Clinical update on frontotemporal dementia: diagnosis and treatment.

OBJECTIVES: To provide a clinical update for general psychiatrists on frontotemporal dementias (FTDs) using a selective narrative review of recent findings and advances in conceptualising, diagnosing and treating FTD. CONCLUSIONS: General psychiatrists can apply their skills to support patients, carers, GPs and allied health workers in comprehensive care of persons with FTD.

Validity and reliability of the Behavioural Assessment Tool for Cognition and Higher Function (BATCH) in neuropsychiatric patients.

OBJECTIVE: Patients with mental health disorders frequently have difficulties with their cognitive functioning. Assessment of cognition in this population can be complicated by psychiatric symptomatology, making standard written and verbal assessment methods difficult. In these situations, observations by nursing and allied staff of patients' routine activities provide an important source of information about cognitive ability. The Behavioural Assessment Tool for Cognition and Higher Function (BATCH) was developed to record observations of patients' daily functioning under subheadings that reflect cognitive domains. Its capacity to provide a measure of cognitive function through observational means was assessed in a neuropsychiatric unit. METHOD: A consecutive sample of 76 adult neuropsychiatry inpatients were assessed over 6 months using BATCH. BATCH measures the frequency of given behaviours grouped under 10 functional and cognitive domains: orientation, attention/concentration, personal responsibility, volition, adaptation, problem-solving/judgement, executive function, memory, language, and visuospatial function. Data from routine standardized cognitive (Mini-Mental Status Examination, MMSE; Neuropsychiatry Unit Cognitive Screening Tool, NUCOG), psychiatric (Neuropsychiatric Inventory; Health of the Nation Outcome Scale) and functional (Bristol Activities of Daily Living Scale; Barthel Index) instruments were collected to determine the relative contribution of cognitive function to scores on the BATCH. RESULTS: A strong correlation was found between total BATCH scores and total NUCOG and MMSE scores. BATCH and NUCOG subdomains correlated significantly in all subscales. BATCH demonstrated very high internal consistency. Linear regression analysis showed that the strongest determinant of BATCH scores was cognitive function as measured on the NUCOG. A significant subscale x group effect showed lower BATCH scores in memory, orientation, attention, executive function and language in dementia sufferers compared to psychiatric and neurological patient groups. CONCLUSION: BATCH scores correlated strongly with pencil-and-paper measures of cognitive function. BATCH provides clinicians with a means of assessing cognitive function through behavioural observation, thus enabling assessment of patients with behavioural disturbance or severe psychopathology. This tool has practical application for adult and aged clients across all observational mental health settings.

The development and validation of a carer questionnaire to assess cognitive function in neuropsychiatric patients.

OBJECTIVES: The carer history is an integral part of the assessment of patients with cognitive impairment. We aimed to develop a comprehensive yet concise carer questionnaire, the CogRisk, which captures actuarial risk variables for cognitive impairment in addition to key symptoms suggestive of cognitive decline in a number of cognitive domains, and to then assess its validity and reliability in a neuropsychiatric population. METHOD: Carers of patients assessed for cognitive impairment completed the CogRisk, and patients were clinically assessed using the Mini-Mental State Examination (MMSE) and Neuropsychiatry Unit COGnitive assessment tool (NUCOG). Reliability was assessed using test-retest and interrater measures and measures of internal consistency. Construct and concurrent validity was assessed using correlation between total and subscale scores on the CogRisk, total scores on the NUCOG and MMSE, and subscale scores on the NUCOG. Predictive validity was determined using measures of sensitivity and specificity and using receiver operating characteristic (ROC) methods. RESULTS: The CogRisk was completed by all carers in less than 10 min. The total CogRisk score correlated significantly with total MMSE and NUCOG scores (r=-0.511 and -0.563, respectively) and remained highly significant when age and education were controlled for. Internal consistency of CogRisk items was high (alpha=0.943). Intrarater reliability of the CogRisk was high with an intraclass correlation coefficient of .978 (P<.001), and interrater reliability between carers was also high at 0.868 (P<.05). Sensitivity and specificity for the detection of dementia were .70 and .73, respectively, with area under the ROC curve not significantly different from that of the MMSE or NUCOG. CONCLUSION: The CogRisk is a brief carer-rated tool of a patient's cognitive functioning developed for use within a neuropsychiatric setting. It exhibited good concurrent validity, internal consistency, and interrater and intrarater reliability. The CogRisk also demonstrated good sensitivity and specificity for dementia. The CogRisk provides carer information, which complements the clinical assessment and can be used to focus on direct carer interview.

Recovery of cognitive function in neuropsychiatric Langerhan's cell histiocytosis.

Langerhan's cell histiocytosis (LCH) has been described as a progressive neurological disorder marked by neurological and cognitive decline. The authors here report a case of a childhood LCH sufferer who made a significant recovery of neuropsychological function in the absence of motor recovery in late adolescence. This differential recovery of motor and cognitive functioning may relate to the interaction between LCH and childhood and adolescent neurodevelopmental processes.