Frontal Lobe Resource Cover - Onehealth.ca

Frontal Lobe
Resource Package

Frontal vs. Alzheimer Dementia
FTD
Reduced speech output
Good comprehension
Personality changes early
Preserved spatial
orientation
Memory loss variable
Apraxia uncommon
Possible motor signs
AD
Fluent aphasia
Reduced comprehension
Personality changes late
Impaired spatial
orientation
Memory loss early
Apraxia common
Motor signs uncommon
early

Seniors’ Mental Health Programs Standardized Assessment Scales
ADMINISTRATION AND SCORING GUIDELINES
Scale/Screen:
Use(s):
The Executive Interview (EXIT)
A short screen (25 items) to detect possible frontal lobe
dysfunction.
To help predict executive cognitive function (ECF) related
impairments in self care and functional status.
To help predict behaviours caused by executive dyscontrol.
To help determine appropriate care strategies to prevent or
reduce problem behaviours.
Time Taken:
Rationale(s):
Commentary:
Approximately 15 minutes
The Folstein MMSE is relatively insensitive as a measure of frontal
lobe dysfunction. Some dementias present initially with personality
and behavioural changes related to frontal lobe dysfunction, rather
than the more familiar orientation and memory problems seen in
Alzheimer’s Disease. The EXIT is a valid and reliable tool to
identify and measure the severity of these problems.
It correlates well with level of care and problem behaviour
It discriminates people at earlier stages of cognitive impairment
than the SMMSE.
Executive dysfunction is common in dementia. The disturbed
behaviour in demented elderly may be a consequence of impaired
executive dysfunction. This influences a person’s independence by
interfering with directing, planning, execution, and self-regulation of
behaviour. The EXIT defines the behavioural consequence of
executive dysfunction and provides a standard clinical encounter in
which they can be observed.
“Executive Cognitive Function (ECF) are those processes which
orchestrate relatively simple ideas, movements, or actions into
complex goal directed behaviour. Without them, behaviour
important to independent living, such as cooking, dressing, or self
care can be expected to break down into their component parts.
We believe that executive deficits undermine the independence of
many patients and lead directly to the expression of common
behaviour problems in the nursing home.” (Donald R. Royall)
Enquiries: S.A.S. Committee Chair, c/o AHE Community Geriatric Psychiatry, (780) 424-4660

Seniors’ Mental Health Programs Standardized Assessment Scales
Administration:
Scoring:
The rules and time limits are outlined for each item in the
screen.
Practise administering the screen if you haven’t done one in the
past 2 weeks.
Keep continuity between the sections (i.e. cue yourself between
sections – use a red arrow to ensure you turn the page and
continue the test without a break between tasks).
Use a monotone, neutral voice.
Practise the gestures beforehand and know the type/how many
cues to give.
Explain to the person being tested that, “the reason for the
assessment is to help us better understand how you are able to
organize your thoughts to cope with everyday problems and
activities.” You can also say “parts of the assessment may
seem odd to you, but it all has a point, so do the best you can.”
Make comments on the side rather than scoring during
administration.
Pay attention to the behaviours seen and be prepared for
unusual responses (re: perseveration), so you can deal with
them while minimizing effects on standardized administration.
A scoring sheet is included in the screen format. Royall, Mahurin &
Gray did the original research with a population randomly selected
across 4 levels of care. EXIT scores greater than 15 were strongly
correlated with a variety of common disruptive behaviours. Interrater
reliability was high
(r = .90). EXIT scores correlated well with other measures of
Executive Cognitive Function (ECF).
Reference: Royall D.R., Mahurin R.K., Gray K.F., (1992) Bedside Assessment of
Executive Cognitive Impairment. The EXIT Interview. JAGS (Journal of the
American Geriatrics Society)
40: 1221-1226.
Tips on How to Administer The EXIT
Royall D.R., Cabello M., Polk M.J., (1998). Executive Dyscontrol: An
Important Factor Affecting The Level of are Received by Older Retirees.
JAGS 46:1519 –1524.
Updated: May 18, 2005
WP/SMHPCC/Guidelines – EXIT Test
Enquiries: S.A.S. Committee Chair, c/o AHE Community Geriatric Psychiatry, (780) 424-4660

