Category verbal fluency performance may be impaired in amnestic mild cognitive impairment

Balthazar, Márcio Luiz Figueredo; Cendes, Fernando; Damasceno, Benito Pereira

doi:10.1590/S1980-57642008DN10200008

Abstract

To study category verbal fluency (VF) for animals in patients with amnestic mild cognitive impairment (aMCI), mild Alzheimer disease (AD) and normal controls.

Method:

Fifteen mild AD, 15 aMCI, and 15 normal control subjects were included. Diagnosis of AD was based on DSM-IV and NINCDS-ADRDA criteria, while aMCI was based on the criteria of the International Working Group on Mild Cognitive Impairment, using CDR 0.5 for aMCI and CDR 1 for mild AD. All subjects underwent testing of category VF for animals, lexical semantic function (Boston Naming-BNT, CAMCOG Similarities item), WAIS-R forward and backward digit span, Rey Auditory Verbal Learning (RAVLT), Mini-Mental Status Examination (MMSE), and other task relevant functions such as visual perception, attention, and mood state (with Cornell Scale for Depression in Dementia). Data analysis used ANOVA and a post-hoc Tukey test for intergroup comparisons, and Pearson's coefficient for correlations of memory and FV tests with other task relevant functions (statistical significance level was p<0.05).

Results:

aMCI patients had lower performance than controls on category VF for animals and on the backward digit span subtest of WAIS-R but higher scores compared with mild AD patients. Mild AD patients scored significantly worse than aMCI and controls across all tests.

Conclusion:

aMCI patients may have poor performance in some non-memory tests, specifically category VF for animals in our study, where this could be attributable to the influence of working memory.

Key Words:
verbal fluency; mild cognitive impairment; Alzheimer disease; neuropsychological tests.

Resumo

Estudar a fluência verbal (FV) para a categoria animais no comprometimento cognitivo leve amnéstico (aCCL), doença de Alzheimer (DA) leve e controles normais.

Método:

Incluímos 15 pacientes com DA leve, 15 com aCCL e 15 controles normais, usando os critérios DSM-IV, NINCDS-ADRDA e CDR 1 para DA, e os do International Working Group on Mild Cognitive Impairment, e CDR 0,5 para aCCL. Todos os sujeitos passaram por avaliação da FV para a categoria animais, função léxico-semântica (Teste de nomeação de Boston - TNB, item de Similaridades do CAMCOG), extensão de dígitos direto e indireto do WAIS-R, aprendizado auditivo-verbal de Rey (TAAVR), Mini-Exame do Estado Mental (MEEM), e de outras funções (contraprovas) capazes de influenciar nestes testes, como percepção visual, atenção e estado de humor (este com a Escala Cornell para Depressão em Demência). A análise dos dados usou o teste de análise de variância (ANOVA) seguido do teste de Tukey post hoc para comparações entre os grupos e o coeficiente de Pearson para correlação entre testes e contraprovas (nível de significância p<0,05).

Resultados:

Os pacientes com aCCL tiveram performance inferior à dos controles nos testes de FV para animais e na extensão de dígitos indireta do WAIS-R. Pacientes com DA leve tiveram performance inferior à de sujeitos com aCCL e controles em todos os testes.

Conclusão:

Pacientes com aCCL tiveram desempenho rebaixado em testes de fluência verbal para animais, o que pode ter sido influenciado pela memória operacional.

Palavras-chave:
fluência verbal; comprometimento cognitivo leve; doença de Alzheimer; testes neuropsicológicos.

