1
|
Gómez-Valadés A, Martínez R, Rincón M. Designing an effective semantic fluency test for early MCI diagnosis with machine learning. Comput Biol Med 2024; 180:108955. [PMID: 39153392 DOI: 10.1016/j.compbiomed.2024.108955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2024] [Revised: 07/04/2024] [Accepted: 07/26/2024] [Indexed: 08/19/2024]
Abstract
Semantic fluency tests are one of the key tests used in batteries for the early detection of Mild Cognitive Impairment (MCI) as the impairment in speech and semantic memory are among the first symptoms, attracting the attention of a large number of studies. Several new semantic categories and variables capable of providing complementary information of clinical interest have been proposed to increase their effectiveness. However, this also extends the time required to complete all tests and get the overall diagnosis. Therefore, there is a need to reduce the number of tests in the batteries and thus the time spent on them while maintaining or increasing their effectiveness. This study used machine learning methods to determine the smallest and most efficient combination of semantic categories and variables to achieve this goal. We utilized a database containing 423 assessments from 141 subjects, with each subject having undergone three assessments spaced approximately one year apart. Subjects were categorized into three diagnostic groups: Healthy (if diagnosed as healthy in all three assessments), stable MCI (consistently diagnosed as MCI), and heterogeneous MCI (when exhibiting alternations between healthy and MCI diagnoses across assessments). We obtained that the most efficient combination to distinguish between these categories of semantic fluency tests included the animals and clothes semantic categories with the variables corrects, switching, clustering, and total clusters. This combination is ideal for scenarios that require a balance between time efficiency and diagnosis capability, such as population-based screenings.
Collapse
Affiliation(s)
- Alba Gómez-Valadés
- Universidad Nacional de Educación a Distancia, Madrid, 28040, Comunidad Autónoma de Madrid, Spain(1).
| | - Rafael Martínez
- Universidad Nacional de Educación a Distancia, Madrid, 28040, Comunidad Autónoma de Madrid, Spain(1).
| | - Mariano Rincón
- Universidad Nacional de Educación a Distancia, Madrid, 28040, Comunidad Autónoma de Madrid, Spain(1).
| |
Collapse
|
2
|
Ferrante FJ, Migeot J, Birba A, Amoruso L, Pérez G, Hesse E, Tagliazucchi E, Estienne C, Serrano C, Slachevsky A, Matallana D, Reyes P, Ibáñez A, Fittipaldi S, Campo CG, García AM. Multivariate word properties in fluency tasks reveal markers of Alzheimer's dementia. Alzheimers Dement 2024; 20:925-940. [PMID: 37823470 PMCID: PMC10916979 DOI: 10.1002/alz.13472] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 08/15/2023] [Accepted: 08/20/2023] [Indexed: 10/13/2023]
Abstract
INTRODUCTION Verbal fluency tasks are common in Alzheimer's disease (AD) assessments. Yet, standard valid response counts fail to reveal disease-specific semantic memory patterns. Here, we leveraged automated word-property analysis to capture neurocognitive markers of AD vis-à-vis behavioral variant frontotemporal dementia (bvFTD). METHODS Patients and healthy controls completed two fluency tasks. We counted valid responses and computed each word's frequency, granularity, neighborhood, length, familiarity, and imageability. These features were used for group-level discrimination, patient-level identification, and correlations with executive and neural (magnetic resonanance imaging [MRI], functional MRI [fMRI], electroencephalography [EEG]) patterns. RESULTS Valid responses revealed deficits in both disorders. Conversely, frequency, granularity, and neighborhood yielded robust group- and subject-level discrimination only in AD, also predicting executive outcomes. Disease-specific cortical thickness patterns were predicted by frequency in both disorders. Default-mode and salience network hypoconnectivity, and EEG beta hypoconnectivity, were predicted by frequency and granularity only in AD. DISCUSSION Word-property analysis of fluency can boost AD characterization and diagnosis. HIGHLIGHTS We report novel word-property analyses of verbal fluency in AD and bvFTD. Standard valid response counts captured deficits and brain patterns in both groups. Specific word properties (e.g., frequency, granularity) were altered only in AD. Such properties predicted cognitive and neural (MRI, fMRI, EEG) patterns in AD. Word-property analysis of fluency can boost AD characterization and diagnosis.
