Semantic, phonologic, and verb fluency in Huntington's disease

Azambuja, Mariana Jardim; Haddad, Monica Santoro; Radanovic, Marcia; Barbosa, Egberto Reis; Mansur, Letícia Lessa

doi:10.1590/S1980-57642008DN10400009

Abstract

Verbal fluency tasks have been identified as important indicators of executive functioning impairment in patients with frontal lobe dysfunction. Although the usual evaluation of this ability considers phonologic and semantic criteria, there is some evidence that fluency of verbs would be more sensitive in disclosing frontostriatal physiopathology since frontal regions primarily mediate retrieval of verbs. Huntington's disease usually affects these circuitries. Objective: To compare three types of verbal fluency task in the assessment of frontal-striatal dysfunction in HD subjects. Methods: We studied 26 Huntington's disease subjects, divided into two subgroups: mild (11) and moderate (15) along with 26 normal volunteers matched for age, gender and schooling, for three types of verbal fluency: phonologic fluency (F-A-S), semantic fluency and fluency of verbs. Results: Huntington's disease subjects showed a significant reduction in the number of words correctly generated in the three tasks when compared to the normal group. Both controls and Huntington's disease subjects showed a similar pattern of decreasing task performance with the greatest number of words being generated by semantic elicitation followed by verbs and lastly phonologic criteria. We did not find greater production of verbs compared with F-A-S and semantic conditions. Moreover, the fluency of verbs distinguished only the moderate group from controls. Conclusion: Our results indicated that phonologic and semantic fluency can be used to evaluate executive functioning, proving more sensitive than verb fluency. However, it is important to point out that the diverse presentations of Huntington's disease means that an extended sample is necessary for more consistent analysis of this issue.

Key words:
Huntington's disease; verbal fluency; neuropsychological tests; cognition

Resumo

As provas de fluência verbal têm sido consideradas como importantes indicadores de comprometimento executivo em pacientes com disfunção de lobo frontal. Embora a avaliação usual dessas habilidades seja baseada em critérios fonológicos e semânticos, existem evidências de que a fluência de verbos seria mais sensível para desvelar a fisiopatologia fronto-estriatal, já que regiões frontais são mediadoras primárias da recuperação de verbos e que a doença de Huntington afeta esses circuitos. Objetivo: Comparar três tipos de fluência verbal na avaliação da disfunção fronto-estriatal, em indivíduos com doença de Huntington. Métodos: Estudamos 26 sujeitos com doença de Huntington divididos em dois grupos: leve (11) e moderado (15), e 26 voluntários normais, emparelhados segundo idade, gênero e escolaridade, nas três condições de fluência: fonema inicial (F-A-S), fluência semântica (animais) e fluência de verbos. Resultados: Os indivíduos com doença de Huntington mostraram redução significante no número de palavras geradas corretamente nas três condições, quando comparados com o grupo normal. Em controles e na doença de Huntington, notamos comportamento semelhante: maior número de itens gerados por elicitação semântica, seguidos pelos critérios fluência de verbos e fonológico. Não encontramos alteração mais acentuada na produção de verbos, quando comparada com as condições F-A-S e semântica; a fluência de verbos distinguiu somente os doentes mais graves dos controles. Conclusão: Nossos resultados indicam a fluência fonológica e semântica podem ser utilizadas e são mais sensíveis do que a fluência de verbos para avaliar o funcionamento executivo. É importante pontuar, entretanto, que a diversidade de apresentação da doença de Huntington exige a ampliação da casuística para análise consistente do tema.

Palavras-chave:
doença de Huntington; fluência verbal; testes neuropsicológicos; cognição

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References

¹
Rosser A, Hodges JR. Initial letter and semantic category fluency in Alzheimer's disease, Huntington's disease, and progressive supranuclear palsy. J Neurol Neurosurg Psychiatry 1994;57:1389-1394.
²
Bayles KA, Tomoeda CK. Confrontation naming impairment in dementia. Brain Lang 1983;9:98-114.
³
Tröster AI, Salmon DP, McCullough D, Butters N. A Comparison of the category fluency deficits associated with Alzheimer's and Huntington's disease. Brain Lang 1989;37:500-513.
⁴
Troyer AK, Moscovitch M, Winocur G. Clustering and switching as two components of verbal fluency: evidence from younger and older healthy adults. Neuropsychology 1997;11:138-146.
⁵
Ho AK, Sahakian, BJ, Robbins TW, Barker RA, Rosser AE, Hodges JR. Verbal fluency in Huntington's disease: a longitudinal analysis of phonemic and semantic cluster and switching. Neuropsychologia 2002;40:1277-1284.
⁶
Arango-Lasprilla JC, Rogers H, Lengenfelder J, Deluca J, Moreno S, Lopera F. Cortical and subcortical diseases: do true neuropsychological differences exist? Arch Clin Neuropsychol 2006;21:29-40.
⁷
Butters N, Wolfe J, Granholm E, Martone M. An assessment of verbal recall, recognition and fluency abilities in patients with Huntington's disease. Cortex 1986;22:11-32.
⁸
Hodges JR, Salmon DP, Butters N. The nature of the naming deficit in Alzheimer's and Huntington's disease. Brain 1991; 114:1547-1558.
⁹
Smith S, Butters N, White R, Lyon L, Granholm. Priming semantic relations in patients with Huntington's Disease. Brain Lang 1988; 33:27-40.
¹⁰
Piatt AL, Fieldes JA, Paolo AM, Tröster AI. Action (verb naming) fluency as an executive function measure: convergent and divergent evidence of validity. Neuropsychologia1999;37:1499-1503.
¹¹
Cappa SF, BinettiG, Pezzini MA, Padovani A, Rozzini L, Trabucchi M. Object and action naming in Alzheimer's disease and frontotemporal dementia. Neurology 1998;50:351-355.
¹²
Péran P, Démonet JF, Pernet C, Cardebat D. Verb and noun generation tasks in Huntington's disease. Mov Disord 2003; 19:565-571.
¹³
Huntington Study Group. Unified Huntington's disease rating scale: reliability and consistency. Mov Disord 1996; 11:136-142.
¹⁴
Butters N, Granholm E, Salmon DP, Grant I, Wolfe J. Episodic and semantic memory: A comparison of amnesic and demented patientes. J Clin Exp Neuropsychol 1987;9:479-497.
¹⁵
Hodges JR, Salmon DP, Butters N. Differential impairment of semantic and episodic memory in Alzheimer's and Huntington's disease: a controlled prospective study. J Neurol Neurosurg Psychiatry 1990;53:1089-1095.
¹⁶
Pillon B, Deweer B, Agid Y, Dubois B. Explicit memory in Alzheimer's, Huntington's, and Parkinson's Diseases. Arch Neurol 1993;50:374-379.
¹⁷
Damasio AR, Tranel D. Nouns and verbs are retrieved with differentially distributes neural systems. Proc Natl Acad Sci USA 1993;90:4957-4960.

