Cerebral blood flow patterns underlying the differential impairment in category vs letter fluency in Alzheimer’s disease

Keilp, John G.; Gorlyn, Marianne; Alexander, Gene E.; Stern, Yaakov; Prohovnik, Isak

doi:10.1016/s0028-3932(99)00032-9

Cited by 29 publications

(27 citation statements)

References 33 publications

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“…Even though both categorical and phonemic fluency tests involve word production (language), the former is dependent on semantic memory systems and the latter on executive control, to implement mental planning and searching strategies. 54,55 It has been shown to represent a surrogate of dorsolateral pre-frontal cortex function, bilaterally 56 . Letter P fluency had the biggest isolated AUC in our sample.…”

Section: Discussionmentioning

confidence: 72%

A score based on screening tests to differentiate mild cognitive impairment from subjective memory complaints

et al. 2013

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It is not easy to differentiate patients with mild cognitive impairment (MCI) from subjective memory complainers (SMC). Assessments with screening cognitive tools are essential, particularly in primary care where most patients are seen. The objective of this study was to evaluate the diagnostic accuracy of screening cognitive tests and to propose a score derived from screening tests. Elderly subjects with memory complaints were evaluated using the Mini Mental State Examination (MMSE) and the Brief Cognitive Battery (BCB). We added two delayed recalls in the MMSE (a delayed recall and a late-delayed recall, LDR), and also a phonemic fluency test of letter P fluency (LPF). A score was created based on these tests. The diagnoses were made on the basis of clinical consensus and neuropsychological testing. Receiver operating characteristic curve analyses were used to determine area under the curve (AUC), the sensitivity and specificity for each test separately and for the final proposed score. MMSE, LDR, LPF and delayed recall of BCB scores reach statistically significant differences between groups (P=0.000, 0.03, 0.001 and 0.01, respectively). Sensitivity, specificity and AUC were MMSE: 64%, 79% and 0.75 (cut off <29); LDR: 56%, 62% and 0.62 (cut off <3); LPF: 71%, 71% and 0.71 (cut off <14); delayed recall of BCB: 56%, 82% and 0.68 (cut off <9). The proposed score reached a sensitivity of 88% and 76% and specificity of 62% and 75% for cut off over 1 and over 2, respectively. AUC were 0.81. In conclusion, a score created from screening tests is capable of discriminating MCI from SMC with moderate to good accurancy.

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Section: Discussionmentioning

confidence: 72%

A score based on screening tests to differentiate mild cognitive impairment from subjective memory complaints

et al. 2013

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“…Moreover, the letter fluency test requires the ability to suppress the normal habit of using words according to their meaning 6,13 . Recent studies employing neuroimaging techniques show interesting findings about the location of verbal fluency performances in AD 14,15 . Keilp et al suggested that the primary predictor of category fluency was mean flow and the primary predictor of letter fluency was the left frontal flow, employing 133 Xe SPECT in AD 14 .…”

Section: Discussionmentioning

confidence: 99%

“…6,13 Recent studies employing neuroimaging techniques show interesting findings about the location of verbal fluency performances in AD. 14,15 Keilp et al suggested that the primary predictor of category fluency was mean flow and the primary predictor of letter fluency was the left frontal flow, employing 133 Xe SPECT in AD. 14 Fama et al suggested that in AD, category fluency was correlated with the frontal and temporal grey matter volumes, but letter fluency was not significantly associated with any brain volume employing volumetry.…”

Section: Relationship Between Verbal Fluency Scores and Regional Cerementioning

confidence: 99%

“…14,15 Keilp et al suggested that the primary predictor of category fluency was mean flow and the primary predictor of letter fluency was the left frontal flow, employing 133 Xe SPECT in AD. 14 Fama et al suggested that in AD, category fluency was correlated with the frontal and temporal grey matter volumes, but letter fluency was not significantly associated with any brain volume employing volumetry. 15 Although there are some differences between previous studies and this study in terms of the location of verbal fluency performances in AD, it would be appropriate to consider that verbal fluency tasks require the following abilities mediated by the left inferior dorsolateral prefrontal cortex (BA 10-46): spontaneity, initiation, organization of output, shortterm memory and seeking strategy, the so-called executive function described by Cummings and Trimble.…”

Section: Relationship Between Verbal Fluency Scores and Regional Cerementioning

confidence: 99%

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Relationship between regional cerebral blood flow and verbal fluency in Alzheimer's disease

Kitabayashi¹,

Ueda²,

Tsuchida³

et al. 2001

Psychiatry Clin Neurosci

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Category and letter verbal fluency tests are widely used for dementia detection and severity measure. Performances of these tasks have been regarded to be mainly associated with the left frontal lobe function. However, some recent studies suggest that there are different neuropsychological bases between these two tasks, and the brain region which contributes to these performances still remains unclear in Alzheimer's disease (AD). To clarify the neural basis of verbal fluency in AD, we examined the relationship between performances of these tasks and regional cerebral blood flow (rCBF). Twenty-five AD patients were administered verbal fluency tasks and single photon emission computed tomography (SPECT) scans. Thirteen cortical regions of interest were symmetrically defined in each hemisphere. Letter fluency scores were correlated significantly only with the left prefrontal (Brodmann's area (BA) 10-46) regional cerebral blood flow (rCBF). In contrast, category fluency scores were correlated most strongly with the left temporal rCBF and also with the left prefrontal (BA 10-46) rCBF. In conclusion, the present study suggests that left prefrontal (BA 10-46) dysfunction contributes to decline in both letter and category fluency scores in AD, while typical posterior dysfunction of AD has a closer relationship with decline in category fluency scores.

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“…Supporting this perspective, studies have found neurocognitive difference scores predict effort on testing (Langeluddecke & Lucas, 2003), dementia subtype (Cerhan et al, 2002;Jacobson et al, 2002), and localization of neurological impairment (Keilp et al, 1999;Wilde et al, 2001) at the group level. Unfortunately, there is scant evidence for the utility of ipsative approaches on the individual level (Cerhan et al, 2002;Keilp et al, 1999;Wilde et al, 2001). The few positive findings have been in the area of malingering detection and detection of Alzheimer's disease (for examples, see Jacobson et al, 2002;Millis et al, 1998).…”

Section: Introductionmentioning

confidence: 98%

Increasing the reliability of ipsative interpretations in neuropsychology: A comparison of reliable components analysis and other factor analytic methods

Frazier

Youngstrom

Chelune

et al. 2004

J Int Neuropsychol Soc

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Ipsative approaches to neuropsychological assessment typically involve interpreting difference scores between individual test scores. The utility of these methods is limited by the reliability of neuropsychological difference scores and the number of comparisons between scores. The present study evaluated the utility of difference scores using factor analytic methods, including reliable components analysis (RCA), equally weighted composites and individual neuropsychological measures. Data from 1,364 individuals referred for neuropsychological assessment were factor analyzed and the resulting solutions were used to compute composite scores. Reliabilities and confidence intervals were derived for each method. Results indicated that RCA outperformed other factor analytic methods, but produced a slightly different factor structure. Difference scores derived using orthogonal solutions were slightly more reliable than oblique methods, and both were more reliable than those from equally weighted composites and individual measures. Confidence intervals for difference scores were considerably smaller for factor methods relative to those for individual test comparisons, due to the greater reliability of factor based difference scores and the smaller number of comparisons required. These findings suggest that difference scores derived from orthogonal factor solutions, particularly RCA solutions, may improve reliability for clinical assessment purposes.

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Cerebral blood flow patterns underlying the differential impairment in category vs letter fluency in Alzheimer’s disease

Cited by 29 publications

References 33 publications

A score based on screening tests to differentiate mild cognitive impairment from subjective memory complaints

A score based on screening tests to differentiate mild cognitive impairment from subjective memory complaints

Relationship between regional cerebral blood flow and verbal fluency in Alzheimer's disease

Increasing the reliability of ipsative interpretations in neuropsychology: A comparison of reliable components analysis and other factor analytic methods

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