The impact of a language stimulation program on maintaining verbal fluency in Alzheimer's disease

Verbal fluency impairment is common in patients with Parkinson’s disease (PD), but the effect of drugs on verbal fluency in PD patients has not been comprehensively evaluated. We conducted a network meta-analysis based on four online databases to compare the effect of drugs on verbal fluency in PD patients. This study was performed and reported according to PRISMA-NMA guidelines. In total, 6 out of 3707 articles (three RCTS and three cross-sectional studies) covering eight drug regimens were included (five for letter fluency, five for semantic fluency). In terms of letter fluency, the ranking of the overall efficacy of included drug regimens was: levodopa, levodopa combined with pramipexole, rotigotine, cabergoline, pramipexole, pergolide, but no drug regimen presented a significant advantage over the others. In terms of semantic fluency, the ranking of the overall efficacy of included drug regimens was: rotigotine, levodopa, cabergoline, pergolide, pramipexole, among which, levodopa alone (SMD = 0.93, 95%CI: 0.28–1.59) and rotigotine alone (SMD = 1.18, 95%CI: 0.28–2.09) were statistically superior to pramipexole, while no significant difference was identified between all the other drug regimens. Levodopa and rotigotine seem to be more appropriate choices for PD patients with verbal fluency impairment. Further study is needed to illustrate the efficacy of drugs on verbal fluency in PD patients.

Background: Alzheimer's disease (AD) is the most common type of dementia. Patients with AD have impaired semantic knowledge of nouns and verbs as well as the ability to verb retrieval. Objectives: The aim of this study was to compare verbal fluency and verb fluency and to investigate the association between severity and types of fluency (verbal-verb) in patients with AD. Patients and Methods: This cross-sectional study was performed on 30 patients (14 males, 16 females) with AD. The participants were assessed using the Mini Mental State Examination (MMSE) and a neurologist made the diagnosis of AD. In order to examine verb and verbal fluency, the subjects were asked to name any words that they remember in one minute. Scoring was based on the correct number of items and data analysis was performed by SPSS 16. Results: There was a significant positive correlation between letter fluency and verb fluency (P = 0.013), letter fluency and semantic fluency (P < 0.001), and verb fluency and semantic fluency (P = 0.002) in patients with AD. The results showed significant differences between letter fluency (P < 0.001), verb fluency (P = 0.034), and semantic fluency (P < 0.001) among patients with different severity of AD. In addition, the most frequently produced words in letter fluency were /a/, /s/, and /f/, consecutively. The mean ratio of semantic fluency to letter fluency was 3:5. Conclusions: In patients with AD, verb fluency was impaired more than semantic fluency was. Verb fluency task is an important criterion in diagnosis of early dementia. Therefore, the investigation of verb fluency in susceptible individuals with dementia might prevents the progression of the disorder.

Verbal fluency, clustering, and switching in patients with psychosis following traumatic brain injury (PFTBI)

Calculation deficits are a common early manifestation of Alzheimer disease (AD). To investigate oral and written calculation skills in AD patients using quantitative and qualitative methods. Comparison among controls, patients with mild AD, and patients with moderate AD on measures of arithmetic skill. Tertiary care university medical center. Twenty patients with AD (11 with mild AD, 9 with moderate AD) and 23 elderly controls. Tests of oral arithmetic (Wechsler Adult Intelligence Scale-Third Edition [WAIS-III] Arithmetic subtest) and written arithmetic (Wide Range Achievement Test-3 [WRAT-3] Arithmetic subtest) were administered, and overall group differences were examined. Errors on selected WRAT-3 problems were qualitatively analyzed across groups using a set of error codes. Patients with mild and moderate AD performed significantly below controls on both oral and written arithmetic tasks (P<.001). Patients with moderate AD performed worse than those with mild AD on written arithmetic (P<.002) but not on oral arithmetic tasks. On selected WRAT-3 problems, single- and multiple-digit addition and subtraction operations and single-digit division operations were preserved in patients with mild AD. In contrast, only single-digit addition was preserved in patients with moderate AD. Errors of operation substitution and number position were the most common error types observed in AD patients. Patients with moderate AD displayed multiple error types and high incidence rates compared with controls, while patients with mild AD exhibited error types and incidence rates intermediate to controls and patients with moderate AD. A decline in calculation abilities is one of the hallmark cognitive features of AD. Patients with mild AD maintain relative preservation of simple written calculation skills but demonstrate marked impairment as task complexity increases. Patients with moderate AD demonstrate global impairments extending to the simplest arithmetic skills. These findings suggest that loss of calculation abilities in AD is both hierarchical (by arithmetic operation) and a function of disease severity.

