Semantic Verbal Fluency test in dementia: Preliminary retrospective analysis

Lopes, Marcos; Brucki, Sonia Maria Dozzi; Giampaoli, Viviana; Mansur, Letícia Lessa

doi:10.1590/S1980-57642009DN30400009

Abstract

The Semantic Verbal Fluency (SVF) test entails the generation of words from a given category within a pre-set time of 60 seconds.

Objectives:

To verify whether socio-demographic and clinical data of individuals with dementia correlate with the performance on the SVF test and to ascertain whether differences among the criteria of number of answers, clusters and data spread over the intervals, predict clinical results.

Methods:

This was a retrospective study of 49 charts of demented patients classified according to the Clinical Dementia Rating (CDR) scale. We correlated education, age and gender, as well as CDR and Mini-Mental State Exam (MMSE) scores with the number of answers, clustering and switching distributed over four 15-second intervals on the SVF test.

Results:

The correlation between number of answers and quartiles was weak (r=0.407, p=0.004; r=0.484, p<0.001) but correlation between the number of clusters and responses was strong (r=0.883, p<0.001). The number of items on the SVF was statistically significant with MMSE score (p=0.01) and there was a tendency for significance on the CDR (p=0.06). The results indicated little activity regarding what we propose to call cluster recalling in the two groups.

Discussion:

The SVF test, using number of items generated, was found to be more effective than classic screening tests in terms of speed and ease of application in patients with CDR 2 and 3.

Key words:
verbal fluency; evaluation; cognition; dementia.

Resumo

A Fluência Verbal Semântica (FVS) requer a geração de palavras de determinada categoria, num tempo pré-fixado de 60 segundos.

Objetivos:

Verificar se os dados sociodemográficos e clínicos de indivíduos com demências se correlacionam com a FVS; apontar possíveis diferenças entre critérios de número de respostas, agrupamentos e dados distribuídos nos intervalos predizem resultados clínicos.

Métodos:

Este é um estudo retrospectivo de 49 prontuários de pacientes com demência, classificados de acordo com a escala de estadiamento de demência (Clinical Dementia Rating-CDR). Foram correlacionados os dados de educação, idade e gênero e CDR e Mini-Exame do Estado Mental (MEEM) ao número de respostas, agrupamentos e mudanças de critério (switchings) gerados, em quatro intervalos de 15 segundos.

Resultados:

As correlações entre número de respostas, quartis e entre número de respostas e de quartis foram baixas (r=0.407, p=0.004; r=0.484, p<0.001); porém, a correlação foi alta entre número de agrupamentos e de respostas (r=0.883, p<0.001). O número de itens gerados na SVF foi estatisticamente significante com o MMSE (p=0.01) e houve tendência à significância no CDR (p=0.06). Os resultados indicaram pouca atividade daquilo que chamamos de cluster recalling nos dois grupos.

Discussão:

A FVS com o critério de itens gerados pode ser considerado instrumento clínico vantajoso em relação às varreduras clássicas, em pacientes com CDR 2 e 3, pela rapidez e facilidade de aplicação.

Palavras-chave:
fluência verbal; avaliação; cognição; demência.