Collapse
Affiliation(s)
- Franco J. Ferrante
- Centro de Neurociencias CognitivasUniversidad de San AndrésVictoriaProvincia de Buenos AiresArgentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET)Ciudad Autónoma de Buenos AiresArgentina
- Facultad de IngenieríaUniversidad de Buenos Aires (FIUBA)CABAArgentina
| | - Joaquín Migeot
- Latin American Brain Health (BrainLat) InstituteUniversidad Adolfo IbáñezPeñalolénRegión MetropolitanaChile
- Center for Social and Cognitive Neuroscience (CSCN)School of PsychologyUniversidad Adolfo IbáñezLas CondesChile
| | - Agustina Birba
- Centro de Neurociencias CognitivasUniversidad de San AndrésVictoriaProvincia de Buenos AiresArgentina
- Instituto Universitario de NeurocienciaUniversidad de La LagunaLa LagunaTenerifeEspaña
- Cognitive Department of PsychologyUniversidad de La LagunaLa LagunaTenerifeEspaña
| | - Lucía Amoruso
- Centro de Neurociencias CognitivasUniversidad de San AndrésVictoriaProvincia de Buenos AiresArgentina
- Basque Center on Cognition Brain and Language (BCBL)San SebastiánGipuzkoaEspaña
- IkerbasqueBasque Foundation for ScienceBilbaoSpain
| | - Gonzalo Pérez
- Centro de Neurociencias CognitivasUniversidad de San AndrésVictoriaProvincia de Buenos AiresArgentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET)Ciudad Autónoma de Buenos AiresArgentina
- Facultad de IngenieríaUniversidad de Buenos Aires (FIUBA)CABAArgentina
| | - Eugenia Hesse
- Centro de Neurociencias CognitivasUniversidad de San AndrésVictoriaProvincia de Buenos AiresArgentina
- Departamento de Matemática y CienciasUniversidad de San AndrésVictoriaProvincia de Buenos AiresArgentina
| | - Enzo Tagliazucchi
- Latin American Brain Health (BrainLat) InstituteUniversidad Adolfo IbáñezPeñalolénRegión MetropolitanaChile
- Departamento de FísicaUniversidad de Buenos Aires and Instituto de Física de Buenos Aires (IFIBA‐CONICET)CABAArgentina
| | - Claudio Estienne
- Instituto de Ingeniería BiomédicaUniversidad de Buenos AiresBuenos AiresArgentina
| | - Cecilia Serrano
- Unidad de Neurología CognitivaHospital César MilsteinCABAArgentina
| | - Andrea Slachevsky
- Neuropsychology and Clinical Neuroscience Laboratory (LANNEC)Physiopathology Department ‐ ICBMNeurocience and East Neuroscience DepartmentsFaculty of MedicineUniversity of ChileProvidenciaSantiagoChile
- Geroscience Center for Brain Health and Metabolism (GERO)Faculty of MedicineUniversity of ChileProvidenciaSantiagoChile
- Memory and Neuropsychiatric Clinic (CMYN) Neurology DepartmentHospital del Salvador and Faculty of MedicineUniversity of ChileProvidenciaSantiagoChile
- Servicio de NeurologíaDepartamento de MedicinaClínica Alemana‐Universidad del DesarrolloLas CondesRegión MetropolitanaChile
| | - Diana Matallana
- Instituto de EnvejecimientoDepartment of PsychiatrySchool of MedicinePontifical Xaverian UniversityBogotáColombia
- Department of Mental HealthHospital Universitario Santa Fe de BogotáBogotáColombia
| | - Pablo Reyes
- Centro de Memoria y CogniciónIntellectus‐Hospital Universitario San IgnacioBogotáColombia
- Pontificia Universidad JaverianaDepartments of PhysiologyPsychiatry and Aging InstituteBogotáColombia
| | - Agustín Ibáñez
- Centro de Neurociencias CognitivasUniversidad de San AndrésVictoriaProvincia de Buenos AiresArgentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET)Ciudad Autónoma de Buenos AiresArgentina
- Latin American Brain Health (BrainLat) InstituteUniversidad Adolfo IbáñezPeñalolénRegión MetropolitanaChile
- Global Brain Health Institute, University of California San Francisco, San Francisco, California, USATrinity College DublinDublinIreland
| | - Sol Fittipaldi
- Centro de Neurociencias CognitivasUniversidad de San AndrésVictoriaProvincia de Buenos AiresArgentina
- Latin American Brain Health (BrainLat) InstituteUniversidad Adolfo IbáñezPeñalolénRegión MetropolitanaChile
- Global Brain Health Institute, University of California San Francisco, San Francisco, California, USATrinity College DublinDublinIreland
| | - Cecilia Gonzalez Campo
- Centro de Neurociencias CognitivasUniversidad de San AndrésVictoriaProvincia de Buenos AiresArgentina
- Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET)Ciudad Autónoma de Buenos AiresArgentina
| | - Adolfo M. García
- Centro de Neurociencias CognitivasUniversidad de San AndrésVictoriaProvincia de Buenos AiresArgentina
- Latin American Brain Health (BrainLat) InstituteUniversidad Adolfo IbáñezPeñalolénRegión MetropolitanaChile
- Global Brain Health Institute, University of California San Francisco, San Francisco, California, USATrinity College DublinDublinIreland
- Departamento de Lingüística y LiteraturaFacultad de HumanidadesUniversidad de Santiago de ChileEstación CentralSantiagoChile
| |
Collapse
|
3
|
Yucebas D, Fox-Fuller JT, Cabrera AB, Baena A, McDowell CP, Aduen P, Vila-Castelar C, Bocanegra Y, Tirado V, Sanchez JS, Cronin-Golomb A, Lopera F, Quiroz YT. Associations of category fluency clustering performance with in vivo brain pathology in autosomal dominant Alzheimer's disease. J Int Neuropsychol Soc 2024; 30:77-83. [PMID: 37185154 PMCID: PMC10600324 DOI: 10.1017/s1355617723000243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/17/2023]
Abstract
OBJECTIVES Alzheimer's disease (AD) is known to impact semantic access, which is frequently evaluated using the Category Fluency (Animals) test. Recent studies have suggested that in addition to overall category fluency scores (total number of words produced over time), poor clustering could signal AD-related cognitive difficulties. In this study, we examined the association between category fluency clustering performance (i.e., stating words sequentially that are all contained within a subcategory, such as domestic animals) and brain pathology in individuals with autosomal dominant Alzheimer's disease (ADAD). METHODS A total of 29 non-demented carriers of the Presenilin1 E280A ADAD mutation and 32 noncarrier family members completed the category fluency test (Animals) and the Mini-Mental State Examination (MMSE). The participants also underwent positron emission tomography (PET) scans to evaluate in vivo amyloid-beta in the neocortex and tau in medial temporal lobe regions. Differences between carriers and noncarriers on cognitive tests were assessed with Mann-Whitney tests; associations between cognitive test performance and brain pathology were assessed with Spearman correlations. RESULTS Animal fluency scores did not differ between carriers and noncarriers. Carriers, however, showed a stronger association between animal fluency clustering and in vivo AD brain pathology (neocortical amyloid and entorhinal tau) relative to noncarriers. CONCLUSION This study indicates that using category fluency clustering, but not total score, is related to AD pathophysiology in the preclinical and early stages of the disease.