The Executive Interview (EXIT)
Seniors‘ Mental Health Programs Standardized Assessment Scales
Global Testing Observations:
Check as many as observed during testing
Patient/Client Label
Perseveration
Date
Imitation Behavior
Intrusions
Diagnosis
Frontal Release Signs
Lack of Spontaneity/Prompting Needed
Disinhibited Behaviors
Education Level
Utilization Behavior
TOTAL SCORE
1. Number-Letter Task
—I‘d like you to say some numbers and letters for me like this.“
—1-A, 2-B, 3-what would come next“
—C“
—Now you try it starting with the number 1“. Keep going until I say —stop“.
1 2 3 4 5
A B C D E
—Stop“
SCORE 0 No errors
1 Complete task with prompting (or repeat instruction)
2 Doesn‘t complete task
Royall, D.R., Mahurin, R.K., and Gray, K.F., 1992 Page 1
Revised: May 18, 2005
Enquires: SAS Committee Chair/ Alberta Hospital Edmonton Community Geriatric Psychiatry, (780) 424-4660.

Seniors‘ Mental Health Programs Standardized Assessment Scales
2. Word Fluency
—I am going to give you a letter. You will have one minute to name as many words as you can
thinkofwhichbegin with thatletter.“
—For example, with the letter ”P‘ you could say ”Peter, pot, plant‘… and so on. Are you ready“
—Do you have any questions“
—The letter is œ A. Go!“
SCORE 0 10 or more words
1 5 to 9 words
2 Less than 5 words
3. Design Fluency
(Examiner draws while patient watches)
—Look at these pictures. Each is made with only four (4) lines. I am going to give you one
minute to draw as many DIFFERENT designs as you can. The only rules are that they must
each be different and be drawn with four lines. Now go!“
If patient cannot do due to poor vision, score 0
SCORE 0 10 or more unique drawings (no copies of examples)
1 5 to 9 unique drawings
2 Less than 5 unique drawings
4. Anomalous Sentence Repetition
—Listen very carefully and repeat these sentences exactly … (Read the sentence in a neutral
tone.) Can use any familiar, overlearned phrase that 1) has one word changed 2) is part of a
longer sequence, poem, prayer, etc.
a) —I pledge allegiance to those flags“ or — Oh Canada, your home and native land.“
b) —Mary fed a little lamb.“
c) —A stitch in time saves lives.“
d) —Tinkle tinkle little star.“
e) —A B C D U F G“
SCORE 0 No errors
1 Fails to make one or more changes
2 Continues with one or more expressions (e.g. —Mary had a little lamb whose fleece was white
as snow“)
Royall, D.R., Mahurin, R.K., and Gray, K.F., 1992 Page 2
Revised: May 18, 2005
Enquires: SAS Committee Chair/ Alberta Hospital Edmonton Community Geriatric Psychiatry, (780) 424-4660.

Seniors‘ Mental Health Programs Standardized Assessment Scales
5. Thematic Perception (see previous page)
(Patient shown picture by examiner) —Tell me what is happening in this picture.“
If patient cannot see picture due to poor vision, score 0
SCORE 0 Tells spontaneous story (story = setting,3 characters, action)
1 Tells story with prompting x 1 (—anything else“)
2 Fails to tell story despite prompt (patientmust name the setting)
6. Memory/Distraction Task
—Remember these three words.“ —BOOK, TREE,HOUSE“
(Patient repeats words till all three are registered).
—Remember them œ —I‘ll ask you to repeat them for me later.“
Now œ spell CAT for me …“
—Good. Now spell it backwards…“
—OK. Tell me those words we learned.
SCORE 0 Patient names one or all of the three words correctly without naming Cat (Examiner may
prompt: —Anything else“)
1 Other responses (describe:________________________________________)
2 Patient names CAT as one of the three words (perseveration)
7. Interference Task (see previous page)
—What color are these letters“ (Examinershows the patient and sweeps hand back and forth
over the letters.)
SCORE 0 —black“
1 —brown“ (repeat questions x1) —black“
2 —brown“(prompt) —brown“ (intrusion)
If patient names any other colour, score 0 but make a note of response.
Royall, D.R., Mahurin, R.K., and Gray, K.F., 1992 Page 3
Revised: May 18, 2005
Enquires: SAS Committee Chair/ Alberta Hospital Edmonton Community Geriatric Psychiatry, (780) 424-4660.

