Skip to main content Accessibility help
×
Home

Verbal fluency in the detection of mild cognitive impairment and Alzheimer's disease among Brazilian Portuguese speakers: the influence of education

  • Marcia Radanovic (a1), Breno Satler Diniz (a1), Roberta M Mirandez (a1), Tânia Maria da Silva Novaretti (a1), Mariana Kneese Flacks (a1), Mônica S Yassuda (a1) and Orestes Vicente Forlenza (a1)...

Abstract

Background: Verbal fluency (VF) tasks are simple and efficient clinical tools to detect executive dysfunction and lexico-semantic impairment. VF tasks are widely used in patients with suspected dementia, but their accuracy for detection of mild cognitive impairment (MCI) is still under investigation. Schooling in particular may influence the subject's performance. The aim of this study was to compare the accuracy of two semantic categories (animals and fruits) in discriminating controls, MCI patients and Alzheimer's disease (AD) patients.

Methods: 178 subjects, comprising 70 controls (CG), 70 MCI patients and 38 AD patients, were tested on two semantic VF tasks. The sample was divided into two schooling groups: those with 4–8 years of education, and those with 9 or more years.

Results: Both VF tasks – animal fluency (VFa) and fruits fluency (VFf) – adequately discriminated CG from AD in the total sample (AUC = 0.88 ± 0.03, p < 0.0001) and in both education groups, and high educated MCI from AD (VFa: AUC = 0.82 ± 0.05, p < 0.0001; VFf: AUC = 0.85 ± 0.05, p < 0.0001). Both tasks were moderately accurate in discriminating CG from MCI (VFa: AUC = 0.68 ± 0.04, p < 0.0001; VFf: AUC = 0.73 ± 0.04, p < 0.0001) regardless of the schooling level, and MCI from AD in the total sample (VFa: AUC = 0.74 ± 0.05, p < 0.0001; VFf: AUC = 0.76 ± 0.05, p < 0.0001). Neither of the two tasks differentiated low educated MCI from AD. In the total sample, fruits fluency best discriminated CG from MCI and MCI from AD; a combination of the two improved the discrimination between CG and AD.

Conclusions: Both categories were similar in discriminating CG from AD; the combination of both categories improved the accuracy for this distinction. Both tasks were less accurate in discriminating CG from MCI, and MCI from AD.

Copyright

Corresponding author

Correspondence should be addressed to: Dr Marcia Radanovic, Rua Cristiano Viana, 163 ap. 92, São Paulo – SPBrazil 05411-000. Phone: +55 11 3088 9708; Fax: +55 11 3088 9708. Email: marciaradanovic@yahoo.com.br or marciaradanovic@gmail.com.

