Verbal fluency in Alzheimer’s disease and mild cognitive impairment in individuals with low educational level and its relationship with reading and writing habits

Tessaro, Bruna; Hermes-Pereira, Andressa; Schilling, Lucas Porcello; Fonseca, Rochele Paz; Kochhann, Renata; Hübner, Lilian Cristine

doi:10.1590/1980-57642020dn14-030011

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Dementia & Neuropsychologia

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Original Article • Dement. neuropsychol. 14 (03) • Jul-Sep 2020 • https://doi.org/10.1590/1980-57642020dn14-030011 copy

Verbal fluency in Alzheimer’s disease and mild cognitive impairment in individuals with low educational level and its relationship with reading and writing habits

Fluência verbal na doença de Alzheimer e comprometimento cognitivo leve na baixa escolaridade e sua relação com hábitos de leitura e de escrita

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT.

Verbal fluency (VF) has contributed to building cognitive maps as well as differentiating healthy populations from those with dementia.

Objectives:

To compare the performance of healthy controls and patients with mild cognitive impairment (MCI) and Alzheimer’s disease (AD) in two semantic VF tasks (animals/clothes) and a phonemic VF task (letter P). Also, to analyze the relationship between the frequency of reading and writing habits (FRWH) and VF in individuals with low educational level.

Methods:

Sixty-seven older adults aged 60-80 years and with 2-8 years of schooling were divided into three groups: controls (n=25), older adults with MCI (n=24), and older adults with AD (n=18). We analyzed the type, mean size, and number of clusters, switches, intersections, and returns. A post-hoc single-factor ANOVA analysis was conducted to verify differences between groups.

Results:

Total words in the phonemic VF and the animal category discriminated the three groups. Regarding the animal category, AD patients performed worse than controls in the total number of words, taxonomic clusters, returns, and number of words remembered. We found a moderate correlation between FRWH and total number of words in the phonemic fluency.

Conclusions:

Semantic (animate) and phonemic (total words) VF differentiated controls and clinical groups from each other - the phonemic component was more related to FRWH than the semantic one. The phonemic VF seems to be more related to cognitive reserve. VF tasks, considering total words and cluster analyses, are a valuable tool to test healthy and cognitively impaired older adults who have a low educational level.

Keywords:
fluency; Alzheimer’s Disease; Mild Cognitive Impairment; reading; writing; habits; schooling

	C	MCI	AD	p-value	Post-hoc
	n=25	n=24	n=18	p-value	Post-hoc
Gender (female) - n (%)	17 (37.31)	18 (35.82)	11 (26.87)	0.628	-
Age*	67.76 (4.91)	70.54 (6.05)	73.89 (4.75)	0.002	AD>C
Schooling*	4.84 (1.90)	5.25 (1.72)	5.28 (1.87)	0.645	-
Reading habits*	6.76 (3.40)	4.09 (2.97)	4.70 (3.16)	0.031	C>MCI
Writing habits*	3.61 (2.06)	1.86 (1.95)	1.35 (1.37)	0.009	C>MCI, C>AD