Seniors‘ Mental Health Programs Standardized Assessment Scales
8. Automatic Behavior I
(Patient holds hands forward palms down.)
—Relax while I check your reflexes…“
(Rotate patient’s arms one at a time at the elbow. Gauge patient’s active
participation/anticipation of the rotation.)
SCORE 0 Patient remains passive
1 Equivocal
2 Patient actively copies the circular motion
9. Automatic Behavior II
(Patient holds hands out palms up.)
—Just relax.“
(Examiner pushes down on patient’s hands – gently at first, becoming more forceful. Gauge
patient’s active participation in the responses.)
SCORE 0 Patient offers no resistance (remains passive)
1 Equivocalresponse
2 Actively resists (or complies)with examiner
10. Grasp Reflex
(Patient holds hand out with open palms down.)
—Just Relax.“
(Both palms are lightly stroked simultaneous by the examiner, who looks for grasping/gripping
actions in the fingers.)
SCORE 0 Absent
1 Equivocal
2 Present
Patient grasps firmly enough to drawn up and out of chair by examiner.
Royall, D.R., Mahurin, R.K., and Gray, K.F., 1992 Page 4
Revised: May 18, 2005
Enquires: SAS Committee Chair/ Alberta Hospital Edmonton Community Geriatric Psychiatry, (780) 424-4660.

Seniors‘ Mental Health Programs Standardized Assessment Scales
11. Social Habit I
Fix subject’s eyes. Silently count to three while maintaining subject’s gaze, then say “Thank
you.”
SCORE 0 Replies with a question (e.g. —Thank you for what“)
1 Other responses œ describe: _______________________________________
2 —You‘re welcome.“
12. Motor Impersistence
—Stick out your tongue and say ”aah‘ till I say stop…Go!“ (count to three silently)
(Subject must sustain a constant tone, not “ah…ah…ah…”)
SCORE 0 Completes taskspontaneously
1 Completes taskwith examiner modeling task for patient
2 Fails task despite modeling by examiner
13. Snout Reflex
—Just Relax.“
(Examiner slowly brings index finger towards patient’s lips, pausing momentarily 2” away.
Finger is then placed vertically across lips and then is lightly tapped with the other hand.
Observe lips for puckering.)
SCORE 0 Notpresent
1 Equivocal
2 Present
Suck reflex œ lips pucker while examiner is pausing 2“ away
14. Finger-Nose-Finger Task
(Examiner holds up index finger.)
—Touch my finger.“
(Leaving finger in place, examiner says…)
—Now touch your nose.“
SCORE 0 Patient complies, using same hand
1 Other response œ describe: _______________________________________
2 Patient complies, using other hand while continuing to touch examiner‘s finger
Royall, D.R., Mahurin, R.K., and Gray, K.F., 1992 Page 5
Revised: May 18, 2005
Enquires: SAS Committee Chair/ Alberta Hospital Edmonton Community Geriatric Psychiatry, (780) 424-4660.

15. Go/No-Go Task
Seniors‘ Mental Health Programs Standardized Assessment Scales
—Now…when I touch my nose, you raise your finger like this.“ (Examiner raises index finger.)
—When I raise my finger, you touch your nose like this.“ (Examiner touches nose with index
finger.)
(Have patient repeat instructions if possible.)
(Examiner begins task. Leave finger in place while awaiting patient’s response. After each
presentation, examiner puts his/her hand down.)
Examiner
Patient
F N F
N F N
F N F
F N F
N F N
SCORE 0 Performs sequence correctly
1 Correct, required prompting/repeat instructions
2 Fail sequence despite prompting/repeat instructions
16. Echopraxia
—Now listen carefully. I want you to do exactly what I say. Ready“
—Touch your ear.“ (Examiner touches his nose and keeps finger there.)
SCORE 0 Patient touches his ear
1 Other response _______________________________________________
(look for —mid-position“ stance)
2 Patient touches his nose
17. Luria Hand Sequence I
Palm/Fist
—Can you do this“
(Invite patient to watch while alternating palms/fist with either hand. Once patient begins, ask
patient to —Keep going“ while examiner stops. Count the number of successive palm/fist
cycles.)
SCORE 0 4 cycles without error after examiner stops
1 4 cycles with additional verbal prompt (—Keep going“) or modeling
2 Unsuccessful despite prompting/modeling (watch for —mid position“stances)
Royall, D.R., Mahurin, R.K., and Gray, K.F., 1992 Page 6
Revised: May 18, 2005
Enquires: SAS Committee Chair/ Alberta Hospital Edmonton Community Geriatric Psychiatry, (780) 424-4660.

18. Luria Hand Sequence II
3Hands
—Can you do this“
Seniors‘ Mental Health Programs Standardized Assessment Scales
(Examiner models: a) slap, b) fist, c) cut – while patient imitates each step)
—Now follow me.“ (Examiner begins to repeat sequence.)
—Keep doing this till I say stop.“ (Examiner stops.)
SCORE 0 3 cycles without error after examiner stops
1 3 cycles with additional verbal prompt (—Keep going“) or modeling
2 Unsuccessful
19. Grip Task
(Examiner presents hands to patient as shown below.)
—Squeeze my fingers.“
SCORE 0 Patient grips fingers
1 Other responses œ describe: _______________________________________
2 Patient pulls examiner‘s hands together
20. Echopraxia II
(Suddenly and without warning, the examiner slaps his hands together.)
SCORE 0 Patient does not imitate examiner
1 Patient hesitates, uncertain
2 Patient imitates slap
Royall, D.R., Mahurin, R.K., and Gray, K.F., 1992 Page 7
Revised: May 18, 2005
Enquires: SAS Committee Chair/ Alberta Hospital Edmonton Community Geriatric Psychiatry, (780) 424-4660.

21. Complex Command Task
Seniors‘ Mental Health Programs Standardized Assessment Scales
—Put your left hand on top of your head and close your eyes. That was good…“
(Examiner remains aloof, begins next task.)
SCORE 0 Patient stops when next task began
1 Equivocal œ holds posture during part of next task
2 Patient maintains posture through completion of next task œ has to be told to cease
(Quickly go on to next task)
22. Serial Order Reversal Task
(Have patient recite the months of the year)
—…Now start with January and say the months of the year backwards…“
SCORE 0 No errors, at least past September
1 Gets past September but requires repeat instructions (—Just start with January and say then all
backwards.“)
2 Can‘t succeed despite prompting. (Patient must start with January)
23. Counting Task I
(Examiner taps each picture around the figure in a clockwise direction.)
—Please count the fish in this picture out loud.“
SCORE 0 Four
1 Less than four
2 More than four
24. Utilization Behavior
(Examiner holds pen near point and dramatically “presents” it to the patient asking:)
—What is this called“
SCORE 0 —Pen“
1 Reaches,hesitates
2 Patient takes pen from examiner (utilization behavior)
25. Imitation Behavior
(Examiner flexes wrist up and down and points to it asking:)
—What is this called“
SCORE 0 —Wrist“
1 Other response œ describe: _______________________________________
2 Patient flexes wrist up and down (echopraxia)
Royall, D.R., Mahurin, R.K., and Gray, K.F., 1992 Page 8
Revised: May 18, 2005
Enquires: SAS Committee Chair/ Alberta Hospital Edmonton Community Geriatric Psychiatry, (780) 424-4660.

Seniors‘ Mental Health Programs Standardized Assessment Scales
The Executive Interview (EXIT )
Royall et al. (1992)
Summary Sheet
Patient/Client Label
Score Sheet
1. Number-LetterTask 0 1 2
2. Word Fluency 0 1 2
3. Design Fluency 0 1 2
4. Anomalous Sentence Repetition 0 1 2
5. Thematic Perception 0 1 2
6. Memory/DistractionTask 0 1 2
7. Interference Task 0 1 2
8. Automatic Behavior I 0 1 2
9. Automatic Behavior II 0 1 2
10. GraspReflex 0 1 2
11. SocialHabit 0 1 2
12. MotorImpersistence 0 1 2
13. SnoutReflex 0 1 2
14. Finger-Nose-FingerTask 0 1 2
15. Go/No-G oTask 0 1 2
16. Echopraxia 0 1 2
17. Luria Hand Sequence I 0 1 2
18. Luria Hand Sequence II 0 1 2
19. Grip Task 0 1 2
20. Echopraxia II 0 1 2
21. Complex Command Task 0 1 2
22. Serial Order Reversal Task 0 1 2
23. Counting Task I 0 1 2
24. UtilizationBehavior 0 1 2
25. ImitationBehavior 0 1 2
SCORE
Total
Global Test Observations
Executive Cognitive Functions (ECFs) often become impaired in frontal lobe damage and dementia. ECFs are
the cognitive processes that orchestra relatively simple ideas, movement, and actions into complex goaldirected
behaviors during internal and external distractions. Executive control includes goal
selection/formation, sequencing, self-monitoring, and inhibition of irrelevant or inappropriate behaviors.
Lea, C., Louie, N., Quach, J., & Tan, M. (09-06-2000) Page 9
Revised: May 18, 2005
Enquires: SAS Committee Chair/ Alberta Hospital Edmonton Community Geriatric Psychiatry,(780) 424-4660.

Seniors‘ Mental Health Programs Standardized Assessment Scales
Complex behaviors (i.e., meal preparation, financial and medication management) break down into their
component parts and patients become either overdependent on environmental cues, easily distracted and
perseverative, or apathetic and environmentally indifferent. This leads to functional disability by undermining
goal-directed actions (organization, planning, insight, judgment, persistence, and self-control). Evidence of
ECF impairment can be observed in difficulties with ADL, IADL or impaired behavioral functions as described
in the following:
Global Observations of Executive Dyscontrol Behaviors
Perseveration: The tendency to continue doing something in a previously established pattern beyond a
desired degree of appropriateness (i.e., repeating the same word), even after a new stimulus is presented
or difficulty shifting from one response pattern to another. This can be seen in tasks 1, 3, 6, 14, 15, 22.
Imitation: Copying another‘s movements (or actions) without voluntary control, often in a pathological
manner (echolalia, echpraxia). This can be seen in tasks 8, 15, 16, 20, 25.
Intrusions: Inappropriate response influenced by lack of selective attention. This response often has
something that corresponds to a super-imposed or preceding task or test procedure (i.e., interference of
part of task into subsequent tasks). This can be seen in tasks 4, 6, 7, 15, 16, 22, 23.
Frontal Release Signs: Primitive reflexes that indicate a lack of frontal lobe inhibition or decorticalization
(i.e., grasping reflexes and sucking responses). This can be seen in tasks 8, 9, 10, 13, 19.
Lack of Spontaneity/Prompting Needed: Evidence of decreased drive, inability to initiate tasks or plan
ahead, apathetic behaviors for the opinions of others, and shallowness of affect. The apparent apathy
improves with prompting. This can be seen in tasks 1, 2, 3, 5, 12, 14, 15, 17, 18, 21, 22.
Disinhibited Behaviors: Involuntary behaviors that could be subtle but socially inappropriate. A person
with disinhibited behaviors may have difficulty suppressing one idea while selecting another due to a lack
of divided attention. This can be seen in tasks 3, 4, 11, 20.
Utilization Behaviors: The tendency to grasp manually and use objects presented within reach of the
hands of an individual. These behaviors often indicate a decrease ability to conceptualize. This behavior
is triggered by familiar objects. This can be seen in tasks 19, 24, 25.
Summary:
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
Examiner: _____________________________________________
Date:__________________________
References
Becker, E.L., & Laudau, S.I. (Eds.) (1986). International Dictionary of Medicine and Biology. New York: Wiley.
Mills, B., Royall, D., Mahurin, R., et al. (In press). Effects of executive cognitive deficits on decisional competency: Bedside
assessment with Executive Interview (EXIT).
Paulsen, J.S., Stout, J.C., DeLaPena, J. Romero, R. et al. (1996). Frontal behavioral syndromes in cortical and subcortical
dementia. Assessment,3(3), 327-337.
Royall, D. (1994) Precis of executive dyscontrol as a cause of problem behavior in Dementia. Experimental Aging Research,
20, 73-94.
Royall, D., Mahurin, R., & Gray, K. (1992). Bedside assessment of executive cognitive impairment: The Executive Interview.
Journal of American Geriatrics Society ,40, 1221-1226.
Swash, M., Oxbury, J. (Eds). (1991). Clinical Neurology. New York: Churchill Livingstone.
Walsh, K. (1991). Understanding brain damage: A primer of neuropsychological evaluation. (2 nd ed.). New York: Churchill
Livingstone.
Lea, C., Louie, N., Quach, J., & Tan, M. (09-06-2000) Page 10
Revised: May 18, 2005
Enquires: SAS Committee Chair/ Alberta Hospital Edmonton Community Geriatric Psychiatry, (780) 424-4660.

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Seniors’ Mental Health Programs Standardized Assessment Scales
ADMINISTRATION AND SCORING GUIDELINES
Scale/Screen:
Use(s):
Frontal Assessment Battery (FAB)
A short bedside cognitive and behavioral battery to assess
frontal lobe functions.
Time Taken: Approximately ten minutes.
Rationale(s):
Commentary:
The FAB is a more concise scale than the other commonly used
bedside frontal lobe scale, the EXIT, which has 25 items. This may
make it more acceptable to patients and clinicians alike. Whether it
will be of equal clinical value is yet to be discerned.
The FAB is comprised of six subtests which were selected by
the research team, “because the score of each of them
significantly correlated with frontal metabolism, as measured in
terms of the regional distribution of 18-fluorodeoxyglucose in a
Positron Emission Tomography (PET) study of patients with
frontal lobe damage of various etiologies.”
Summary of the six subtests:
Conceptualization: Test Item - “Similarities”
Patients with frontal lobe dysfunction may experience difficulty
formulating abstract connections between the test items, eg.,
banana and orange. They may, instead, show a tendency to offer
more concrete links or they may be unable to establish any
similarity between the items.
Mental Flexibility: Test item - “Verbal Fluency”
Subjects with frontal lobe dysfunction experience problems in
adapting promptly and acting appropriately in novel or changing
situations. Tests of verbal fluency have been shown to be an
accurate reflection of mental flexibility. Frontal lobe lesions
decrease lexical fluency with left frontal lesions causing lower word
production than right.
Enquiries: S.A.S. Committee Chair, c/o AHE Community Geriatric Psychiatry, (780) 424-4660

