A Comparison of Phonemic, Semantic, and Alternating Word Fluency in Parkinson's Disease

Abstract

Word fluency in 45 medicated non-demented Parkinson's disease (PD) patients and 45 normal control subjects was studied with a Phonemic Word Fluency (PWF) task using the letters F, A, and S, a Semantic Word Fluency (SWF) task using the categories animals, boys' names, and states, and an Alternating Word Fluency (AWF) task requiring the person to alternate between colors and occupations, animals and states, and words beginning with C and P. The number of words generated did not differ for trials with F, A, S, or states, but PD patients generated significantly fewer animal names and boys' names. PD patients also generated significantly fewer words on each of the three AWF trials. The PD patients scored 21% lower than the normal control group on the total AWF score, but only 10% lower for the PWF and SWF scores. The greater impairment on the AWF task which requires the use of internal attentional control to rapidly shift mental set can be considered a type of executive functioning deficit. This is consistent with the growing literature suggesting frontal systems dysfunction in PD and with the view that dopaminergic treatment only incompletely restores functioning in the frontostriatal system.

Assessing Impairment of Executive Function and Psychomotor Speed in Premanifest and Manifest Huntington’s Disease Gene-expansion Carriers

“…From a clinical perspective, it is always important whether the cognitive profile fits with the clinical impression and the types of complaints that HD gene-expansion carriers and their caregivers have when examined. Fluency tests and Alternating fluency have been said to measure mental speed, cognitive flexibility, set-shifting, interference managing, internal attentional control/ monitoring, and strategy generation (Costa et al, 2014; Larsson et al, 2008; Lezak, 2004; Testa et al, 2012; Zec et al, 1999). When premanifest HD gene-expansion carriers and patients with early HD are worried about cognitive decline and referred to neuropsychological assessment, some of the most common complaints they have are problems keeping up at work, especially keeping track of and shifting between assignments and they often describe mental slowing.…”

“…We based our choice of executive function tests on the Factor Analysis made by Testa, Bennett, and Ponsford (2012): Stroop interference test and Trail Making Test B were thought to measure set-shifting and interference management, Zoo map test and Brixton test was thought to measure task analysis, The Hayling test was thought to reflect response inhibition and the lexical fluency test was thought to measure strategy generation and regulation. Alternating fluency was not part of the factor analysis by Testa et al (2012), but have been associated with internal attentional control and set-shifting difficulties in Parkinson’s disease (Zec et al, 1999), thus we chose to make an additional label called internal attentional control.…”

Tablet Technology for Writing and Drawing during Functional Magnetic Resonance Imaging: A Review

“…The system was programmed to support several tablet-facilitated language tasks, such as number counting and phonemic fluency (recalling as many words as possible that start with a certain consonant, within 60 s), enabling the patient to respond either by overt speech or writing [ 57 , 61 , 62 , 63 ]. In related experiments, both the overt speech and written versions of the phonemic fluency task were found to produce similar behavioural performance as measured by the average words per minute, for a sample of 12 young healthy adults [ 62 ] and 45 patients with Parkinson’s disease [ 64 ]. In addition, the brain activity associated with the written version of phonemic fluency was found to be consistent with previous results of verbal fluency tasks [ 62 , 65 , 66 , 67 ].…”

Clinical neuropsychological assessment in older adults with Lewy body disease and Parkinson's disease.

“…Language is typically preserved early in the course of PD (Gunzler, Schoenberg, Riley, Walter, & Maciunas, 2011;Tröster & Fields, 2008). When deficits are observed, they tend to be in verbal fluency (Flowers, Robertson, & Sheridan, 1995;McDowd et al, 2011;Zec et al, 1999). In the 20-year Sydney Multicentre Study, significant declines in lexical and semantic fluency emerged in patients with late-onset PD at the 20-year point that were not present at baseline and were only modestly present at 10-year follow-up (Reid et al, 2011).…”