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References

¹
Brucki SM, Malheiros SM, Okamoto IH, Bertolucci PH. Normative data on the verbal fluency test in the animal category in our milieu. Arq Neuropsiquiatr 1997;55:56-61.
²
Caramelli P, Carthery-Goulart MT, Porto CS, Charchat-Fichman H, Nitrini R. Category Fluency as a screening test for Alzheimer disease in illiterate and literate patients. Alzheimer Dis Assoc Disord 2007;21:65-67.
³
Capitani E, Laiacona M, Barbarotto R. Gender affects word retrieval of certain categories in semantic fluency tasks. Cortex 1999;35:273-278.
⁴
Foss MP, Vale FA, Speciali JG. Influence of education on the neuropsychological assessment of the elderly: application and analysis of the results from the Mattis Dementia Rating Scale (MDRS). Arq Neuropsiquiatr 2005;63:119-126.
⁵
Porto CS, Fichman HC, Caramelli P, Bahia VS, Nitrini R. Brazilian version of the Mattis dementia rating scale: diagnosis of mild dementia in Alzheimer's disease. Arq Neuropsiquiatr 2003;61:339-345.
⁶
Bertolucci PH, Okamoto IH, Brucki SM, Siviero MO, Toniolo Neto J, Ramos LR. Applicability of the CERAD neuropsychological battery to Brazilian elderly. Arq Neuropsiquiatr 2001; 59:532-536.
⁷
Nitrini R, Caramelli P, Herrera Junior E, et al. Performance of illiterate and literate nondemented elderly subjects in two tests of long-term memory. J Int Neuropsychol Soc 2004;10:634-638.
⁸
Brickman AM, Paul RH, Cohen RA, et al. Category and letter verbal fluency across the adult lifespan: relationship to EEG theta power. Archives of Clinical Neuropsychology 2005: 20:561-573.
⁹
Costafreda SG, Fu CHY, Lee L, Everitt B, Brammer MJ, David S. A systematic review and quantitative appraisal of fMRI studies of verbal fluency: role of the left inferior frontal gyrus. Hum Brain Mapp 2006:27:799-810.
¹⁰
Szatkowska I, Grabowska A e Szymanska O. Phonological and semantic fluencies are mediated by different regions of the prefrontal cortex. Acta Neurobiol Exp 2000;60:503-508.
¹¹
Henry JD, Crawford JR, Phillips LH. Verbal fluency performance in dementia of the Alzheimer's type: a meta-analysis. Neuropsychologia 2004:42:1212-1222.
¹²
Altmann LJP, McClung JS. Effects of semantic impairment on language use in Alzheimer's disease. Seminars in Speech and Language, 2008;29:18-31.
¹³
Fernaeus S-E, Ostberg P, Hellstrom A, Wahlund LO. Cut the coda: Early fluency intervals predict diagnoses. Cortex 2008: 44:161-169.
¹⁴
Duff Canning SJ, Leach L, Stuss D, Ngo L, Black SE. Diagnostic utility of abbreviated fluency measures in Alzheimer disease and vascular dementia. Neurology 2004:62:556-562.
¹⁵
Levy JA, Chelune GJ. Cognitive-behavioral profiles of neurodegenerative dementias:beyond Alzheimer's disease. J Geriatr Pspychiatry Neurol 2007;20:227-38.
¹⁶
Cosentino S, Scarmeas N, Albert SM, Stern Y. Verbal fluency predicts mortality in Alzheimer disease. Cogn Behav Neurol 2006;19:123-9.
¹⁷
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.
¹⁸
Rosch E. Principles of categorization. In: Rosch E, Lloyd B, editors. Cognition and categorization. Hillsdale: Lawrence Erlbaum Associates; 1978.
¹⁹
Lakoff G. Women, fire and dangerous things: What categories reveal about the mind. Chicago: The University of Chicago Press; 1987.
²⁰
Pulvermüller F, The neuroscience of language, New York: Cambridge University Press; 2002.
²¹
Abwender DA, Swan JG, Bowerman JT, Connolly SW. Qualitative Analysis of verbal fluency output: review and comparison of several scoring methods. Assessment 2001;8:323-338.
²²
R Development Core Team, R: A Language and Environment for Statistical Computing, R Foundation for Statistical Computing, Vienna, Austria, 2008, ISBN 3-900051-07-0, http://www.R-project.org
» http://www.R-project.org
²³
Wajman JR, Bertolucci PH. Comparison between neuropsychological evaluation instruments for severe dementia. Arq Neuropsiquiatr 2006;64:736-740.

Publication Dates

Publication in this collection
Oct-Dec 2009

History

Received
19 Aug 2009
Accepted
21 Sept 2009

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

[1] ¹
Brucki SM, Malheiros SM, Okamoto IH, Bertolucci PH. Normative data on the verbal fluency test in the animal category in our milieu. Arq Neuropsiquiatr 1997;55:56-61.

[2] ²
Caramelli P, Carthery-Goulart MT, Porto CS, Charchat-Fichman H, Nitrini R. Category Fluency as a screening test for Alzheimer disease in illiterate and literate patients. Alzheimer Dis Assoc Disord 2007;21:65-67.

[3] ³
Capitani E, Laiacona M, Barbarotto R. Gender affects word retrieval of certain categories in semantic fluency tasks. Cortex 1999;35:273-278.

