The psychological construct of word fluency

Cognitive and emotional-behavioural outcomes of Turkish Duchenne muscular dystrophy population and its association with motor function

PURPOSE

The aim of this study was to examine the cognitive and emotional-behavioural outcomes of Turkish children with Duchenne muscular dystrophy (DMD) in comparison with healthy peers, to determine its relationship with motor functions, and to analyse the difference of cognitive and emotional-behavioural outcomes according to the site of mutations.

METHOD

Children aged 7-16 years with DMD (n = 68) and age-matched typically developing children (n = 33) were included in the study. The cognitive and emotional-behavioural status and the motor functions were assessed in detail. Children with DMD also divided into two groups as "proximal" and "distal" site mutation groups to compare the cognitive and emotional-behavioural outcomes.

RESULTS

The children with DMD and typically developing children were similar in terms of age and body mass index (p > 0.05). Significant differences were found between children with DMD and typically developing peers in almost all subtests of both cognitive and emotional-behavioural assessments (p < 0.05). Cognitive and emotional-behavioural parameters were weakly correlated with specific motor parameters responsive to cognitive functioning (p < 0.05). Children with distal site mutation performed significantly worser than those with proximal site mutation in particular cognitive subtest (p < 0.05).

CONCLUSIONS

It is concluded that comprehensive and detailed evaluation of cognitive and emotional-behavioural features of children with DMD is essential for better implementation of rehabilitation programs to maintain motor function which especially requires cognitive ability, since a Turkish cohort represented challenges in particular domains of cognitive and emotional-behavioural areas.

CLINICAL TRIAL REGISTRATION NUMBER

NCT05661071.

Designing an effective semantic fluency test for early MCI diagnosis with machine learning

Semantic fluency tests are one of the key tests used in batteries for the early detection of Mild Cognitive Impairment (MCI) as the impairment in speech and semantic memory are among the first symptoms, attracting the attention of a large number of studies. Several new semantic categories and variables capable of providing complementary information of clinical interest have been proposed to increase their effectiveness. However, this also extends the time required to complete all tests and get the overall diagnosis. Therefore, there is a need to reduce the number of tests in the batteries and thus the time spent on them while maintaining or increasing their effectiveness. This study used machine learning methods to determine the smallest and most efficient combination of semantic categories and variables to achieve this goal. We utilized a database containing 423 assessments from 141 subjects, with each subject having undergone three assessments spaced approximately one year apart. Subjects were categorized into three diagnostic groups: Healthy (if diagnosed as healthy in all three assessments), stable MCI (consistently diagnosed as MCI), and heterogeneous MCI (when exhibiting alternations between healthy and MCI diagnoses across assessments). We obtained that the most efficient combination to distinguish between these categories of semantic fluency tests included the animals and clothes semantic categories with the variables corrects, switching, clustering, and total clusters. This combination is ideal for scenarios that require a balance between time efficiency and diagnosis capability, such as population-based screenings.

An examination of the clinical utility of phonemic fluency in healthy adults and adults with mild cognitive impairment

The Controlled Oral Word Association Test (COWAT) is a widely utilized measure of phonemic fluency. However, two issues remain: (1) whether demographic, cognitive variables, or version of test administered predict performance; (2) if the test is predictive of Mild Cognitive Impairment (MCI). Recent studies report that item-level analyses such as lexical frequency may be more sensitive to early cognitive change. The purpose of this study was to examine the clinical utility of the COWAT, considering both total correct words and the lexical frequency. Sixty-seven healthy adults and thirty-seven adults with MCI completed neuropsychological testing. Mann-Whitney U tests were used to determine if there was a difference in COWAT performance between groups. Elastic net regression models were used to assess whether variance in total scores/lexical frequencies can be predicted by demographics, test version, or diagnosis; which cognitive tests explained the variance in performance; and how total scores and lexical frequencies compared with other cognitive tests in predicting diagnosis. Overall, individuals with MCI produced fewer and higher frequency words. The variance in total correct words or lexical frequency was not explained by demographics, test version, or diagnosis. Total correct words was a more important predictor of diagnosis than lexical frequency.

Aging and Olfactory Training: A Scoping Review

Background and Objectives

Decreased olfactory function commonly occurs alongside the aging process. Research suggests olfactory training (OT) has the potential to improve olfactory and cognitive function in individuals with and without olfactory dysfunction. The degree to which these benefits extend into older age and among those with cognitive impairment (i.e., people with dementia and mild cognitive impairment) is less clear. The purpose of the current review was to investigate the extent to which OT affects olfactory function, cognition, and well-being among older people.

Research Design and Methods

A scoping review of the literature was conducted in PubMed, Embase, EbscoHost, and SCOPUS. Articles were considered eligible for original research studies with human populations, included adults aged 55 and older, performed any type of OT, and included a form of olfactory testing. The data from the included studies were synthesized and presented narratively.

Results

A total of 23 studies were included. The results suggest that OT provides multiple benefits to older adults, including those with cognitive impairment. Particularly, OT was associated with measurable changes in olfactory function, improved cognitive function, specifically semantic verbal fluency and working memory, reduced depressive symptoms, and protection from cognitive decline.

Discussion and Implications

The findings suggest that benefits from OT extend beyond changes in olfactory function and include improved cognitive function, amelioration of depressive symptoms, and protection from cognitive decline. Future research is needed across specific participant groups, including those with differentiated types of dementia, to investigate the olfactory and cognitive benefits of OT.

Microstructural analysis of verbal fluency performance in relapsing-remitting multiple sclerosis based on the impact of disability level

Verbal fluency (VF) evaluates language and cognitive abilities. This study compared VF in Relapsing-Remitting Multiple Sclerosis (RRMS) and healthy controls (HC), examining variables including correct responses (CR), mean cluster size (MCS), switches (S), and fluency difference score (FDS). RRMS participants were subgrouped by Expanded Disability Status Scale (EDSS), to explore the relationship between MS severity and VF. Twenty-four RRMS participants and matched HCs underwent Mini-Mental State Exam and VF Test. Statistical analysis compared VF between RRMS subgroups based on severity levels, and in HC. RRMS significantly impacted the CR, and S (CRSF p = 0.01, SSF p = 0.002; CRPF=0.002, SPF p = 0.002), while there was no significant difference in FDS between RRMS groups (p = 0.9). No significant relationship was found between EDSS scores, and VF subtests (CRSF p = 0.061, MCSSF p = 0.46, SSF p = 0.051, CRPF p = 0.521, MCSPF p = 0.966, SPF p = 0.599). In RRMS, our results demonstrate impairments in all VF parameters except the MCSSF+PF, and FDS. This study suggests that intact MCSSF+PF may reflect preserved verbal memory and word recall, while significant switching differences may indicate impaired cognitive flexibility. Similar FDS to those of HC suggest that no performance discrepancy in subtests in RRMS. Intact MCS might be a distinctive pattern in the early clinical stage of MS.

Predictive factors of post-operative apathy in patients with diffuse frontal gliomas undergoing awake brain mapping

Patients with diffuse frontal gliomas often present with post-operative apathy after tumour removal. However, the association between apathy and tumour removal of gliomas from the frontal lobe remains unknown. This study aimed to investigate the factors influencing post-operative apathy after tumour removal in patients with diffuse frontal gliomas. We compared the demographics and clinical characteristics of patients with and without post-operative apathy in a cohort of 54 patients who underwent awake brain mapping for frontal gliomas. The frequency of clinical parameters such as left-sided involvement, high-grade tumour types (WHO grades III, IV), main tumour location in the anterior cingulate gyrus (ACC) and/or dorsolateral prefrontal cortex (DLPFC) and orbitofrontal cortex (OFC) was significantly greater in the apathetic group compared to the non-apathetic group. The apathetic group scored significantly lower on neuropsychological assessments such as the Letter Fluency Test among the Word Fluency Tests than the non-pathetic group (p = .000). Moreover, the scores of Parts 3, and 3-1 of the Stroop test were significantly lower in the apathetic group than those in the non-apathetic group (p = .023, .027, respectively). Multivariate model analysis revealed that the appearance of post-operative apathy was significantly related to side of the of lesion [left vs. right, hazard ratio (HR) = 8.00, 95% confidence interval (CI) = 1.36-46.96, p = .021], location of the main tumour in the frontal lobe (ACC/DLPFC/OFC vs. others, HR = 7.99, 95% CI = 2.16-29.59, p = .002), and the Letter Fluency Test (HR = .37, 95% CI = .15-.90, p = .028). Post-operative apathy is significantly associated with ACC and/or DLPFC and OFC in the left hemisphere of diffuse frontal gliomas. Apathy in frontal gliomas is correlated with a decline in the Letter Fluency Test scores. Therefore, this instrument is a potential predictor of post-operative apathy in patients with diffuse frontal gliomas undergoing awake brain mapping.

