Assessment of Frontal Lobe Functions in Geriatric Patients

Recommended Bedside Tests

The American Academy of Neurology recommends using the Frontal Assessment Battery (FAB), Luria's test for motor sequences and loops, and the Go/No-Go test as primary bedside instruments for assessing frontal lobe functions in geriatric patients 1, 2
FAB is a validated tool for assessing frontal lobe functions, taking around 10 minutes to administer and including six subtests, which evaluate conceptualization, mental flexibility, motor programming, interference sensitivity, inhibitory control, and environmental autonomy 3
The Luria test for motor sequences and loops is a simple and effective method for assessing executive functions at the bedside, evaluating motor programming and the ability to perform sequential actions 1, 2
The Go/No-Go test assesses the ability to inhibit and control impulses, and is a sensitive indicator of frontal lobe dysfunction 1, 2

The Montreal Cognitive Assessment (MoCA) is more sensitive to detecting mild cognitive impairment than the MMSE, and includes an assessment of executive functions, which are often impaired in frontal lobe pathology 4
Verbal fluency, especially letter fluency, is a useful tool for assessing frontal lobe functions, and the letter fluency test is particularly useful in the differential diagnosis of behavioral variant frontotemporal dementia 1
The Hayling sentence completion test is sensitive to frontal lobe dysfunction and useful in differential diagnosis, evaluating the ability to inhibit verbal responses 1
The Trail Making Test – part B assesses cognitive flexibility and attention switching, and is particularly useful in the differential diagnosis of behavioral variant frontotemporal dementia 1
The Stroop test evaluates selective attention and cognitive control, and is sensitive to frontal lobe dysfunction 1

Initial assessment: Use a general screening test (MoCA, ACE-III, or DCQ) 1, 2
If no abnormalities are found on general screening: Add a specific executive function test (FAB, FES) or bedside executive function tests (Luria test, Go/No-Go) 1, 2
In diagnostically uncertain cases: Supplement bedside screening tests with a neuropsychological assessment testing all domains 1

Diagnosis should not be based solely on the results of a global cognitive screening test 1
Serial/longitudinal neuropsychological assessments are preferable to single assessments 1
Combining cognitive tests with functional screenings and informant reports may improve detection of cases among individuals with cognitive difficulties 3