Accuracy of the semantic fluency test to separate healthy old people from patients with Alzheimers disease in a low education population / Acurácia do teste de fluência semântica para separar pessoas saudáveis de pacientes com doença de Alzheimer em uma população de baixa escolaridade

OBJECTIVE: Evaluate the accuracy of two semantic categories of the verbal fluency test (supermarket and animal categories) to separate healthy elderly individuals and lower educated Alzheimer's disease patients. METHODS: We evaluated 69 older adults with less than 5 years of schooling, consisting of 31 healthy elderly, and 38 patients diagnosed with Alzheimer's disease. Semantic verbal fluency was evaluated using the animal and supermarket categories. Mann-Whitney U and Independent t Tests were used to compare the two groups, and the diagnostic accuracy of the tests was analyzed by sensitivity, specificity, likelihood ratio's, and the Area Under the Curve (AUC). RESULTS: We found a significant difference between the healthy older and Alzheimer's disease groups, in both, animal (p = 0.014) and supermarket verbal fluency (p < 0.001). The supermarket category showed better overall diagnostic accuracy (AUC = 0.840, 95% CI = 0.746-0.933; p < 0.001) compared to the animal category (AUC = 0.671, 95% CI = 0.543-0.800; p = 0.014). CONCLUSION: The supermarket category of semantic verbal fluency provides better accuracy than the animal category for the identification of dementia in a Brazilian elderly population with low educational level.

OBJETIVO: Avaliar a acurácia de duas categorias semânticas do teste de fluência verbal (categorias de supermercado e animal) para separar idosos saudáveis e pacientes com doença de Alzheimer com baixa escolaridade. MÉTODOS: Avaliamos 69 idosos com menos de 5 anos de escolaridade, consistindo em 31 idosos saudáveis e 38 pacientes diagnosticados com a doença de Alzheimer. A fluência verbal semântica foi avaliada nas categorias animal e supermercado. O teste de Mann-Whitney U e o teste t independente foram usados para comparar os dois grupos, e a precisão diagnóstica dos testes foi analisada por sensibilidade, especificidade, razão de verossimilhança e área sob a curva (AUC). RESULTADOS: Encontramos uma diferença significativa entre os grupos de idosos saudáveis e com doença de Alzheimer, tanto na fluência verbal de animais (p = 0,014) quanto na de supermercado (p < 0,001). A categoria supermercado apresentou melhor precisão diagnóstica geral (AUC = 0,840; IC 95% = 0,746- 0,933; p < 0,001) em comparação com a categoria animal (AUC = 0,671; IC 95% = 0,543-0,800; p = 0,014). CONCLUSÃO: A categoria supermercado de fluência verbal semântica fornece melhor acurácia do que a categoria animal para a identificação de demência em uma população idosa brasileira com baixo nível educacional.

Fluidez verbal fonológica, morfológica y semántica en sujetos con enfermedad de Parkinson / Phonologic, morphologic and semantic verbal fluency in Parkinson disease subjects

Resumen La Enfermedad de Parkinson (EP) es una patología progresiva con degeneración del sistema dopaminérgico nigro-estriatal con disfunción de proyecciones frontales que genera alteraciones en funciones ejecutivas. Esta condición debería afectar particularmente la capacidad de evocar unidades léxicas y recuperarlas desde la memoria de largo plazo; no obstante, si bien se cuenta con datos acerca de este comportamiento, aún es necesario determinar qué subcomponentes del lenguaje se ven afectados a fin de comprender con mayor especificidad tanto la patología como su manifestación lingüística. En este marco, el objetivo del presente estudio consistió en describir el rendimiento en tareas de fluidez verbal de tipo fonológica, morfosintáctica, semántica y sus combinaciones en participantes con enfermedad de Parkinson (EP). Para ello, se realizó un estudio transversal con 42 sujetos, agrupados en Adulto Mayor Sano (AMS; n = 23) y Adulto Mayor Diagnosticado con EP (EP; n = 19). Cada sujeto realizó un total de 15 tareas de fluidez verbal en las que debió evocar la mayor cantidad de unidades léxicas en 60 segundos, las que fueron, además, medidas en intervalos de 15 segundos. Los resultados permitieron observar diferencias estadísticamente significativas en las subtareas de tipo fonológica de fonema excluido, categoría gramatical, relaciones semánticas y de combinación campo léxico y fonema inicial. Estos datos parecen indicar que los sujetos con EP muestran un rendimiento significativamente inferior en tareas que exigen alto control inhibitorio, dado que las subtareas que combinan niveles de la lengua implican evocación e inhibición.

Abstract Parkinson's disease (PD) is a progressive pathology that implies a degeneration of the nigro-striatal dopaminergic system with dysfunction of frontal projections, which generates alterations in executive functions, specifically in sustained attention, working memory, planning and cognitive flexibility, among others. In fact, this pathology has repercussions on several language components. Particularly, there is evidence indicating that the ability to evoke lexical units and recover them from long-term memory or lexicon is affected. Although these types of tasks seem to be sensitive for the detection of Parkinson's disease, both in patients with mild cognitive impairment and another with dementia, it is still necessary to have evidence to determine which specific subcomponents of the language are affected, since this will allow us to understand with more specificity both the pathology and its linguistic manifestation, at the same time as to design therapies by support teams for this type of patients. In this context, verbal fluency (VF) tests could contribute to obtaining this type of information. VF is defined as an executive function that involves the access and evocation of clusters of linguistic information, and that is related to attention and working memory processes, since it is initiated by the activation of information groups through specific search strategies Moreover, it involves various linguistic functions, such as the naming, and executive functions of planning, working memory and initiation of behavior. Specifically, this type of task consists of requesting the subject under evaluation to nominate the largest number of elements of a lexical category according to a specific rule for a specific time, such as names of countries or word containing the phoneme / f /. From there, it has been observed which associated language areas are activated: ventral-anterior lower frontal gyrus in categorical tasks, dorsal-posterior lower frontal gyrus in phonological tasks and parietal areas of the right hemisphere that are associated with executive functions and attentional processes in tasks of greater complexity. Within this framework, the aim of the present study was to describe the performance in tasks of verbal fluency of a phonological, morph syntactic, semantic type and their combinations in participants diagnosed with Parkinson's disease (PD). For this, a cross-sectional study was conducted with 42 subjects, grouped as healthy older adults (AMS; n = 23) and older adults diagnosed with PD without dementia (EP; n = 19). The subjects of the control group had a mean age of 66 years (SD = 6.9) and 11.5 years of schooling (SD = 3.1); on the other hand, subjects with PD had a mean age of 71 years (SD = 8.03) and 13.2 years of schooling (SD = 3.9). Each subject performed a total of 15 verbal fluency tasks, in which he had to evoke the greatest number of lexical units in 60 seconds, which were also measured in intervals of 15 seconds. The results shown statistically significant differences in the sub-tasks of the phonemic type of excluded phoneme (FVFLE1: p = .012 and FVFLE2: p = .047), morph syntactic adjective categories (FVM2: p = .005), in the synonymy relationships (FVS3: p = .028) and lexical field and phonology (FVSF: p = .004). These data seem to indicate that subjects with Parkinson's disease show significantly lower performance in tasks that require high inhibitory control, since subtasks that combine tongue levels involve evocation and inhibition at the same time. These results are consistent with the pathophysiology of the condition.

Methodological criteria for scoring clustering and switching in verbal fluency tasks / Critérios metodológicos para análises de clustering e switching em tarefas de fluência verbal / Criterios metodológicos para análisis de estrategias de agrupación en tareas de fluidez verbal

The objective of this study was to describe an adaptation to Brazilian Portuguese of the methodological criteria for analysis of clustering and switching in semantic verbal fluency (SVF) and phonemic verbal fluency (PVF) tasks. The adaptation process consisted of six steps, including the selection of the clustering and switching variables based on data from a sample of 419 children and the analysis of inter-rater reliability (six raters). The following variables were scored: the total number of words generated the raw number of clusters, the mean cluster size, and the raw number of switches. There was a significant association between raters (intra-class correlation coefficients between 0.95 and 0.99), showing that the analytical method was reliable. Our study provides an evaluation of SVF and PVF tasks that goes beyond the overall score, making it possible to investigate the cognitive processes underlying this neuropsychological function.