Differential contribution of language and executive functioning to verbal fluency performance in glioma patients

Glioma patients often suffer from deficits in language and executive functioning. Performance in verbal fluency (generating words within one minute according to a semantic category-category fluency, or given letter-letter fluency) is typically impaired in this patient group. While both language and executive functioning play a role in verbal fluency, the relative contribution of both domains remains unclear. We aim to retrospectively investigate glioma patients' performance on verbal and nonverbal fluency and to explore the influence of language and executive functioning on verbal fluency. Sixty-nine adults with gliomas in eloquent areas underwent a neuropsychological test battery (verbal fluency, nonverbal fluency, language, and executive functioning tests) before surgery (T1) and a subgroup of 31 patients also at three (T2) and twelve months (T3) after surgery. Preoperatively, patients were impaired in all verbal fluency tasks and dissociations were found based on tumour location. In contrast, nonverbal fluency was intact. Different language and executive functioning tests predicted performance on category fluency animals and letter fluency, while no significant predictors for category fluency professions were found. The longitudinal results indicated that category fluency professions deteriorated after surgery (T1-T2, T1-T3) and that nonverbal fluency improved after surgery (T1-T3, T2-T3). Verbal fluency performance can provide information on different possible underlying deficits in language and executive functioning in glioma patients, depending on verbal fluency task selection. Efficient task (order) selection can be based on complexity. Category fluency professions can be selected to detect more permanent long-term deficits.

Structural brain morphometry differences and similarities between young patients with Crohn's disease in remission and healthy young and old controls

Introduction

Crohn's disease (CD), one of the main phenotypes of inflammatory bowel disease (IBD), can affect any part of the gastrointestinal tract. It can impact the function of gastrointestinal secretions, as well as increasing the intestinal permeability leading to an aberrant immunological response and subsequent intestinal inflammation. Studies have reported anatomical and functional brain changes in Crohn's Disease patients (CDs), possibly due to increased inflammatory markers and microglial cells that play key roles in communicating between the brain, gut, and systemic immune system. To date, no studies have demonstrated similarities between morphological brain changes seen in IBD and brain morphometry observed in older healthy controls..

Methods

For the present study, twelve young CDs in remission (M = 26.08 years, SD = 4.9 years, 7 male) were recruited from an IBD Clinic. Data from 12 young age-matched healthy controls (HCs) (24.5 years, SD = 3.6 years, 8 male) and 12 older HCs (59 years, SD = 8 years, 8 male), previously collected for a different study under a similar MR protocol, were analyzed as controls. T1 weighted images and structural image processing techniques were used to extract surface-based brain measures, to test our hypothesis that young CDs have different brain surface morphometry than their age-matched young HCs and furthermore, appear more similar to older HCs. The phonemic verbal fluency (VF) task (the Controlled Oral Word Association Test, COWAT) (Benton, 1976) was administered to test verbal cognitive ability and executive control.

Results/Discussion

On the whole, CDs had more brain regions with differences in brain morphometry measures when compared to the young HCs as compared to the old HCs, suggesting that CD has an effect on the brain that makes it appear more similar to old HCs. Additionally, our study demonstrates this atypical brain morphometry is associated with function on a cognitive task. These results suggest that even younger CDs may be showing some evidence of structural brain changes that demonstrate increased resemblance to older HC brains rather than their similarly aged healthy counterparts.

Interactions between functional networks in Parkinson's disease mild cognitive impairment

The study of mild cognitive impairment (MCI) is critical to understand the underlying processes of cognitive decline in Parkinson's disease (PD). Functional connectivity (FC) disruptions in PD-MCI patients have been observed in several networks. However, the functional and cognitive changes associated with the disruptions observed in these networks are still unclear. Using a data-driven methodology based on independent component analysis, we examined differences in FC RSNs among PD-MCI, PD cognitively normal patients (PD-CN) and healthy controls (HC) and studied their associations with cognitive and motor variables. A significant difference was found between PD-MCI vs PD-CN and HC in a FC-trait comprising sensorimotor (SMN), dorsal attention (DAN), ventral attention (VAN) and frontoparietal (FPN) networks. This FC-trait was associated with working memory, memory and the UPDRS motor scale. SMN involvement in verbal memory recall may be related with the FC-trait correlation with memory deficits. Meanwhile, working memory impairment may be reflected in the DAN, VAN and FPN interconnectivity disruptions with the SMN. Furthermore, interactions between the SMN and the DAN, VAN and FPN network reflect the intertwined decline of motor and cognitive abilities in PD-MCI. Our findings suggest that the memory impairments observed in PD-MCI are associated with reduced FC within the SMN and between SMN and attention networks.

How well does the discrepancy between semantic and letter verbal fluency performance distinguish Alzheimer's dementia from typical aging?

In Alzheimer's dementia (AD), greater declines in semantic fluency (SF) relative to letter fluency (LF) have been assumed to reflect semantic disintegration. However, the same pattern is observed in typical aging and neurodegenerative disorders besides AD. We examined this assumption by comparing different aspects of SF and LF performance in older adults with and without dementia, and identifying which verbal fluency measures most clearly distinguish AD from typical aging. Verbal fluency data were compared from 109 individuals with AD and 66 typically aging adults. Correct items, clusters, and errors were analyzed using both raw counts and proportions. Regression analyses examined Task-by-Group interactions and the impact of demographic variables on verbal fluency measures. ROC analyses examined the sensitivity and specificity of the different outcome measures. In regressions, interactions were found for raw but not proportional data, indicating that different group patterns were driven largely by the number of correct items produced. Similarly, in ROC analyses, raw SF totals showed stronger discriminability between groups than either raw discrepancy scores (SF-LF) or discrepancy ratios (SF/LF). Age and cognitive status (MMSE) were the strongest individual predictors of performance. Findings suggest that AD entails quantitative declines in verbal fluency, but qualitatively similar patterns of performance relative to typically aging adults. Thus, SF declines in AD seem to be at least partially attributable to an exaggeration of the underlying mechanisms common to typical aging, and do not necessarily implicate semantic disintegration.

Acoustic and phonemic processing are impaired in individuals with aphasia

Acoustic and phonemic processing are understudied in aphasia, a language disorder that can affect different levels and modalities of language processing. For successful speech comprehension, processing of the speech envelope is necessary, which relates to amplitude changes over time (e.g., the rise times). Moreover, to identify speech sounds (i.e., phonemes), efficient processing of spectro-temporal changes as reflected in formant transitions is essential. Given the underrepresentation of aphasia studies on these aspects, we tested rise time processing and phoneme identification in 29 individuals with post-stroke aphasia and 23 healthy age-matched controls. We found significantly lower performance in the aphasia group than in the control group on both tasks, even when controlling for individual differences in hearing levels and cognitive functioning. Further, by conducting an individual deviance analysis, we found a low-level acoustic or phonemic processing impairment in 76% of individuals with aphasia. Additionally, we investigated whether this impairment would propagate to higher-level language processing and found that rise time processing predicts phonological processing performance in individuals with aphasia. These findings show that it is important to develop diagnostic and treatment tools that target low-level language processing mechanisms.

Language Differences Among Individuals with Normal Cognition, Amnestic and Non-Amnestic MCI, and Alzheimer's Disease

OBJECTIVE

To investigate differences in language performance among older adults with normal cognition (CN), mild cognitive impairment (MCI), and Alzheimer's disease (ad). Owing to the conflicting literature concerning MCI, discrepancies between amnestic (aMCI) and non-amnestic MCI (naMCI) were explored in greater detail.

METHOD

The study sample was drawn from the older (>64 years) HELIAD cohort. Language performance was assessed via semantic and phonemic fluency, confrontation naming, verbal comprehension, verbal repetition as well as a composite language index. Age, sex, and education adjusted general linear models were used to quantify potential pairwise differences in language performance.

RESULTS

The present analysis involved 1607 participants with CN, 146 with aMCI [46 single and 100 multi-domain aMCI], 92 with naMCI [41 single and 51 multi-domain naMCI], and 79 with ad. The mean age and education of our predominantly female (60%) participants were 73.82 (±5.43) and 7.98 (±4.93) years, respectively. MCI individuals performed between those with CN and ad, whereas participants with aMCI performed worse compared to those with naMCI, especially in the semantic fluency and verbal comprehension tasks. Discrepancies between the aMCI and naMCI groups were driven by the exquisitely poor performance of multi-domain aMCI subgroup.