[4] ⁴
Foss MP, Vale FA, Speciali JG. Influence of education on the neuropsychological assessment of the elderly: application and analysis of the results from the Mattis Dementia Rating Scale (MDRS). Arq Neuropsiquiatr 2005;63:119-126.

[5] ⁵
Porto CS, Fichman HC, Caramelli P, Bahia VS, Nitrini R. Brazilian version of the Mattis dementia rating scale: diagnosis of mild dementia in Alzheimer's disease. Arq Neuropsiquiatr 2003;61:339-345.

[6] ⁶
Bertolucci PH, Okamoto IH, Brucki SM, Siviero MO, Toniolo Neto J, Ramos LR. Applicability of the CERAD neuropsychological battery to Brazilian elderly. Arq Neuropsiquiatr 2001; 59:532-536.

[7] ⁷
Nitrini R, Caramelli P, Herrera Junior E, et al. Performance of illiterate and literate nondemented elderly subjects in two tests of long-term memory. J Int Neuropsychol Soc 2004;10:634-638.

[8] ⁸
Brickman AM, Paul RH, Cohen RA, et al. Category and letter verbal fluency across the adult lifespan: relationship to EEG theta power. Archives of Clinical Neuropsychology 2005: 20:561-573.

[9] ⁹
Costafreda SG, Fu CHY, Lee L, Everitt B, Brammer MJ, David S. A systematic review and quantitative appraisal of fMRI studies of verbal fluency: role of the left inferior frontal gyrus. Hum Brain Mapp 2006:27:799-810.

[10] ¹⁰
Szatkowska I, Grabowska A e Szymanska O. Phonological and semantic fluencies are mediated by different regions of the prefrontal cortex. Acta Neurobiol Exp 2000;60:503-508.

[11] ¹¹
Henry JD, Crawford JR, Phillips LH. Verbal fluency performance in dementia of the Alzheimer's type: a meta-analysis. Neuropsychologia 2004:42:1212-1222.

[12] ¹²
Altmann LJP, McClung JS. Effects of semantic impairment on language use in Alzheimer's disease. Seminars in Speech and Language, 2008;29:18-31.

[13] ¹³
Fernaeus S-E, Ostberg P, Hellstrom A, Wahlund LO. Cut the coda: Early fluency intervals predict diagnoses. Cortex 2008: 44:161-169.

[14] ¹⁴
Duff Canning SJ, Leach L, Stuss D, Ngo L, Black SE. Diagnostic utility of abbreviated fluency measures in Alzheimer disease and vascular dementia. Neurology 2004:62:556-562.

[15] ¹⁵
Levy JA, Chelune GJ. Cognitive-behavioral profiles of neurodegenerative dementias:beyond Alzheimer's disease. J Geriatr Pspychiatry Neurol 2007;20:227-38.

[16] ¹⁶
Cosentino S, Scarmeas N, Albert SM, Stern Y. Verbal fluency predicts mortality in Alzheimer disease. Cogn Behav Neurol 2006;19:123-9.

[17] ¹⁷
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.

[18] ¹⁸
Rosch E. Principles of categorization. In: Rosch E, Lloyd B, editors. Cognition and categorization. Hillsdale: Lawrence Erlbaum Associates; 1978.

[19] ¹⁹
Lakoff G. Women, fire and dangerous things: What categories reveal about the mind. Chicago: The University of Chicago Press; 1987.

[20] ²⁰
Pulvermüller F, The neuroscience of language, New York: Cambridge University Press; 2002.

[21] ²¹
Abwender DA, Swan JG, Bowerman JT, Connolly SW. Qualitative Analysis of verbal fluency output: review and comparison of several scoring methods. Assessment 2001;8:323-338.

[22] ²²
R Development Core Team, R: A Language and Environment for Statistical Computing, R Foundation for Statistical Computing, Vienna, Austria, 2008, ISBN 3-900051-07-0, http://www.R-project.org
» http://www.R-project.org

[23] ²³
Wajman JR, Bertolucci PH. Comparison between neuropsychological evaluation instruments for severe dementia. Arq Neuropsiquiatr 2006;64:736-740.

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