BackgroundThere is limited information on the epidemiology of MCI and Alzheimer's Disease in Taiwan. As such the current study sought to describe the demographic profiles, healthcare resource use, and trends in treatment patterns for mild cognitive impairment (MCI) and Alzheimer's disease (AD) in Taiwan.MethodData was analysed using the National Health Insurance Research Database (NHIRD), a database covering 99.6% of the population. An annual analysis was conducted from 2018 to 2022 and included people aged ≥50 years diagnosed with MCI (ICD‐9: 331.83; ICD‐10: F067) or AD (ICD‐9: 331.0; ICD‐10: G30.x). As there is no standard coding for AD severity, a diagnostic algorithm was developed based on literature, NHIRD feasibility and neurologist expert consultation. On this basis patients were stratified by disease severity (MCI, mild AD, moderate AD, severe AD). Descriptive statistics summarized demographic characteristics, annual treatment trends, and healthcare resource use.ResultFrom 2018 to 2022, the prevalence of people with AD increased by 19.6%, reaching 131,053 in 2022. Females represented approximately two‐thirds of the AD population. In terms of treatment, Donepezil use rose from 20.3% in 2018 to 28.2% in 2022, with the highest usage among patients with mild AD (74.6% in 2022). Memantine use increased notably among moderate (64.7%) and severe AD patients (54.3%), reflecting its role in later‐stage management. Traditional Chinese Medicine (TCM) utilization remained consistent, peaking at 22.2% in 2022. Severe AD patients exhibited high rates of non‐pharmacological therapies such as physical therapy (5.3%), which were rarely used in mild AD cases. Patients with MCI demonstrated limited pharmacological intervention, with stable prevalence at 24,440 in 2022 and minimal treatment variation. Differences in age distribution showed a high median age in severe AD patients (84 years) relative to mild (81 years) and moderate (81 years). Moderate and severe AD patients had a high reliance on combination therapies involving cholinesterase inhibitors and memantine. Healthcare resource use was noteworthy.ConclusionThe results highlight increasing AD prevalence and evolving treatment patterns, with rising use of donepezil in MCI and memantine in advanced stages. These trends can inform healthcare strategies for managing MCI and AD in Taiwan.

Tc-99m HMPAO brain SPECT findings in mild and moderate Alzheimer's disease: Correlation with event related potentials

We directly assessed the clinical trials' evidence for memantine's efficacy in mild Alzheimer disease (AD). Memantine is indicated in the United States and Europe for moderate to severe AD, which is diagnosed if a patient has a Mini-Mental State Examination (MMSE) score of less than 15 or less than 20, respectively. Yet memantine is very frequently prescribed for mild AD and mild cognitive impairment, and a manufacturer-sponsored meta-analysis claimed its efficacy in mild AD. Manufacturer-sponsored meta-analyses, registries, presentations, and publications were systematically searched for randomized placebo-controlled, parallel-group clinical trials of memantine in patients with mild to moderate AD. The trials' characteristics and outcomes were extracted by one reviewer and checked by another. Meta-analyses were performed as inverse variance-weighted averages of mean differences using fixed-effects models. Summary results for patients with mild AD were obtained by contrasting the summary results for patients with mild or moderate AD with the summary results for the subset of patients with moderate AD. Three trials were identified that included 431 patients with mild AD (ie, with MMSE scores of 20-23) and 697 patients with moderate AD (ie, with MMSE scores of 10-19). There were no significant differences between memantine and placebo on any outcome for patients with mild AD, either within any trial or when data were combined: mean differences (95% confidence intervals [CIs]) on the Alzheimer Disease Assessment Scale-cognitive subscale (ADAS-cog), the Clinician's Interview-Based Impression of Change plus caregiver's input (CIBIC-plus), the Alzheimer Disease Cooperative Study-activities of daily living (ADCS-ADL) scale, and the Neuropsychiatric Inventory (NPI) were -0.17 (95% CI, -1.60 to 1.26), -0.09 (95% CI, -0.30 to 0.12), 0.62 (95% CI, -1.64 to 2.71), and 0.09 (95% CI, -2.11 to 2.29), respectively. For patients with moderate AD, there were small differences on the ADAS-cog and the CIBIC-plus, -1.33 (95% CI, -2.28 to -0.38) and -0.16 (95% CI, -0.32 to 0.00), respectively, but no differences on the ADCS-ADL scale (-0.57 [95% CI, -1.75 to 0.60]) or the NPI (0.25 [95% CI, -1.48 to 1.99]). Despite its frequent off-label use, evidence is lacking for a benefit of memantine in mild AD, and there is meager evidence for its efficacy in moderate AD. Prospective trials are needed to further assess the potential for efficacy of memantine either alone or added to cholinesterase inhibitors in mild and moderate AD.

