Comparison of Design Fluency Test results among patients with Parkinson’s disease, frontotemporal dementia, and the control group

Document Type : Original Article

Authors

1 Department of Psychiatry, Isfahan University of Medical Sciences, Isfahan, Iran

2 Department of Health Psychology, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran

3 Department of Epidemilogy and Biostatistics, School of Public Health, Isfahan University of Medical Sciences, Isfahan, Iran

4 Neuropsychiatry Unit, Kashani Hospital, Isfahan University of Medical Sciences, Isfahan, Iran

Abstract

Background: Design Fluency Test (DFT) is a nonverbal frame-free, nonstructured assessment of executive function (EF). Since previous studies evaluating EF in Parkinson's disease (PD) have mainly used verbal assessments for EF, this study aims to evaluate the pattern of executive domains in PD using DFT and to compare it with behavioral variant frontotemporal dementia (FTD) as a prototype for executive dysfunction and also with normal controls (NCs). Materials and Methods: Twenty-eight patients with PD, 27 with FTD, and 27 NCs were included in the study in Ayatollah Kashani Neuropsychiatry Clinic affiliated to Isfahan University of Medical Sciences from September 2019 to February 2020. All participants were assessed via semi-structured neuropsychiatric interview, questionnaire for demographic profile (age, handedness, gender, education, and marital status), duration of illness, comorbid medical condition, comorbid psychiatric illnesses and medications, DFT, Short Parkinson's Evaluation Scale, Frontal Assessment Battery, Judgment of Line Orientation, and Neuropsychiatry Unit Cognitive Assessment Tool. Results: Fixed condition novelty score was significantly different between FTD and PD (P < 0.001), FTD and control (P < 0.001), and also between PD and control (P = 0.001). When free and fixed condition novelty scores were considered to predict diagnostic attribution, multinomial logistic regression revealed that odds ratio for free condition novelty score was 0.705 (P = 0.005, 95% confidence interval [CI] = 0.553–0.899) and 0.494 (P = 0.001, 95% CI = 0.328–0.744) in PD and FTD, respectively. The odds ratio for fixed condition novelty score was 0.772 (P = 0.011, 95% CI = 0.632–0.942) and 0.449 (P = 0.00, 95% CI = 0.292–0.691). Conclusion: DFT subscores can be helpful in diagnosis and differentiation between FTD and PD.

Keywords

1.
Balestrino R, Schapira AHV. Parkinson disease. Eur J Neurol 2020;27:27-42.  Back to cited text no. 1
    
2.
Nelson TJ, Truong T, Truong B, Bilyeu CV, Zhao J, Stains CI. A luminescence-based assay for monitoring changes in alpha-synuclein aggregation in living cells. RSC Adv 2020;10:16675-8.  Back to cited text no. 2
    
3.
Ball N, Teo WP, Chandra S, Chapman J. Parkinson's disease and the environment. Front Neurol 2019;10:218.  Back to cited text no. 3
    
4.
Marino BL, de Souza LR, Sousa KP, Ferreira JV, Padilha EC, da Silva CH, et al. Parkinson's disease: A review from pathophysiology to treatment. Mini Rev Med Chem 2020;20:754-67.  Back to cited text no. 4
    
5.
Cinar E, Yalcin-Cakmakli G, Saka E, Ulusoy A, Yuruker S, Elibol B, et al. Modelling cognitive deficits in Parkinson's disease: Is CA2 a gateway for hippocampal synucleinopathy? Exp Neurol 2020;330:113357.  Back to cited text no. 5
    
6.
Armstrong MJ, Okun MS. Diagnosis and treatment of Parkinson disease: A review. JAMA 2020;323:548-60.  Back to cited text no. 6
    
7.
Elia LP, Reisine T, Alijagic A, Finkbeiner S. Approaches to develop therapeutics to treat frontotemporal dementia. Neuropharmacology 2020;166:107948. doi: 10.1016/j.neuropharm.2020.107948. Epub 2020 Jan 8. PMID: 31962288.  Back to cited text no. 7
    
8.
Fogel Y, Rosenblum S, Hirsh R, Chevignard M, Josman N. Daily performance of adolescents with executive function deficits: An empirical study using a complex-cooking task. Occup Ther Int. 2020 Feb 6;2020:3051809. doi: 10.1155/2020/3051809. PMID: 32099539; PMCID: PMC7026736.  Back to cited text no. 8
    