Seniors’ Mental Health Programs Standardized Assessment Scales
Motor Programming: Test item - “Luria fist-palm-edge series.
Instrumental and basic activities of daily living are affected by
frontal lobe lesions interfering in the subject’s ability to
operationalize actions in an organized sequence to achieve desired
goals. Luria’s fist-palm-edge test may uncover deficits in this area.
Subjects with frontal lobe deficits may be unable to learn the
demonstrated sequence or they may mimic two of the three actions
or they may even perseverate with one gesture.
Sensitivity to Interference:
Test item - “Conflicting Instructions”
Actions may speak louder than words for individuals with frontal
lobe impairment. In the “conflicting instructions” subtest, i.e, “tap
twice when I tap once” then “tap once when I tap twice”, subjects
with frontal lobe dysfunction may be misdirected by the more
powerful and obvious physical stimulus of tapping than with the
examiner’s oral instruction.
Inhibitory Control Test: Test Item - “GO-NO-GO”
Impulsivity is characteristic of some forms of frontal lobe
dysfunction. The “Go-No-Go” test is a measure of impulsivity. It
examines the subject’s ability to inhibit the response previously
called for by the examiner, i.e., tap once when I tap once”, but then,
“do not tap when I tap twice”. Subjects with frontal lobe lesions
may have difficulty inhibiting their previously learned response.
Environmental Autonomy :Test item - “Environmental Control”
Patients with frontal lobe impairment may have a decreased ability
to inhibit inappropriate or automatic responses to sensory stimuli
occurring in their immediate environment. For example, the sight of
an object may provoke the subject to reach out and use it
(utilization behavior), or they may imitate actions witnessed in
others (imitation behavior). They are also more dependent on
environmental cues to manage their daily activities because
executive dyscontrol disrupts their self-directed planning abilities.
Enquiries: S.A.S. Committee Chair, c/o AHE Community Geriatric Psychiatry, (780) 424-4660

Seniors’ Mental Health Programs Standardized Assessment Scales
ADMINISTRATION AND SCORING INSTRUCTIONS
(The following instructions are taken from the Appendix of the referenced article by Dubois et al 2000)
1. Similarities (conceptualization)
“In what way are they alike”
A banana and an orange (in the event of total failure: “they are not alike” or
partial failure: “both have peel,” help the patient by saying: “both a banana and
an orange are…”; but credit 0 for the item, do not help the patient for the two
following items)
A table and a chair
A tulip, a rose, and a daisy
Score: only category responses (fruits, furniture, flowers) are considered correct
2. Lexical fluency (mental flexibility)
“Say as many words as you can beginning with the letter ‘S’, any words except
surnames or proper nouns.”
If the patient gives no response during the first 5 seconds, say: “for instance,
snake.” If the patient pauses 10 seconds, stimulate him by saying “any word
beginning with the letter ‘S’. The time allowed is 60 seconds.
Score: word repetitions or variations (shoe, shoemaker), surnames, or proper
nouns are not counted as correct responses.
3. Motor series (programming)
“Look carefully at what I’m doing.”
The examiner, seated in front of the patient, performs alone three times with his
left hand the series of Luria “fist-edge-palm”. “Now, with your right hand do the
same series, first with me, then alone.” The examiner performs the series three
times with the patient, then says to him/her: “Now, do it on your own.”
Score:
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
Enquiries: S.A.S. Committee Chair, c/o AHE Community Geriatric Psychiatry, (780) 424-4660