CONCLUSIONS

Overall, individuals could be hierarchically arranged in a continuum of language impairment with the CN individuals constituting the healthy reference and naMCI, aMCI, ad patients representing gradually declining classes in terms of language performance. Exploration of language performance via separation of single from multi-domain naMCI provided a potential explanation for the conflicting evidence of previous research.

Does comorbid depression impact executive functioning (EF) in adults diagnosed with ADHD?: a comparison of EF across diagnoses in clinically-referred individuals

INTRODUCTION

Executive functioning (EF) is a salient factor in both ADHD as well as depressive disorders. However, sparse literature has examined whether depression severity impacts EF concurrently among adults with ADHD. The goal of this study was to examine differences in EF between adult patients diagnosed with ADHD and those diagnosed with a non-ADHD primary psychopathological condition, as a function of both ADHD presentation and depression severity in a diverse clinical sample.

METHOD

This crosssectional study included 404 adult patients clinically referred for neuropsychological evaluation to assist with differential diagnosis and/or treatment planning related to known or suspected ADHD. Various EF tasks and a measure of depression severity were administered. One-way MANOVA analyses were conducted to compare EF performance between individuals diagnosed with ADHD or a non-ADHD primary psychopathological condition, with additional analyses examining group differences based on ADHD presentation and depression severity. Regression analyses also examined the potential contribution of depression severity to each EF measure within each group.

RESULTS

No significant EF performance differences were found when comparing individuals diagnosed with ADHD and those with a non-ADHD primary psychopathological condition, nor based on ADHD presentation. When comparing across groups using cut-offs for high or low depression, only one EF measure showed significant differences between groups. Further, depression severity generally did not predict reduced EF performances with the exception of verbal fluency and working memory performances in select groups.

CONCLUSIONS

This study demonstrated that individuals with ADHD generally perform comparably on EF measures regardless of the presence or absence of comorbid depression. These results suggest further examination of EF deficits when they emerge for adults with ADHD, especially beyond comorbid depression severity.

Normative data for the verb fluency test in the adult French-Quebec population and validation study in mild cognitive impairment

Verbal fluency tests are used to assess executive functions and language. The verb fluency test has proven successful in distinguishing healthy individuals (HCs) from participants with pathological conditions. However, few normative and psychometric studies have been published for the verb fluency test. The aim of Study 1 was to provide normative data in the adult population of French Québec for the verb fluency test. The aim of Study 2 was to determine its discriminant validity and test-retest reliability. The normative sample consisted of 424 HCs aged 50-92 years. Multiple linear regressions were used to generate equations for calculating Z-scores. To assess discriminant validity, the performance of 46 HCs was compared with that of 46 participants with mild cognitive impairment (MCI). To determine test-retest reliability, the test was administered twice, 3 months apart, to a group of 25 HCs. Age, sex, and education level were significantly related to performance on the test. The test distinguished the performance of HCs from that of participants with MCI. Test-retest analysis showed that scores had good stability over time. Norms and psychometric data for the verb fluency test will help clinicians and researchers better identify executive and language impairments associated with pathological conditions.

Insomniacs show greater prefrontal activation during verbal fluency task compared to non-insomniacs: a functional near-infrared spectroscopy investigation of depression in patients

BACKGROUND

Previous studies have shown that insomnia affects human prefrontal function and that there are specific patterns of brain activation to counteract sleep and improve cognition. However, the effects of insomnia on the prefrontal cortex of MDD (major depressive disorder) patients and the patterns of activation to counteract sleep in MDD patients remain unclear. The aim of this study is to examine this using fNIRS (functional near-infrared spectroscopy).

METHODS

Eighty depressed patients and 44 healthy controls were recruited for this study. fNIRS was used to assess changes in the concentration of oxygenated hemoglobin ([oxy-Hb]) in the prefrontal cortex of all participants during the VFT (verbal fluency test) and to record the number of words created to assess cognitive ability. The Pittsburgh Sleep Quality Index was used to assess sleep quality, and the Hamilton Rating Scale for Depression (24-item) and Hamilton Rating Scale for Anxiety (14-item) were used to assess the severity of depression and anxiety.

RESULTS

When comparing patients, the healthy control group had significantly higher [oxy-Hb] values in the bilateral prefrontal cortex during VFT than the MDD group. In the MDD group, the [oxy-Hb] values in all brain regions except the right DLPFC were significantly higher in the group with insomnia than in the group without insomnia, but their VFT performance was significantly lower than in the group without insomnia and the healthy group. PSQI scores were positively correlated with [oxy-Hb] values in some left-brain regions, whereas HAMD and HAMA scores were not correlated with [oxy-Hb] values.

CONCLUSION

The PFC was significantly less active during VFT in those with MDD than in healthy controls. All brain regions, except the right DLPFC, were significantly more active in MDD patients with insomnia than in those without insomnia, suggesting that sleep quality needs to be an important indicator in fNIRS screening. In addition, there was a positive correlation between the severity of insomnia in the left VLPFC and the level of activation, suggesting a role for the left brain region in the neurophysiology of overcoming sleepiness in MDD patients. these findings may provide new ideas for the treatment of MDD patients in the future.

TRIAL REGISTRATION

Our experiment was registered in the China Clinical Trial Registry (registration number ChiCTR2200065622) on November 10.( The first patient was recruited in 10/11/2022.).

Parkinson's disease disrupts the ability to initiate and apply episodic foresight

OBJECTIVE

While Parkinson's disease is associated with impairments in many aspects of prospective cognition, no study to date has tested whether these difficulties extend to problems using episodic foresight to guide future-directed behavior. To provide the first examination of whether people with Parkinson's disease are impaired in their capacity to initiate and apply episodic foresight.

METHOD

People with Parkinson's disease (n = 42), and a demographically matched neurotypical comparison group (n = 42) completed a validated behavioral assessment that met strict criteria for assessing episodic foresight (Virtual Week-Foresight), as well as a broader neurocognitive and clinical test battery.

RESULTS

People with Parkinson's disease were significantly less likely than the comparison group to acquire items that would later allow a problem to be solved and were also less likely to subsequently use these items for problem resolution. These deficits were largely unrelated to performance on other cognitive measures or clinical characteristics of the disorder.

CONCLUSIONS

The ability to engage in episodic foresight in an adaptive way is compromised in Parkinson's disease. This appears to be a stable feature of the disorder, and one that is distinct from other clinical symptoms and neurocognitive deficits. It is now critical to establish exactly why these difficulties exist and how they impact on real-life functional capacity.

Cognitive performance in multiple sclerosis: what is the role of the gamma-aminobutyric acid system?

Cognitive impairment occurs in 40-65% of persons with multiple sclerosis and may be related to alterations in glutamatergic and GABAergic neurotransmission. Therefore, the aim of this study was to determine how glutamatergic and GABAergic changes relate to cognitive functioning in multiple sclerosis in vivo. Sixty persons with multiple sclerosis (mean age 45.5 ± 9.6 years, 48 females, 51 relapsing-remitting multiple sclerosis) and 22 age-matched healthy controls (45.6 ± 22.0 years, 17 females) underwent neuropsychological testing and MRI. Persons with multiple sclerosis were classified as cognitively impaired when scoring at least 1.5 standard deviations below normative scores on ≥30% of tests. Glutamate and GABA concentrations were determined in the right hippocampus and bilateral thalamus using magnetic resonance spectroscopy. GABA-receptor density was assessed using quantitative [¹¹C]flumazenil positron emission tomography in a subset of participants. Positron emission tomography outcome measures were the influx rate constant (a measure predominantly reflecting perfusion) and volume of distribution, which is a measure of GABA-receptor density. Twenty persons with multiple sclerosis (33%) fulfilled the criteria for cognitive impairment. No differences were observed in glutamate or GABA concentrations between persons with multiple sclerosis and healthy controls, or between cognitively preserved, impaired and healthy control groups. Twenty-two persons with multiple sclerosis (12 cognitively preserved and 10 impaired) and 10 healthy controls successfully underwent [¹¹C]flumazenil positron emission tomography. Persons with multiple sclerosis showed a lower influx rate constant in the thalamus, indicating lower perfusion. For the volume of distribution, persons with multiple sclerosis showed higher values than controls in deep grey matter, reflecting increased GABA-receptor density. When comparing cognitively impaired and preserved patients to controls, the preserved group showed a significantly higher volume of distribution in cortical and deep grey matter and hippocampus. Positive correlations were observed between both positron emission tomography measures and information processing speed in the multiple sclerosis group only. Whereas concentrations of glutamate and GABA did not differ between multiple sclerosis and control nor between cognitively impaired, preserved and control groups, increased GABA-receptor density was observed in preserved persons with multiple sclerosis that was not seen in cognitively impaired patients. In addition, GABA-receptor density correlated to cognition, in particular with information processing speed. This could indicate that GABA-receptor density is upregulated in the cognitively preserved phase of multiple sclerosis as a means to regulate neurotransmission and potentially preserve cognitive functioning.