9.
Li S, Ou R, Yuan X, Liu H, Hou Y, Wei Q, et al. Executive dysfunctions and behavioral changes in early drug-naïve patients with Parkinson's disease. J Affect Disord 2019;243:525-30.  Back to cited text no. 9
    
10.
Meyer A, Zimmermann R, Gschwandtner U, Hatz F, Bousleiman H, Schwarz N, Fuhr P. Apathy in Parkinson's disease is related to executive function, gender and age but not to depression. Front Aging Neurosci 2015;6:350.  Back to cited text no. 10
    
11.
Jaywant A, Musto G, Neargarder S, Gilbert KS, Cronin-Golomb A. The effect of Parkinson's disease on verbal and non-verbal fluency. J Clin Neuropsychol 2014;36:278-89.  Back to cited text no. 11
    
12.
Marin D, Madotto E, Fabbro F, Skrap M, Tomasino B. Design fluency and neuroanatomical correlates in 54 neurosurgical patients with lesions to the right hemisphere. J Neurooncol 2017;135:141-50.  Back to cited text no. 12
    
13.
Kuiper JS, Oude Voshaar RC, Verhoeven FE, Zuidema SU, Smidt N. Comparison of cognitive functioning as measured by the ruff figural fluency test and the CogState computerized battery within the LifeLines Cohort Study. BMC Psychol 2017;5:15.  Back to cited text no. 13
    
14.
Harter SL, Hart CC, Harter GW. Expanded scoring criteria for the design fluency test: Reliability and validity in neuropsychological and college samples. Arch Clin Neuropsychol 1999;14:419-32.  Back to cited text no. 14
    
15.
Marinus J, Visser M, Stiggelbout AM, Rabey JM, Martínez-Martín P, Bonuccelli U, Kraus PH, van Hilten JJ. A short scale for the assessment of motor impairments and disabilities in Parkinson's disease: the SPES/SCOPA. J Neurol Neurosurg Psychiatry. 2004;75:388-95.  Back to cited text no. 15
    
16.
Barekatain M, Walterfang M, Behdad M, Tavakkoli M, Mahvari J, Maracy MR, et al. Validity and reliability of the Persian language version of the neuropsychiatry unit Cognitive Assessment Tool. Dement Geriatr Cogn Disord 2010;29:516-22.  Back to cited text no. 16
    
17.
Asaadi S, Ashrafi F, Omidbeigi M, Nasiri Z, Pakdaman H, Amini-Harandi A. Persian version of frontal assessment battery: Correlations with formal measures of executive functioning and providing normative data for Persian population. Iran J Neurol 2016;15:16-22.  Back to cited text no. 17
    
18.
Gullett JM, Price CC, Nguyen P, Okun MS, Bauer RM, Bowers D. Reliability of three Benton Judgment of line orientation short forms in idiopathic Parkinson's disease. Clin Neuropsychol 2013;27:1167-78.  Back to cited text no. 18
    
19.
Jones-Gotman M, Milner B. Design fluency: The invention of nonsense drawings after focal cortical lesions. Neuropsychologia 1977;15:653-74.  Back to cited text no. 19
    
20.
Varney NR, Roberts RJ, Struchen MA, Hanson TV, Franzen KM, Connell SK. Design fluency among normals and patients with closed head injury. Arch Clin Neuropsychol 1996;11:345-53.  Back to cited text no. 20
    
21.
Uysal-Cantürk P, Hanağası HA, Bilgiç B, Gürvit H, Emre M. An assessment of movement disorder society task force diagnostic criteria for mild cognitive impairment in Parkinson's disease. Eur J Neurol 2018;25:148-53.  Back to cited text no. 21
    
22.
Bezdicek O, Růžička F, Fendrych Mazancova A, Roth J, Dušek P, Mueller K, et al. Frontal assessment battery in Parkinson's disease: Validity and morphological correlates. J Int Neuropsychol Soc 2017;23:675-84.  Back to cited text no. 22
    
23.
Jaywant A, Musto G, Neargarder S, Gilbert KS. The effect of Parkinson's disease subgroup on verbal and non-verbal fluency. J clin Exp Neuropsychol 2014;36:278-89.  Back to cited text no. 23
    
24.
Koerts J, Van Beilen M, Tucha O, Leenders KL, Brouwer WH. Executive functioning in daily life in Parkinson's disease: Initiative, planning and multi-task performance. PLoS One 2011;6:e29254.  Back to cited text no. 24