Collapse
Affiliation(s)
- Defne Yucebas
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, 02155, USA
| | - Joshua T. Fox-Fuller
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, 02155, USA
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Alex Badillo Cabrera
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Ana Baena
- Grupo de Neurociencias de Antioquia, University of Antioquia, Medellin, Colombia
| | - Celina Pluim McDowell
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, 02155, USA
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Paula Aduen
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Clara Vila-Castelar
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Yamile Bocanegra
- Grupo de Neurociencias de Antioquia, University of Antioquia, Medellin, Colombia
- Hospital Pablo Tobon Uribe, Medellin, Colombia
| | - Victoria Tirado
- Grupo de Neurociencias de Antioquia, University of Antioquia, Medellin, Colombia
- Hospital Pablo Tobon Uribe, Medellin, Colombia
| | - Justin S. Sanchez
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Alice Cronin-Golomb
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, 02155, USA
| | - Francisco Lopera
- Grupo de Neurociencias de Antioquia, University of Antioquia, Medellin, Colombia
| | - Yakeel T. Quiroz
- Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- Grupo de Neurociencias de Antioquia, University of Antioquia, Medellin, Colombia
- Department of Neurology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
4
|
Sharma V, Malek-Ahmadi M. Meta-Analysis of Animal Fluency Performance in Amnestic Mild Cognitive Impairment and Cognitively Unimpaired Older Adults. Alzheimer Dis Assoc Disord 2023; 37:259-264. [PMID: 37561948 PMCID: PMC10529905 DOI: 10.1097/wad.0000000000000568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 06/19/2023] [Indexed: 08/12/2023]
Abstract
Animal fluency is a commonly used neuropsychological measure that is used in the diagnosis of amnestic mild cognitive impairment (aMCI) and Alzheimer disease. Although most individuals with aMCI have clinically normal scores on this test, several studies have shown that aMCI individuals' performance is significantly lower than that of cognitively unimpaired (CU) individuals. The aim of this meta-analysis was to characterize the effect size of animal fluency performance differences between aMCI and CU individuals. Literature search with search terms used were: "animal fluency and mild cognitive impairment," "semantic fluency and mild cognitive impairment," "category fluency and mild cognitive impairment." Both the standardized mean difference and the raw mean difference were derived from random effects analyses. Demographically adjusted z-scores for animal fluency performance for the aMCI groups were obtained to determine normative performance. Nineteen studies were included in the analysis. The standardized mean difference for animal fluency performance between CU and aMCI was 0.89 (95% confidence interval: [0.73; 1.04], P <0.001), I2 =70.3% [52.7%; 81.4%], which reflects a large effect size with moderate heterogeneity. The raw mean difference was -4.08 [-4.75; -3.38], P <0.001. The mean animal fluency z-score for aMCI groups was in the Low Average range (z=-0.77). This study found a substantial difference in animal fluency performance between aMCI and CU individuals. The aMCI groups' normative performance did not fall into the impaired range, indicating that there are important subclinical differences in animal fluency performance that may inform the design of cognitive end points for Alzheimer's disease prevention trials.
Collapse
Affiliation(s)
- Vivek Sharma
- Midwestern University, Arizona College of Osteopathic Medicine, Glendale, AZ
| | - Michael Malek-Ahmadi
- Banner Alzheimer’s Institute, Phoenix, AZ
- University of Arizona College of Medicine-Phoenix, Dept. of Biomedical Informatics, Phoenix, AZ
| |
Collapse
|
5
|
Townsend SAM, Marcotte K, Brisebois A, Smidarle AD, Schneider F, Loureiro F, Soder RB, Franco ADR, Marrone LCP, Hübner LC. Neuroanatomical correlates of macrostructural receptive abilities in narrative discourse in unilateral left hemisphere stroke: A behavioural and voxel-based morphometry study. INTERNATIONAL JOURNAL OF LANGUAGE & COMMUNICATION DISORDERS 2023; 58:826-847. [PMID: 36448625 DOI: 10.1111/1460-6984.12825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 10/29/2022] [Indexed: 05/12/2023]
Abstract
BACKGROUND Little is known about story retelling and comprehension abilities in groups with lower levels of education and socio-economic status (SES). A growing body of evidence suggests the role of an extended network supporting narrative comprehension, but few studies have been conducted in clinical populations, even less in developing countries. AIMS To extend our knowledge of the impact of a stroke on macrostructural aspects of discourse processes, namely main and complementary information, in individuals with middle-low to low SES and low levels of education. Relationships were tested between the performance in story retell and comprehension and reading and writing habits (RWH). Also, the associations between retelling and comprehension measures and their structural grey matter (GM) correlates were explored. METHODS & PROCEDURES A total of 17 adults with unilateral left hemisphere (LH) chronic ischaemic stroke without the presence of significant aphasia and 10 matched (age, education and SES) healthy controls (HC) participated in the study. Retell and comprehension tasks were performed after listening or reading narrative stories. Voxel-based morphometry (VBM) analysis was conducted on a subgroup of nine individuals with LH stroke and the 10 matched controls using structural magnetic resonance imaging (MRI). OUTCOMES & RESULTS Retelling and comprehension abilities were not significantly different between LH and HC, nonetheless quantitively lower in LH. Exploratory correlations showed that retelling and comprehension abilities in both written and auditory modalities were correlated with naming abilities. At the neural level, written comprehension positively correlated with GM density of the LH, including areas in the temporal pole, superior and middle temporal gyrus as well as the orbitofrontal cortex, precentral and postcentral gyri. Auditory narrative comprehension was associated with GM density of the lingual gyrus in the right hemisphere. CONCLUSIONS & IMPLICATIONS The present results suggest that retelling and comprehension of auditory and written narratives are relatively well-preserved in individuals with a LH stroke without significant aphasia, but poorer than in HC. The findings replicate previous studies conducted in groups with higher levels of education and SES both at the behavioural and neural levels. Considering that naming seems to be associated with narrative retell and comprehension in individuals with lower SES and education, this research provides evidence on the importance of pursuing further studies including larger samples with and without aphasia as well as with various SES and education levels. WHAT THIS PAPER ADDS What is already known on this subject Story retell and comprehension of auditory and written discourse have been shown to be affected after stroke, but most studies have been conducted on individuals with middle to high SES and high educational levels. What this paper adds to existing knowledge The study reports on narrative retell and comprehension in both auditory and written modalities in groups of HC and individuals with LH brain damage, with low-to-middle SES and lower levels of education. What are the potential or actual clinical implications of this work? This study highlights the importance of taking into consideration the sociodemographic and RWH of patients when assessing discourse retell and comprehension in both auditory and written modalities. It also underlines the importance of including patients without significant aphasia following LH stroke to look at the effect of both stroke and aphasia on narrative comprehension and story retelling.
Collapse
Affiliation(s)
- Sabrine Amaral Martins Townsend
- School of Humanities (Linguistics Department), Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Rio Grande do Sul, Brazil
- University of Santa Cruz do Sul (UNISC), Postdoctoral Program in Linguistics-Santa Cruz do Sul, Rio Grande do Sul, Brazil
| | - Karine Marcotte
- Centre de recherche du Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, QC, Canada
- École d'orthophonie et d'audiologie, Faculté de médecine, Université de Montréal, Montréal, QC, Canada
| | - Amelie Brisebois
- Centre de recherche du Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Montréal, QC, Canada
- École d'orthophonie et d'audiologie, Faculté de médecine, Université de Montréal, Montréal, QC, Canada
| | - Anderson Dick Smidarle
- School of Humanities (Linguistics Department), Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Rio Grande do Sul, Brazil
| | - Fernanda Schneider
- Federal Institute of Education, Science and Technology of Rio Grande do Sul (IFRS-Ibirubá), Bento Goncalves, Rio Grande do Sul, Brazil
| | - Fernanda Loureiro
- Institut of Geriatrics and Gerontology, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Rio Grande do Sul, Brazil
| | - Ricardo Bernardi Soder
- Brain Institute (InsCer), Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
- School of Medicine, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Rio Grande do Sul, Brazil
| | - Alexandre da Rosa Franco
- Department of Psychiatry, NYU Grossman School of Medicine, New York, NY, USA
- Center for Biomedical Imaging and Neuromodulation, The Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY, USA
- Center for the Developing Brain, Child Mind Institute, New York, NY, USA
| | - Luiz Carlos Porcello Marrone
- Brain Institute (InsCer), Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul, Brazil
- Neurology Center, Hospital São Lucas at Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Rio Grande do Sul, Brazil
- Medicine School, Luteran University of Brazil (ULBRA), Porto Alegre, Rio Grande do Sul, Brazil
- Morphology Sciences Department, ICBS, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Rio Grande do Sul, Brazil
| | - Lilian Cristine Hübner
- School of Humanities (Linguistics Department), Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Rio Grande do Sul, Brazil
- National Council for Scientific and Technological Development (CNPq), Federal Capital, Brasília, Brazil
| |
Collapse
|
6
|
Henderson SK, Peterson KA, Patterson K, Lambon Ralph MA, Rowe JB. Verbal fluency tests assess global cognitive status but have limited diagnostic differentiation: evidence from a large-scale examination of six neurodegenerative diseases. Brain Commun 2023; 5:fcad042. [PMID: 36910418 PMCID: PMC9999359 DOI: 10.1093/braincomms/fcad042] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 11/23/2022] [Accepted: 02/20/2023] [Indexed: 02/25/2023] Open
Abstract
Verbal fluency is widely used as a clinical test, but its utility in differentiating between neurodegenerative dementias and progressive aphasias, and from healthy controls, remains unclear. We assessed whether various measures of fluency performance could differentiate between Alzheimer's disease, behavioural variant of frontotemporal dementia, non-fluent and semantic variants of primary progressive aphasia, progressive supranuclear palsy, corticobasal syndrome and healthy controls. Category and letter fluency tasks were administered to 33 controls and 139 patients at their baseline clinical visit. We assessed group differences for total number of words produced, psycholinguistic word properties and associations between production order and exemplar psycholinguistic properties. Receiver operating characteristic curves determined which measure could best discriminate patient groups and controls. The total word count distinguished controls from all patient groups, but neither this measure nor the word properties differentiated the patient groups. Receiver operating characteristic curves revealed that, when comparing controls to patients, the strongest discriminators were total word count followed by word frequency. Word frequency was the strongest discriminator for semantic variant of primary progressive aphasia versus other groups. Fluency word counts were associated with global severity as measured by Addenbrooke's Cognitive Examination Revised. Verbal fluency is an efficient test for assessing global brain-cognitive health but has limited utility in differentiating between cognitively and anatomically disparate patient groups. This outcome is consistent with the fact that verbal fluency requires many different aspects of higher cognition and language.
Collapse
Affiliation(s)
- Shalom K Henderson
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge CB2 7EF, UK
- Department of Clinical Neurosciences, University of Cambridge, Cambridge CB2 7EF, UK
| | - Katie A Peterson
- Department of Clinical Neurosciences, University of Cambridge, Cambridge CB2 7EF, UK
- Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 7EF, UK
| | - Karalyn Patterson
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge CB2 7EF, UK
- Department of Clinical Neurosciences, University of Cambridge, Cambridge CB2 7EF, UK
- Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 7EF, UK
| | - Matthew A Lambon Ralph
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge CB2 7EF, UK
- Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 7EF, UK
| | - James B Rowe
- MRC Cognition and Brain Sciences Unit, University of Cambridge, Cambridge CB2 7EF, UK
- Department of Clinical Neurosciences, University of Cambridge, Cambridge CB2 7EF, UK
- Cambridge University Hospitals NHS Foundation Trust, Cambridge CB2 7EF, UK
| |
Collapse
|
7
|
Olmos-Villaseñor R, Sepulveda-Silva C, Julio-Ramos T, Fuentes-Lopez E, Toloza-Ramirez D, Santibañez RA, Copland DA, Mendez-Orellana C. Phonological and Semantic Fluency in Alzheimer's Disease: A Systematic Review and Meta-Analysis. J Alzheimers Dis 2023; 95:1-12. [PMID: 37482994 PMCID: PMC10578227 DOI: 10.3233/jad-221272] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2023] [Indexed: 07/25/2023]
Abstract
BACKGROUND Semantic and Phonological fluency (SF and PF) are routinely evaluated in patients with Alzheimer's disease (AD). There are disagreements in the literature regarding which fluency task is more affected while developing AD. Most studies focus on SF assessment, given its connection with the temporoparietal amnesic system. PF is less reported, it is related to working memory, which is also impaired in probable and diagnosed AD. Differentiating between performance on these tasks might be informative in early AD diagnosis, providing an accurate linguistic profile. OBJECTIVE Compare SF and PF performance in healthy volunteers, volunteers with probable AD, and patients with AD diagnosis, considering the heterogeneity of age, gender, and educational level variables. METHODS A total of 8 studies were included for meta-analysis, reaching a sample size of 1,270 individuals (568 patients diagnosed with AD, 340 with probable AD diagnosis, and 362 healthy volunteers). RESULTS The three groups consistently performed better on SF than PF. When progressing to a diagnosis of AD, we observed a significant difference in SF and PF performance across our 3 groups of interest (p = 0.04). The age variable explained a proportion of this difference in task performance across the groups, and as age increases, both tasks equally worsen. CONCLUSION The performance of SF and PF might play a differential role in early AD diagnosis. These tasks rely on partially different neural bases of language processing. They are thus worth exploring independently in diagnosing normal aging and its transition to pathological stages, including probable and diagnosed AD.
Collapse
Affiliation(s)
- Rocio Olmos-Villaseñor
- Speech and Language Therapy School, Health Sciences Department, Faculty of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
- Laboratory of Language Rehabilitation and Stimulation (LARES), Speech and Language Therapy School, Health Sciences Department, Faculty of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Consuelo Sepulveda-Silva
- Speech and Language Therapy School, Health Sciences Department, Faculty of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
- Laboratory of Language Rehabilitation and Stimulation (LARES), Speech and Language Therapy School, Health Sciences Department, Faculty of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Teresa Julio-Ramos
- Laboratory of Language Rehabilitation and Stimulation (LARES), Speech and Language Therapy School, Health Sciences Department, Faculty of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - Eduardo Fuentes-Lopez
- Speech and Language Therapy School, Health Sciences Department, Faculty of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
| | - David Toloza-Ramirez
- Exercise and Rehabilitation Sciences Institute, School of Speech Therapy, Faculty of Rehabilitation Sciences, Universidad Andres Bello, Santiago, Chile
| | - Rodrigo A. Santibañez
- Neurology Department, Faculty of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- Neurology Service, Complejo Asistencial Doctor Sótero del Río, Santiago, Chile
| | - David A. Copland
- Queensland Aphasia Research Centre, School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia
| | - Carolina Mendez-Orellana
- Speech and Language Therapy School, Health Sciences Department, Faculty of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
- Laboratory of Language Rehabilitation and Stimulation (LARES), Speech and Language Therapy School, Health Sciences Department, Faculty of Medicine, Pontificia Universidad Catolica de Chile, Santiago, Chile
| |
Collapse
|
8
|
Martino P, Cervigni M, Portillo N, Gallegos M, Politis D, Bortoli MÁD, Vivas J. Three verbal fluency tasks: Normative data and convergent validity in Argentines over 50 years. Dement Neuropsychol 2022; 16:481-488. [DOI: 10.1590/1980-5764-dn-2022-0026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 07/08/2022] [Accepted: 08/03/2022] [Indexed: 12/07/2022] Open
Abstract
Abstract Verbal fluency tasks are frequently used in neuropsychological assessment, standing out for their easy application and good sensitivity to early cognitive impairment. However, in Argentina, the availability of updated norms is limited, especially for the action fluency variant. There is also little evidence of validity. Objectives: The aim of this study was to obtain Argentine norms for three verbal fluency tasks and to analyze their convergent validity. Methods: Using a nonprobability sampling method, 303 Argentines from a nonclinical population (age mean=66.8, 50–91 years) were recruited to participate in this study. Those with medical conditions that could compromise neuropsychological performance were excluded. Three verbal fluency tasks (i.e., phonological, semantic, and action), the Montreal Cognitive Assessment (MoCA) test, and the Digit Span-WAIS III test were administered. Correlations and multiple regressions were subsequently performed. Results: Education and age significantly explained 11.8% of the variance in phonological fluency, 15.8% of the variance in semantic fluency, and 20.2% of the variance in action fluency. Hence, the normative data varied according to educational level and age group, with normal performance limit values between 9 and 14 for phonological fluency, 11 and 18 for semantic fluency, and 8 and 17 for action fluency. Positive correlations were obtained between all verbal fluency tasks, as well as between the MoCA test and the Digit Span test. Conclusions: This study supports the applicability of three verbal fluency tasks in an Argentine context by providing age- and education-corrected norms and acceptable evidence of convergent validity.
Collapse
Affiliation(s)
- Pablo Martino
- Universidad Nacional de Rosario, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas, Argentina
| | - Mauricio Cervigni
- Universidad Nacional de Rosario, Argentina; Consejo Nacional de Investigaciones Científicas y Técnicas, Argentina
| | | | - Miguel Gallegos
- Universidad Católica del Maule, Chile; Pontificia Universidade Católica de Minas Gerais, Argentina
| | - Daniel Politis
- Consejo Nacional de Investigaciones Científicas y Técnicas, Argentina; Universidad de Buenos Aires, Argentina
| | | | - Jorge Vivas
- Consejo Nacional de Investigaciones Científicas y Técnicas, Argentina; Universidad Nacional de Mar del Plata, Argentina
| |
Collapse
|
9
|
Iñesta C, Oltra-Cucarella J, Sitges-Maciá E. Regression-Based Normative Data for Independent and Cognitively Active Spanish Older Adults: Verbal Fluency Tests and Boston Naming Test. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11445. [PMID: 36141718 PMCID: PMC9517509 DOI: 10.3390/ijerph191811445] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 09/06/2022] [Accepted: 09/07/2022] [Indexed: 06/02/2023]
Abstract
An increased cognitive reserve is associated with changes in the pattern of cognitive decline during aging. Thus, normative data adapted to the characteristics of the target population are needed to reduce the possibility of false diagnoses. The aim of this work was to develop normative data for the Phonemic Verbal Fluency test, the Semantic Verbal Fluency test and the Boston Naming Test (BNT). METHOD Regression-based normative data were calculated from a sample of 118 non-depressed, cognitively active, independent community-dwelling adults aged 55 or older (64.4% women) from SABIEX (University for Seniors at the Universidad Miguel Hernández de Elche). Raw scores were regressed on age, sex, and education. RESULTS The effects of age and education varied across neuropsychological measures. No effect of sex was found in any of the tests assessed. Statistically significant differences were found in the proportion of low scores using SABIEX or population-based normative datasets. The level of agreement identifying individuals labeled as showing one or more low scores was only fair-to-good. CONCLUSIONS Normative data obtained from the general population might not be sensitive to identify low scores in cognitively active older adults, increasing the risk of misdiagnoses. A friendly calculator is available for neuropsychological assessment.
Collapse
Affiliation(s)
- Clara Iñesta
- SABIEX, Universidad Miguel Hernández de Elche, Av. de la Universidad, 03207 Elche, Spain
| | - Javier Oltra-Cucarella
- SABIEX, Universidad Miguel Hernández de Elche, Av. de la Universidad, 03207 Elche, Spain
- Department of Health Psychology, Miguel Hernández University of Elche, 03202 Elche, Spain
| | - Esther Sitges-Maciá
- SABIEX, Universidad Miguel Hernández de Elche, Av. de la Universidad, 03207 Elche, Spain
- Department of Health Psychology, Miguel Hernández University of Elche, 03202 Elche, Spain
| |
Collapse
|
10
|
Malcorra BLC, Mota NB, Weissheimer J, Schilling LP, Wilson MA, Hübner LC. Reading and writing habits compensate for aging effects in speech connectedness. NPJ SCIENCE OF LEARNING 2022; 7:13. [PMID: 35676305 PMCID: PMC9178018 DOI: 10.1038/s41539-022-00129-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Accepted: 05/18/2022] [Indexed: 05/06/2023]
Abstract
We investigate the association of short- and long-range recurrences (speech connectedness) with age, education, and reading and writing habits (RWH) in typical aging using an oral narrative production task. Oral narrative transcriptions were represented as word-graphs to measure short- and long-range recurrences. Speech connectedness was explained by the combination of age, education, and RWH, and the strength of RWH's coefficient reflects the aging effect.