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References

¹
Winblad B, Palmer K, Kivipelto M, et al. Mild cognitive impairment-beyond controversies, towards a consensus: report of the International Working Group on Mild Cognitive Impairment. J Intern Med 2004;256:240-246.
²
Petersen RC. Mild cognitive impairment as a diagnostic entity. J Intern Med 2004;256:183-194.
³
Murphy KJ, Rich JB, Troyer AK. Verbal fluency patterns in amnestic mild cognitive impairment are characteristic of Alzheimer's type dementia. J Int Neuropsychol Soc 2006;12:570-574.
⁴
Henry JD, Crawford JR, Phillips LH. Verbal fluency performance in dementia of the Alzheimer's type: A metanalysis. Neuropsychologia 2004;42:1212-1222.
⁵
Estes WK. Learning theory and intelligence. Am Psychol 1974;29:740-749.
⁶
Morris JC. The clinical dementia rating (CDR): Current version and scoring rules. Neurology 1993;43:2412-2414.
⁷
McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM. Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer's Disease. Neurology 1984;34:939-944.
⁸
Brucki SMD, Nitrini R, Caramelli P, Bertolucci PHF, Okamoto IH. Sugestões para o uso do mini-exame do estado mental no Brasil. Arq Neuropsiquiatr 2003;61:777-781.
⁹
Rey A. L'examen clinique in psychologie. Paris: Press Universitaire de France; 1964.
¹⁰
Lezak MD. Neuropsychological Assessment. 3rd ed. New York: Oxford University Press; 2004.
¹¹
Roth M, Huppert FA, Tym E, Mountjoy CQ. The Cambridge Examination for Mental Disorders of the Elderly: CAMDEX. Cambridge University Press; 1988.
¹²
Christensen A-L. Luria's Neuropsychological Investigation. 2nd ed. Copenhagen: Munksgaard; 1979.
¹³
Wechsler D. Wechsler Memory Scale - Revised: Manual. The Psychological Corporation. Hartcourt Brace Jovanovich Inc; 1987.
¹⁴
Alexopoulos GS, Abrams RC, Young RC, Shamoian CA. Cornell Scale for Depression in Dementia. Biol Psychiatry 1988;23:271-284.
¹⁵
Dudas RB, Clague F, Thompson SA, et al. Episodic and semantic memory in mild cognitive impairment. Neuropsychologia 2005;43:1266-1276.
¹⁶
Adlam AL, Bozeat S, Arnold R et al. Semantic knowledge in mild cognitive impairment and mild Alzheimer's disease. Cortex 2006;42:675-684.
¹⁷
Radanovic M, Carthery-Goulart MT, Charchat-Fichman H, et al. Analysis of brief language tests in the detection of cognitive decline and dementia. Dement Neuropsychol 2007;1:37-45.
¹⁸
Perry RH, Watson P, Hodges JR. The nature and staging of attention dysfunction in early (minimal and mild) Alzheimer's disease: relationship to episodic and semantic memory impairment. Neuropsychologia 2000;38:252-271.

Publication Dates

Publication in this collection
Apr-Jun 2007

This is an open-access article distributed under the terms of the Creative Commons Attribution License

[1] ¹
Winblad B, Palmer K, Kivipelto M, et al. Mild cognitive impairment-beyond controversies, towards a consensus: report of the International Working Group on Mild Cognitive Impairment. J Intern Med 2004;256:240-246.

[2] ²
Petersen RC. Mild cognitive impairment as a diagnostic entity. J Intern Med 2004;256:183-194.

[3] ³
Murphy KJ, Rich JB, Troyer AK. Verbal fluency patterns in amnestic mild cognitive impairment are characteristic of Alzheimer's type dementia. J Int Neuropsychol Soc 2006;12:570-574.

[4] ⁴
Henry JD, Crawford JR, Phillips LH. Verbal fluency performance in dementia of the Alzheimer's type: A metanalysis. Neuropsychologia 2004;42:1212-1222.

[5] ⁵
Estes WK. Learning theory and intelligence. Am Psychol 1974;29:740-749.

[6] ⁶
Morris JC. The clinical dementia rating (CDR): Current version and scoring rules. Neurology 1993;43:2412-2414.

[7] ⁷
McKhann G, Drachman D, Folstein M, Katzman R, Price D, Stadlan EM. Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer's Disease. Neurology 1984;34:939-944.

[8] ⁸
Brucki SMD, Nitrini R, Caramelli P, Bertolucci PHF, Okamoto IH. Sugestões para o uso do mini-exame do estado mental no Brasil. Arq Neuropsiquiatr 2003;61:777-781.

[9] ⁹
Rey A. L'examen clinique in psychologie. Paris: Press Universitaire de France; 1964.

[10] ¹⁰
Lezak MD. Neuropsychological Assessment. 3rd ed. New York: Oxford University Press; 2004.

[11] ¹¹
Roth M, Huppert FA, Tym E, Mountjoy CQ. The Cambridge Examination for Mental Disorders of the Elderly: CAMDEX. Cambridge University Press; 1988.

[12] ¹²
Christensen A-L. Luria's Neuropsychological Investigation. 2nd ed. Copenhagen: Munksgaard; 1979.

[13] ¹³
Wechsler D. Wechsler Memory Scale - Revised: Manual. The Psychological Corporation. Hartcourt Brace Jovanovich Inc; 1987.

[14] ¹⁴
Alexopoulos GS, Abrams RC, Young RC, Shamoian CA. Cornell Scale for Depression in Dementia. Biol Psychiatry 1988;23:271-284.

[15] ¹⁵
Dudas RB, Clague F, Thompson SA, et al. Episodic and semantic memory in mild cognitive impairment. Neuropsychologia 2005;43:1266-1276.

[16] ¹⁶
Adlam AL, Bozeat S, Arnold R et al. Semantic knowledge in mild cognitive impairment and mild Alzheimer's disease. Cortex 2006;42:675-684.

[17] ¹⁷
Radanovic M, Carthery-Goulart MT, Charchat-Fichman H, et al. Analysis of brief language tests in the detection of cognitive decline and dementia. Dement Neuropsychol 2007;1:37-45.

[18] ¹⁸
Perry RH, Watson P, Hodges JR. The nature and staging of attention dysfunction in early (minimal and mild) Alzheimer's disease: relationship to episodic and semantic memory impairment. Neuropsychologia 2000;38:252-271.

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