Phonemic verbal fluency and age: A preliminary study

Steiner, Veronique Agnes Guernet; Mansur, Leticia Lessa; Brucki, Sonia Maria D.; Nitrini, Ricardo

doi:10.1590/S1980-57642009DN20400017

Abstract

Verbal fluency (VF) has been one of the most frequently used instruments in clinics and research, both independently or included in a battery recommended for the detection of cognitive alterations. Phonemic-verbal fluency (PVF) is an interesting variant for cognitive diagnosis particularly because studies indicate that it is less influenced by age. Objectives: 1. To estimate the effects of age on PVF tests in their original forms, with the /f/-/a/-/s/ phonemes. 2. To estimate the effects of the phoneme /p/ and compare it to the original form in item generation. 3. To verify associations between the Token Test (TT), Mini-Mental State Exam (MMSE) and depressive symptoms on performance with /f/-/a/-/s/-/p/ phonemes. Methods: Forty-eight healthy individuals with ages ranging from 30 to 80 years were evaluated with the MMSE, TT and PVF tests. Results: Age was correlated with the MMSE, TT and depressive symptoms. There was no association between age and performance on the fluency test, independent of the phoneme used. Among the socio-demographic factors studied, age had a significant impact on performance. There was no phoneme effect in item-generation, when comparing the traditional form of VF (/f/-/a/-/s/) and the /p/ phoneme. Conclusions: The traditional form of FAS is interchangeable with the modified presentation, therefore both forms may be used in clinical or research settings. PVF is a valuable approach for detecting cognitive alterations in the aged, given its stability throughout the ageing process.

Key words:
evaluation; ageing; verbal fluency; cognition

Resumo

A fluência verbal (FV) fonêmica tem sido um dos instrumentos mais frequentemente utilizados em atividades clínicas e de pesquisa, de modo isolado ou incluída em baterias recomendadas para a detecção de alterações cognitivas. A versão fonêmica da FV é uma variante interessante para o diagnóstico cognitivo, particularmente porque estudos indicam sua resistência aos efeitos do envelhecimento. Objetivos: 1. Estimar os efeitos de envelhecimento na FV fonêmica, na forma original, com os fonemas /f/-/a/-/s/. 2. Estimar os efeitos de fonema/letra alternativo P e comparar com a forma original de geração de itens. 3. Verificar associações entre o Token Teste (TT), Mini-Exame do Estado Mental (MEEM) e sintomas depressivos na geração de itens com fonemas /f/-/a/-/s/-/p/. Métodos: Quarenta e oito indivíduos saudáveis com idade entre 30 e 80 anos foram avaliados com o MEEM, TT e testes de FV fonêmica. Resultados: A idade correlacionou-se com o MEEM, TT e sintomas depressivos. Não houve associação entre idade e desempenho no teste de fluência independentemente do fonema/letra utilizado. Tomando-se em consideração o conjunto de fatores sociodemográficos, a idade teve impacto significativo no desempenho. Não houve efeito de fonema na geração de itens, quando se comparou a forma tradicional, com F-A-S e o fonema P. Conclusões: A forma tradicional de apresentação do F-A-S pode ser intercambiada com a apresentação modificada, então é possível usar ambas as formas em atividade clínica e de pesquisa. A FV fonêmica é um instrumento interessante para detectar alterações cognitivas no idoso, dada sua estabilidade no processo de envelhecimento.

