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De Vito AN, Emrani S, Hallowell E, Goldstein A, Davis JD, Margolis SA. Medication management error types: Associations with mild cognitive impairment subtype. Clin Neuropsychol 2024:1-16. [PMID: 38588668 DOI: 10.1080/13854046.2024.2339560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 04/01/2024] [Indexed: 04/10/2024]
Abstract
Objective: Medication management errors are suspected to be prevalent among older adults with mild cognitive impairment (MCI). This study examined types of simulated medication-taking errors in cognitively normal older adults (CN; n = 131), single domain amnestic MCI (sdMCI, n = 91), and multi-domain MCI (mdMCI, n = 44). Errors were measured using the medication management ability assessment (MMAA). Methods: 266 participants seen for neuropsychological evaluation (94.4% White, 57.9% female, average age = 72, average education = 14 years) completed the MMAA (version 4.1), a performance-based task of medication management. Group differences in MMAA total scores, accuracy, and error types were evaluated using Kruskall-Wallis H tests. This study was the first to explore a newly operationalized error, perseverations, caused by taking a specific dose ≥2 times during the simulation. Results: CN and sdMCI groups had higher MMAA total scores than individuals with mdMCI, indicating better overall performance. The mdMCI group made a higher number of omission errors (missed pills) than other groups, but no differences were found for commission errors (extra pills). The sdMCI group made more perseverative errors compared to the CN group. Conclusions: Individuals with mdMCI made more simulated medication management errors than CN and sdMCI groups, indicating that they may be most vulnerable to difficulties in medication management. In contrast, sdMCI individuals were more likely to make perseverative errors, which may reflect a tendency towards overcompensation of memory loss. Future studies should assess whether MMAA performance is associated with patterns of real-world medication-taking in more diverse samples of older adults.
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Affiliation(s)
- Alyssa N De Vito
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
- Memory and Aging Program, Butler Hospital, Providence, RI, USA
| | - Sheina Emrani
- Department of Neurology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Emily Hallowell
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
- Department of Mental Health and Behavioral Science and Services, Providence Veterans Affairs Medical Center, Providence, RI, USA
| | - Allyson Goldstein
- Department of Psychiatry, Rhode Island Hospital, Providence, RI, USA
| | - Jennifer D Davis
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
- Department of Psychiatry, Rhode Island Hospital, Providence, RI, USA
| | - Seth A Margolis
- Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA
- Department of Psychiatry, Rhode Island Hospital, Providence, RI, USA
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Delgado-Losada ML, Rubio-Valdehita S, López-Higes R, Campos-Magdaleno M, Ávila-Villanueva M, Frades-Payo B, Lojo-Seoane C. Phonological fluency norms for Spanish middle-aged and older adults provided by the SCAND initiative (P, M, & R). J Int Neuropsychol Soc 2024; 30:172-182. [PMID: 37465902 DOI: 10.1017/s1355617723000309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
OBJECTIVE Verbal fluency tests are quick and easy to administer neuropsychological measures and are regularly used in neuropsychological assessment. Additionally, phonological fluency is a widely used paradigm that is sensitive to cognitive impairment. This paper offers normative data of phonological verbal fluency (letters P, M, R) for Spanish middle- and older-aged adults, considering sociodemographic factors, and different measures such as the total number of words, errors (perseveration and intrusions), and 15 sec-segmented scores. METHOD A total of 1165 cognitively unimpaired participants aged between 50 and 89 years old, participated in the study. Data for P were obtained for all participants. Letters M and R were also administered to a subsample of participants (852) aged 60 to 89 years. In addition, errors and words produced every 15 seconds were collected in the subsample. To verify the effect of sociodemographic variables, linear regression was used. Adjustments were calculated for variables that explained at least 5% of the variance (R2 ≥ .05). RESULTS Means and standard deviations by age, scaled scores, and percentiles for all tests across different measures are shown. No determination coefficients equal to or greater than .05 were found for sex or age. The need to establish adjustments for the educational level was only found in some of the measures. CONCLUSIONS The current norms provide clinically useful data to evaluate Spanish-speaking natives from Spain aged from 50 to 89 years. Specific patterns of cognitive impairment can be analyzed using these normative data and may be important in neuropsychological assessment.