Este artigo objetiva apresentar uma adaptação ao português brasileiro dos critérios metodológicos para análises de clustering e switching em tarefas de fluência verbal semântica (FVS) e ortográfica (FVO). São descritas as seis etapas realizadas no processo de adaptação destes critérios, incluindo o processo de extração das variáveis de clustering e switching a partir de dados de amostras de crianças (N=419) e a análise da fidedignidade da concordância entre juízes (N=6). As variáveis avaliadas são número total de palavras evocadas, número de clusters, média do tamanho dos clusters e número de switches. Houve forte associação entre juízes (Coeficientes de Correlação Intraclasse entre 0,95 a 0,99) indicando fidedignidade do método de análise. Este estudo contribui com a avaliação da FVS e FVO para além do escore geral, permitindo investigar os processos cognitivos subjacentes a esta função neuropsicológica.

Este artículo presenta una adaptación para el portugués brasileño de criterios metodológicos de análisis de estrategias de agrupación (clustering y switching) en tareas de fluidez verbal semántica (FVS) y fluidez verbal fonológica (FVF). El proceso de adaptación de estos criterios consiste en seis pasos, incluyendo el proceso de extracción de las variables de clustering y switching de una muestra formada por 419 niños y el análisis de fiabilidad entre seis jueces. Se investigaron las siguientes variables: número total de palabras generadas, número de grupos de palabras (clusters), tamaño medio de los grupos y número de saltos (switches). Hubo una fuerte asociación entre jueces (coeficientes de correlación intraclase entre 0,95 y 0,99), indicando así la fiabilidad del método analítico. Este estudio contribuye a la evaluación de la FVS y FVF más allá de la puntuación global, lo que permite investigar los procesos cognitivos subyacentes a esta función neuropsicológica.

Generación de agrupamientos semánticos en una tarea de fluidez verbal en pacientes víctimas de un accidente cerebro vascular y controles sin patología cerebral / Generation of semantic clustering in a verbal fluency task in stroke patients and patients without cerebral pathology

Este artículo se propone comparar el desempeño de tres grupos de personas en una tarea de fluidez verbal semántica: pacientes que sufrieron un Accidente Cerebro Vascular (ACV), adultos mayores sanos y adultos jóvenes sanos. La tarea consiste en solicitarle a lo participantes que emitan la mayor cantidad de ejemplares que conozcan de una categoría semántica en un lapso de tiempo de un minuto. En este caso se escogió la categoría animales. En primer lugar, el análisis de varianza permitió detectar diferencias de medias significativas (p<0.05) en la cantidad de palabras emitidas por grupo, siendo los pacientes los que produjeron menor cantidad de ejemplares. Luego, se realizó un escalamiento multidimensional por grupo para analizar los agrupamientos de los ejemplares de acuerdo al orden en que fueron emitidos. Se observó que los pacientes son los que generaron menor cantidad de agrupamientos y los adultos jóvenes mayor cantidad de agrupamientos. De este modo, cabe suponer que existe una asociación entre la escasa conformación de agrupamientos y la dificultad en la recuperación de ejemplares de la memoria semántica. Así, tanto en el grupo de pacientes como en las personas adultas mayores (en menor grado) habría un funcionamiento deficiente los mecanismos de recuperación de la información semántica que disminuiría la capacidad de generar ejemplares de una categoría semántica.

The aim of the present article is to compare the performance of three groups of people in a semantic fluency task: stroke patients, older healthy adults and young healthy adults. The task requires the participants to say as many exemplars as possible from a semantic category in one minute. In the current research, the semantic category animal was chosen. First, analysis of variance revealed a significant group differences (p<0.05) in the number of exemplars generated, poorer for stroke patients. Then, it was conducted a multidimensional scaling for each group to analyze the clustering of exemplars according to the order of emission. It was observed that stroke patients generated less clusters than the other groups, while young adults generated a mayor number of clusters. Then, it is possible to assume an association between the scarce clustering and the difficulty in the recovery of exemplars from the semantic memory. To conclude, in both, patients and older adults group (in a minor degree), there would be an impaired performance in the use of organization strategies in semantic recovery that would diminish the capacity to generate exemplars from a semantic category.