Is the Frontal Assessment Battery reliable in ALS patients?

The assessment of frontal functions in ALS patients is important because of the overlap with the behavioural variant of frontotemporal dementia (bvFTD). We investigated the applicability and reliability of the Frontal Assessment Battery (FAB) within a cohort of predominantly prevalent ALS patients. The FAB was administered to 85 ALS patients and eight ALS-bvFTD patients. Original scores and the percentage of items that could be performed were recorded. Item-adjusted scores of the FAB were calculated. The ALS Functional Rating Scale-Revised version (ALSFRS-R) was used to assess disease severity. Eighty-seven patients (94%) had ALS symptoms of more than one year. Twenty patients (21.5%) were not able to perform one or more FAB items. The original FAB score correlated with the ALSFRS-R score (r = 0.30; p < 0.01), while the item-adjusted FAB score did not. In contrast to the original FAB scores, the item-adjusted FAB score was lower in ALS-bvFTD patients (66.7, range 33.3-100) compared to ALS patients without bvFTD (94.4, range 38.9-100; p < 0.01). In summary, 20% of prevalent ALS patients could not complete the FAB, which limits its use in ALS and emphasizes the importance of disease specific instruments and adjusting for motor impairment in cognitive and behavioural examinations of ALS patients.