Using Bayesian Networks to Investigate Psychological Constructs: The Case of Empathy

Network analysis is an emerging field for the study of psychopathology that considers constructs as arising from the interactions among their constituents. Pairwise effects among psychological components are often investigated by using this framework. Few studies have applied Bayesian networks, models that include directed interactions to perform causal inference on psychological constructs. Directed graphical models may be less straightforward to interpret in case the construct at hand does not contain symptoms but instead psychometric items from self-report measures. However, they may be useful in validating specific research questions that arise while using standard pairwise network models. In this study, we use Bayesian networks to investigate a well-known psychological construct, empathy from the Interpersonal Reactivity Index, in large two samples of 1973 university students from Belgium. Overall, our results support the hypotheses emphasizing empathic concern (i.e., sympathy) as causally important in the construct of empathy, and overall attribute the primacy of emotional components of empathy over their intellectual counterparts. Bayesian networks help researchers identify the plausible causal relationships in psychometric data, to gain new insight on the psychological construct under examination, help generate new hypotheses and provide evidence relevant to old ones.

Cognitive impairment predicts engagement in inpatient stroke rehabilitation

Patient engagement during inpatient rehabilitation is an important component of rehabilitation therapy, as lower levels of engagement are associated with poorer outcomes. Cognitive deficits may impact patient engagement during inpatient stroke rehabilitation. Here, we assess whether patient performance on the cognitive tasks of the 30-min National Institute of Neurologic Disorders and Stroke - Canadian Stroke Network (NINDS-CSN) screening battery predicts engagement in inpatient stroke rehabilitation. Prospective data from 110 participants completing inpatient stroke rehabilitation at an academic medical center were utilized for the present analyses. Cognitive functioning was assessed at inpatient stroke rehabilitation admission using the NINDS-CSN cognitive battery. Patient engagement was evaluated at discharge from an inpatient rehabilitation unit using the Hopkins Rehabilitation Engagement Rating Scale. The results demonstrate that the NINDS-CSN cognitive battery, specifically subtests measuring executive functioning, attention and processing speed, predicts patient engagement in inpatient stroke rehabilitation. Cognitively impaired patients undergoing rehabilitation may benefit from modifications and interventions to increase engagement and improve functional outcomes.

Three verbal fluency tasks: Normative data and convergent validity in Argentines over 50 years

Verbal fluency tasks are frequently used in neuropsychological assessment, standing out for their easy application and good sensitivity to early cognitive impairment. However, in Argentina, the availability of updated norms is limited, especially for the action fluency variant. There is also little evidence of validity.

Objectives

The aim of this study was to obtain Argentine norms for three verbal fluency tasks and to analyze their convergent validity.

Methods

Using a nonprobability sampling method, 303 Argentines from a nonclinical population (age mean=66.8, 50-91 years) were recruited to participate in this study. Those with medical conditions that could compromise neuropsychological performance were excluded. Three verbal fluency tasks (i.e., phonological, semantic, and action), the Montreal Cognitive Assessment (MoCA) test, and the Digit Span-WAIS III test were administered. Correlations and multiple regressions were subsequently performed.

Results

Education and age significantly explained 11.8% of the variance in phonological fluency, 15.8% of the variance in semantic fluency, and 20.2% of the variance in action fluency. Hence, the normative data varied according to educational level and age group, with normal performance limit values between 9 and 14 for phonological fluency, 11 and 18 for semantic fluency, and 8 and 17 for action fluency. Positive correlations were obtained between all verbal fluency tasks, as well as between the MoCA test and the Digit Span test.

Conclusions

This study supports the applicability of three verbal fluency tasks in an Argentine context by providing age- and education-corrected norms and acceptable evidence of convergent validity.

Attentional Demand of Motor Speech Encoding: Evidence From Parkinson's Disease

PURPOSE

While the involvement of attention in utterance planning is well established at the conceptual and lexical levels, the attentional demands of postlexical processes are still debated. This study investigates the involvement of attentional resources on motor speech encoding during utterance production in the context of Parkinson's disease (PD), a population allowing to assess if the attentional demands observed in a dual-task paradigm (the dual-task costs [DTCs]) are explained by postlexical difficulties and not solely by executive impairment.

METHOD

Speech production was analyzed in a dual-task paradigm with 30 participants presenting with motor speech disorders due to hypokinetic dysarthria in the context of PD. The dual-task comprised an automatic speech task in which participants recited the days of the week and two nonverbal tasks evaluating processing speed and inhibition. The severity of dysarthria and performance in several executive tests (inhibition, verbal fluency, and cognitive shifting) were used as potential predictors of the DTCs.

RESULTS

Individuals with PD exhibited a DTC on the nonverbal tasks and on the speech task when the secondary task was inhibition (the most difficult one). Additionally, the severity of dysarthria and a poorer performance in cognitive shifting predicted a more severe DTC on speech rate. Finally, modulation of the magnitude of the DTCs was observed, depending on the difficulty of the nonverbal secondary task.

CONCLUSION

The results suggest that, in PD, postlexical processes require attentional resources and cognitive shifting is related to dual-task performance in speech.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.21265893.

Poorer cognitive function and environmental airborne Mn exposure determined by biomonitoring and personal environmental monitors in a healthy adult population

BACKGROUND/AIM

In the Santander Bay (Cantabria, northern Spain), a ferromanganese alloy plant is located. Our objective was to characterize the Mn personal exposure of adult healthy volunteers living in this highly Mn exposed region, and to determine its association with a poorer cognitive function.

METHODS

Cross-sectional study analyzing 130 consecutive participants. Cognitive function was assessed by Stroop Color Word, Verbal Fluency tests, Trail Making Test (TMT), Digit Span (WAIS III) and Rey Osterrieth Complex Figure (ROCF) tests and crude scores were standardized according to NEURONORMA norms. Exposure to Mn was assessed in terms of source distance, by Personal Environmental Monitors (PEMs) allowing the separation of fine (PM2.5) and coarse (PM10-2.5) particles (obtaining the bioaccessible fraction by in-vitro bioaccessibility tests), and by biomarkers (blood, hair and fingernails). Age, sex, study level and number of years of residence were predefined as confounding variables and adjusted Mean Differences (MDs) were obtained.

RESULTS

Statistically significant lower scores (negative MDs) in all test were observed when living near the industrial emission source, after adjusting for the predefined variables. Regarding PEMs results, statistically significant lower scores in all Stroop parts were obtained in participants with higher levels of Total Mn in All fractions (PM10). For Verbal Fluency tests, negative MDs were obtained for both bioaccessible fractions. Digit Span Backward scores were lower for those with higher levels in the bioaccessible coarse fraction, and negative MDs were also observed for the ROCF Delayed part and the non-bioaccessible fine fraction. As regards to Mn in fingernails, adjusted MDs of -1.60; 95%CI (-2.57 to -0.64) and -1.45; 95%CI (-2.29 to -0.61) for Digit Span Forward and Backward parts were observed.

CONCLUSIONS

Our results support an association between poorer cognitive function and environmental airborne Mn exposure.