		C	MCI	AD	F	p-value	Post-hoc
		n=12	n=12	n=9	F	p-value	Post-hoc
Clothes	Total number of clusters - first 15 s	2.33 (1.30)	2.75 (2.22)	1.33 (1.23)	0.97	0.39	-
	Total mean cluster size - first 15 s	1.09 (0.70)	1.29 (0.58)	1.14 (0.91)	0.40	0.67	-
	Total taxonomic cluster	1.67 (1.23)	1.50 (1.45)	1.00 (1.22)	0.14	0.87	-
	Total phonological cluster	0.67 (0.78)	1.17 (1.19)	0.33 (0.50)	1.68	0.20	-
	Total mixed cluster	0.00 (0.00)	0.08 (0.29)	0.00 (0.00)	2.42	0.11	-
	Total switches	1.50 (1.00)	1.83 (2.12)	0.56 (1.01)	0.77	0.47	-
	Intersections	0.08 (0.29)	0.17 (0.39)	0.00 (0.00)	0.50	0.61	-
	Returns	0.33 (0.65)	0.17 (0.39)	0.00 (0.00)	0.70	0.50	-
	Total words	12.17 (5.14)	11.83 (3.97)	7.33 (3.00)	1.57	0.22
		C	MCI	AD	F	p-value	Post-hoc
		n=13	n=12	n=9	F	p-value	Post-hoc
Animals	Total number of clusters - first 15 s	3.31 (1.60)	2.08 (1.38)	1.78 (0.97)	4.46	0.02	AD<C
	Total mean cluster size - first 15 s	2.99 (1.79)	3.49 (2.10)	2.17 (1.41)	1.49	0.24	-
	Total taxonomic cluster	3.15 (1.57)	2.08 (1.38)	1.67 (1.00)	3.63	0.04	AD<C
	Total phonological cluster	0.08 (0.28)	0.00 (0.00)	0.00 (0.00)	1.51	0.24	-
	Total mixed cluster	0.08 (0.28)	0.00 (0.00)	0.11 (0.33)	0.83	0.45	-
	Total switches	2.31 (1.60)	1.08 (1.38)	0.89 (0.78)	4.26	0.02	AD<C
	Intersections	0.23 (0.44)	0.00 (0.00)	0.11 (0.33)	1.37	0.27	-
	Returns	0.85 (0.89)	0.25 (0.62)	0.00 (0.00)	5.29	0.01	AD<C
	Total words	13.31 (3.71)	9.25 (4.31)	6.33 (2.00)	9.98	<0.001	C>MCI, C>AD
		C	MCI	AD	F	p-value	Post-hoc
		n=24	n=24	n=18	F	p-value	Post-hoc
Phonemic	Total number of clusters - first 15 s	2.25 (1.26)	1.79 (1.14)	1.44 (1.29)	1.60	0.21	-
	Total mean cluster size - first 15 s	1.58 (0.88)	1.81 (1.65)	1.26 (1.09)	0.85	0.43	-
	Total thematic cluster	0.13 (0.34)	0.04 (0.20)	0.22 (0.43)	1.20	0.31	-
	Total taxonomic cluster	0.29 (0.55)	0.33 (0.56)	0.17 (0.38)	0.49	0.61	-
	Total semantic cluster	0.42 (0.58)	0.37 (0.57)	0.39 (0.50)	0.13	0.88	-
	Total phonological cluster	1.71 (1.12)	1.42 (1.01)	1.00 (1.08)	1.15	0.32	-
	Total mixed cluster	0.13 (0.34)	0.00 (0.00)	0.06 (0.24)	1.92	0.15	-
	Total switches	1.33 (1.13)	0.88 (1.03)	0.78 (0.94)	1.19	0.31	-
	Intersections	0.04 (0.20)	0.17 (0.38)	0.17 (0.38)	1.33	0.27	-
	Returns	0.33 (0.56)	0.33 (0.56)	0.11 (0.32)	0.81	0.45	-
	Total words	9.92 (4.48)	6.46 (3.15)	6.33 (3.93)	5.20	0.01	C>MCI, C>AD

Academia Brasileira de Neurologia, Departamento de Neurologia Cognitiva e Envelhecimento R. Vergueiro, 1353 sl.1404 - Ed. Top Towers Offices, Torre Norte, São Paulo, SP, Brazil, CEP 04101-000, Tel.: +55 11 5084-9463 | +55 11 5083-3876 - São Paulo - SP - Brazil
E-mail: revistadementia@abneuro.org.br | demneuropsy@uol.com.br

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[1] Lilian Cristine Hubner. Pontifical Catholic University of Rio Grande do Sul. Ipiranga Ave., 6681 Building 8, Room 403 - Partenon - 90619-900 Porto Alegre RS - Brazil. E-mail: lilian.c.hubner@gmail.com