Galantamine (hydrobromide), a reversible acetylcholinesterase inhibitor and allosteric nicotinic receptor modulator, slows cognitive and functional decline in mild to moderate dementia of the Alzheimer's type. Although several drugs are indicated for mild to moderate Alzheimer's disease (AD), no published study has separately analysed mild and moderate AD subgroups to assess the effect of dosage. To compare the efficacy and safety of galantamine 16 and 24 mg/day in patient subgroups with mild or moderate AD. This post hoc analysis (n = 838) of a 5-month, randomized, double-blind, placebo-controlled trial evaluated the efficacy and safety of galantamine 16 and 24 mg/day in a subgroup of patients with mild AD (Mini-Mental State Examination [MMSE] >18) and a subgroup with moderate AD (MMSE 10-18). Efficacy outcomes included the Alzheimer's Disease Assessment Scale-cognitive subscale (ADAS-cog) score and treatment response (ADAS-cog maintenance [>or=0-point improvement], improvement >or=4 points and improvement >or=7 points). Mean ADAS-cog scores of patients with mild AD demonstrated significant improvement from baseline with galantamine 16 and 24 mg/day (p < 0.001 for both), whereas cognitive function did not change significantly for placebo recipients (p = 0.559). Patients with moderate AD improved with galantamine 24 mg/day (p = 0.009) but not with 16 mg/day (p = 0.768); a decline occurred with placebo (p < 0.001). A greater proportion of patients treated with galantamine 16 mg/day (76% and 52% for mild and moderate AD, respectively) or 24 mg/day (69% and 61%, respectively) demonstrated a treatment response (i.e. ADAS-cog was maintained or improved) relative to placebo (55% and 28%, respectively; p < 0.05). Patients with moderate AD trended toward greater response with the 24 mg/day dosage than with the 16 mg/day dosage. Galantamine was well tolerated. Adverse events were comparable for all study groups with mild or moderate AD. This post hoc analysis suggests that galantamine 16 mg/day is the optimal dosage for patients with mild AD, as similar efficacy is observed with the 24 mg/day dose. However, patients with moderate AD appear to gain additional benefit from galantamine 24 mg/day.

Effects of acute estradiol administration on perimenstrual worsening of working memory, verbal fluency, and inhibition in patients with suicidal ideation: A randomized, crossover clinical trial

Strategy prompts increase verbal fluency in people with Alzheimer’s disease

To assess empirically the competency of patients with Alzheimer's disease (AD) to consent to medical treatment under different legal standards (LSs). Comparison of normal older subjects and patients with AD on measures of competency to consent to medical treatment. University medical center. Normal older control subjects (n = 15) and patients with probable AD (n = 29 [15 with mild and 14 with moderate AD]). Two specialized clinical vignettes were developed that test a subject's capacity to consent to medical treatment under five well-established LSs for this competency: LS1, evidencing treatment choice; LS2, making the reasonable choice; LS3, appreciating consequences of choice; LS4, providing rational reasons for choice; and LS5, understanding treatment situation and choices. Performance on the LSs was compared across control and AD groups using Student's t test, chi 2, and analysis of variance. Demented subjects were categorized as competent, marginally competent, or incompetent under each LS by using a cutoff score derived from normal control performance. No differences between groups emerged for LS1 and LS2. Control subjects performed significantly better than patients with mild AD on LS4 and LS5, and significantly better than patients with moderate AD on LS3, LS4, and LS5. Patients with mild AD performed significantly better than patients with moderate AD on LS4 and LS5. With respect to competency status, patients with AD showed a consistent and progressive pattern of compromise (marginal competence or incompetence) related to dementia severity and stringency of the LS. A reliable prototype instrument validly discriminated the competency performance and classified the competency status of control subjects and patients with mild and moderate AD under five LSs for competency to consent to medical treatment. While the groups performed equivalently on minimal standards requiring merely a treatment choice (LS1) or the reasonable treatment choice (LS2), patients with mild AD had difficulty with more difficult standards requiring rational reasons (LS4) and understanding treatment information (LS5), and patients with moderate AD had difficulty with appreciation of consequences (LS3), rational reasons (LS4), and understanding treatment (LS5). The results raised the concern that many patients with mild AD may not be competent to consent to treatment and supported the value of standardized clinical vignettes for assessment of competency in dementia.