Dopamine-Related Reduction of Semantic Spreading Activation in Patients With Parkinson's Disease

Impaired performance in verbal fluency (VF) tasks is a frequent observation in Parkinson's disease (PD). As to the nature of the underlying cognitive deficit, it is commonly attributed to a frontal-type dysexecutive syndrome due to nigrostriatal dopamine depletion. Whereas dopaminergic medication typically improves VF performance in PD, e.g., by ameliorating impaired lexical switching, its effect on semantic network activation is unclear. Data from priming studies suggest that dopamine causes a faster decay of semantic activation spread. The aim of the current study was to examine the impact of dopaminergic medication on the dynamic change of word frequency during VF performance as a measure of semantic spreading activation. To this end, we performed a median split analysis of word frequency during phonemic and semantic VF task performance in a PD group tested while receiving dopaminergic medication (ON) as well as after drug withdrawal (i.e., OFF), and in a sample of age-matched healthy volunteers (both groups n = 26). Dopaminergic medication in the PD group significantly affected phonemic VF with improved word production as well as increased error-rates. The expected decrease of word frequency during VF task performance was significantly smaller in the PD group ON medication than in healthy volunteers across semantic and phonemic VF. No significant group-difference emerged between controls and the PD group in the OFF condition. The comparison between both treatment conditions within the PD group did not reach statistical significance. The observed pattern of results indicates a faster decay of semantic network activation during lexical access in PD patients on dopaminergic medication. In view of improved word generation, this finding is consistent with a concept of more focused neural activity by an increased signal-to-noise ratio due to dopaminergic neuromodulation. However, the effect of dopaminergic stimulation on VF output suggests a trade-off between these beneficial effects and increased error-rates.

Adults Who Stutter Show Diminished Word Fluency, Regardless of Mode

PURPOSE

Language abilities have long been thought to be weaker in adults who stutter (AWS) compared to adults who do not stutter (AWNS). However, it is unknown whether modality affects language performance by AWS in time pressure situations. This study aimed to examine lexical access and retrieval abilities of AWS in oral and typed modes.

METHOD

Fifteen AWS and 15 well-matched AWNS completed computer-administered letter fluency tasks. Adults were asked to orally produce words that began with one of two letter targets and type words that began with one of two alternate letters. Conditions were counterbalanced across participants.

RESULTS

Generalized linear mixed-effects models were evaluated to determine the effects of group (AWS/AWNS), mode (oral/typed), and expressive vocabulary on letter fluency performance. Group predicted letter fluency such that AWS generated fewer items on both the oral and typed letter fluency tasks. Mode did not impact letter fluency results. Expressive Vocabulary Test scores predicted letter fluency similarly in both AWS and AWNS.

CONCLUSIONS

AWS were not penalized by oral task demands. AWS generated fewer items on the letter fluency tasks regardless of response mode, suggesting that they have weaker lexical access abilities. Furthermore, better expressive vocabulary skills were associated with better letter fluency performance in both groups.

Effects of computer-based cognitive rehabilitation on working memory in patients with acquired brain injury in the chronic phase, a pilot-study

BACKGROUND

Working memory impairment is common in patients in the chronic phase after acquired brain injury (ABI), and there is a need to develop efficacious rehabilitation methods. This trial explored the effects of two different computer-based cognitive rehabilitation (CBCR) programmes on working memory in the chronic phase after ABI, as well as the role of continuous support versus no support from a health professional on the efficacy of CBCR.

METHODS

A total of 72 patients were randomized into four different groups for a 12-week intervention: Two groups trained with the CBCR-programmes 'Cogmed' and 'Brain+ Health,' respectively, and one group completed active-control training. All three groups received continuous support from a health professional. The last group trained with the CBCR programme 'Brain+ Health' but received no support. Before and after the intervention, patients were tested with a neuropsychological battery of working memory, attention and executive functions.

RESULTS

Both CBCR-programmes improved working memory when administered with support from a health professional. The programmes improved different sub-components of working memory, possibly because of their individual content and design. None of the CBCR-programmes were more efficacious than sham-training with support. CBCR without support did not improve working memory in patients.

Neural Correlates of Letter and Semantic Fluency in Primary Progressive Aphasia

Verbal fluency (VF) is an informative cognitive task. Lesion and functional imaging studies implicate distinct cerebral areas that support letter versus semantic fluency and the understanding of neural and cognitive mechanisms underlying task performance. Most lesion studies include chronic stroke patients. People with primary progressive aphasia (PPA) provide complementary evidence for lesion-deficit associations, as different brain areas are affected in stroke versus PPA. In the present study we sought to determine imaging, clinical and demographic correlates of VF in PPA. Thirty-five patients with PPA underwent an assessment with letter and category VF tasks, evaluation of clinical features and an MRI scan for volumetric analysis. We used stepwise regression models to determine which brain areas are associated with VF performance while acknowledging the independent contribution of clinical and demographic factors. Letter fluency was predominantly associated with language severity (R2 = 38%), and correlated with the volume of the left superior temporal regions (R2 = 12%) and the right dorsolateral prefrontal area (R2 = 5%). Semantic fluency was predominantly associated with dementia severity (R2 = 47%) and correlated with the volume of the left inferior temporal gyrus (R2 = 7%). No other variables were significantly associated with performance in the two VF tasks. We concluded that, independently of disease severity, letter fluency is significantly associated with the volume of frontal and temporal areas whereas semantic fluency is associated mainly with the volume of temporal areas. Furthermore, our findings indicated that clinical severity plays a critical role in explaining VF performance in PPA, compared to the other clinical and demographic factors.

Increase in Right Temporal Cortex Thickness Is Related to Decline of Overall Cognitive Function in Patients With Hypertension

Background: Hypertension is associated with poorer cognitive functions, but the mechanisms are unclear.

Objective: This research aims to explore the cognitive status of elderly patients with hypertension and the possible mechanisms of hypertension affecting cognitive function.

Methods: Data were obtained from the China Longitudinal Aging Study (CLAS), and a total of 128 residents, aged 60 years and above, were recruited in this study. Based on whether they had hypertension, these 128 people were divided into the hypertension (n = 64) and non-hypertension groups (n = 64). The Beijing version of the Mini-Mental State Examination (MMSE) and Montreal Cognitive Assessment (MoCA) were used to assess the overall cognitive function of the subjects, while digit span, language fluency, Wechsler mapping, and Wechsler wood block were used to assess their domain-specific cognitive function (both at baseline and follow-up stages). At the same time, we also examined baseline blood biochemical indicators (such as total protein, fasting plasma glucose (FPG), high-density lipoprotein (HDL), low-density lipoprotein (LDL), cholesterol, and triglyceride) and baseline MRI data of hippocampus and amygdala volume and temporal polar cortex thickness.

Results: The total protein and thickness of temporal polar cortex in patients with hypertension were significantly higher than those in normal controls, but the scores on MMSE, MoCA, digit span, Wechsler mapping and Wechsler wood block at baseline were significantly lower than those in normal controls (p < 0.05). By linear regression analysis and correlation analysis (age and education were controlled), we found that baseline Wechsler mapping scores were negatively correlated with total protein (B = −0.243, t = −3,735, p < 0.001, 95% confidence interval (CI): −0.371 to −0.114); and both the follow-up MMSE score (B = 2.657, t = 2.002, p = 0.049, 95% CI: 0.009~5.306) and the change score of MMSE (r = −0.025, p = 0.047) were related to the thickness of the right temporal pole cortex. Then, by linear regression analysis (mediating model), we found that hypertension may influence follow-up MMSE scores by influencing the cortical thickness of the right temporal pole (B = 1.727, p = 0.022, 95% CI: 0.261–3.193).

Conclusions: Elderly patients with hypertension exhibit poorer overall cognitive function and executive function, and the mechanism may be related to the effect of hypertension on the cortical thickness of the right temporal pole.

Resting State Networks Related to the Maintenance of Good Cognitive Performance During Healthy Aging

Purpose: Maintenance of cognitive performance is important for healthy aging. This study aims to elucidate the relationship between brain networks and cognitive function in subjects maintaining relatively good cognitive performance.

Methods: A total of 120 subjects, with equal number of participants from each age group between 20 and 70 years, were included in this study. Only participants with Addenbrooke’s Cognitive Examination – Revised (ACE-R) total score greater than 83 were included. Anatomical T1-weighted MR images and resting-state functional MR images (rsfMRIs) were taken from all participants using a 3-tesla MRI scanner. After preprocessing, several factors associated with age including the ACE-R total score, scores of five domains, sub-scores of ACE-R, and brain volumes were tested. Morphometric changes associated with age were analyzed using voxel based morphometry (VBM) and changes in resting state networks (RSNs) were examined using dual regression analysis.

Results: Significant negative correlations with age were seen in the total gray matter volume (GMV, r = −0.58), and in the memory, attention, and visuospatial domains. Among the different sub-scores, the score of the delayed recall (DR) showed the highest negative correlation with age (r = −0.55, p < 0.001). In VBM analysis, widespread regions demonstrated negative correlation with age, but none with any of the cognitive scores. Quadratic approximations of cognitive scores as functions of age showed relatively delayed decline compared to total GMV loss. In dual regression analysis, some cognitive networks, including the dorsal default mode network, the lateral dorsal attention network, the right / left executive control network, the posterior salience network, and the language network, did not demonstrate negative correlation with age. Some regions in the sensorimotor networks showed positive correlation with the DR, memory, and fluency scores.