Palavras-chave:
avaliação; envelhecimento; fluência verbal; cognição

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References

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Thurstone LL. Primary Mental Abilities. Chicago: University of Chicago Press; 1938.
²
Nitrini R, Caramelli P, Bottino CMC, Damasceno BP, Brucki SMD, Anghinah R. Diagnóstico de doença de Alzheimer no Brasil. Arq Neuropsiquiatr 2005;63:720-727.
³
Cosentino S, Scarmeas N, Albert SM, Stern Y. Verbal fluency predicts mortality in Alzheimer disease. Cogn Behav Neurol 2006;19:123-129.
⁴
Henry JD, Crawford JR. Verbal fluency deficits in Parkinson's disease: a meta-analysis. J Int Neuropsychol Soc 2004;10:608-622.
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Henry JD, Crawford, Phillips LH. Verbal fluency performance in dementia of the Alzheimer's type: a meta-analysis. Neuropsychologia 2004;42:1212-1222.
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Troyer AK, Moscovitch M, Winocur G, Alexander MP, Stuss D. Clustering and switching on verbal fluency: the effects of focal temporal and temporal-lobe lesions. Neuropsychologia 1998;36:449-504.
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Kosmidis MH, Vlahou CH, Panagiotaki P e Kiosseoglou G. The verbal fluency task on the Greek population: normative data and clustering and switching strategies. J Int Neuropsychol Soc 2004;10:164-172.
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Troyer AK, Moscovitch M, Winocur G. Clustering and switching as two components of verbal fluency: evidence from younger and healthy adults. Neuropsychology 1997;11:138-146.
⁹
Steinberg BA, Bieliauskas LA, Smith GE, Ivnik RJ. Mayo's Older Americans Normative Studies: Age and IQ-adjusted norms for the Trail-Making Test, the Stroop Test and MAE Controlled Oral Word Association Test. Clin Neuropsychol 2005;19: 329-377.
¹⁰
Lucas JA, Ivnik RJ, Smith GE, et al. Mayo's Older African Americans Normative Studies: norms for Boston Naming Test, Controlled Oral Word Association, Category Fluency, Animal Naming, Token Test, WRAT Reading, Trail Making Test, Stroop Test and Judgement of Line Orientation. Clin Neuropsychol 2005;19:243-269.
¹¹
Gonzalez HM, Mungas D, Haan MN. A semantic verbal fluency for English and Spanish-speaking older Mexican-americans. Arch Clin Neuropsychol 2005;20:199-208.
¹²
Tombaugh TN, Kozak J, Rees L. Normative data stratified by age and education for two measures of verbal fluency: FAS and animal naming. Arch Clin Neuropsychol 1999;14:167-177.
¹³
Loonstra AS, Tarlow AR, Sellers AH. COWAT metanorms across age, education, and gender. Appl Neuropsychol 2001;8:161-166.
¹⁴
Tun PA, Lachman ME. Telephone assessment of cognitive function in adulthood: the Brief Test of Adult Cognition by Telephone. Age Ageing 2006;35:629-632.
¹⁵
Hamdan AC, Bueno OFA. Relações entre controle executivo e memória episódica verbal no comprometimento cognitivo leve e na demência tipo Alzheimer. Estud Psicol(Natal) 2005;10:63-71.
¹⁶
Senhorini MC, Amaro Jr E, de Mello Ayres A, de Simone A, Busatto GF. Phonemic fluency in Portuguese-speaking subjects in Brazil: ranking of letters. J Clin Exp Neuropsychol 2006;28:1191-1200.
¹⁷
Folstein M, Folstein S, Mc Hugh P. Mini-mental state: A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12:189-198.
¹⁸
Yesavage JA, Brink TL, Rose TL, Lum O. Development and validation of a geriatric depression scale: a preliminary report. J Psychat Res 1983;17:37-49.
¹⁹
Brucki SM, Nitrini R, Caramelli P, Bertolucci PH, Okamoto IH. Suggestions for utilization of the mini-mental state examination in Brazil. Arq Neuropsiquiatr 2003;61: 777-781.
²⁰
Smith GE, Ivnik RJ. Normative neuropsychology. In: Petersen RC, editor. Mild Cognitive Impairment. New York: Oxford; 2003:63-88.
²¹
De Renzi E, Faglioni P. Normative data and screening power of a shortened version of the Token Test. Cortex 1978;14: 41-49.
²²
Doufuil C, Clayton D, Brayne C, et al. Population norms for the MMSE in the very old: Estimates based on longitudinal data. Neurology 2000;55:1609-1613.
²³
Castro-Costa E, Fuzikawa C, Uchoa E, Firmo JOA, Lima-Costa MF. Norms for the Mini-Mental State Examination. Arq Neuropsiquiatr 2008;66:524-528.
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Rosenberg PB, Lyketos CF. Mild cognitive impairment: searching for the prodrome of Alzheimer's disease. World Psychiatry 2008;7:72-78.
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Publication Dates

Publication in this collection
Oct-Dec 2008

History

Received
29 Oct 2008
Accepted
24 Nov 2008

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

[1] ¹
Thurstone LL. Primary Mental Abilities. Chicago: University of Chicago Press; 1938.

[2] ²
Nitrini R, Caramelli P, Bottino CMC, Damasceno BP, Brucki SMD, Anghinah R. Diagnóstico de doença de Alzheimer no Brasil. Arq Neuropsiquiatr 2005;63:720-727.

[3] ³
Cosentino S, Scarmeas N, Albert SM, Stern Y. Verbal fluency predicts mortality in Alzheimer disease. Cogn Behav Neurol 2006;19:123-129.

[4] ⁴
Henry JD, Crawford JR. Verbal fluency deficits in Parkinson's disease: a meta-analysis. J Int Neuropsychol Soc 2004;10:608-622.

