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Multicenter Study
. 2021;79(4):1735-1745.
doi: 10.3233/JAD-201088.

Improving the Diagnosis of the Frontal Variant of Alzheimer's Disease with the DAPHNE Scale

Elsa Lehingue  1 , Julien Gueniat  2 , Sandra Jourdaa  3 , Jean BenoÎt Hardouin  4   5 , Amandine Pallardy  6 , Hélène Courtemanche  7   8 , Laëtitia Rocher  7   8 , Frédérique Etcharry-Bouyx  9 , Sophie Auriacombe  10 , Hélène Mollion  1 , Maité Formaglio  1 , Olivier Rouaud  11 , Cédric Bretonnière  8 , Catherine Thomas-Antérion  12 , Claire Boutoleau-Bretonnière  7   8
Affiliations
Multicenter Study

Improving the Diagnosis of the Frontal Variant of Alzheimer's Disease with the DAPHNE Scale

Elsa Lehingue et al. J Alzheimers Dis. 2021.

Abstract

Background: The frontal variant of Alzheimer's disease (fAD) is poorly understood and poorly defined. The diagnosis remains challenging. The main differential diagnosis is the behavioral variant of frontotemporal degeneration (bvFTD). For fAD, there is some dissociation between the clinical frontal presentation and imaging and neuropathological studies, which do not always find a specific involvement of the frontal lobes. DAPHNE is a behavioral scale, which demonstrated excellent performance to distinguish between bvFTD and AD.

Objective: The aim of the present study was to assess the reliability of this new tool to improve the clinical diagnosis of fAD.

Methods: Twenty fAD patients and their caregivers were prospectively included and were compared with 36 bvFTD and 22 AD patients.

Results: The three main behavioral disorders in the fAD patients were apathy, loss of empathy, and disinhibition. Three disorders were discriminant because they were less frequent and less severe in the fAD patients than in the bvFTD patients, namely hyperorality, neglect, and perseverations. This specific pattern of behavioral disorders was corroborated by SPECT or 18FDG PET-CT scan that showed that patients with fAD could have a medial frontal hypoperfusion, whereas in bvFTD patients the orbitofrontal cortex was the main involved region, with more diffuse hypoperfusion.

Conclusion: We demonstrated that DAPHNE had good sensitivity and good specificity to discriminate between the three groups and in particular between fAD and bvFTD patients. DAPHNE is a quick tool that could help clinicians in memory clinics not only to differentiate bvFTD from typical AD but also from fAD.

Keywords: Alzheimer’s disease; behavioral disorders; frontotemporal dementia; scale.

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Conflict of interest statement

Authors’ disclosures available online (https://www.j-alz.com/manuscript-disclosures/20-1088r2).

Figures

Fig.1
Fig.1
Mean score for the 6 domains of DAPHNE-6 scale for the 3 groups. AD, Alzheimer’s disease; fAD, frontal Alzheimer’s disease; FTD, behavioral variant frontotemporal dementia. The x-axis represents a maximum value of 1 for each of the six domains of DAPHNE-6. For each domain, the score was significantly different between the three groups (Kruskal-Wallis; all p values < 10-3) except for apathy.
Fig.2
Fig.2
Mean scores for the ten items of DAPHNE for fAD and bvFTD patients. fAD, frontal Alzheimer’s disease; FTD, behavioral variant frontotemporal dementia. The y-axis (theoretical maximum value of 4) was censored, considering the highest mean observed. * indicates a significant statistical difference with a p-value<0.05. ** indicates a significant statistical difference with a p-value<0.01. Cohen’s d for spending, loss of initiative, eating disorders, bulimia, and personal neglect are respectively 0.56, 0.67, 0.75, 0.87, and 0.91.
See this image and copyright information in PMC

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