Conclusion: Some domains of the cognitive test did not correlate with age, and even the highly correlated sub-scores such as the DR score, showed delayed decline compared to the loss of total GMV. Some RSNs, especially involving cognitive control regions, were relatively maintained with age. Furthermore, the scores of memory, fluency, and the DR were correlated with the within-network functional connectivity values of the sensorimotor network, which supported the importance of exercise for maintenance of cognition.

Differences in Diffusion Tensor Imaging White Matter Integrity Related to Verbal Fluency Between Young and Old Adults

Throughout adulthood, the brain undergoes an array of structural and functional changes during the typical aging process. These changes involve decreased brain volume, reduced synaptic density, and alterations in white matter (WM). Although there have been some previous neuroimaging studies that have measured the ability of adult language production and its correlations to brain function, structural gray matter volume, and functional differences between young and old adults, the structural role of WM in adult language production in individuals across the life span remains to be thoroughly elucidated. This study selected 38 young adults and 35 old adults for diffusion tensor imaging (DTI) and performed the Controlled Oral Word Association Test to assess verbal fluency (VF). Tract-Based Spatial Statistics were employed to evaluate the voxel-based group differences of diffusion metrics for the values of fractional anisotropy (FA), mean diffusivity (MD), axial diffusivity (AD), radial diffusivity (RD), and local diffusion homogeneity (LDH) in 12 WM regions of interest associated with language production. To investigate group differences on each DTI metric, an analysis of covariance (ANCOVA) controlling for sex and education level was performed, and the statistical threshold was considered at p < 0.00083 (0.05/60 labels) after Bonferroni correction for multiple comparisons. Significant differences in DTI metrics identified in the ANCOVA were used to perform correlation analyses with VF scores. Compared to the old adults, the young adults had significantly (1) increased FA values on the bilateral anterior corona radiata (ACR); (2) decreased MD values on the right ACR, but increased MD on the left uncinate fasciculus (UF); and (3) decreased RD on the bilateral ACR. There were no significant differences between the groups for AD or LDH. Moreover, the old adults had only a significant correlation between the VF score and the MD on the left UF. There were no significant correlations between VF score and DTI metrics in the young adults. This study adds to the growing body of research that WM areas involved in language production are sensitive to aging.

Hand preference in referential gestures: Relationships to accessing words for speaking in monolingual and bilingual children

INTRODUCTION

Infants' right-hand preference for pointing is associated with higher vocabulary. It is not clear whether the link between right-hand preference for gesturing and language persists into the preschool years. The primary purpose of the present study was to test whether preschool children's hand preference for referential gestures was associated with their language abilities. Secondarily, we predicted that the children's right-hand preference would be negatively associated with their visuospatial abilities. We also predicted that monolingual children would show a strong right-hand preference while bilinguals might show a reduced right-hand preference.

METHODS

Monolingual and bilingual children between the ages of four and six years did a storytelling task. Their referential gestures were coded for hand use (right, left, both). We measured language skills (receptive vocabulary, semantic fluency).

RESULTS

We found no difference between bilinguals and monolinguals on hand preference. Semantic fluency was a positive predictor and vocabulary a negative predictor of right-hand preference. Children's visuospatial abilities were not a predictor of right-hand preference.

CONCLUSION

These results suggest that right-hand preference may help children select semantically appropriate words out of their existing vocabulary. In other words, this preference may be related to children's construction of the message that they would like to produce. The association between hand preference and language skills persists into the preschool years.

Verbal Fluency Tasks: Influence of Age, Gender, and Education and Normative Data for the Spanish Native Adult Population

OBJECTIVE

Phonological and semantic verbal fluency (VF) tasks are frequently used to assess language and executive functions in both clinical and research settings. F, A, and S are the most commonly used letters in phonological tasks across languages and cultures. Unfortunately, the lack of norms for the native Spanish population for these letters, and for certain semantic categories such as "proper names," may lead to misinterpretation of scores due to demographic differences. The aim of the present study was to provide normative data for F, A, and S and for "proper names," "animals," and "fruits and vegetables" for the native Spanish population.

METHOD

257 healthy subjects took part in the study (ages: 17-100 years, 3-20 years of education). Correlation, multiple regression, and t-tests were used to select the most appropriate variables for stratification.

RESULTS

Education was the best predictor of performance in all tasks, followed by age. Given that t-test results showed no differences related to gender, with the only exception of the semantic category "animals," this variable was not considered for stratification. Consequently, the data were stratified in two education levels (<13, ≥13 years of education) and in two age levels (<60, ≥60) within the low-educational level group. Mean, standard deviation, and percentile scores for each group are provided.

CONCLUSIONS

The present norms provide a reference for clinicians assessing VF. This data may also facilitate comparisons with other normative studies in cross-cultural and cross-linguistic research.

Effects of Combined Physical Movement Activity and Multifaceted Cognitive Training in Older People with Mild Neurocognitive Disorder in a Rural Community: A Randomized Control Trial

INTRODUCTION

Cognitive deterioration in older people with mild neurocognitive disorders (mNCD) increases the risk of progress to major NCD. Health professionals worldwide are trying to find strategies for prevention. There is a limited number of studies that deal with cultural conditions in northern Thailand.

OBJECTIVES

This study aimed to investigate the effects of a combination of physical movement activity and multifaceted cognitive training on cognitive function in older people with mNCD.

METHODS

A randomized control trial involving 70 mNCD people, according to DSM-5 criteria, was conducted on an intervention group and a control group (n = 35 each). The program for the intervention group included 24 sessions (twice a week). The outcome measures on cognitive function were assessed before and after the intervention by means of composite cognitive measures for older people, i.e., the Trail-Making Test (TMT), Digit Span (DS), Verbal Fluency (VF), Word-List Learning (WLL), and Block Design (BD).

RESULTS

The combined intervention enhanced cognitive function. TMT-A was significantly improved in the intervention group. There were significant improvements in DS sequence scores, letter verbal fluency (LVF), and category verbal fluency (CVF). Comparing the groups, there were significant differences in LVF including immediate and delayed recall. BD improved significantly in the intervention group.

CONCLUSIONS

The combined intervention appeared to be effective in delaying/preventing cognitive deterioration and cognitive functional decline in people with mNCD. Further studies on a variation of treatments suited to cultural conditions and their effects are needed. Trials in other communities are also recommended.

Letter and category Fluency Test in Spanish-Speaking Children with Neurodevelopmental Disorders

Introduction

Verbal fluency test is a short psychometric test, which is sensitive to verbal ability and executive control impairment. We did not find studies that analyze verbal fluency in relation to the neurodevelopmental disorders in Spanish-speaking children with letters P-M. Our objective was to analyze the verbal fluency of Spanish-speaking children with neurodevelopmental disorders.

Method

We carried out a retrospective cross-sectional study to analyze the performance of children who had undergone a neuropsychological assessment.

Results

We included 164 patients. There were 55 (33.54%) patients with low intellectual performance (LIP), 19 (11.59%) patients with dyslexia , and 90 (54.88%) patients had an ADHD. Patients with LIP showed lower phonological fluency than patients with ADHD. As for semantic fluidity, differences were observed between patients with LIP and ADHD and also between LIP and dyslexia. The probability of having LIP was 9.6 times greater when somebody had a scale score lower than 7 in the PF task and it was 16.7 times greater when the scale score was lower than 7 in the SF task.

Conclusions

There was a direct relationship between FSIQ and the performance in verbal fluency test, which is a brief and effective neuropsychological test in revealing deficits in executive functions, verbal abilities, and LIP.

