Cognitive reserve moderates the association between cerebral blood flow and language performance in older adults with mild cognitive impairment

Higher cognitive reserve (CR) may offer protection from cognitive changes associated with reduced cerebral blood flow (CBF). We investigated CR as a moderator of the effect of CBF on cognition in older adults with mild cognitive impairment (MCI; N = 46) and those who are cognitively unimpaired (CU; N = 101). Participants underwent arterial spin labeling MRI, which was used to quantify CBF in 4 a priori regions. Estimated verbal intelligence quotient (VIQ) served as a proxy for CR. Multiple linear regressions examined whether VIQ moderated associations between CBF and cognition and whether this differed by cognitive status. Outcomes included memory and language performance. There were 3-way interactions (CBF*VIQ*cognitive status) on category fluency when examining hippocampal, superior frontal, and inferior frontal CBF. Follow-up analyses revealed that, within the MCI but not CU group, there were CBF*VIQ interactions on fluency in all a priori regions examined, where there were stronger, positive associations between CBF and fluency at higher VIQ. Conclusion: In MCI, higher CR plays a role in strengthening CBF-fluency associations.

Differences Between Semantic and Phonemic Verbal Fluency in Adolescents With Reading Disorders

OBJECTIVES

This study aimed to examine which verbal fluency task is most useful in assessing adolescents with reading disorders (RD).

METHOD

Eighty-three Hebrew-speaking adolescents (ages 12-15), 42 of them with RD, completed semantic and phonemic fluency tasks, and their scores were converted to standardized scores according to population norms.

RESULTS

Scores on the semantic task were similar in the RD and the control group, unlike scores on the phonemic task, which were significantly lower in the RD group. The RD group demonstrated higher semantic than phonemic scores, unlike the control group whose standardized scores on both tasks were similar. Phonemic but not semantic fluency scores predicted spelling scores within the RD group.

CONCLUSIONS

Adolescents with RD have no difficulty on a semantic fluency task, but perform below expected age-matched levels on the phonemic fluency task. To document this task-difference, practitioners must administer both fluency tasks when assessing RD.

Brain structure associations with phonemic and semantic fluency in typically-developing children

Verbal fluency is the ability to retrieve lexical knowledge quickly and efficiently and develops during childhood and adolescence. Few studies have investigated associations between verbal fluency performance and brain structural variation in children. Here we examined associations of verbal fluency performance with structural measures of frontal and temporal language-related brain regions and their connections in 73 typically-developing children aged 7-13 years. Tract-based spatial statistics was used to extract fractional anisotropy (FA) from the superior longitudinal fasciculus/arcuate fasciculus (SLF/AF), and the white matter underlying frontal and temporal language-related regions. FreeSurfer was used to extract cortical thickness and surface area. Better semantic and phonemic fluency performance was associated with higher right SLF/AF FA, and phonemic fluency was also modestly associated with lower left SLF/AF FA. Explorative voxelwise analyses for semantic fluency suggested associations with FA in other fiber tracts, including corpus callosum and right inferior fronto-occipital fasciculus. Overall, our results suggest that verbal fluency performance in children may rely on right hemisphere structures, possibly involving both language and executive function networks, and less on solely left hemisphere structures as often is observed in adults. Longitudinal studies are needed to clarify whether these associations are mediated by maturational processes, stable characteristics and/or experience.

Cross-sectional associations of amyloid burden with semantic cognition in older adults without dementia: A systematic review and meta-analysis

Previous research suggests the presence of subtle semantic decline in early stages of Alzheimer's disease. This study investigated associations between amyloid burden, a biomarker for Alzheimer's disease, and tasks of semantic impairment in older individuals without dementia. A systematic search in MEDLINE, PsycINFO, and Embase yielded 3691 peer-reviewed articles excluding duplicates. After screening, 41 studies with overall 7495 participants were included in the meta-analysis and quality assessment. The overall weighted effect size of the association between larger amyloid burden and larger semantic impairment was 0.10 (95% CI [-0.03; 0.22], p = 0.128) for picture naming, 0.19 (95% CI [0.11; 0.27], p < 0.001) for semantic fluency, 0.15 (95% CI [-0.15; 0.45], p = 0.326) for vocabulary, and 0.10 (95% CI [-0.14; 0.35], p = 0.405; 2 studies) for WAIS Information. Risk of bias was highest regarding comparability, as effect sizes were often not calculated on covariate-adjusted statistics. The relevance of the indicated amyloid-related decline in semantic fluency for research and clinical applications is likely negligible due to the effect's small magnitude. Future research should develop more sensitive metrics of semantic fluency to optimize its use for early detection of Alzheimer's disease-related cognitive impairment.

Which cognitive functions subserve clustering and switching in category fluency? Generalisations from an extended set of semantic categories using linear mixed-effects modelling

Clustering and switching are hypothesised to reflect the automatic and controlled components in category fluency, respectively, but how they are associated with cognitive functions has not been fully elucidated, due to several uncertainties. (1) The conventional scoring method that segregates responses by semantic categories could not optimally dissociate the automatic and controlled components. (2) The temporal structure of individual responses, as characterised by mean retrieval time (MRT) and mean switching time (MST), has seldom been analysed alongside the more well-studied variables, cluster size (CS) and number of switches (NS). (3) Most studies examined only one to a few semantic categories, raising concerns of generalisability. This study built upon a distance-based automatic clustering procedure, referred to as temporal-semantic distance procedure, to thoroughly characterise the category fluency performance. Linear mixed-effects (LME) modelling was applied to re-examine the differential associations of clustering and switching with cognitive functions with a sample of 80 university students. Our results revealed that although lexical retrieval speed (LRS) is clearly the determining factor for effective clustering and switching, matrix reasoning and processing speed also have significant roles to play, possibly in the processes of identifying and validating the semantic relationships. Interestingly, total fluency score was accurately predicted by the four clustering/switching indices alone; including the cognitive variables did not significantly improve the prediction. These findings underline the importance of the clustering and switching indices in explaining the category fluency performance and the cognitive demands in category fluency.

Associations between memory and verbal fluency tasks

Previous studies have provided inconsistent evidence concerning the association between delayed retrieval of story information from long-term memory and retrieval of words on verbal fluency tasks. The current study looks for shared retrieval mechanisms in these tasks from childhood to old age. Three-hundred and eighty participants (ages 5-91) performed tasks of story recall, digit span, phonemic fluency, and semantic fluency. Significant correlations between delayed story recall and both fluency tasks emerged in all age groups, and the contribution of delayed story recall to fluency performance remained significant when analyzing the combined effects of story recall and digit span. These findings suggest that retrieval of information through story recall and retrieval of words on fluency tasks may share similar cognitive components.

Genetic and Environmental Influences on Verbal Fluency in Middle Age: A Longitudinal Twin Study

Mounting evidence suggests that measures of phonemic fluency and semantic fluency are differentially associated with other cognitive and health phenotypes, but few studies have examined their shared and unique variance, especially using genetically-informative designs. In this study, 1464 middle-aged twins completed six fluency subtests at up to two time-points (mean age 56 and 62 years). Confirmatory factor analyses supported a two-factor solution: a General Fluency latent factor explained variation in all six subtests and a Semantic-Specific factor accounted for additional variance in semantic subtests. Both factors were explained primarily by genetic influences at both waves (a² = 0.57-0.76). There was considerable stability of individual differences over 6 years (r = .90 for General Fluency, r = .81 for Semantic-Specific), especially for genetic influences (r_g = .94 and 1.0, respectively). These results suggest that semantic fluency can be viewed as a combination of general and semantic-specific variance, but phonemic fluency is captured entirely by the general factor.

Category fluency in schizophrenia: opposing effects of negative and positive symptoms?

INTRODUCTION

Category fluency is associated with speed-, executive- and semantic impairments in schizphrenia. It has traditionally been linked to negative symptoms, whereas the relation to positive symptoms is mixed. Associations to the consensus negative, positive and disorganisation factors have not been analysed before.

METHODS

Animal fluency was administered to 81 patients with schizophrenia. Measures of overall performance and applied strategies were analysed in relation to the Wallwork five-factor PANSS-model.

RESULTS

Negative and disorganisation symptoms were negatively related to overall fluency performance. Positive symptoms were positively related to overall performance when controlling for disorganisation symptoms. Negative symptoms were related to fewer switches, less repetitions, less single animals intrusions, and both less rare and common animals. Positive symptoms were related to more effective retrieval of sub-category exemplars following a sub-category title, whereas there were no relation between symptoms and exemplars when the title was not retrieved. The Beta values of negative and positive symptoms were opposite.

CONCLUSION

This is the first study showing that positive symptoms are related to increased fluency performance when disorganisation is controlled for. Like previous studies, negative symptoms were found to depress fluency. Strategy measures indicated that negative symptoms predispose for rigidity, whereas positive symptoms facilitate more efficient associative pathways.

Executive dysfunction and survival in patients with amyotrophic lateral sclerosis: Preliminary report from a Serbian centre for motor neuron disease

Our objective was to determine whether the presence of executive dysfunction in non-demented amyotrophic lateral sclerosis (ALS) patients might affect the longevity of survival. Forty-eight consecutive non-demented ALS patients (mean age = 52.93 ± 12.37) were followed for five years. All patients underwent clinical and neuropsychological assessments at baseline visit. Further, a yearly follow-up check for associated dementia (ALS-Dem) was completed and the time of death was recorded, when applicable. Executive deficits were shown in 49.5% of ALS patients, with the most striking differences found on the tests of verbal fluency (both phonemic and category, p < 0.01); as well as inefficient strategy on a working memory test (p < 0.05); as on the more demanding levels of the planning and problem solving task (p < 0.01). It appears that the baseline executive status might predict survival in ALS (p = 0.075), and the patients presenting executive dysfunction could have up to three times greater risk of death, after adjustment by several potential confounding factors. In conclusion, this study suggests that executive dysfunction could potentially influence survival in ALS patients. The cognitive testing might give us important clues about the prognosis of the disease. Further studies with larger sample size are necessary.

Verbal Fluency in Parkinson's Patients with and without Bilateral Deep Brain Stimulation of the Subthalamic Nucleus: A Meta-analysis

OBJECTIVES

Patients with Parkinson's disease often experience significant decline in verbal fluency over time; however, deep brain stimulation of the subthalamic nucleus (STN-DBS) is also associated with post-surgical declines in verbal fluency. The purpose of this study was to determine if Parkinson's patients who have undergone bilateral STN-DBS have greater impairment in verbal fluency compared to Parkinson's patients treated by medication only.

METHODS

A literature search yielded over 140 articles and 10 articles met inclusion criteria. A total of 439 patients with Parkinson's disease who underwent bilateral STN-DBS and 392 non-surgical patients were included. Cohen's d, a measure of effect size, was calculated using a random effects model to compare post-treatment verbal fluency in patients with Parkinson's disease who underwent STN-DBS versus those in the non-surgical comparison group.

RESULTS

The random effects model demonstrated a medium effect size for letter fluency (d=-0.47) and a small effect size for category fluency (d=-0.31), indicating individuals with bilateral STN-DBS had significantly worse verbal fluency performance than the non-surgical comparison group.

CONCLUSIONS

Individuals with Parkinson's disease who have undergone bilateral STN-DBS experience greater deficits in letter and category verbal fluency compared to a non-surgical group.

Language-dependent performance on the letter fluency task in patients with schizophrenia

Two types of verbal fluency tasks (letter fluency task; LFT, category fluency task; CFT) have been widely used to assess cognitive function in people with psychiatric diseases including schizophrenia. The task demand of the LFT is considered to vary across languages, as the cognitive process largely relies on sound and writing systems. Specifically, a sound unit for a letter (s) and a manner of association between them are assumed to be related with the performance. In the current study, three analyses have been conducted to examine this issue, using Japanese, Turkish, and English-speaking patients with schizophrenia. It was hypothesized that severity of letter fluency impairment would be in the order of Japanese, Turkish, and English speaking patients according to the inflexibility of a word search. First, performance on the LFT and the CFT was compared among Japanese (N=40), Turkish (N=30), and the US (N=31) patients (Analysis 1). A significant difference was found between the US and other two groups only in the LFT. Second, verbal fluency performance was compared between Japanese and Turkish patients by contrasting the degree of disassociations from normal controls (Japanese: N=20, Turkish: N=30) (Analysis 2). In Japanese patients, performance on the LFT was more severely impaired compared to that on the CFT while the opposite trend was found in the Turkish counterpart, suggesting that letter fluency performance was more degraded in Japanese patients. Finally, Analysis 3 was conducted to examine the relative order of letter fluency impairment among Japanese, Turkish and English-speaking patients. Disassociation in English users with schizophrenia was estimated based on previous meta-analytic reviews. The effect size (ES) for the letter fluency deficit was the largest in the Japanese sample, while the other two groups share similar ESs. The results from the three analyses partially supported the hypothesis for the severity of the letter fluency impairment in patients with schizophrenia. The language-dependency of letter fluency impairment was thought to be explained by the theoretical model built on unique properties of sound and writing systems. The considerations presented here would provide useful information for optimizing the portability of cognitive tasks across languages.

Deriving semantic structure from category fluency: clustering techniques and their pitfalls

Assessing verbal output in category fluency tasks provides a sensitive indicator of cortical dysfunction. The most common metrics are the overall number of words produced and the number of errors. Two main observations have been made about the structure of the output, first that there is a temporal component to it with words being generated in spurts, and second that the clustering pattern may reflect a search for meanings such that the 'clustering' is attributable to the activation of a specific semantic field in memory. A number of sophisticated approaches to examining the structure of this clustering have been developed, and a core theme is that the similarity relations between category members will reveal the mental semantic structure of the category underlying an individual's responses, which can then be visualized by a number of algorithms, such as MDS, hierarchical clustering, ADDTREE, ADCLUS or SVD. Such approaches have been applied to a variety of neurological and psychiatric populations, and the general conclusion has been that the clinical condition systematically distorts the semantic structure in the patients, as compared to the healthy controls. In the present paper we explore this approach to understanding semantic structure using category fluency data. On the basis of a large pool of patients with schizophrenia (n = 204) and healthy control participants (n = 204), we find that the methods are problematic and unreliable to the extent that it is not possible to conclude that any putative difference reflects a systematic difference between the semantic representations in patients and controls. Moreover, taking into account the unreliability of the methods, we find that the most probable conclusion to be made is that no difference in underlying semantic representation exists. The consequences of these findings to understanding semantic structure, and the use of category fluency data, in cortical dysfunction are discussed.