Verbal fluency in senile dementia: an analysis of search and knowledge

Self-Perceived Health, Objective Health, and Quality of Life among People Aged 50 and Over: Interrelationship among Health Indicators in Italy, Spain, and Greece

It is well known that self-perceived health (SPH), even if it is a subjective health indicator, is significantly associated with objective health and quality of life (QoL) in the general population. Whether it can be considered an indicator of cognitive functioning and quality of life in the elderly is still an open issue. This study used a data-driven approach to investigate the interrelationship among SPH, non-communicable diseases (NCDs), QoL, and cognitive functioning to answer this question. The study sample included information about 12,831 people living in Italy, Spain, and Greece, extracted from the Survey on Health, Aging, and Retirement in Europe, in the year 2015. The additive Bayesian networks methodology was used to identify the best directed acyclic graphs (DAG) for SPH, QoL, and NCDs. Results were given as posterior estimates of generalized linear models (GLM) coefficients, with 95% credibility intervals. Good SPH was associated with a decreasing number of chronic diseases in Italy (coeff = −0.52, 95%CI: [−0.59, −0.44]), Spain (coeff = −0.53, 95%CI: [−0.60, −0.46]) and Greece (coeff = −0.57, 95%CI: [−0.64, −0.50]). Age and Body Mass Index were determinants of NCDs in all countries. QoL of elderly was associated with SPH in Italy (coeff = 0.12, 95%CI: [0.10, 0.14]), Spain (coeff = 0.16, 95%CI: [0.15, 0.18]), and Greece (coeff = 0.18, 95%CI: [0.16, 0.20]). The number of NCDs was higher for people who were not employed in Spain (coeff = 0.45, 95%CI: [0.37, 0.53]) and was decreasing for a unitary increase in years of education in Greece (coeff = −0.12, 95%CI: [−0.14, −0.09]). As a general rule, the framework of the interrelationship among NCDs, SPH, and QoL was similar for Italy, Spain, and Greece. The connections found among indicators could be proposed to identify strategies for health promotion and healthy aging among people aged 50 and above, which are viable in general and at a country level. Reinforcing strategies targeted at some health indicators could have relevant effects on other related indicators.

Category fluency test: effects of age, gender and education on total scores, clustering and switching in Brazilian Portuguese-speaking subjects

Verbal fluency tests are used as a measure of executive functions and language, and can also be used to evaluate semantic memory. We analyzed the influence of education, gender and age on scores in a verbal fluency test using the animal category, and on number of categories, clustering and switching. We examined 257 healthy participants (152 females and 105 males) with a mean age of 49.42 years (SD = 15.75) and having a mean educational level of 5.58 (SD = 4.25) years. We asked them to name as many animals as they could. Analysis of variance was performed to determine the effect of demographic variables. No significant effect of gender was observed for any of the measures. However, age seemed to influence the number of category changes, as expected for a sensitive frontal measure, after being controlled for the effect of education. Educational level had a statistically significant effect on all measures, except for clustering. Subject performance (mean number of animals named) according to schooling was: illiterates, 12.1; 1 to 4 years, 12.3; 5 to 8 years, 14.0; 9 to 11 years, 16.7, and more than 11 years, 17.8. We observed a decrease in performance in these five educational groups over time (more items recalled during the first 15 s, followed by a progressive reduction until the fourth interval). We conclude that education had the greatest effect on the category fluency test in this Brazilian sample. Therefore, we must take care in evaluating performance in lower educational subjects.

Accessing semantic knowledge in dementia: evidence from a word definition task

We examine production of word definitions by people with probable Alzheimer's disease (pAD). In the first experiment, healthy young adults defined concrete, imageable nouns to provide a baseline of definitional ability. Analysis of these definitions identified the key defining features of each target item. In the second experiment, pAD participants and elderly controls produced definitions of the same items. In the third experiment, healthy young participants rated the adequacies of these definitions. Although as expected the pAD participants produced fewer good definitions than the other two groups, most of their responses still contained some relevant information. pAD definitions contained fewer pieces of information and the information they produced was more tangential to the primary concept than that provided by the young or elderly participants. We identify two possible explanations in semantic loss and metalinguistic impairment. We consider metalinguistic impairment to provide the more plausible explanation of pAD patients' definitional performance.

Semantic organization, strategy use, and productivity in bilingual semantic verbal fluency

This study of semantic verbal fluency addressed two research questions: (1) What are the between-language similarities and differences in the performance of balanced bilinguals? (2) What is the relationship between productivity and the use of a semantic grouping strategy to organize responses? Forty neurologically normal, bilingual adults were tested twice in each language (French/English), in a 2 (Language) by 2 (Test) by 2 (Group) design. On Test 2, half the 40 subjects were instructed to group items by subcategory, while half simply repeated the test. Results showed (1) many more between-language similarities than differences and (2) no between-group differences in productivity.