Executive Function, Working Memory, and Verbal Fluency in Relation to Non-Verbal Intelligence in Greek-Speaking School-Age Children with Developmental Language Disorder

Developmental Language Disorder (DLD) is often associated with impairments in working memory (WM), executive functions (EF), and verbal fluency. Moreover, increasing evidence shows poorer performance of children with DLD on non-verbal intelligence tests relative to their typically developing (TD) peers. Yet, the degree and generality of relevant difficulties remain unclear. The present study aimed at investigating WM capacity, key EFs and verbal fluency in relation to non-verbal intelligence in Greek-speaking school-age children with DLD, compared to TD peers (8–9 years). To our knowledge, the present study is the first to attempt a systematic relevant assessment with Greek-speaking school-age children, complementing previous studies mostly involving English-speaking participants. The results showed that children with DLD scored lower than TD peers on the non-verbal intelligence measure. Groups did not differ in the inhibition measures obtained (tapping resistance to either distractor or proactive interference), but children with DLD were outperformed by TD peers in the WM capacity, updating, monitoring (mixing cost), and verbal fluency (phonological and semantic) measures. The effects showed limited (in the case of backward digit recall) or no dependence on non-verbal intelligence. Findings are discussed in terms of their theoretical and practical implications as well as in relation to future lines of research.

Does the cerebellar sequential theory explain spoken language impairments? A literature review

During the past decades, converging evidence from clinical, neuroimaging and neuroanatomical studies has demonstrated the key role of the cerebellum in the processing of non-motor aspects of language. Although more is known about the way in which the cerebellum participates in the mechanisms involved in written language, there is ambiguous information on its role in other aspects of language, such as in non-motor aspects of spoken language. Thus, to contribute additional insight into this important issue, in the present work, we review several original scientific papers focusing on the most frequent non-motor spoken language impairments evidenced in patients affected by cerebellar pathology, namely, verbal working memory, grammar processing and verbal fluency impairments. Starting from the collected data, we provide a common interpretation of the spoken language disorders in cerebellar patients, suggesting that sequential processing could be the main mechanism by which the cerebellum participates in these abilities. Indeed, according to the cerebellar sequential theory, spoken language impairments could be due to altered cerebellar function to supervise, synchronize and coordinate the activity of different functional modules, affecting the correct optimization of linguistic processing.

L2 Verbal Fluency and Cognitive Mechanism in Bilinguals: Evidence from Tibetan-Chinese Bilinguals

As a basic indicator of verbal ability, verbal fluency refers to the degree of fluency in the use of language to convey information. The different components of working memory play an important role in verbal fluency. The inhibiting control mechanism takes place during L2 production processing in bilinguals, which may affect their verbal fluency and distinguish them from native speakers. The participants of our study were 90 Tibetan-Chinese bilinguals and 30 native Chinese speakers. The study attempts to investigate the verbal fluency and cognitive mechanism of bilinguals' L2. The present study's results found L2 verbal fluency in Tibetan-Chinese bilinguals is significantly lower than that of native Chinese speakers. L2 verbal fluency has changed under the influence of their mother tongue, mainly manifested as its semantic fluency of L2 relying not only on the visuospatial sketchpad but also the phonological loop. Moreover, the processing of bilinguals' L2 is influenced by the processing mode of L1 in the verbal fluency task.

Normative data for Verbal Fluency and Object Naming Tests in a sample of European Portuguese adult population

The purpose of the present study was to calculate the construct validity, internal consistency and normative data of the Phonological Verbal Fluency Test (letters F, A, S, and M), Semantic Verbal Fluency Test (Animals, Fruits and Professions categories), and Boston Naming Test (short and standard version), and to generate normative data for these tests after adjusting for age, education, and sex. A sample of 293 European Portuguese adults participated in the study. Results showed adequate construct validity and internal consistency for all of the tests and the final multiple regression models found that age and education were significantly associated with P-VFT (letters F, A, S, and M), S-VFT (Animals, Fruits and Professions categories), and BNT performance. Sex was only found to have an effect on the fruit category, with women scoring higher than men. The normative data provided in this study will contribute to improving the clinical practice of neuropsychology in Portugal.

Reproductive aging and executive functions in healthy women

The aim of this study was to analyze the influence of reproductive aging on executive functions. We assessed executive functions in three groups of healthy women in the premenopausal (n = 45, mean age = 30.89, SD = 10.5), perimenopausal (n = 31, mean age = 50.06, SD = 3.6) and postmenopausal (n = 24, mean age = 63.39, SD = 6.5) phase. No differences between groups were observed in working memory, verbal fluency, inhibitory control, planning, and cognitive flexibility. However, when the analyses were repeated with participants with occupations with lower intellectual demands, perimenopausal and postmenopausal women performed worse than premenopausal women in semantic verbal fluency. This study provides important evidence to understand the effects of reproductive aging on cognitive performance in healthy women. Our findings indicate that cognitive reserve-related factors may be important to understand the differences in executive functions associated with reproductive aging.

Qualitative and quantitative aspects of the F-A-S fluency test in people with aphasia

Verbal fluency tests are widely used in neuropsychological assessment. The quantitative and qualitative analysis of the performance of aphasic individuals on the phonemic verbal fluency (PVF) test can contribute to a better understanding of cognitive changes in this group of patients.

Characteristics of resting-state functional connectivity in older adults after the PICMOR intervention program: a preliminary report

BACKGROUND

The present study aimed to provide a basis for future research examining the neural mechanisms that underlie the beneficial effect of an intervention program, Photo-Integrated Conversation Moderated by Robots (PICMOR), on verbal fluency in older adults as identified in our previous randomized controlled trial. In this preliminary report, we conducted an additional experiment using resting-state functional magnetic resonance imaging (rsfMRI) after the intervention period. Specifically, we investigated the resting-state functional connectivity (rsFC) characteristics of the intervention group (INT) compared to the control group (CONT).

METHODS

rsfMRI data were acquired from 31 and 30 participants in INT and CONT, respectively, after the intervention. In the analyses, two of the most important regions in verbal fluency, the left inferior and middle frontal gyri, were selected as seed regions, and the rsFCs were compared between groups. We also conducted regression analyses for rsFCs using the difference in individual phonemic verbal fluency task (PVFT) scores between the pre- and post-intervention periods (i.e., post- minus pre-intervention) as an independent variable.

RESULTS

We found higher rsFC in INT than in CONT between the left inferior frontal gyrus as a seed region and the temporal pole and middle frontal gyrus. The rsFC strength between the left inferior frontal gyrus and temporal pole positively correlated with an increased PVFT score between the pre- and post-intervention periods. In contrast, we found lower rsFC in INT than in CONT between the left middle frontal gyrus as a seed region and the posterior cingulate cortex, precuneus, and postcentral gyrus.

CONCLUSIONS

Our findings suggest that the beneficial intervention effect of PICMOR on verbal fluency is characterized by enhanced rsFC of the left inferior frontal gyrus with semantic and executive control-related regions and suppressed rsFC between the left middle frontal gyrus and posterior cortical midline structures. No definitive conclusions can be made because of a lack of rsfMRI data before the intervention. However, this pilot study provides the candidates for rsFCs, reflecting the beneficial effects of PICMOR on the brain network involved in verbal fluency.

TRIAL REGISTRATION

The trial was retrospectively registered at the UMIN Clinical Trials Registry ( UMIN000036667 ) (May 7th, 2019).

Cognitive reserve and network efficiency as compensatory mechanisms of the effect of aging on phonemic fluency

Compensation in cognitive aging is a topic of recent interest. However, factors contributing to cognitive compensation in functions such as phonemic fluency (PF) are not completely understood. Using cross-sectional data, we investigated cognitive reserve (CR) and network efficiency in young (32-58 years) versus old (59-84 years) individuals with high versus low performance in PF. ANCOVA was used to investigate the interaction between CR, age, and performance in PF. Random forest and graph theory analyses were conducted to study the contribution of cognition to PF and efficiency measures, respectively. Higher CR increased performance in PF and reduced age-related differences in PF. A slightly higher number of cognitive functions contributed to performance in high CR groups. The networks were more integrated in high CR individuals, both in the older age and high-performance groups. The strength and segregation of the networks were decreased in high-performance groups with high CR. We conclude that PF decreases less with age in individuals with higher CR, possibly due to a greater capacity to recruit non-linguistic cognitive networks, and efficient use of language networks, thereby integrating information in a rapid way across less fragmented networks. High CR and network efficiency seem to be important factors for cognitive compensation.

