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The cognitive profile of behavioural variant FTD and its similarities with ALS: a systematic review and meta-analysis
  1. Emma Beeldman1,
  2. Joost Raaphorst2,
  3. Michelle Klein Twennaar1,
  4. Rosanne Govaarts1,
  5. Yolande A L Pijnenburg3,
  6. Rob J de Haan4,
  7. Marianne de Visser1,
  8. Ben A Schmand5
  1. 1Department of Neurology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
  2. 2Department of Neurology, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Centre, Nijmegen, The Netherlands
  3. 3Department of Neurology, VU medical center, VU University, Amsterdam, The Netherlands
  4. 4Clinical Research Unit, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
  5. 5Department of Medical Psychology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
  1. Correspondence to Emma Beeldman, Department of Neurology, Academic Medical Center, University of Amsterdam, Amsterdam 22700, The Netherlands; e.beeldman{at}amc.uva.nl

Abstract

Approximately 30% of patients with amyotrophic lateral sclerosis (ALS) have cognitive impairment and 8%–14% fulfil the criteria for behavioural variant frontotemporal dementia (bv-FTD). The cognitive profiles of ALS and bv-FTD have been reported to be comparable, but this has never been systematically investigated. We aimed to determine the cognitive profile of bv-FTD and examine its similarities with that of ALS, to provide evidence for the existence of a cognitive disease continuum encompassing bv-FTD and ALS. We therefore systematically reviewed neuropsychological studies on bv-FTD patients and healthy volunteers. Neuropsychological tests were divided in 10 cognitive domains and effect sizes were calculated for all domains and compared with the cognitive profile of ALS by means of a visual comparison and a Pearson’s r correlation coefficient. We included 120 studies, totalling 2425 bv-FTD patients and 2798 healthy controls. All cognitive domains showed substantial effect sizes, indicating cognitive impairment in bv-FTD patients compared to healthy controls. The cognitive domains with the largest effect sizes were social cognition, verbal memory and fluency (1.77–1.53). The cognitive profiles of bv-FTD and ALS (10 cognitive domains, 1287 patients) showed similarities on visual comparison and a moderate correlation 0.58 (p=0.13). When social cognition, verbal memory, fluency, executive functions, language and visuoperception were considered, i.e. the cognitive profile of ALS, Pearson’s r was 0.73 (p=0.09), which raised to 0.92 (p=0.03), when language was excluded in this systematic analysis of patients with a non-language subtype of FTD. The cognitive profile of bv-FTD consists of deficits in social cognition, verbal memory, fluency and executive functions and shows similarities with the cognitive profile of ALS. These findings support a cognitive continuum encompassing ALS and bv-FTD.

  • frontotemporal dementia
  • motor neuron disease
  • cognition

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Footnotes

  • Contributors EB was involved in the study concept, literature search, analysis and interpretation of the data, statistical analysis, drafting/revising the manuscript for content and study coordination. JR was involved in the study concept, analysis and interpretation of the data and drafting/revising the manuscript for content. MKT was involved in the literature search, analysis and interpretation of the data and drafting/revising the manuscript for content. RG was involved in the literature search, analysis and interpretation of the data and drafting/revising the manuscript for content. YALP was involved in the analysis and interpretation of the data, statistical analysis and drafting/revising the manuscript for content. RJdH was involved in the analysis and interpretation of the data, statistical analysis and drafting/revising the manuscript for content. MdV was involved in the analysis and interpretation of the data, statistical analysis and drafting/revising the manuscript for content. BAS was involved in the analysis and interpretation of the data, drafting/revising the manuscript for content and study coordination.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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