Seniors’ Mental Health Programs Standardized Assessment Scales
4. Conflicting instructions (sensitivity to interference)
“Tap twice when I tap once”.
To be sure that the patient has understood the instruction, a series of three trials
is run: 1-1-1. “Tap once when I tap twice.” To be sure that the patient has
understood the instruction, a series of three trials is run: 2-2-2. The examiner
performs the following series: 1-1-2-1-2-2-2-1-1-2.
Score: see test sheet
5. Go-No Go (inhibitory control)
“Tap once when I tap once.”
To be sure that the patient has understood the instruction, a series of three trials
is run: 1-1-1. “Do not tap when I tap twice.” To be sure that the patient has
understood the instruction, a series of three trials is run: 2-2-2. The examiner
performs the following series: 1-1-2-1-2-2-2-1-1-2.
Score: see test sheet
6. Prehension behavior (environmental autonomy/control)
The examiner is seated in front of the patient. Place the patient’s hands palm up
on his/her knees. Without saying anything, 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.”
Score: see test sheet
Reference:
B. Dubois, A. Slachevsky, I. Litvan and B. Pillon. The FAB: A frontal
assessment battery at bedside. Neurology 55, December 2000, 1621-
1626.
Updated: June 8, 2005
WP/SMHPCC/Guidelines-FAB
Enquiries: S.A.S. Committee Chair, c/o AHE Community Geriatric Psychiatry, (780) 424-4660

Seniors’ Mental Health Programs Standardized Assessment Scales
FAB:
AFrontal Assessment Battery at the Bedside
Age: _____________
Date: _____________________________________
Patient/Client Label
Assessed By: _______________________________
Test & Scoring Instructions: Score
SIMILARITIES
In what way are they
alike
3 correct ---------------------------------- 3
2 correct ---------------------------------- 2
1 correct ---------------------------------- 1
0 correct ---------------------------------- 0
LEXICAL FLUENCY
> 9 words --------------------------------- 3
6 - 9 words ------------------------------- 2
3 - 5 words ------------------------------- 1
< 3 words --------------------------------- 0
(don’t score repetitions or word variations)
MOTOR SERIES
PROGRAMMING
6 series alone --------------------------- 3
3 series alone --------------------------- 2
fails alone, but 3 with ------------------ 1
can’t do ----------------------------------- 0
CONFLICTING
INSTRUCTIONS
No error ----------------------------------- 3
1 or 2 errors ------------------------------ 2
> 2 errors --------------------------------- 1
taps like examiner 4 consecutive times - 0
GO-NO-GO (INHIBITORY CONTROL)
No error ---------------------------------- 3
1 or 2 errors ----------------------------- 2
> 2 errors -------------------------------- 1
taps like examiner 4 consecutive times - 0
ENVIRONMENTAL CONTROL
Patient doesn’t take hands -------------- 3
Hesitates and asks what to do --------- 2
Takes hands without hesitation -------- 1
Takes hands even after told not to ---- 0
(can prompt for #1 only) –
but score 0 for that item
Say as many words as
you can beginning with
the letter “S”, except
surnames or proper
names.
Look carefully at what
I’m doing: Luria: fistpalm-edge
(3 times)
Tap twice when I tap
once: series 1-1-1
Tap once when I tap
twice: series 2-2-2
Tap once when I tap
once 1-1-1
Do not tap when I tap
twice 2-2-2
Place the patient’s hands
palm up on his/her knees
1. A banana and orange
2. A table and a chair
3. A tulip, a rose and a daisy
Time 60 seconds.
Can give example if no response
in 5 seconds or prompt if quiet for
10 seconds.
Now with your right hand, do
the same series with me, then
alone.
(with X3, alone X6)
Series: 1-1-2-1-2-2-2-1-1-2
Series: 1-1-2-1-2-2-2-1-1-2
Move your hands close to
patient’s hands and touch the
palms of both hands with your
fingers. If patient takes hands,
say “Now, do not take my
hands” and try again.
Scoring: 16-18 = normal or non significant 13-15 = mild impairment significant
7-12 = moderate impairment 0-6 = severe impairment Score: /18
Comments:_______________________________________________________________________________
________________________________________________________________________________________
Dubois, B., Slachevsky, A., Litvan, I., & Pillon, B. (2000) . The FAB: A frontal assessment battery at bedside. Neurology,
55, 1621-1626.
B. Dubois (personal communication, July 5, 2005) Revised: July 18/05
Enquires: SAS Committee Chair/ Alberta Hospital Edmonton Community Geriatric Psychiatry, (780) 424-4660.