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Affiliation(s)
- M L Delgado-Losada
- Department of Experimental Psychology, Complutense University of Madrid, 28223 Madrid, Spain
| | - S Rubio-Valdehita
- Department of Social Work and Differential Psychology, Complutense University of Madrid, 28223 Madrid, Spain
| | - R López-Higes
- Department of Experimental Psychology, Complutense University of Madrid, 28223 Madrid, Spain
| | - M Campos-Magdaleno
- Department of Developmental and Educational Psychology, University of Santiago de Compostela, 15782 Santiago de Compostela, Spain
| | | | - B Frades-Payo
- CIEN Foundation, Carlos III Institute of Health, 28029, Madrid, Spain
| | - C Lojo-Seoane
- Department of Developmental and Educational Psychology, University of Santiago de Compostela, 15782 Santiago de Compostela, Spain
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Mgaieth F, Baksh RA, Startin CM, Hamburg S, Hithersay R, Pape S, Zetterberg H, Ashton NJ, Tamayo-Elizalde M, Saini F, Idris M, Consortium TL, Strydom A. Exploring semantic verbal fluency patterns and their relationship to age and Alzheimer's disease in adults with Down syndrome. Alzheimers Dement 2023; 19:5129-5137. [PMID: 37114906 DOI: 10.1002/alz.13097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 03/22/2023] [Accepted: 03/23/2023] [Indexed: 04/29/2023]
Abstract
INTRODUCTION Adults with Down syndrome (DS) are at ultra-high risk of developing Alzheimer's disease (AD), characterized by poor episodic memory and semantic fluency in the preclinical phase in the general population. We explored semantic fluency performance in DS and its relationship to age, AD, and blood biomarkers. METHODS A total of 302 adults with DS at baseline and 87 at follow-up from the London Down Syndrome Consortium cohort completed neuropsychological assessments. Blood biomarkers were measured with the single molecule array technique in a subset of 94 participants. RESULTS Poorer verbal fluency performance was observed as age increases. Number of correct words declined in those with AD compared to those without over 2 years and was negatively correlated with neurofilament light (r = -0.37, P = .001) and glial fibrillary acidic protein (r = -0.31, P = .012). DISCUSSION Semantic fluency may be useful as an early indicator of cognitive decline and provide additional information on AD-related change, showing associations with biomarkers in DS.
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Affiliation(s)
- Farah Mgaieth
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - R Asaad Baksh
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- The LonDownS Consortium, London, UK
| | - Carla M Startin
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- The LonDownS Consortium, London, UK
- Division of Psychiatry, University College London, London, UK
- School of Psychology, University of Roehampton, London, UK
| | | | - Rosalyn Hithersay
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- The LonDownS Consortium, London, UK
- Division of Psychiatry, University College London, London, UK
| | - Sarah Pape
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Henrik Zetterberg
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
- Clinical Neurochemistry Laboratory, Sahlgrenska University Hospital, Mölndal, Sweden
- Department of Neurodegenerative Disease, UCL Institute of Neurology, London, UK
- UK Dementia Research Institute at UCL, London, UK
- Hong Kong Center for Neurodegenerative Diseases, Hong Kong, China
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin, USA
| | - Nicholas J Ashton
- South London and Maudsley NHS Foundation Trust, London, UK
- Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, the Sahlgrenska Academy at the University of Gothenburg, Mölndal, Sweden
- Institute of Psychiatry, Psychology and Neuroscience Maurice Wohl Institute Clinical Neuroscience Institute, King's College London, London, UK
- Centre for Age-Related Medicine, Stavanger University Hospital, Stavanger, Norway
| | - Miren Tamayo-Elizalde
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Fedal Saini
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Mina Idris
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | | | - Andre Strydom
- Department of Forensic and Neurodevelopmental Sciences, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
- The LonDownS Consortium, London, UK
- Division of Psychiatry, University College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
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Bairami S, Folia V, Liampas I, Ntanasi E, Patrikelis P, Siokas V, Yannakoulia M, Sakka P, Hadjigeorgiou G, Scarmeas N, Dardiotis E, Kosmidis MH. Exploring Verbal Fluency Strategies among Individuals with Normal Cognition, Amnestic and Non-Amnestic Mild Cognitive Impairment, and Alzheimer's Disease. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:1860. [PMID: 37893577 PMCID: PMC10608566 DOI: 10.3390/medicina59101860] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Revised: 10/14/2023] [Accepted: 10/17/2023] [Indexed: 10/29/2023]
Abstract
Background and Objectives: The present study explored the utilization of verbal fluency (VF) cognitive strategies, including clustering, switching, intrusions, and perseverations, within both semantic (SVF) and phonemic (PVF) conditions, across a continuum of neurocognitive decline, spanning from normal cognitive ageing (NC) to mild cognitive impairment (MCI) and its subtypes, amnestic (aMCI) and non-amnestic (naMCI), as well as AD. Materials and Methods: The study sample was derived from the Hellenic Longitudinal Investigation of Aging and Diet (HELIAD) cohort. The sample included 1607 NC individuals, 146 with aMCI (46 single-domain and 100 multi-domain), 92 with naMCI (41 single-domain and 51 multi-domain), and 79 with AD. Statistical analyses, adjusting for sex, age, and education, employed multivariate general linear models to probe differences among these groups. Results: Results showed that AD patients exhibited poorer performance in switching in both VF tasks and SVF clustering compared to NC. Similarly, the aMCI group performed worse than the NC in switching and clustering in both tasks, with aMCI performing similarly to AD, except for SVF switching. In contrast, the naMCI subgroup performed similarly to those with NC across most strategies, surpassing AD patients. Notably, the aMCI subgroup's poor performance in SVF switching was mainly due to the subpar performance of the multi-domain aMCI subgroup. This subgroup was outperformed in switching in both VF tasks by the single-domain naMCI, who also performed better than the multi-domain naMCI in SVF switching. No significant differences emerged in terms of perseverations and intrusions. Conclusions: Overall, these findings suggest a continuum of declining switching ability in the SVF task, with NC surpassing both aMCI and AD, and aMCI outperforming those with AD. The challenges in SVF switching suggest executive function impairment associated with multi-domain MCI, particularly driven by the multi-domain aMCI.
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Affiliation(s)
- Styliani Bairami
- Lab of Cognitive Neuroscience, School of Psychology, Aristotle University of Thessaloniki, University Campus, 54124 Thessaloniki, Greece
| | - Vasiliki Folia
- Lab of Cognitive Neuroscience, School of Psychology, Aristotle University of Thessaloniki, University Campus, 54124 Thessaloniki, Greece
| | - Ioannis Liampas
- Department of Neurology, University Hospital of Larissa, School of Medicine, University of Thessaly, Mezourlo Hill, 41110 Larissa, Greece
| | - Eva Ntanasi
- Department of Nutrition and Dietetics, Harokopio University, 70 El. Venizelou, 17671 Athens, Greece
- 1st Department of Neurology, Aiginition Hospital, National and Kapodistrian University of Athens Medical School, Vassilissis Sofias Ave 72, 11528 Athens, Greece
| | - Panayiotis Patrikelis
- Lab of Cognitive Neuroscience, School of Psychology, Aristotle University of Thessaloniki, University Campus, 54124 Thessaloniki, Greece
| | - Vasileios Siokas
- Department of Neurology, University Hospital of Larissa, School of Medicine, University of Thessaly, Mezourlo Hill, 41110 Larissa, Greece
| | - Mary Yannakoulia
- Department of Nutrition and Dietetics, Harokopio University, 70 El. Venizelou, 17671 Athens, Greece
| | - Paraskevi Sakka
- Athens Alzheimer’s Association, 89 M. Mousourou & 33 Stilponos St, 11636 Athens, Greece
| | - Georgios Hadjigeorgiou
- Department of Neurology, University Hospital of Larissa, School of Medicine, University of Thessaly, Mezourlo Hill, 41110 Larissa, Greece
- School of Medicine, University of Cyprus, 93 Agiou Nikolaou St, Engomi, Nicosia 2408, Cyprus
| | - Nikolaos Scarmeas
- 1st Department of Neurology, Aiginition Hospital, National and Kapodistrian University of Athens Medical School, Vassilissis Sofias Ave 72, 11528 Athens, Greece
- Taub Institute for Research in Alzheimer’s Disease and the Aging Brain, The Gertrude H. Sergievsky Center, Department of Neurology, Columbia University, 710 West 168th St, New York, NY 10032, USA
| | - Efthimios Dardiotis
- Department of Neurology, University Hospital of Larissa, School of Medicine, University of Thessaly, Mezourlo Hill, 41110 Larissa, Greece
| | - Mary H. Kosmidis
- Lab of Cognitive Neuroscience, School of Psychology, Aristotle University of Thessaloniki, University Campus, 54124 Thessaloniki, Greece
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Torres K, Singleton M. Analyses of correct responses and errors on measures of verbal fluency among Parkinson's disease and essential tremor patients. Clin Neuropsychol 2023; 37:1479-1497. [PMID: 36550679 DOI: 10.1080/13854046.2022.2157885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Accepted: 12/07/2022] [Indexed: 12/24/2022]
Abstract
Objective: Parkinson's disease (PD) and essential tremor (ET) involve neuroanatomical circuitry that impact frontal lobe functioning, via the striatum and cerebellum, respectively. The aim of this exploratory study was to investigate quantitative and qualitative performance between and within these groups on measures of verbal fluency. Method: Sixty-three PD and 53 ET patients completed neuropsychological testing. Linear regression models with robust variance estimation compared verbal fluency performance between groups related to correct responses and errors. Paired t-tests investigated within group error rates. Results: PD patients gave more correct responses for phonological (β ̂ =5.3, p=.01) and category fluency (β ̂ =4.1, p=.01) than ET patients; however, when processing speed was added as a covariate, this attenuated performance on both measures and only phonological fluency remained significant (β ̂ =4.0, p=.04). There were no statistical differences in error scores between groups. Error rates within groups suggested that PD patients had higher error rates in total errors and perseveration errors on phonological fluency (M = 2.6, p=.00; M = 1.6, p=.00) and higher total errors and set-loss error rates on category switching (M = 5.1, p<.001; M = 4.1, p<.001). ET patients had higher error rate with relation to total errors and set-loss errors on phonological fluency (M = 2.5, p=.00; M = 1.5, p=.02) and category switching (M = 3.9, p=,00; M = 3.9, p<.001). Conclusions: PD patients performed better than ET patients on phonological fluency. PD patients appear to make more perseveration errors on phonological fluency, while ET patients made more set-loss errors. Implications for frontal lobe dysfunction and clinical impact are discussed.
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Affiliation(s)
- Karen Torres
- Department of Neurology, University of Washington, Seattle, WA, USA
| | - Michael Singleton
- Institute of Translational Health Sciences, University of Washington, Seattle, WA, USA
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Gordon JK, Chen H. How well does the discrepancy between semantic and letter verbal fluency performance distinguish Alzheimer's dementia from typical aging? NEUROPSYCHOLOGY, DEVELOPMENT, AND COGNITION. SECTION B, AGING, NEUROPSYCHOLOGY AND COGNITION 2023; 30:729-758. [PMID: 35612362 DOI: 10.1080/13825585.2022.2079602] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Accepted: 05/13/2022] [Indexed: 06/15/2023]
Abstract
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.
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Affiliation(s)
- Jean K Gordon
- Department of Communication Sciences & Disorders, University of Iowa, Iowa City, IA, USA
| | - Haoxuan Chen
- Department of Communication Sciences & Disorders, University of Iowa, Iowa City, IA, USA
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7
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Wright LM, De Marco M, Venneri A. Current Understanding of Verbal Fluency in Alzheimer's Disease: Evidence to Date. Psychol Res Behav Manag 2023; 16:1691-1705. [PMID: 37179686 PMCID: PMC10167999 DOI: 10.2147/prbm.s284645] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Accepted: 04/05/2023] [Indexed: 05/15/2023] Open
Abstract
Since their development, verbal fluency tests (VFTs) have been used extensively throughout research and in clinical settings to assess a variety of cognitive functions in diverse populations. In Alzheimer's disease (AD), these tasks have proven particularly valuable in identifying the earliest forms of cognitive decline in semantic processing and have been shown to relate specifically to brain regions associated with the initial stages of pathological change. In recent years, researchers have developed more nuanced techniques to evaluate verbal fluency performance, extracting a wide range of cognitive metrics from these simple neuropsychological tests. Such novel techniques allow for a more detailed exploration of the cognitive processes underlying successful task performance beyond the raw test score. The versatility of VFTs and the richness of data they may provide, in light of their low cost and speed of administration, therefore, highlight their potential value both in future research as outcome measures for clinical trials and in a clinical setting as a screening measure for early detection of neurodegenerative diseases.
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Affiliation(s)
- Laura M Wright
- Translational and Clinical Research Institute, Newcastle University, Newcastle Upon Tyne, UK
| | - Matteo De Marco
- Department of Life Sciences, Brunel University London, London, UK
| | - Annalena Venneri
- Department of Life Sciences, Brunel University London, London, UK
- Department of Medicine and Surgery, University of Parma, Parma, Italy
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Beber BC, Liedtke FV, Oliveira FSD, Müller-Silveira L, Alves EV, Chaves MLF, Salles JFD. Clustering and switching analysis of verb fluency in individuals with Alzheimer's disease. Codas 2023; 35:e20210179. [PMID: 37075412 PMCID: PMC10145992 DOI: 10.1590/2317-1782/20232021179pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 03/18/2022] [Indexed: 04/21/2023] Open
Abstract
PURPOSE To investigate verb fluency performance in individuals with Alzheimer's disease compared with healthy older adults by analyzing total correct responses, number of clusters, average cluster size, and number of switches. METHODS This is a case-control study of 39 healthy older adults and 29 older adults with a diagnosis of Alzheimer's disease. Verb fluency performance was analyzed in terms of total number of correct verbs retrieved, number of clusters, average cluster size, and number of switches. To obtain the study outcomes, we previously conducted a procedure for categorization of the verbs that would compose the clusters. The classification of verbs was adapted for this study, including assessment by raters and analysis of inter-rater reliability. RESULTS Individuals with Alzheimer's disease showed significantly poorer performance than healthy controls in the number of switches and total number of correct verbs retrieved. The two groups did not differ significantly in the other measures. CONCLUSION In this study, individuals with Alzheimer's disease showed impaired verb fluency, characterized by a reduced number of verbs retrieved and fewer transitions between verb categories. The findings suggest that, in Alzheimer's disease, verb fluency is more sensitive to cognitive deficits resulting from executive dysfunction than from semantic disruption.
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Affiliation(s)
- Bárbara Costa Beber
- Departamento de Fonoaudiologia, Universidade Federal de Ciências da Saúde de Porto Alegre - UFCSPA - Porto Alegre (RS), Brasil
- Programa de Pós-graduação em Ciências da Reabilitação, Universidade Federal de Ciências da Saúde de Porto Alegre - UFCSPA - Porto Alegre (RS), Brasil
| | - Franceia Veiga Liedtke
- Programa de Pós-graduação em Psicologia, Universidade Federal do Rio Grande do Sul - UFRGS - Porto Alegre (RS), Brasil
| | - Felipe Schroeder de Oliveira
- Programa de Pós-graduação em Psicologia, Universidade Federal do Rio Grande do Sul - UFRGS - Porto Alegre (RS), Brasil
- Curso de Psicologia, Universidade Franciscana - UFN - Santa Maria (RS), Brasil
| | - Lucas Müller-Silveira
- Programa de Pós-graduação em Psicologia, Universidade Federal do Rio Grande do Sul - UFRGS - Porto Alegre (RS), Brasil
| | - Emily Viega Alves
- Curso de Fonoaudiologia, Universidade Federal de Ciências da Saúde de Porto Alegre - UFCSPA - Porto Alegre (RS), Brasil
| | - Márcia Lorena Fagundes Chaves
- Departamento de Medicina Interna, Programa de Pós-graduação em Medicina - Ciências Médicas, Universidade Federal do Rio Grande do Sul - UFRGS - Porto Alegre (RS), Brasil
| | - Jerusa Fumagalli de Salles
- Programa de Pós-graduação em Psicologia, Universidade Federal do Rio Grande do Sul - UFRGS - Porto Alegre (RS), Brasil
- Departamento de Psicologia do Desenvolvimento e da Personalidade, Universidade Federal do Rio Grande do Sul - UFRGS - Porto Alegre (RS), Brasil
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Liampas I, Folia V, Zoupa E, Siokas V, Yannakoulia M, Sakka P, Hadjigeorgiou G, Scarmeas N, Dardiotis E, Kosmidis MH. Qualitative Verbal Fluency Components as Prognostic Factors for Developing Alzheimer's Dementia and Mild Cognitive Impairment: Results from the Population-Based HELIAD Cohort. Medicina (B Aires) 2022; 58:medicina58121814. [PMID: 36557016 PMCID: PMC9786933 DOI: 10.3390/medicina58121814] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Revised: 11/29/2022] [Accepted: 12/06/2022] [Indexed: 12/13/2022] Open
Abstract
Background and Objectives: The aim of the present study was to investigate the prognostic value of the qualitative components of verbal fluency (clustering, switching, intrusions, and perseverations) on the development of mild cognitive impairment (MCI) and dementia. Materials and Methods: Participants were drawn from the multidisciplinary, population-based, prospective HELIAD (Hellenic Longitudinal Investigation of Aging and Diet) cohort. Two participant sets were separately analysed: those with normal cognition and MCI at baseline. Verbal fluency was assessed via one category and one letter fluency task. Separate Cox proportional hazards regressions adjusted for important sociodemographic parameters were performed for each qualitative semantic and phonemic verbal fluency component. Results: There were 955 cognitively normal (CN), older (72.9 years ±4.9), predominantly female (~60%) individuals with available follow-up assessments after a mean of 3.09 years (±0.83). Among them, 34 developed dementia at follow-up (29 of whom progressed to Alzheimer's dementia (AD)), 160 developed MCI, and 761 remained CN. Each additional perseveration on the semantic condition increased the risk of developing all-cause dementia and AD by 52% and 55%, respectively. Of note, participants with two or more perseverations on the semantic task presented a much more prominent risk for incident dementia compared to those with one or no perseverations. Among the remaining qualitative indices, none were associated with the hazard of developing all-cause dementia, AD, and MCI at follow-up. Conclusions: Perseverations on the semantic fluency condition were related to an increased risk of incident all-cause dementia or AD in older, CN individuals.
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Affiliation(s)
- Ioannis Liampas
- Department of Neurology, University Hospital of Larissa, School of Medicine, University of Thessaly, Mezourlo Hill, 41110 Larissa, Greece
| | - Vasiliki Folia
- Lab of Cognitive Neuroscience, School of Psychology, Aristotle University of Thessaloniki, University Campus, 54124 Thessaloniki, Greece
- Correspondence:
| | - Elli Zoupa
- Lab of Cognitive Neuroscience, School of Psychology, Aristotle University of Thessaloniki, University Campus, 54124 Thessaloniki, Greece
| | - Vasileios Siokas
- Department of Neurology, University Hospital of Larissa, School of Medicine, University of Thessaly, Mezourlo Hill, 41110 Larissa, Greece
| | - Mary Yannakoulia
- Department of Nutrition and Dietetics, Harokopio University, 70 El. Venizelou, 17671 Athens, Greece
| | - Paraskevi Sakka
- Athens Alzheimer’s Association, 89 M. Mousourou & 33 Stilponos St, 11636 Athens, Greece
| | - Georgios Hadjigeorgiou
- Department of Neurology, University Hospital of Larissa, School of Medicine, University of Thessaly, Mezourlo Hill, 41110 Larissa, Greece
- School of Medicine, University of Cyprus, 93 Agiou Nikolaou St, Engomi, Nicosia 2408, Cyprus
| | - Nikolaos Scarmeas
- 1st Department of Neurology, Aiginition Hospital, National and Kapodistrian University of Athens Medical School, 72-74 Vassilissis Sofias Ave, 11528 Athens, Greece
- Taub Institute for Research in Alzheimer’s Disease and the Aging Brain, The Gertrude H. Sergievsky Center, Department of Neurology, Columbia University, 710 West 168th St, New York, NY 10032, USA
| | - Efthimios Dardiotis
- Department of Neurology, University Hospital of Larissa, School of Medicine, University of Thessaly, Mezourlo Hill, 41110 Larissa, Greece
| | - Mary H. Kosmidis
- Lab of Cognitive Neuroscience, School of Psychology, Aristotle University of Thessaloniki, University Campus, 54124 Thessaloniki, Greece
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Fradkin I, Eldar E. If you don’t let it in, you don’t have to get it out: Thought preemption as a method to control unwanted thoughts. PLoS Comput Biol 2022; 18:e1010285. [PMID: 35834438 PMCID: PMC9282588 DOI: 10.1371/journal.pcbi.1010285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2022] [Accepted: 06/06/2022] [Indexed: 11/18/2022] Open
Abstract
To attain goals, people must proactively prevent interferences and react to interferences once they occur. Whereas most research focuses on how people deal with external interferences, here we investigate the use of proactive and reactive control in dealing with unwanted thoughts. To examine this question, we asked people to generate an association to each of several repeating cue words, while forbidding the repetition of associations. Reactively rejecting and replacing unwanted repeated associations after they occur entails slower response times. Conversely, proactive control entails constricting the search space and thus faster response times. To gain further insight into different potential proactive thought control mechanisms, we augmented the analysis of raw response times with a novel, hypothesis-based, tractable computational model describing how people serially sample associations. Our results indicate that people primarily react to unwanted thoughts after they occur. Yet, we found evidence for two latent proactive control mechanisms: one that allows people to mitigate the episodic strengthening of repeated thoughts, and another that helps avoid looping in a repetitive thought. Exploratory analysis showed a relationship between model parameters and self-reported individual differences in the control over unwanted thoughts in daily life. The findings indicate the novel task and model can advance our understanding of how people can and cannot control their thoughts and memories, and benefit future research on the mechanisms responsible for unwanted thought in different psychiatric conditions. Finally, we discuss implications concerning the involvement of associative thinking and various control processes in semantic fluency, decision-making and creativity.
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Affiliation(s)
- Isaac Fradkin
- Department of Psychology, Hebrew University of Jerusalem, Jerusalem, Israel
- * E-mail:
| | - Eran Eldar
- Department of Psychology, Hebrew University of Jerusalem, Jerusalem, Israel
- Department of Cognitive and Brain Sciences, Hebrew University of Jerusalem, Jerusalem, Israel
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11
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Sohtorik İlkmen Y, Soncu Büyükişcan E. Verbal Fluency Tests: Normative Data Stratified by Age and Education in an Istanbul Sample. TURKISH JOURNAL OF NEUROLOGY 2022. [DOI: 10.4274/tnd.2022.36824] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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12
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Itaguchi Y, Castro-Chavira SA, Waterloo K, Johnsen SH, Rodríguez-Aranda C. Evaluation of Error Production in Animal Fluency and Its Relationship to Frontal Tracts in Normal Aging and Mild Alzheimer's Disease: A Combined LDA and Time-Course Analysis Investigation. Front Aging Neurosci 2022; 13:710938. [PMID: 35095462 PMCID: PMC8790484 DOI: 10.3389/fnagi.2021.710938] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Accepted: 12/06/2021] [Indexed: 11/13/2022] Open
Abstract
Semantic verbal fluency (VF), assessed by animal category, is a task widely used for early detection of dementia. A feature not regularly assessed is the occurrence of errors such as perseverations and intrusions. So far, no investigation has analyzed the how and when of error occurrence during semantic VF in aging populations, together with their possible neural correlates. The present study aims to address the issue using a combined methodology based on latent Dirichlet allocation (LDA) analysis for word classification together with a time-course analysis identifying exact time of errors' occurrence. LDA is a modeling technique that discloses hidden semantic structures based on a given corpus of documents. We evaluated a sample of 66 participants divided into a healthy young group (n = 24), healthy older adult group (n = 23), and group of patients with mild Alzheimer's disease (AD) (n = 19). We performed DTI analyses to evaluate the white matter integrity of three frontal tracts purportedly underlying error commission: anterior thalamic radiation, frontal aslant tract, and uncinate fasciculus. Contrasts of DTI metrics were performed on the older groups who were further classified into high-error rate and low-error rate subgroups. Results demonstrated a unique deployment of error commission in the patient group characterized by high incidence of intrusions in the first 15 s and higher rate of perseverations toward the end of the trial. Healthy groups predominantly showed very low incidence of perseverations. The DTI analyses revealed that the patients with AD committing high-error rate presented significantly more degenerated frontal tracts in the left hemisphere. Thus, our findings demonstrated that the appearance of intrusions, together with left hemisphere degeneration of frontal tracts, is a pathognomic trait of mild AD. Furthermore, our data suggest that the error commission of patients with AD arises from executive and working memory impairments related partly to deteriorated left frontal tracts.
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Affiliation(s)
| | | | - Knut Waterloo
- Department of Psychology, UiT The Artic University of Norway, Tromsø, Norway
- Department of Neurology, University Hospital North Norway, Tromsø, Norway
| | - Stein Harald Johnsen
- Department of Neurology, University Hospital North Norway, Tromsø, Norway
- Brain and Circulation Research Group, Department of Clinical Medicine, UiT The Artic University of Norway, Tromsø, Norway
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13
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Jacobs S, Mercuri G, Holtzer R. Assessing within-task verbal fluency performance: the utility of individual time intervals in predicting incident mild cognitive impairment. AGING NEUROPSYCHOLOGY AND COGNITION 2020; 28:733-747. [PMID: 32901518 DOI: 10.1080/13825585.2020.1817306] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The current study aimed to determine whether word generation performance on individual within-task 20-second time intervals predicted conversion to Mild Cognitive Impairment (MCI) status. Longitudinal data (Mean follow-up=2.95±1.64 years) was collected from cognitively-healthy community-dwelling older adults (N=344; %female=56.1). Performance on letter and semantic fluency tasks was divided into three consecutive within-task 20-second intervals. Incident MCI status (n=50) was determined via established diagnostic case conference. Fully adjusted Cox proportional-hazards regression models revealed that greater word production on semantic fluency across all time intervals significantly predicted a reduced risk of incident MCI [0-20 seconds (HR=0.906, p=0.002), 21-40 seconds (HR=0.904, p=0.02), and 41-60 seconds (HR=0.892, p=0.017)]. Conversely, on letter fluency, greater word production within the 41-60 second time interval only was significantly associated with reduced risk of incident MCI (HR=0.886, p=0.002). Overall, the clinical use of within-interval performance is supported given evidence of predictive sensitivity and ease of administration.
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Affiliation(s)
- Sydney Jacobs
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA
| | - Giulia Mercuri
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA
| | - Roee Holtzer
- Ferkauf Graduate School of Psychology, Yeshiva University, Bronx, NY, USA.,Department of Neurology, Albert Einstein College of Medicine, Bronx, NY, USA
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Tessaro B, Hermes-Pereira A, Schilling LP, Fonseca RP, Kochhann R, Hübner LC. Verbal fluency in Alzheimer's disease and mild cognitive impairment in individuals with low educational level and its relationship with reading and writing habits. Dement Neuropsychol 2020; 14:300-307. [PMID: 32973983 PMCID: PMC7500813 DOI: 10.1590/1980-57642020dn14-030011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Verbal fluency (VF) has contributed to building cognitive maps as well as differentiating healthy populations from those with dementia. Objectives To compare the performance of healthy controls and patients with mild cognitive impairment (MCI) and Alzheimer's disease (AD) in two semantic VF tasks (animals/clothes) and a phonemic VF task (letter P). Also, to analyze the relationship between the frequency of reading and writing habits (FRWH) and VF in individuals with low educational level. Methods Sixty-seven older adults aged 60-80 years and with 2-8 years of schooling were divided into three groups: controls (n=25), older adults with MCI (n=24), and older adults with AD (n=18). We analyzed the type, mean size, and number of clusters, switches, intersections, and returns. A post-hoc single-factor ANOVA analysis was conducted to verify differences between groups. Results Total words in the phonemic VF and the animal category discriminated the three groups. Regarding the animal category, AD patients performed worse than controls in the total number of words, taxonomic clusters, returns, and number of words remembered. We found a moderate correlation between FRWH and total number of words in the phonemic fluency. Conclusions Semantic (animate) and phonemic (total words) VF differentiated controls and clinical groups from each other - the phonemic component was more related to FRWH than the semantic one. The phonemic VF seems to be more related to cognitive reserve. VF tasks, considering total words and cluster analyses, are a valuable tool to test healthy and cognitively impaired older adults who have a low educational level.
