A mosquito bites and a butterfly flies: A specific response type of frontal patients in a similarity task

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Patients with neurodegenerative diseases affecting the frontal lobes have difficulties in categorization tasks, such as the similarity tasks. They give two types of unusual response to the question: “In what way are an orange and a banana alike?”, either a differentiation (“one is yellow, the other is orange”) or a concrete similarity (“they are sweet”).


To characterize the categorization deficit of frontal patients and develop a short diagnostic tool to assess the nature of these difficulties.


We analyzed the responses provided by frontal and non-frontal neurodegenerative patients in a novel verbal similarity task (SimiCat). We included 40 frontal patients with behavioral variant fronto-temporal dementia (bvFTD) and progressive supranuclear palsy (PSP), 23 patients with Alzheimer's disease (AD) and 41 healthy matched controls. Responses that did not correspond to the expected taxonomic category (e.g.: fruits) were considered as errors.


All patients groups were impaired at the SimiCat test compared to controls. Differentiation errors were specific to frontal patients. Receiver operating characteristic analyses showed that a cut-off of two differentiation errors or more achieved 85% sensitivity of 100% specificity to discriminate bvFTD from AD. A short version of the test (<5 min) showed similar discriminative validity as the full version.


Differentiation responses were specific to frontal patients. The SimiCat demonstrates good discriminative validity to differentiate between bvFTD and AD. The short version of the test is a promising diagnostic tool that will need validation in future studies.

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