Publication Dates

Publication in this collection
Oct-Dec 2007

History

Received
25 Oct 2007
Reviewed
08 Nov 2007
Accepted
30 Nov 2007

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

[1] ¹
Rosser A, Hodges JR. Initial letter and semantic category fluency in Alzheimer's disease, Huntington's disease, and progressive supranuclear palsy. J Neurol Neurosurg Psychiatry 1994;57:1389-1394.

[2] ²
Bayles KA, Tomoeda CK. Confrontation naming impairment in dementia. Brain Lang 1983;9:98-114.

[3] ³
Tröster AI, Salmon DP, McCullough D, Butters N. A Comparison of the category fluency deficits associated with Alzheimer's and Huntington's disease. Brain Lang 1989;37:500-513.

[4] ⁴
Troyer AK, Moscovitch M, Winocur G. Clustering and switching as two components of verbal fluency: evidence from younger and older healthy adults. Neuropsychology 1997;11:138-146.

[5] ⁵
Ho AK, Sahakian, BJ, Robbins TW, Barker RA, Rosser AE, Hodges JR. Verbal fluency in Huntington's disease: a longitudinal analysis of phonemic and semantic cluster and switching. Neuropsychologia 2002;40:1277-1284.

[6] ⁶
Arango-Lasprilla JC, Rogers H, Lengenfelder J, Deluca J, Moreno S, Lopera F. Cortical and subcortical diseases: do true neuropsychological differences exist? Arch Clin Neuropsychol 2006;21:29-40.

[7] ⁷
Butters N, Wolfe J, Granholm E, Martone M. An assessment of verbal recall, recognition and fluency abilities in patients with Huntington's disease. Cortex 1986;22:11-32.

[8] ⁸
Hodges JR, Salmon DP, Butters N. The nature of the naming deficit in Alzheimer's and Huntington's disease. Brain 1991; 114:1547-1558.

[9] ⁹
Smith S, Butters N, White R, Lyon L, Granholm. Priming semantic relations in patients with Huntington's Disease. Brain Lang 1988; 33:27-40.

[10] ¹⁰
Piatt AL, Fieldes JA, Paolo AM, Tröster AI. Action (verb naming) fluency as an executive function measure: convergent and divergent evidence of validity. Neuropsychologia1999;37:1499-1503.

[11] ¹¹
Cappa SF, BinettiG, Pezzini MA, Padovani A, Rozzini L, Trabucchi M. Object and action naming in Alzheimer's disease and frontotemporal dementia. Neurology 1998;50:351-355.

[12] ¹²
Péran P, Démonet JF, Pernet C, Cardebat D. Verb and noun generation tasks in Huntington's disease. Mov Disord 2003; 19:565-571.

[13] ¹³
Huntington Study Group. Unified Huntington's disease rating scale: reliability and consistency. Mov Disord 1996; 11:136-142.

[14] ¹⁴
Butters N, Granholm E, Salmon DP, Grant I, Wolfe J. Episodic and semantic memory: A comparison of amnesic and demented patientes. J Clin Exp Neuropsychol 1987;9:479-497.

[15] ¹⁵
Hodges JR, Salmon DP, Butters N. Differential impairment of semantic and episodic memory in Alzheimer's and Huntington's disease: a controlled prospective study. J Neurol Neurosurg Psychiatry 1990;53:1089-1095.

[16] ¹⁶
Pillon B, Deweer B, Agid Y, Dubois B. Explicit memory in Alzheimer's, Huntington's, and Parkinson's Diseases. Arch Neurol 1993;50:374-379.

[17] ¹⁷
Damasio AR, Tranel D. Nouns and verbs are retrieved with differentially distributes neural systems. Proc Natl Acad Sci USA 1993;90:4957-4960.

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