Medical Student Research Fellowship for Summer 2003

Mentor: Anne M. Lipton, M.D., Ph.D.
Department: Neurology
Phone: 648-7467

Two projects:

Project I Title: Comparison of Frontal Assessment Battery (FAB) Scores in Alzheimer's disease (AD) and Frontotemporal dementia (FTD)

Introduction: The FAB is a short bedside cognitive and behavioral battery to assess frontal functions. It has been shown to have good interrater reliability, internal consistency, and discriminant validity in distinguishing control subjects from patients with frontal dysfunction. It also has good concurrent validity as demonstrated by a high correlation with performance on the Mattis Dementia Rating Scale and the Wisconsin Card Sorting Test (WCST), independent of the Mini-Mental State Examination (MMSE). Thus, the FAB is a useful test of executive dysfunction independent of global cognitive deterioration.

Patients with AD have variable executive/frontal deficits, and performance on the FAB in this population is unknown. Determination of cut-off scores that can distinguish patients with predominant frontal dysfunction from those with AD will enhance the clinical utility of this instrument. The FAB may also be useful in distinguishing subtypes of FTD.

Specific Aims: The objective of this study is to compare scores and subscores of the FAB in a group of AD patients and a group of subjects with FTD. Cutoff scores for diagnosis will be determined in addition to identifying which subtests of the FAB are most useful in clinical differentiation of these groups. A secondary aim is to determine whether the FAB or its subscales can distinguish the behavioral and language subtypes of FTD.

Research Plan: Two board-certified neurologists routinely administer the FAB to patients enrolled at the UT-Southwestern Alzheimer's Disease Center. FAB total and subscale scores will be collected and entered into a computer database. The ADC database will be reviewed for each patient to collect such demographic and clinical factors as age, gender, race, and education as well as diagnosis and scores of tests such as the MMMSE and WCST. Following data collection, statistical analysis will be performed. Planned statistical tests include analysis of covariance to determine discriminant validity, using such variables as age, gender, race, and education as covariates. Multiple regression will be performed to evaluate the influence of such independent variables as age, MMSE score, and number of errors on the WCST.

Significance: Determining clinical validity of the FAB in AD and FTD will further the clinical utility of this instrument and enable clinicians to identify dementia subtypes more readily.

Project II Title: Volumetric morphometry of the hippocampus in Alzheimer's disease

Human subjects IRB approved project number (where applicable): 0484 35000

Animal subjects IRB approved project number (where applicable):

Project Type (patient-based research, animal-based research, or basic research; this characterization is only to permit a general classification for grouping similar types of projects)

Brief Description of Project:
Student will be trained on software for volumetric measurements of brain regions of interest. Voxel measurements will be made of the hippocampus in AD and control subjects. Hippocampal volumes will be compared between groups and between right and left sides in individual subjects and groups.

Previous Research Activities or Publications with Medical Students:
Work with Raul Benavides, 2002 UTSW Summer Research Program:

Lipton AM, Benavides R. Neuroimaging shows greater lateralization in autopsy-proven FTD than AD. Platform presentation at the 4th International Conference on Frontotemporal Dementias, Lund, Sweden, April 24-26, 2003.

Lipton AM, Benavides R, Hynan LS. Disease duration is shorter in Frontotemporal dementia than in Alzheimer's disease. Neurology 2003;60(S1):A377.

Lipton, AM, Benavides R, Hynan L. Disease duration is shorter in Frontotemporal dementia than in Alzheimer disease. Presented at the Frontotemporal dementia/Pick's Disease Conference, London, Ontario, September 13-15, 2002, and the American Academy of Neurology meeting, Honolulu, Hawaii, March 29-April 5, 2003.

Devi Saha, a visiting student from New York Medical College, worked with me in Summer 2000 and won the Student Research Prize at her institution based on a presentation of her summer research project on lateralization in Alzheimer's disease.

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