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Review
. 2024 Jun 16;3(2):e210.
doi: 10.1002/pcn5.210. eCollection 2024 Jun.

A systematic review of cognitive and behavioral tools to differentiate behavioral variant frontotemporal dementia from other conditions

Affiliations
Review

A systematic review of cognitive and behavioral tools to differentiate behavioral variant frontotemporal dementia from other conditions

Joshua Flavell et al. PCN Rep. .

Abstract

The behavioral variant of frontotemporal dementia (bvFTD) is thought to be the commonest clinical presentation of frontotemporal lobar degeneration and is predominantly characterized by changes in behavior. In patients lacking unequivocal biomarker evidence of frontotemporal neurodegeneration, the clinical diagnosis of bvFTD is often unstable. In response, we conducted a systematic review and critical appraisal of cognitive and behavioral tools that have sought to differentiate bvFTD from other conditions. A systematic literature review of PubMed, Scopus, and Web of Science was conducted on December 31, 2023 for cognitive and behavioral tools that differentiated bvFTD from other cohorts. Ninety-six studies were included. The quality appraisal of almost all studies was low and introduced a high risk of bias. The few studies that were of high quality had a prospective study design and recruited patients suspected (but not yet confirmed) to have bvFTD. These studies reported that behavioral tools (e.g., the Frontal Behavioral Inventory) and social cognition tests (e.g., the Ekman's Faces Test) had good test performance in differentiating bvFTD from a broad range of psychiatric and neurological conditions. Importantly, the review highlighted the extreme paucity of studies that have evaluated methods where, in Bayesian terms, there is genuine clinical uncertainty regarding a diagnosis of bvFTD. Most studies used healthy controls of typical Alzheimer's disease as comparators-groups that often have negligible pretest probability of bvFTD. In response, we propose a study design checklist for studies seeking to develop diagnostic algorithms in bvFTD research.

Keywords: cognition; diagnostic; frontotemporal dementias; review; tests.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) flow diagram. This figure depicts the PRISMA flow diagram of the studies identified, screened, and included.
Figure 2
Figure 2
Clinical tools. This figure depicts the number of cognitive, behavioral, and other clinical tools identified by this review.
Figure 3
Figure 3
Summary of test performance for the main comparator cohorts. This figure depicts the diagnostic accuracy of tests in differentiating behavioral variant frontotemporal dementia (BvFTD) from other groups through Forest plots. Each point represents the area under the curve (AUC) value for tests assessing executive function, social cognition, other cognitive, behavioral, and other clinical tools with the horizontal lines indicating 95% confidence intervals. Mean (range) shows the average and variability of the AUC between studies.
Figure 4
Figure 4
Risk of bias. This figure depicts the risk of bias of the included studies according to the Quality Assessment of Diagnostic Accuracy Studies 2 quality appraisal tool.

References

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