The Effects of Nordic Walking With Poles With an Integrated Resistance Shock Absorber on Cognitive Abilities and Cardiopulmonary Efficiency in Postmenopausal Women

Late adulthood is associated with atrophy of brain areas, which contribute to cognitive deterioration and increase the risk of depression. On the other hand, aerobic exercise can improve learning and memory function, ameliorate mood, and prevent neurodegenerative changes. This study demonstrates the effect of Nordic walking (NW) and NW with poles with an integrated resistance shock absorber (NW with RSA) on aerobic capacity and body composition in postmenopausal women. It also measures the brain-derived neurotrophic factor (BDNF) and glial cell line-derived neurotrophic factor (GDNF) serum levels and determines correlations with cognitive functions and depression symptoms. These relationships with the use of NW with RSA as a new form of exercise have not been described thus far. In this study, 31 women (NW - 16, NW with RSA - 15) participated in eight weeks of training. The findings showed that only NW with RSA training caused a significant decrease in body mass and body mass index (p < 0.05). There were no significant changes in GDNF levels between groups studied. Regarding BDNF, a significant decrease (p < 0.05) in the NW group and an increase (not statistically significant) in the NW with RSA group was found. A comparative analysis of cognitive and depression outcomes and changes in BDNF and GDNF concentration showed no significant differences in the efficacy of either form of training. Training loads resulted in a significant increase in VO₂max in both the NW (p < 0.01) and NW with RSA (p < 0.05) groups. This indicates an improvement in cardiopulmonary efficiency of the examined women.

Increased conceptual switching by dopaminergic treatment in patients with Parkinson's disease

Cognitive changes including reduced word production in verbal fluency (VF) tasks are frequently observed in Parkinson's disease (PD) with ambiguous effects of dopaminergic medication on these symptoms. Here, we studied the impact of dopaminergic medication on specific cognitive components underlying VF task performance in 21 participants with PD on their regular medication and following dopamine withdrawal compared with healthy controls. We used temporal cluster analysis (TCA) to differentiate phases of VF output relating to fast automatic lexical activation ('clusters') and slower attention-demanding shifts ('switches'). Dopaminergic medication led to increased switching and, in non-alternating VF tasks, to the formation of smaller and shorter word clusters. The number of switches was correlated with higher cognitive scores and showed an inverse relationship with VF error rates. Increased switching operations during VF task performance can be interpreted in view of nigrostriatal dopaminergic roles for balancing system state versus change propensities. The additional effect on word clustering suggests a modulation of semantic spreading activation mechanisms underlying lexical search, presumably involving non-nigrostriatal, e.g., mesocortical dopaminergic networks.

Recruiting the right hemisphere: Sex differences in inter-hemispheric communication during semantic verbal fluency

Sex differences in cognitive functions are heavily debated. Recent work suggests that sex differences do stem from different processing strategies utilized by men and women. While these processing strategies are likely reflected in different brain networks, so far the link between brain networks and processing strategies remains speculative. In the present study we seek for the first time to link sex differences in brain activation patterns to sex differences in processing strategies utilizing a semantic verbal fluency task in a large sample of 35 men and 35 women, all scanned thrice. For verbal fluency, strategies of clustering and switching have been described. Our results show that men show higher activation in the brain network supporting clustering, while women show higher activation in the brain network supporting switching. Furthermore, converging evidence from activation results, lateralization indices and connectivity analyses suggests that men recruit the right hemisphere more strongly during clustering, but women during switching. These results may explain findings of differential performance and strategy-use in previous behavioral studies.

Measurement and Structure of Cognition in the Longitudinal Aging Study in India-Diagnostic Assessment of Dementia

OBJECTIVES

To test whether a relatively complex model of human cognitive abilities based on Cattell-Horn-Carroll (CHC) theory, developed mainly in English-speaking samples, adequately describes correlations among tests in the Longitudinal Aging Study in India-Diagnostic Assessment of Dementia (LASI-DAD), and to develop accurate measures of cognition for older individuals in India.

DESIGN

LASI-DAD participants were recruited from participants aged 60 years and older from 14 states in the core LASI survey, with a stratified sampling design.

SETTING

Participants were interviewed at home or in a participating hospital, according to their preferences.

PARTICIPANTS

Community-residing older adults aged 60 years and older (N = 3,224).

MEASUREMENTS

A variety of cognitive tests were administered during two pretests and chosen for their appropriateness for measuring cognition in older adults in India and suitability for calibration with the core LASI survey and the Harmonized Cognitive Assessment Protocol.

RESULTS

We evaluated the factor structure of the test battery and its conformity with a classical CHC factor model that incorporated measurement models for general cognition, five broad domains (orientation, executive functioning, language/fluency, memory, and visuospatial), and five narrow domains (reasoning, attention/speed, immediate memory, delayed memory, and recognition memory) of cognitive performance. Model fit was adequate (root mean square error of approximation = 0.051; comparative fit index = 0.916; standardized root mean squared residual = 0.060).

CONCLUSION

We demonstrated configural factorial invariance of a cognitive battery in the Indian LASI-DAD using CHC theory. Broad domain factors may be used in future research to rank individuals with respect to cognitive performance and classify cognitive impairment. J Am Geriatr Soc 68:S11-S19, 2020.

Cognitive compensatory mechanisms in normal aging: a study on verbal fluency and the contribution of other cognitive functions

Verbal fluency has been widely studied in cognitive aging. However, compensatory mechanisms that maintain its optimal performance with increasing age are not completely understood. Using cross-sectional data, we investigated differentiation and dedifferentiation processes in verbal fluency across the lifespan by analyzing the association between verbal fluency and numerous cognitive measures within four age groups (N=446): early middle-age (32-45 years), late middle-age (46-58 years), early elderly (59-71 years), and late elderly (72-84 years). ANCOVA was used to investigate the interaction between age and fluency modality. Random forest models were conducted to study the contribution of cognition to semantic, phonemic, and action fluency. All modalities declined with increasing age, but semantic fluency was the most vulnerable to aging. The most prominent reduction in performance was observed during the transition from middle-age to early elderly, when cognitive variables stopped contributing (differentiation), and new cognitive variables started contributing (dedifferentiation). Lexical access, processing speed, and executive functions were among the most contributing functions. We conclude that the association between age and verbal fluency is masked by age-specific influences of other cognitive functions. Differentiation and dedifferentiation processes can coexist. This study provides important data for better understanding of cognitive aging and compensatory processes.

Experticia y cognición. Exploración de funciones cognitivas verbales y visoespaciales en arquitectos y psicólogos

Diversas investigaciones han advertido que el ejercicio de algunas profesiones puede conllevar efectos moduladores en la estructura cerebral y el funcionamiento cognitivo. Se presentan los resultados de un estudio exploratorio transversal referente a las modificaciones que las experticias en arquitectura (N = 41, edad: X = 39, DE = 10) y en psicología (N = 40, edad: X = 35, DE = 7) producen sobre procesos cognitivos específicos. El objetivo general fue contribuir a la determinación de perfiles cognitivos diferenciales. Los arquitectos mostraron un mejor rendimiento en tareas que involucran la retención y manipulación de información visoespacial. No se hallaron diferencias significativas en la resolución de tareas verbales. Estos resultados sugieren que la experiencia en arquitectura podría conducir a un desempeño conductual mejorado en procesos cognitivos correspondientes a la memoria de trabajo visoespacial. Se discuten los alcances de la presente exploración y las instancias necesarias para la validación de estas observaciones. Se sugiere la realización de nuevos estudios que integren seguimiento longitudinal y tecnologías de neuroimagen.

Activation of the hypothalamic-pituitary adrenal axis in response to a verbal fluency task and associations with task performance

Speech fluency can be impaired in stressful situations. In this study, it was investigated whether a verbal fluency task by itself, i.e. without the presence of any further stressors, induces responses of the hypothalamic-pituitary adrenal (HPA) axis and of the sympathetic nervous system (SNS). The sample consisted of n = 85 participants (68.2% female; 33.3 ± 15.2 years) who performed two consecutive verbal fluency tasks for two minutes each. The categories were either ‘stress’ or ‘disease’ and ‘animals’ or ‘foods’ which were presented in a randomized order. Three saliva samples were collected, prior to the task (t₀), immediately after (t₁), and ten minutes after it (t₂). Salivary α-amylase and cortisol were assessed. Furthermore, blood pressure, heart rate, and ratings of actual stress perception, level of effort, and tiredness were measured. The verbal fluency task induced a HPA axis response with a maximum cortisol level at t₂ which was independent of task performance. Furthermore, perceived stress and effort, as well as tiredness increased after the task. Moreover, tiredness immediately after the task was negatively correlated with task performance. No α-amylase, blood pressure, or heart rate, and therefore SNS, responses were found. Implications for the integrated specificity model are discussed. We conclude that a verbal fluency task acts like an acute stressor that induces a cortisol and a perceived stress response without the need for further (e.g., social-evaluative) stress components. Therefore, it is a less time-consuming alternative to other stress tasks that can be used in field studies with little effort.