1996). The spectrum of behavioral change in Alzheimer's disease. Neurology, 46, 130135.CrossRefGoogle ScholarPubMed
Mendez, M. F., Perryman, K. M., Miller, B. L. and Cummings, J. L. (1998). Behavioral differences between frontotemporal dementia and Alzheimer's disease: a comparison on the BEHAVE-AD rating scale. International Psychogeriatrics, 10, 155162.CrossRefGoogle ScholarPubMed
Nagata, T. et al. (2009). Correlation between a reduction in Frontal Assessment Battery scores and delusional thoughts in patients with Alzheimer's disease. Psychiatry and Clinical Neurosciences, 63, 449454.CrossRefGoogle ScholarPubMed
Nakaaki, S. et al. (2007). Reliability and validity of the Japanese version of the Frontal Assessment Battery in the patients with the frontal variant of the frontotemporal dementia. Psychiatry and Clinical Neurosciences, 61, 7883.Google Scholar
O'Brien, H. L. et al. (2001). Visual mechanisms of spatial disorientation in Alzheimer's disease. Cerebral Cortex, 11, 10831092.Google Scholar
Perry, R. J., Watson, P. and Hodge, J. R. (2000). The nature and staging of attention dysfunction in early (minimal and mild) Alzheimer's disease: relationship to episodic and semantic memory impairment. Neuropsychologia, 38, 252271.CrossRefGoogle ScholarPubMed
Reisberg, B., Borenstein, J., Salob, S. P., Ferris, S. H., Franssen, E. H, and Georgotas, A. (1987). Behavioral symptoms in Alzheimer's disease: phenomenology and treatment. Journal of Clinical Psychiatry, 48 (5 Suppl.), 915.Google Scholar
Rolland, Y. (2005). A SPECT study of wandering behavior in Alzheimer's disease. International Journal of Geriatric Psychiatry, 20, 816820.CrossRefGoogle ScholarPubMed
Rosen, H. J., Allison, S. C., Schauer, G. F., Gorno-Tempini, M. L., Weiner, M. W. and Miller, B. L. (2005). Neuroanatomical correlated of behavioral disorders in dementia. Brain, 128, 26122625.CrossRefGoogle ScholarPubMed
Scarmeas, N. et al. (2007). Disruptive behavior as a predictor in Alzheimer's disease. Archives of Neurology, 64, 17551761.CrossRefGoogle Scholar
Schonfeld, L. et al. (2007). Wanders with cognitive impairment in Department of Veterans Affair nursing home care units. Journal of the American Geriatrics Society, 55, 692699.Google Scholar
Shinoda-Tagawa, T. et al. (2004). Resident-to-resident violent incidents in nursing homes. JAMA, 291, 591598.Google Scholar
Slachevsky, A. et al. (2004). Frontal Assessment Battery and differential diagnosis of frontotemporal dementia and Alzheimer disease. Archives of Neurology, 61, 11041107.Google Scholar
Swanberg, M. M., Tractenberg, R. E., Mohs, R., Thal, L. J. and Cummings, J. L. 2004. Executive dysfunction in Alzheimer disease. Archives of Neurology, 61, 556560.CrossRefGoogle ScholarPubMed
Takagi, R., Kajimoto, Y., Kamiyoshi, S., Miwa, H. and Kondo, T. (2002). The frontal assessment battery at bedside (FAB) in patients with Parkinson's disease. No Shinkei, 54, 897902 (in Japan).Google Scholar
Warburton, E. et al. (1996). Noun and verb retrieval by normal subjects: studies with PET. Brain, 119, 159179.CrossRefGoogle ScholarPubMed
Yoshida, H. et al. (2009). Frontal Assessment Battery and brain perfusion imaging in early dementia. Dementia and Geriatric Cognitive Disorders, 27, 133138.CrossRefGoogle ScholarPubMed
Zadikoff, C., Lang, A. E. and Klein, C. (2005). Apraxia in movement disorders. Brain, 128, 14801497.Google Scholar