References

Hide All
Acevedo, A. et al. (2000). Category fluency test: normative data for English- and Spanish-speaking elderly. Journal of the International Neuropsychological Society, 6, 760769.
Amunts, K. and Zilles, K. (2006). A multimodal analysis of structure and function in Broca's region. In Grodzinsky, Y. and Amunts, K. (eds.), Broca's Region (pp. 1730). New York: Oxford University Press.
Baldo, J. V., Schwartz, S., Wilkins, D. and Dronkers, N. F. (2006). Role of frontal versus temporal cortex in verbal fluency as revealed by voxel based lesion symptom mapping. Journal of the International Neuropsychological Society, 12, 896900.
Balthazar, M. L. F., Cendes, F. and Damasceno, B. P. (2007). Category verbal fluency performance may be impaired in amnestic mild cognitive impairment. Dementia and Neuropsychologia, 2, 161165.
Bowie, C. R., Harvey, P. D., Moriarty, P. J, Parrella, M., White, L. and Davis, K. L. (2004). A comprehensive analysis of verbal fluency deficit in geriatric schizophrenia. Archives of Clinical Neuropsychology, 19, 289303.
Bottino, C. M. C., Almeida, O. P., Tamai, S., Forlenza, O. V., Scalco, M. Z. and Carvalho, I. A. M. (1999). The Cambridge Examination for Mental Disorders of the Elderly, Brazilian Edition. Translation and adaptation for Portuguese language with authorization of Cambridge University Press. Cambridge: Cambridge University Press.
Brandt, J. and Manning, K. J. (2009). Patterns of word-list generation in Mild Cognitive Impairment and Alzheimer's disease. Clinical Neuropsychologist, 23, 870879. doi: 10.1080/13854040802585063.
Brucki, S. M. D., Nitrini, R., Caramelli, P., Bertolucci, P. H. F. and Okamoto, I. H. (2003). Suggestions for utilization of the Mini Mental State Examination in Brazil. Arquivos de Neuropsiquiatria, 61, 777781.
Brucki, S. M. D. and Rocha, M. S. G. (2004). Category fluency test: effects of age, gender and education on total scores, clustering and switching in Brazilian Portuguese-speaking subjects. Brazilian Journal of Medical and Biological Research, 37, 17711777.
Caramelli, P., Carthery-Goulart, M. T., Porto, C. S., Charchat-Fichman, H. and Nitrini, R. (2007). Category fluency as a screening test for Alzheimer disease in illiterate and literate patients. Alzheimer Disease and Associated Disorders, 21, 6567.
Cooper, D. B., Lacritz, L. H., Weiner, M. F., Rosenberg, R. N. and Cullum, C. M. (2004) Category fluency in mild cognitive impairment: reduced effect of practice in test-retest conditions. Alzheimer Disease and Associated Disorders, 18, 120122.
Cunje, A., Molloy, D. W., Standish, T. I. and Lewis, D. L. (2007). Alternate forms of logical memory and verbal fluency tasks for repeated testing in early cognitive changes. International Psychogeriatrics, 19, 6575.
da Silva, C. G., Petersson, K. M., Faisca, L., Ingvar, M. and Reis, A. (2004). The effects of literacy and education on the quantitative and qualitative aspects of semantic verbal fluency. Journal of Clinical and Experimental Neuropsychology, 26, 266277.
Diaz, M., Sailor, K., Cheung, D. and Kuslansky, G. (2004). Category size effects in semantic and letter fluency in Alzheimer's patients. Brain and Language, 89, 108114.
Diniz, B. S., Yassuda, M. S., Nunes, P. V., Radanovic, M. and Forlenza, O. V. (2007). Mini-mental State Examination performance in mild cognitive impairment subtypes. International Psychogeriatrics, 19, 647656.
Fernandez, T. et al. (2002). [“Household items”: an alternative task to “animals” in the assessment of semantic verbal fluency: a validation study]. Revista de Neurologia, 35, 520523.
Fernández-Turrado, T., Pascual-Millán, L. F., Fernández-Arín, E., Larrodé-Pellicer, P., Santos-Lasaosa, S. and Mostacero-Miguel, E. (2007). [Model of analysis in two halves for semantic fluency tasks]. Revista de Neurologia, 44, 531536.
Folstein, M. F., Folstein, S. E. and McHugh, P. R. (1975). “Mini-mental state”: a practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189198.
Forbes-McKay, K. E., Ellis, A.W., Shanks, M. F. and Venneri, A. (2005). The age of acquisition of words produced in a semantic fluency task can reliably differentiate normal from pathological age related cognitive decline. Neuropsychologia, 43, 16251632.
Gomez, R. G. and White, D. A. (2006). Using verbal fluency to detect very mild dementia of the Alzheimer type. Archives of Clinical Neuropsychology, 21, 771775.
Hamilton, M. (1960). Rating scale for depression. Journal of Neurology, Neurosurgery and Psychiatry, 23, 5662.
Henry, J. D. and Crawford, J. R. (2004). Verbal fluency deficits in Parkinson's disease: a meta-analysis. Journal of the International Neuropsychological Society, 10, 608622.
