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Verbal fluency in the detection of mild cognitive impairment and Alzheimer's disease among Brazilian Portuguese speakers: the influence of education

Published online by Cambridge University Press:  21 July 2009

Marcia Radanovic ,
Breno Satler Diniz ,
Roberta M Mirandez ,
Tânia Maria da Silva Novaretti ,
Mariana Kneese Flacks ,
Mônica S Yassuda  and
Orestes Vicente Forlenza
Marcia Radanovic*
Affiliation:
Psychogeriatric Clinic and Laboratory of Neuroscience (LIM–27), Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, Brazil
Breno Satler Diniz
Affiliation:
Psychogeriatric Clinic and Laboratory of Neuroscience (LIM–27), Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, Brazil
Roberta M Mirandez
Affiliation:
Psychogeriatric Clinic and Laboratory of Neuroscience (LIM–27), Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, Brazil
Tânia Maria da Silva Novaretti
Affiliation:
Psychogeriatric Clinic and Laboratory of Neuroscience (LIM–27), Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, Brazil
Mariana Kneese Flacks
Affiliation:
Psychogeriatric Clinic and Laboratory of Neuroscience (LIM–27), Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, Brazil
Mônica S Yassuda
Affiliation:
Psychogeriatric Clinic and Laboratory of Neuroscience (LIM–27), Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, Brazil
Orestes Vicente Forlenza
Affiliation:
Psychogeriatric Clinic and Laboratory of Neuroscience (LIM–27), Department and Institute of Psychiatry, Faculty of Medicine, University of São Paulo, Brazil
*
Correspondence should be addressed to: Dr Marcia Radanovic, Rua Cristiano Viana, 163 ap. 92, São Paulo – SP – Brazil05411-000. Phone: +55 11 3088 9708; Fax: +55 11 3088 9708. Email: marciaradanovic@yahoo.com.br or marciaradanovic@gmail.com.
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Abstract

Background: Verbal fluency (VF) tasks are simple and efficient clinical tools to detect executive dysfunction and lexico-semantic impairment. VF tasks are widely used in patients with suspected dementia, but their accuracy for detection of mild cognitive impairment (MCI) is still under investigation. Schooling in particular may influence the subject's performance. The aim of this study was to compare the accuracy of two semantic categories (animals and fruits) in discriminating controls, MCI patients and Alzheimer's disease (AD) patients.

Methods: 178 subjects, comprising 70 controls (CG), 70 MCI patients and 38 AD patients, were tested on two semantic VF tasks. The sample was divided into two schooling groups: those with 4–8 years of education, and those with 9 or more years.

Results: Both VF tasks – animal fluency (VFa) and fruits fluency (VFf) – adequately discriminated CG from AD in the total sample (AUC = 0.88 ± 0.03, p < 0.0001) and in both education groups, and high educated MCI from AD (VFa: AUC = 0.82 ± 0.05, p < 0.0001; VFf: AUC = 0.85 ± 0.05, p < 0.0001). Both tasks were moderately accurate in discriminating CG from MCI (VFa: AUC = 0.68 ± 0.04, p < 0.0001; VFf: AUC = 0.73 ± 0.04, p < 0.0001) regardless of the schooling level, and MCI from AD in the total sample (VFa: AUC = 0.74 ± 0.05, p < 0.0001; VFf: AUC = 0.76 ± 0.05, p < 0.0001). Neither of the two tasks differentiated low educated MCI from AD. In the total sample, fruits fluency best discriminated CG from MCI and MCI from AD; a combination of the two improved the discrimination between CG and AD.

Conclusions: Both categories were similar in discriminating CG from AD; the combination of both categories improved the accuracy for this distinction. Both tasks were less accurate in discriminating CG from MCI, and MCI from AD.

Keywords

animals fluencyfruits fluencynormal elderlydementiacognitionsemantic categoriesschoolingneuropsychological tests
Type
Research Article
Information
International Psychogeriatrics , Volume 21 , Issue 6 , December 2009 , pp. 1081 - 1087
Copyright
Copyright © International Psychogeriatric Association 2009

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