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Diagnostic properties of the Frontal Assessment Battery (FAB) in Huntington's disease
Federica Solca1, Edoardo Nicolò Aiello1,2, Simone Migliore3
1Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy.
Insights
The Frontal Assessment Battery (FAB) effectively distinguishes Huntington
Area of Science:
- Neuropsychology
- Neurology
- Clinical Diagnostics
Background:
- Huntington's disease (HD) is a neurodegenerative disorder impacting cognitive function.
- Early and accurate cognitive assessment is crucial for managing HD patients.
- The Frontal Assessment Battery (FAB) is a tool for evaluating executive functions.
Purpose of the Study:
- To evaluate the diagnostic accuracy of the FAB in differentiating healthy controls (HCs) from HD patients.
- To assess the FAB's ability to identify cognitive impairment within the HD patient cohort.
- To compare the FAB's performance against the Unified Huntington's Disease Rating Scale cognitive section (UHDRS-II).
Main Methods:
- A case-control study comparing 38 HD patients and 73 HCs using the FAB.
- Receiver-operating characteristic (ROC) analyses were employed to determine sensitivity, specificity, and predictive values.
- Patients also completed the Montreal Cognitive Assessment (MoCA) and UHDRS.
Main Results:
- The FAB demonstrated strong accuracy in discriminating between HCs and HD patients (AUC = 0.86-0.88).
- The FAB effectively identified cognitive impairment in HD patients (AUC = 0.9-0.91), outperforming the UHDRS-II in some metrics.
- High sensitivity and specificity were observed for the FAB in both case-control and case-finding scenarios.
Conclusions:
- The Frontal Assessment Battery (FAB) is a feasible and accurate tool for cognitive screening in Huntington's disease.
- The FAB provides reliable diagnostic information for both distinguishing HD patients from controls and identifying cognitive deficits within the patient population.
- The FAB's performance supports its utility in routine clinical practice for HD cognitive assessment.
Background:
This study aimed at assessing the diagnostic properties of the Frontal Assessment Battery (FAB) as to its capability to (1) discriminate healthy controls (HCs) from patients with Huntington's disease (HD) and (2) identify cognitive impairment in this population.
Materials:
Thirty-eight consecutive HD patients were compared to 73 HCs on the FAB. Patients further underwent the Montreal Cognitive Assessment (MoCA) and the Unified Huntington's Disease Rating Scale (UHDRS). Receiver-operating characteristics (ROC) analyses were run to assess both intrinsic-i.e., sensitivity (Se) and specificity (Sp), and post-test diagnostics, positive and negative predictive values (PPV; NPV) and likelihood ratios (LR+; LR-), of the FAB both in a case-control setting and to identify, within the patient cohort, cognitive impairment (operationalized as a below-cut-off MoCA score). In patients, its diagnostic accuracy was also compared to that of the cognitive section of the UHDRS (UHDRS-II).
Results:
The FAB and UHDRS-II were completed by 100 and 89.5% of patients, respectively. The FAB showed optimal case-control discrimination accuracy (AUC = 0.86-0.88) and diagnostic properties (Se = 0.68-0.74; Sp = 0.88-0.9; PPV = 0.74-0.8; NPV = 0.84-0.87; LR+ = 5.6-7.68; LR- = 0.36-0.29), performing even better (AUC = 0.9-0.91) at identifying cognitive impairment among patients (Se = 0.73-1; Sp = 0.86-0.71; PPV = 0.79-0.71; NPV = 0.82-1; LR+ =5.13-3.5; LR- = 0.31-0) and comparably to the UHDRS-II (89% vs. 85% of accuracy, respectively; p = 0.46).
Discussion:
In HD patients, the FAB is highly feasible for cognitive screening aims, being also featured by optimal intrinsic/post-test diagnostics within both case-control and case-finding settings.