Henry, J. D., Crawford, J. R. and Phillips, L. H. (2004). Verbal fluency performance in dementia of the Alzheimer's type: a metaanalysis. Neuropsychologia, 42, 12121222.
Henry, J. D., Crawford, J. R. and Phillips, L. H. (2005). A meta-analytic review of verbal fluency deficits in Huntington's disease. Neuropsychology, 19, 243252.
Hirshorn, E. A. and Thompson-Schill, S. L. (2006). Role of the left inferior frontal gyrus in covert word retrieval: neural correlates of switching during verbal fluency. Neuropsychologia, 44, 25472557.
Jones, S., Laukka, E. J. and Bäckman, L. (2006). Differential verbal fluency deficits in the preclinical stages of Alzheimer's disease and vascular dementia. Cortex, 42, 347355.
Jorm, A. F. and Jacomb, P. A. (1989). The Informant Questionnaire on Cognitive Decline in the Elderly: sociodemographics correlates, reliability, validity and some norms. Psychological Medicine, 19, 10151022.
Koepsell, T. D., Kurland, B. F., Harel, O., Johnson, E. A., Zhou, X. H. and Kukull, W. A. (2008). Education, cognitive function, and severity of neuropathology in Alzheimer disease. Neurology, 70, 17321739.
March, E. G. and Pattison, P. (2006). Semantic verbal fluency in Alzheimer's disease: approaches beyond the traditional scoring system. Journal of Clinical and Experimental Neuropsychology, 28, 549566.
Mathuranath, P. S., George, A., Cherian, P. J., Alexander, A., Sarma, S. G. and Sarma, P. S. (2003). Effects of age, education and gender on verbal fluency. Journal of Clinical and Experimental Neuropsychology, 25, 10571064.
McKhann, G., Drachman, D., Folstein, M., Katzman, R., Price, D. and Stadlam, E. M. (1984). Clinical diagnosis of Alzheimer's disease: report of NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Service Task Force on Alzheimer's Disease. Neurology, 34, 939944.
Mok, E. H., Lam, L. C. and Chiu, H. F. (2004). Category verbal fluency test performance in Chinese elderly with Alzheimer's disease. Dementia and Geriatric Cognitive Disorders, 18, 120124.
Murphy, K. J., Rich, J. B. and Troyer, A. K. (2006). Verbal fluency patterns in amnestic mild cognitive impairment are characteristic of Alzheimer's type dementia. Journal of the International Neuropsychological Society, 12, 570574.
Nunes, P. V. et al. (2008). CAMCOG as a screening tool for diagnosis of Mild Cognitive Impairment and Dementia in a Brazilian clinical sample of moderate to high education. International Journal of Geriatric Psychiatry, 23, 11271133.
Nutter-Upham, K. E. et al. (2008). Verbal fluency performance in amnestic MCI and older adults with cognitive complaints. Archives of Clinical Neuropsychology, 23, 229241.
Ostberg, P., Crinelli, R. M., Danielsson, R., Wahlund, L. O., Bogdanovic, N. and Fernaeus, S. E. (2007). A temporal lobe factor in verb fluency. Cortex, 43, 607615.
Patterson, K., Nestor, P. J. and Rogers, T. T. (2007). Where do you know what you know? The representation of semantic knowledge in the human brain. Nature Reviews Neuroscience, 8, 976987.
Petersen, R. C., Smith, G. E., Waring, S. C., Ivnik, R. J., Tangalos, E. G. and Kokmen, E. (1999). Mild Cognitive Impairment: clinical characterization and outcome. Archives of Neurology, 56, 303308.
Radanovic, M. et al. (2007). Analysis of brief language tests in the detection of cognitive decline and dementia. Dementia and Neuropsychologia, 1, 3745.
Robinson, L. J. et al. (2006). A meta-analysis of cognitive deficits in euthymic patients with bipolar disorder. Journal of Affective Disorders, 93, 105115.
Roth, M. et al. (1986). CAMDEX: A standardized instrument for the diagnosis of mental disorders in the elderly with special reference to early detection of dementia. British Journal of Psychiatry, 149, 698709.
Sáez-Zea, C., Carnero-Pardo, C. and Gurpegui, M. (2008). [Names of persons: a verbal fluency test without socioeducational influences]. Neurologia, 23, 356360.
Troyer, A. K., Moscovitch, M., Winocur, G., Leach, L. and Freedman, M. (1998). Clustering and switching on verbal fluency tests in Alzheimer's and Parkinson's disease. Journal of the International Neuropsychological Society, 4, 137143.

Keywords

Related content

Powered by UNSILO

Verbal fluency in the detection of mild cognitive impairment and Alzheimer's disease among Brazilian Portuguese speakers: the influence of education

  • Marcia Radanovic (a1), Breno Satler Diniz (a1), Roberta M Mirandez (a1), Tânia Maria da Silva Novaretti (a1), Mariana Kneese Flacks (a1), Mônica S Yassuda (a1) and Orestes Vicente Forlenza (a1)...

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed.