Naming ability in patients with mild to moderate Alzheimer’s disease: what changes occur with the evolution of the disease?

Silagi, Marcela Lima; Bertolucci, Paulo Henrique Ferreira; Ortiz, Karin Zazo

doi:10.6061/clinics/2015(06)07

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Sumário

CLINICAL SCIENCES • Clinics 70 (6) • June 2015 • https://doi.org/10.6061/clinics/2015(06)07 copy

Naming ability in patients with mild to moderate Alzheimer’s disease: what changes occur with the evolution of the disease?

Authorship SCIMAGO INSTITUTIONS RANKINGS

OBJECTIVES:

Naming deficit is a linguistic symptom that appears in the initial phase of Alzheimer’s disease, but the types of naming errors and the ways in which this deficit changes over the course of the disease are unclear. We analyzed the performance of patients with Alzheimer’s disease on naming tasks during the mild and moderate phases and verified how this linguistic skill deteriorates over the course of the disease.

METHODS:

A reduced version of the Boston Naming Test was administered to 30 patients with mild Alzheimer’s disease, 30 patients with moderate Alzheimer’s disease and 30 healthy controls. Errors were classified as verbal semantic paraphasia, verbal phonemic paraphasia, no response (pure anomia), circumlocution, unrelated verbal paraphasia, visual errors or intrusion errors.

RESULTS:

The patients with moderate Alzheimer’s disease had significantly fewer correct answers than did both the control group and the group with mild Alzheimer’s disease. With regard to the pattern of errors, verbal semantic paraphasia errors were the most frequent errors in all three groups. Additionally, as the disease severity increased, there was an increase in the number of no-response errors (pure anomia). The group with moderate Alzheimer’s disease demonstrated a greater incidence of visual errors and unrelated verbal paraphasias compared with the other two groups and presented a more variable pattern of errors.

CONCLUSIONS:

Performance on nominative tasks worsened as the disease progressed in terms of both the quantity and the type of errors encountered. This result reflects impairment at different levels of linguistic processing.

Alzheimer’s disease; Language; Anomia

Naming abilities	Mean (SD)		ANOVA	F	p -value
Naming abilities		CG (30)	Mild AD (30)	F	p -value	Moderate AD (30)
Correct answers	17.2 (2.2)	16.4 (2.3)	13.9 (3.9)	10.68	<0.001*
Verbal semantic paraphasia errors	1.7 (1.5)	1.6 (1.3)	2.1 (1.3)	−1.33	0.270
Verbal phonemic paraphasia errors	0 (0.2)	0.1 (0.3)	0.0 (0.0)	1.33	0.364
Unrelated verbal paraphasia errors	0.2 (0.5)	0.4 (0.6)	1.0 (1.1)	8.34	<0.001*
No-response (pure anomia) errors	0.3 (0.7)	0.9 (1.3)	1.9 (2.5)	7.15	0.001*
Circumlocution errors	0.2 (0.6)	0.3 (0.5)	0.3 (0.8)	0.22	0.799
Visual errors	0.3 (0.5)	0.4 (0.6)	0.7 (0.9)	3.19	0.046
Intrusion errors	0.0 (0.0)	0.0 (0.0)	0.1 (0.4)	1.00	0.372

Comparison among the groups	Difference in means	95% CI (difference)	p -value
Correct responses
Controls x Mild AD	0.83	−1.00 to 2.67	0.810
Controls x Moderate AD	3.33	1.50 to 5.17	<0.001*
Mild AD x Moderate AD	2.50	0.67 to 4.33	0.004*
Unrelated verbal paraphasias
Controls x Mild AD	−0.17	−0.67 to 0.34	1.000
Controls x Moderate AD	−0.80	−1.30 to −0.30	0.001*
Mild AD x Moderate AD	−0.63	−1.14 to −0.13	0.009*
No response (pure anomia)
Controls x Mild AD	−0.63	−1.67 to 0.41	0.422
Controls x Moderate AD	−1.60	−2.64 to −0.56	0.001*
Mild AD x Moderate AD	−0.97	−2.01 to 0.07	0.077

Comparison	Controls		Mild AD		Moderate AD
Comparison		Z	p -value	Z	p -value	Z	p -value
Verbal phonemic paraphasia - Verbal semantic paraphasia	−4.1	<0.001*	−4.3	<0.001*	−4.6	<0.001*
Unrelated verbal paraphasia - Verbal semantic paraphasia	−3.9	<0.001*	−3.9	<0.001*	−3.3	0.001
No response (pure anomia) - Verbal semantic paraphasia	−3.8	<0.001*	−1.9	0.062	−1.1	0.258
Circumlocution - Verbal semantic paraphasia	−3.7	<0.001*	−3.8	<0.001*	−4.4	<0.001*
Visual error - Verbal semantic paraphasia	−3.8	<0.001*	−3.9	<0.001*	−3.9	<0.001*
Intrusion - Verbal semantic paraphasia	−4.1	<0.001*	−4.3	<0.001*	−4.6	<0.001*
Unrelated verbal paraphasia - Verbal phonemic paraphasia	−1.9	0.059	−2.2	0.029	−3.8	<0.001*
No response (pure anomia) - Verbal phonemic paraphasia	−2.3	0.020	−3.1	0.002*	−3.8	<0.001*
Circumlocution - Verbal phonemic paraphasia	−1.9	0.063	−2.5	0.011	−2.3	0.024
Visual error - Verbal phonemic paraphasia	−2.8	0.005	−2.3	0.020	−3.6	<0.001*
Intrusion - Verbal phonemic paraphasia	−1.0	0.317	−1.4	0.157	−1.0	0.317
No response (pure anomia) - Unrelated verbal paraphasia	−0.5	0.589	−2.2	0.027	−1.7	0.092
Circumlocution - Unrelated verbal paraphasia	−0.3	0.773	−0.2	0.816	−2.5	0.011
Visual error - Unrelated verbal paraphasia	−1.1	0.257	0.0	1.000	−1.0	0.340
Intrusion - Unrelated verbal paraphasia	−2.1	0.034	−2.8	0.005	−3.7	<0.001*
Circumlocution - No response (pure anomia)	−0.3	0.729	−2.2	0.027	−2.8	0.005
Visual error - No response (pure anomia)	0.0	1.000	−2.1	0.033	−2.4	0.017
Intrusion - No response (pure anomia)	−2.3	0.024	−3.3	0.001*	−3.6	<0.001*
Visual error - Circumlocution	−0.8	0.414	−0.3	0.796	−1.6	0.107
Intrusion - Circumlocution	−2.1	0.038	−2.9	0.004	−1.5	0.143

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[1] Silagi ML collected, analyzed and interpreted the data and drafted the submitted material. Bertolucci PH performed critical revision of the paper. Ortiz KZ supervised the collection, analysis and interpretation of the data and performed critical revision of the paper.