Category fluency is also predominantly affected in Swiss Alzheimer's disease patients

OBJECTIVES

To establish the comparative efficacy to differentiate between Swiss patients with dementia of the Alzheimer type (DAT) and elderly normal control subjects (NC) on two different verbal fluency tasks: category fluency and letter fluency.

MATERIAL AND METHODS

Fifty Swiss German DAT patients in the early stages of the disease and 50 matched normal control subjects were compared on letter and category fluency tasks.

RESULTS

DAT patients exhibited an overproportional impairment on category fluency as compared with letter fluency. Receiver operating characteristic curves (ROC) showed that category fluency correctly classified a significantly higher number of DAT patients and NC subjects (84%) than letter fluency (70%).

CONCLUSION

As similar findings have been described for English-speaking DAT patients, we conclude that deficiencies in category fluency are a general phenomenon, reflecting impaired structures of semantic knowledge occurring early in the course of Alzheimer's disease.

Verbal fluency in schizophrenia: relationship with executive function, semantic memory and clinical alogia

To examine whether poor verbal fluency in schizophrenia represents a degraded semantic store or inefficient access to a normal semantic store, 25 normal volunteers and 50 DSM-III-R schizophrenic patients, matched for age, sex and IQ, were recruited. Although schizophrenic patients were impaired on both letter and category fluency, they showed a normal pattern of output in that category was superior to letter fluency, and an improvement in category fluency when a cueing technique was employed (Randolph et al. 1993). These results resemble those found in disorders of frontostriatal systems (Parkinson's and Huntington's disease) and suggest that poor verbal fluency in schizophrenia is because of inefficient access to semantic store. A measure of improvement with cueing was directly related to performance on the Stroop executive task. Of all symptom measures derived from SANS and Manchester Scales, only alogia was related to verbal fluency in that superior improvement correlated inversely with the degree of alogia. It is suggested that both alogia and poor verbal fluency are mediated by the same underlying cognitive abnormality that reflects frontostriatal dysfunction.

Semantic memory in Alzheimer's disease: an analysis of category fluency

In order to study the strategies of access to semantic knowledge and the status of semantic representation, we analyzed the performance in a semantic fluency task (Animal naming) of 70 patients with probable Alzheimer's disease (AD), including 40 mild AD patients and 30 moderate-severe AD patients, and 35 matched elderly normal control subjects. The total amount of words produced, their lexical frequency, the number and type of errors, as well as the presence and the type of clusters of related animal names were recorded. AD patients produced less animal exemplars than controls. In addition to a lower total number of clusters, the AD patients showed a strong limitation in clusters' selection, producing a limited number of different clusters. While normal subjects produced several different clusters, only farm animals were clustered by AD patients. When the total amount of words was considered, the mean lexical frequency was higher in the AD group. On the other hand, the words produced within clusters were comparable to terms of lexical frequency and number. These data confirm the impairment of AD patients in category fluency tasks, and suggest a degradation of semantic knowledge as the most likely underlying mechanism.

Verbal fluency in dementia of frontal lobe type and dementia of Alzheimer type

This study compares semantic (category) and letter-initial verbal fluency performance in dementia of frontal lobe type, dementia of Alzheimer type, and control subjects matched for age, sex, and level of education. As well as demographic characteristics, patients were matched for severity of dementia as estimated by the mini mental scale (23.2 (SD 4.9)). All patients with dementia of frontal lobe type had a frontal hypoperfusion on single photon emission computed tomography whereas patients with dementia of Alzheimer type showed mainly posterior deficits. Patients had significantly lower verbal fluency than controls but those with dementia of frontal lobe type did not differ from those with dementia of Alzheimer type in the number of words generated, intrusions, or preservations. Category fluency was more impaired than letter fluency in both dementias. No correlation between frontal index, frontal/parietal index, and fluency was found. Verbal fluency tests are sensitive tools for detecting dementia but do not seem useful in distinguishing between patients with dementia of Alzheimer type and those with dementia of frontal lobe type in early disease.

Language and dementia: a review

In the literature on dementia the presence or absence of language deficits has come to occupy a pivotal position with respect to certain nosological and nosographical issues. These are reviewed critically, together with the results of experimental investigations which have sought to elucidate the nature of the language deficit(s) in patients with dementia, especially that of the Alzheimer type. Attention is drawn to important gaps in current knowledge and suggestions are made regarding the direction of future research.