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Affiliation(s)
- Bruna Tessaro
- Linguistics Department, Pontifícia Universidade Católica do Rio Grande do Sul - Porto Alegre, RS, Brazil
| | | | - Lucas Porcello Schilling
- Brain Institute - Porto Alegre, RS, Brazil.,Neurology Service, São Lucas Hospital, Pontifícia Universidade Católica do Rio Grande do Sul - Porto Alegre, RS, Brazil
| | - Rochele Paz Fonseca
- Psychology Department, Pontifícia Universidade Católica do Rio Grande do Sul - Porto Alegre, RS, Brazil.,National Council for Scientific and Technological Development - Brasília, DF, Brazil
| | - Renata Kochhann
- Psychology Department, Pontifícia Universidade Católica do Rio Grande do Sul - Porto Alegre, RS, Brazil
| | - Lilian Cristine Hübner
- Linguistics Department, Pontifícia Universidade Católica do Rio Grande do Sul - Porto Alegre, RS, Brazil.,National Council for Scientific and Technological Development - Brasília, DF, Brazil
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15
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Perez M, Amayra I, Lazaro E, García M, Martínez O, Caballero P, Berrocoso S, López-Paz JF, Al-Rashaida M, Rodríguez AA, Luna P, Varona L. Intrusion errors during verbal fluency task in amyotrophic lateral sclerosis. PLoS One 2020; 15:e0233349. [PMID: 32469951 PMCID: PMC7259757 DOI: 10.1371/journal.pone.0233349] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 05/05/2020] [Indexed: 12/28/2022] Open
Abstract
BACKGROUND Numerous studies have noted the presence of a dysexecutive component of the ALS-FTD. The most widely replicated result refers to the significantly reduced verbal fluency of ALS patients when compared to healthy people. As ALS patients have motor alterations that interfere with production, qualitative studies have the advantage of being independent of the degree of motor disability and revealing patients' cognitive state. This study examined the production differences between 42 ALS patients who presented with different degrees of dementia and motor impairment and 42 healthy people. Production processes were studied by extending the administration time of a letter fluency task to 2 minutes for the phonemic verbal fluency (PVF) and semantic verbal fluency (SVF) categories. This ensured that the qualitative aspects of verbal fluency were addressed, paying special attention to the new perseverations and intrusions, as well as any clinical correlates that may exist. RESULTS The ALS patients produced a significantly lower number of responses in PVF (p = .017) and SVF (p = .008). The rest of the indicators for frontal lobe alteration also suggested the existence of a dysfunction. The most remarkable results were the number of intrusions on the PVF task, which was much higher in the ALS group (p = .002). However, the number of perseverations did not differ significantly. CONCLUSIONS This study highlights the value of intrusions in addressing cognitive deterioration in ALS patients. This deterioration seems to be independent of the degree of motor impairment and of behavioural alterations. Therefore, the value of the intromissions on the verbal fluency task was highlighted as an indicator of a new cognitive alteration, which can be easily evaluated, even retrospectively.
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Affiliation(s)
| | | | | | | | | | - Patricia Caballero
- University of Deusto, Vizcaya, Spain
- Clinical Psychology, Galdakao University Hospital, Vizcaya, Spain
| | | | | | | | | | | | - Luis Varona
- Department of Neurology, Basurto University Hospital, Vizcaya, Spain
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16
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Clustering and Switching Patterns in Semantic Fluency and Their Relationship to Working Memory in Mild Cognitive Impairment. Dement Neurocogn Disord 2019; 18:47-61. [PMID: 31297135 PMCID: PMC6609534 DOI: 10.12779/dnd.2019.18.2.47] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 04/02/2019] [Accepted: 04/08/2019] [Indexed: 01/24/2023] Open
Abstract
Background and Purpose Semantic verbal fluency test is a neuropsychological assessment that can sensitively detect neuropathological changes. Considering its multifactorial features tapping various cognitive domains such as semantic memory, executive function, and working memory, it is necessary to examine verbal fluency performance in association with underlying cognitive functions. The objective of the current study was to investigate semantic fluency patterns of people with mild cognitive impairment (MCI) based on clustering and switching and their relationship with working memory. Methods Twenty-six individuals with MCI and 23 normal elderly adults participated in this study. A semantic verbal fluency test (animal version) was administered and the performance was analyzed using the following measures: number of correct words, cluster size, and number of switches. Scores of digit forward (DF) and backward span tasks were employed as working memory measures. Results Analyses of variance revealed significant group differences in the numbers of correct words and switches. Multivariate logistic regression and receiver-operating characteristic analyses showed that the number of switches more sensitively distinguished MCI existence than the number of correct words. Stepwise linear regression analysis showed that DF task and age significantly predicted the number of correct words while only the DF task significantly predicted the number of switches. Conclusions Decrement in semantic verbal fluency in MCI seems to be associated with impaired switching abilities. Working memory capacity might serve as the underlying cognitive factor related to decreased verbal fluency in MCI.
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Zemla JC, Austerweil JL. Analyzing Knowledge Retrieval Impairments Associated with Alzheimer's Disease Using Network Analyses. COMPLEXITY 2019; 2019:4203158. [PMID: 31341377 PMCID: PMC6656530 DOI: 10.1155/2019/4203158] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
A defining characteristic of Alzheimer's disease is difficulty in retrieving semantic memories, or memories encoding facts and knowledge. While it has been suggested that this impairment is caused by a degradation of the semantic store, the precise ways in which the semantic store is degraded are not well understood. Using a longitudinal corpus of semantic fluency data (listing of items in a category), we derive semantic network representations of patients with Alzheimer's disease and of healthy controls. We contrast our network-based approach with analyzing fluency data with the standard method of counting the total number of items and perseverations in fluency data. We find that the networks of Alzheimer's patients are more connected and that those connections are more randomly distributed than the connections in networks of healthy individuals. These results suggest that the semantic memory impairment of Alzheimer's patients can be modeled through the inclusion of spurious associations between unrelated concepts in the semantic store. We also find that information from our network analysis of fluency data improves prediction of patient diagnosis compared to traditional measures of the semantic fluency task.
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Affiliation(s)
- Jeffrey C Zemla
- Department of Psychology, University of Wisconsin-Madison, USA
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