Collapse
Affiliation(s)
- Bárbara L C Malcorra
- School of Humanities, Graduate Course in Linguistics, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil.
| | - Natália B Mota
- Institute of Psychiatry, Federal University of Rio de Janeiro (UFRJ), Rio de Janeiro, RJ, Brazil
- Department of Physics, Federal University of Pernambuco (UFPE), Recife, PE, Brazil
| | - Janaina Weissheimer
- Brain Institute, Department of Foreign Languages and Literatures, Federal University of Rio Grande do Norte (UFRN), Natal, RN, Brazil
- National Council for Scientific and Technological Development (CNPq), Brasília, DF, Brazil
| | - Lucas P Schilling
- School of Medicine, Graduate Course in Medicine and Healthy Sciences, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil
- School of Medicine, Graduate Course in Biomedical Gerontology, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil
- Brain Institute of Rio Grande do Sul (InsCer), Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil
| | - Maximiliano A Wilson
- Centre interdisciplinaire de recherche en réadaptation et intégration sociale (CIRRIS), Département de réadaptation, Université Laval, Québec City, QC, Canada
| | - Lilian C Hübner
- School of Humanities, Graduate Course in Linguistics, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil
- National Council for Scientific and Technological Development (CNPq), Brasília, DF, Brazil
| |
Collapse
|
11
|
Schneider F, Marcotte K, Brisebois A, Townsend SAM, Smidarle AD, Soder RB, Marrone LCP, Hübner LC. Macrostructural Aspects in Oral Narratives in Brazilian Portuguese by Left and Right Hemisphere Stroke Patients With Low Education and Low Socioeconomic Status. AMERICAN JOURNAL OF SPEECH-LANGUAGE PATHOLOGY 2022; 31:1319-1337. [PMID: 35302896 DOI: 10.1044/2021_ajslp-21-00205] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Individuals with a stroke in either the left hemisphere (LH) or the right hemisphere (RH) often present macrostructural impairments in narrative abilities. Understanding the potential influence of low education and low socioeconomic status (SES) is critical to a more effective assessment of poststroke language. The first aim was to investigate macrostructural processing in low-education and low-SES individuals with stroke in the LH or RH or without brain damage. The second aim was to verify the relationships between macrolinguistic, neuropsychological, and sociodemographic variables. METHOD Forty-seven adults with LH (n = 15) or RH (n = 16) chronic ischemic stroke and 16 matched (age, education, and SES) healthy controls produced three oral picture-sequence narratives. The macrostructural aspects analyzed were cohesion, coherence, narrativity, macropropositions, and index of lexical informativeness and were compared among the three groups. Then, exploratory correlations were performed to assess associations between sociodemographic (such as SES), neuropsychological, and macrostructural variables. RESULTS Both the LH and the RH presented impairments in the local macrostructural aspect (cohesion), whereas the RH also presented impairments in more global aspects (global coherence and macropropositions). All five macrostructural variables correlated with each other, with higher correlations with narrativity. Naming was correlated with all macrostructural variables, as well as prestroke reading and writing habits (RWH), showing that higher naming accuracy and higher RWH are associated with better macrostructural skills. CONCLUSIONS The present results corroborate the role of the LH in more local processing and that of the RH in more global aspects of discourse. Moreover, this study highlights the importance of investigating discourse processing in healthy and clinical populations of understudied languages such as Brazilian Portuguese, with various levels of education, SES, and RWH.
Collapse
Affiliation(s)
- Fernanda Schneider
- Federal Institute of Education, Science and Technology of Rio Grande do Sul, Ibirubá, Brazil
- Linguistics Department, School of Humanities, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Karine Marcotte
- Centre de recherche du Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Québec, Canada
- École d'orthophonie et d'audiologie, Faculté de médecine, Université de Montréal, Québec, Canada
| | - Amélie Brisebois
- Centre de recherche du Centre intégré universitaire de santé et de services sociaux du Nord-de-l'Île-de-Montréal, Québec, Canada
- École d'orthophonie et d'audiologie, Faculté de médecine, Université de Montréal, Québec, Canada
| | - Sabrine Amaral Martins Townsend
- Linguistics Department, School of Humanities, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
- Postdoctoral Program in Linguistics, University of Santa Cruz do Sul, Rio Grande do Sul, Brazil
| | - Anderson Dick Smidarle
- Linguistics Department, School of Humanities, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Ricardo Bernardi Soder
- Brain Institute of Rio Grande do Sul, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
- School of Medicine, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | | | - Lilian Cristine Hübner
- Linguistics Department, School of Humanities, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
- National Council for Scientific and Technological Development, Brasília, Distrito Federal, Brazil
| |
Collapse
|
12
|
Malcorra BLC, Wilson MA, Schilling LP, Hübner LC. Lower Education and Reading and Writing Habits Are Associated With Poorer Oral Discourse Production in Typical Adults and Older Adults. Front Psychol 2022; 13:740337. [PMID: 35369132 PMCID: PMC8972065 DOI: 10.3389/fpsyg.2022.740337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Accepted: 02/18/2022] [Indexed: 11/28/2022] Open
Abstract
During normal aging there is a decline in cognitive functions that includes deficits in oral discourse production. A higher level of education and more frequent reading and writing habits (RWH) might delay the onset of the cognitive decline during aging. This study aimed at investigating the effect of education and RWH on oral discourse production in older adults. Picture-based narratives were collected from 117 healthy adults, aged between 51 and 82 years (68.6 ± 6.38) with 0-20 years of formal education (10.1 ± 5.69). Measures of macro, microlinguistic and modalizations were computed and entered as dependent variables in hierarchical regression analyses that included age, education and RWH as regressors. Results revealed that higher education explained a better performance at the macrostructure and microstructure dimensions. Higher frequency of RWH explained the production of fewer modalizations. These results demonstrate the positive effect of education and RWH in oral discourse production in older adults. Therefore, higher attention should be given to these social factors.
Collapse
Affiliation(s)
| | - Maximiliano A. Wilson
- Département de Réadaptation, Faculté de Médecine, Centre Interdisciplinaire de Recherche en Réadaptation et Intégration Sociale (CIRRIS), Université Laval, Quebec, QC, Canada
| | - Lucas Porcello Schilling
- Brain Institute of Rio Grande do Sul, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
| | - Lilian Cristine Hübner
- Department of Linguistics, Pontifical Catholic University of Rio Grande do Sul (PUCRS), Porto Alegre, Brazil
- National Council for Scientific and Technological Development (CNPq), Brasília, Brazil
| |
Collapse
|
13
|
Karsazi H, Hatami J, Rostami R, Moghadamzadeh A. The Lifetime of Experiences Questionnaire: Psychometric Properties and Relationships With Memory Function in an Iranian Elderly Sample. Front Psychiatry 2022; 13:889177. [PMID: 35586406 PMCID: PMC9108157 DOI: 10.3389/fpsyt.2022.889177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Accepted: 04/11/2022] [Indexed: 12/03/2022] Open
Abstract
This study aimed to validate the Persian version of the Lifetime of Experiences Questionnaire (LEQ) and examine the relationship between life experience and memory function. To this end, two studies were conducted. Study one examined the factor structure, internal consistency, and convergent and discriminant validity of the Persian version of LEQ with 247 healthy elderly individuals (M age = 70.17, SD = 4.42; 55.9% women). The exploratory factor analysis yielded a five-factor solution, including Knowledge, Physical, Socialization, Artistic, and Leisure dimensions, which accounted for 42.42% of the explained variance. The internal consistency of the LEQ was in the acceptable range (α = 0.703). Also, the LEQ and its subscales (except the Artistic subscale) had a negative relationship with geriatric depression and a positive relationship with a healthy lifestyle, supporting the measure's convergent and discriminant validity. In the second study, we examined the relationship between LEQ (total and subscales score) and memory function using Pearson correlation and moderating analysis with 149 participants (M age = 70.37, SD = 4.29; 55.03% women). The results demonstrated that the LEQ total and subscales scores correlated positively with episodic memory. In the same vein, LEQ total score and Knowledge subscale showed a positive correlation with semantic memory. The results of moderation analysis showed that LEQ subscales have a different role in memory decline. The knowledge subscale as a content component moderates the effect of age on semantic memory (B = 0.005, t = 2.021, p = 0.045), while the mid-life non-specific activities, which are based on life stages, moderate the effect of age on episodic memory (B = 0.007, t = 3.348, p = 0.001). In conclusion, our results indicated that the Persian version of the LEQ is a valid and reliable instrument for measuring experiences and activities throughout life, which can be used in professional clinical and research settings in the aging context with Iranian elderly samples. Furthermore, our findings suggest that various life experiences can be considered cognitive reserves in old age.
Collapse
Affiliation(s)
- Hossein Karsazi
- Department of Psychology, Faculty of Psychology and Educational Sciences, University of Tehran, Tehran, Iran
| | - Javad Hatami
- Department of Psychology, Faculty of Psychology and Educational Sciences, University of Tehran, Tehran, Iran
| | - Reza Rostami
- Department of Psychology, Faculty of Psychology and Educational Sciences, University of Tehran, Tehran, Iran
| | - Ali Moghadamzadeh
- Department of Curriculum Development and Instruction Methods, Faculty of Psychology and Educational Sciences, University of Tehran, Tehran, Iran
| |
Collapse
|
14
|
Kaskikallio A, Karrasch M, Koikkalainen J, Lötjönen J, Rinne JO, Tuokkola T, Parkkola R, Grönholm-Nyman P. Effects of White Matter Hyperintensities on Verbal Fluency in Healthy Older Adults and MCI/AD. Front Aging Neurosci 2021; 13:614809. [PMID: 34025385 PMCID: PMC8134546 DOI: 10.3389/fnagi.2021.614809] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 03/25/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND White matter hyperintensities (WMHs) are markers for cerebrovascular pathology, which are frequently seen in patients with mild cognitive impairment (MCI) and Alzheimer's disease (AD). Verbal fluency is often impaired especially in AD, but little research has been conducted concerning the specific effects of WMH on verbal fluency in MCI and AD. OBJECTIVE Our aim was to examine the relationship between WMH and verbal fluency in healthy old age and pathological aging (MCI/AD) using quantified MRI data. METHODS Measures for semantic and phonemic fluency as well as quantified MRI imaging data from a sample of 42 cognitively healthy older adults and 44 patients with MCI/AD (total n = 86) were utilized. Analyses were performed both using the total sample that contained seven left-handed/ambidextrous participants, as well with a sample containing only right-handed participants (n = 79) in order to guard against possible confounding effects regarding language lateralization. RESULTS After controlling for age and education and adjusting for multiple correction, WMH in the bilateral frontal and parieto-occipital areas as well as the right temporal area were associated with semantic fluency in cognitively healthy and MCI/AD patients but only in the models containing solely right-handed participants. CONCLUSION The results indicate that white matter pathology in both frontal and parieto-occipital cerebral areas may have associations with impaired semantic fluency in right-handed older adults. However, elevated levels of WMH do not seem to be associated with cumulative effects on verbal fluency impairment in patients with MCI or AD. Further studies on the subject are needed.
Collapse
Affiliation(s)
- Alar Kaskikallio
- Department of Psychology, Åbo Akademi University, Turku, Finland
| | - Mira Karrasch
- Department of Psychology, Åbo Akademi University, Turku, Finland
| | | | | | - Juha O. Rinne
- Turku PET-Centre, University of Turku, Turku, Finland
- Division of Clinical Neurosciences, Turku University Hospital, Turku, Finland
| | | | - Riitta Parkkola
- Department of Radiology, University Hospital of Turku, Turku, Finland
| | | |
Collapse
|