[5] ⁵
Henry JD, Crawford, Phillips LH. Verbal fluency performance in dementia of the Alzheimer's type: a meta-analysis. Neuropsychologia 2004;42:1212-1222.

[6] ⁶
Troyer AK, Moscovitch M, Winocur G, Alexander MP, Stuss D. Clustering and switching on verbal fluency: the effects of focal temporal and temporal-lobe lesions. Neuropsychologia 1998;36:449-504.

[7] ⁷
Kosmidis MH, Vlahou CH, Panagiotaki P e Kiosseoglou G. The verbal fluency task on the Greek population: normative data and clustering and switching strategies. J Int Neuropsychol Soc 2004;10:164-172.

[8] ⁸
Troyer AK, Moscovitch M, Winocur G. Clustering and switching as two components of verbal fluency: evidence from younger and healthy adults. Neuropsychology 1997;11:138-146.

[9] ⁹
Steinberg BA, Bieliauskas LA, Smith GE, Ivnik RJ. Mayo's Older Americans Normative Studies: Age and IQ-adjusted norms for the Trail-Making Test, the Stroop Test and MAE Controlled Oral Word Association Test. Clin Neuropsychol 2005;19: 329-377.

[10] ¹⁰
Lucas JA, Ivnik RJ, Smith GE, et al. Mayo's Older African Americans Normative Studies: norms for Boston Naming Test, Controlled Oral Word Association, Category Fluency, Animal Naming, Token Test, WRAT Reading, Trail Making Test, Stroop Test and Judgement of Line Orientation. Clin Neuropsychol 2005;19:243-269.

[11] ¹¹
Gonzalez HM, Mungas D, Haan MN. A semantic verbal fluency for English and Spanish-speaking older Mexican-americans. Arch Clin Neuropsychol 2005;20:199-208.

[12] ¹²
Tombaugh TN, Kozak J, Rees L. Normative data stratified by age and education for two measures of verbal fluency: FAS and animal naming. Arch Clin Neuropsychol 1999;14:167-177.

[13] ¹³
Loonstra AS, Tarlow AR, Sellers AH. COWAT metanorms across age, education, and gender. Appl Neuropsychol 2001;8:161-166.

[14] ¹⁴
Tun PA, Lachman ME. Telephone assessment of cognitive function in adulthood: the Brief Test of Adult Cognition by Telephone. Age Ageing 2006;35:629-632.

[15] ¹⁵
Hamdan AC, Bueno OFA. Relações entre controle executivo e memória episódica verbal no comprometimento cognitivo leve e na demência tipo Alzheimer. Estud Psicol(Natal) 2005;10:63-71.

[16] ¹⁶
Senhorini MC, Amaro Jr E, de Mello Ayres A, de Simone A, Busatto GF. Phonemic fluency in Portuguese-speaking subjects in Brazil: ranking of letters. J Clin Exp Neuropsychol 2006;28:1191-1200.

[17] ¹⁷
Folstein M, Folstein S, Mc Hugh P. Mini-mental state: A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12:189-198.

[18] ¹⁸
Yesavage JA, Brink TL, Rose TL, Lum O. Development and validation of a geriatric depression scale: a preliminary report. J Psychat Res 1983;17:37-49.

[19] ¹⁹
Brucki SM, Nitrini R, Caramelli P, Bertolucci PH, Okamoto IH. Suggestions for utilization of the mini-mental state examination in Brazil. Arq Neuropsiquiatr 2003;61: 777-781.

[20] ²⁰
Smith GE, Ivnik RJ. Normative neuropsychology. In: Petersen RC, editor. Mild Cognitive Impairment. New York: Oxford; 2003:63-88.

[21] ²¹
De Renzi E, Faglioni P. Normative data and screening power of a shortened version of the Token Test. Cortex 1978;14: 41-49.

[22] ²²
Doufuil C, Clayton D, Brayne C, et al. Population norms for the MMSE in the very old: Estimates based on longitudinal data. Neurology 2000;55:1609-1613.

[23] ²³
Castro-Costa E, Fuzikawa C, Uchoa E, Firmo JOA, Lima-Costa MF. Norms for the Mini-Mental State Examination. Arq Neuropsiquiatr 2008;66:524-528.

[24] ²⁴
Rosenberg PB, Lyketos CF. Mild cognitive impairment: searching for the prodrome of Alzheimer's disease. World Psychiatry 2008;7:72-78.

[25] ²⁵
Santos JLF, Lebrão ML, Duarte YAO, Lima FD. Functional performance of the elderly in instrumental activities of daily living: an analysis in the municipality of São Paulo, Brazil. Cad Saúde Pública 2003;24:879-886.

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