A valid measure of the right hemispheric lateral frontal lobe dysfunction, specifically of focal lesions near the anterior insula, in the MFG and in the IFG (Hurtado-Pomares et al., 2018).  It takes 10 minutes to administer and has good inter-rater reliability (kappa = 0.87, p < 0.001) and internal consistency (Cronbach's alpha = 0.78)(Dubois et al., 2000). The Frontal assessment battery is to administer at the bedside.

Authors

• Dubois B; Litvan I; Pillon B; Slachevsky A

Copyright

• Public domain

Scoring and Interpretation 

(Slachevsky et al., 2004)

• We score each of the six items 0 to 3.
• Patients with frontal deficits perform worse.  
• From a maximum of 18,
• A cut-off score of 12 for differentiating frontal dysexecutive type dementias and dementia of Alzheimer’s type.
• A sensitivity of 77% and specificity of 87%

Clinical Uses 

(Dubois et al., 2000; Hurtado-Pomares et al., 2018; Slachevsky et al., 2004)

• Screening for frontotemporal dementia,
• Distinguishing FTD from AD
• Frontal lobe dysfunction in schizophrenia,
• Executive dysfunction seen in Parkinson’s and substance dependence.
• Supranuclear palsy

Items

• Similarities
• Lexical fluency
• Motor series
• Conflicting instructions
• Go/No-Go
• Prehension behavior

Components and Scoring

Similarities

Ask the patient “In what way are they alike?”:

• A banana and an orange (answer: fruits)
• A table and a chair (answer: furniture)
• A tulip, a rose and a daisy (answer: flowers)

Scoring

If the patient says “they are not alike” (total failure) or “both have peels” (partial failure) help the patient with a prompt by saying: “both a banana and an orange are…” However, credit 0 points for the first item. Do not help the patient for the last two items after this. 

• Three correct:                               3 points
• Two correct:                                  2 points
• One correct:                                  1 point
• None correct:                                0 point

Lexical Fluency

Tell the patient: “Say as many words as you can beginning with the letter 'S,' any words except surnames or proper nouns.” The time allowed is 60 seconds.

Scoring

If the patient gives no response during the first 5 seconds, say: “for instance, snake.” If the patient pauses for 10 seconds, prompt them by saying: “any word beginning with the letter 'S.'” Word repetitions or variations (i.e. - “shoe,” “shoemaker”), surnames, or proper nouns are not counted as correct responses.

• More than nine words: 3
• Six to nine words: 2
• Three to five words: 1
• Less than three words: 0

Motor Series ("Luria's Test")

Tell the patient: “Look carefully at what I’m doing.”

• The examiner, seated in front of the patient, performs alone three times using the left hand the series of Luria motions of “fist–edge-palm.” Prompt the patient: “Now, with your right hand do the same series, first with me, then alone.”
• The examiner performs the series three times in total with the patient Now tell the patient: “Now, do it on your own.”
• Observe the patient's actions

Scoring

• Patient performs six correct consecutive series alone: 3
• Patient performs at least three correct consecutive series alone: 2
• Patient fails alone but performs three correct consecutive series with the examiner: 1
• Patient cannot perform three correct consecutive series even with the examiner: 0

Conflicting Instructions

• Tell the patient: “Tap twice when I tap once. “To be sure that the patient has understood the instructions, do a series of three trials run first: 1-1-1
• Tell the patient: “Tap once when I tap twice.” To be sure that the patient has understood the instruction, do a series of three trials run first: 2-2-2
• The examiner now performs the actual following series: 1-1-2-1-2-2-2-1-1-2

Scoring

• No error: 3
• One or two errors: 2
• Over two errors: 1
• Patient taps like the examiner at least four consecutive times: 0

Go–No Go

• Tell the patient: “Tap once when I tap once. “To be sure that the patient has understood the instruction, do a series of three trials run first: 1-1-1
• Tell the patient: “Do not tap when I tap twice. “To be sure that the patient has understood the instruction, do a series of three trials run first: 2-2-2.
• The examiner now performs the actual following series: 1-1-2-1-2-2-2-1-1-2

Scoring

• No error: 3
• One or two errors: 2
• Over two errors: 1
• Patient taps like the examiner at least four consecutive times: 0

Prehension Behavior

Tell the patient: “Do not take my hands.”

• The examiner is seated in front of the patient
• Place the patient’s hands palm up on his/her knees.
• Saying nothing or looking at the patient:
• the examiner brings his/her hands close to the patient’s hands
• and touches the palms of both the patient’s hands, to see if he/she will spontaneously take them.
• If the patient takes the hands, the examiner will try again after asking him/her: “Now, do not take my hands.”

Scoring

• Patient does not take the examiner’s hands: 3
• Patient hesitates and asks what he/she has to do: 2
• Patient takes the hands without hesitation: 1
• Patient takes the examiner’s hand even after he/she has been told not to do so: 0