Solca Federica, Aiello Edoardo Nicolò, Migliore Simone, Torre Silvia, Carelli Laura, Ferrucci Roberta, Priori Alberto, Verde Federico, Ticozzi Nicola, Maffi Sabrina, Ceccarelli Consuelo, Squitieri Ferdinando, Silani Vincenzo, Ciammola Andrea, Poletti Barbara
Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy.
PhD Program in Neuroscience, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.
Front Psychol. 2022 Nov 30;13:1031871. doi: 10.3389/fpsyg.2022.1031871. eCollection 2022.
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.
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).
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; = 0.46).
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.
本研究旨在评估额叶评估量表（FAB）的诊断特性，以确定其能否（1）区分健康对照者（HCs）与亨廷顿舞蹈症（HD）患者，以及（2）识别该人群中的认知障碍。
对38例连续的HD患者和73例HCs进行FAB评估。患者还接受了蒙特利尔认知评估（MoCA）和统一亨廷顿舞蹈症评定量表（UHDRS）。进行了受试者操作特征（ROC）分析，以评估FAB在病例对照研究中的内在诊断指标，即敏感性（Se）和特异性（Sp），以及检验后诊断指标，阳性和阴性预测值（PPV；NPV）和似然比（LR+；LR-），并在患者队列中识别认知障碍（以低于临界值的MoCA分数为操作定义）。在患者中，还将其诊断准确性与UHDRS认知部分（UHDRS-II）的准确性进行了比较。
分别有100%和89.5%的患者完成了FAB和UHDRS-II评估。FAB显示出最佳的病例对照区分准确性（AUC = 0.86 - 0.88）和诊断特性（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），在识别患者中的认知障碍方面表现更好（AUC = 0.9 - 0.91）（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），且与UHDRS-II相当（准确性分别为89%和85%；p = 0.46）。
在HD患者中，FAB对于认知筛查目的而言具有高度可行性，在病例对照和病例发现环境中均具有最佳的内在/检验后诊断特性。