Verbal fluency refers to the ability to generate words quickly and efficiently according to predefined phonological or semantic criteria. Deficits in verbal fluency limit patients’ ability to communicate effectively and to function well in social setups. Multiple sclerosis (MS) patients suffer from various cognitive impairments, and some of them experience language deficits as well. The goal of this study is to examine the contribution of the dorsal and ventral language pathways to verbal fluency in MS patients. All patients (N = 33) underwent diffusion MRI (dMRI) and fluency measurements. Diffusion parameters were calculated along dorsal and ventral language-related pathways and their right-hemispheric homologs, identified individually in each patient. Significant correlations were found between fluency measures and mean fractional anisotropy (FA) in several pathways, including the left fronto-temporal arcuate fasciculus (AFft), bilateral inferior fronto-occipital fasciculus (IFOF), and bilateral frontal aslant tract. Along-tract correlations revealed a more selective pattern of associations: letter-based fluency was associated with FA in a segment of the left AFft (dorsal pathway), while category-based fluency was associated with FA in a segment of the right IFOF (ventral pathway). The observed pattern of associations, mapping letter-based fluency to the dorsal stream and category-based fluency to the ventral stream, fits well within the dual stream framework of language processing. Further studies will be necessary to assess whether these associations generalize to the typical adult population or whether they are tied to the clinical state.

In some previous studies, transcutaneous electrical nerve stimulation (TENS) to the back was shown to improve non-verbal short-term and long-term memory as well as verbal fluency in patients in the early stage of Alzheimer's disease (AD). Moreover, the patients' physical, social and affective functions were also improved. In this study, the effects of TENS applied to the face were studied in patients with mild and severe AD. Fourteen patients with probable AD were used as subjects. To evaluate the effects of treatment, the subjects underwent two kinds of neuropsychological tests as well as a pupillary light reflex test. The pupillary light reflex test was chosen because it has been proven to show poorer results in cases of senile dementia. These three tests were carried out before the treatment, immediately after the treatment and 6 months after the treatment. Improvements were seen in subjects in the TENS groups and the effects of treatment were more significant in mild AD patients than in severe AD patients. However, the improvements were not maintained 6 months after the treatment. The possible mechanisms underlying the beneficial effects of TENS in AD patients are discussed in this paper.

This study aimed to investigate the changes and deterioration in lexical processing caused by Alzheimer's disease (AD). It analyzed the differences in lexical processing between individuals with healthy controls, mild AD, and moderate AD as well as how these groups processed varying lexical aspects. A total of 180 older adults participated in the experiment, including 60 healthy controls, 60 with mild AD, and 60 with moderate AD. Each group was further divided into two subgroups, with each subgroup assigned to one of two different experiments. The experiments assessed the speed and accuracy of lexical processing in both orthography and meaning using compound words. Individuals with mild and moderate AD showed significant differences in the speed and accuracy of lexical processing, both in orthography and meaning, compared to healthy controls. When the prime character shared character-level units with the target word, it enhanced the accuracy of lexical processing in AD patients. Mild AD patients demonstrated a significant advantage in both the speed and accuracy of processing high-frequency words in terms of orthography and meaning, while moderate AD patients only showed a significant advantage in orthographic processing accuracy. The AD group showed no significant differences in the speed and accuracy of processing high- and low-transparency words in terms of orthographic and meaning processing. Lexical processing significantly deteriorated in individuals with AD, with a greater decline observed in those with moderate AD. Differences in lexical processing between mild and moderate AD patients highlighted the varying impact of the disease's severity.

Semantic inhibition is often found to be impaired in Alzheimer´s disease (AD). The sentence completion task (Hayling test) was used to investigate whether it would be useful for differentiating mild AD from moderate AD. Latency responses and error scores in the automatic and inhibition parts of the test were registered in these two groups of patients and in a group of healthy older participants. The types of errors were also analysed. Group differences were analysed by ANOVA. In addition, relationships with other neuropsychological tests were reported. Participants with moderate AD performed worse than controls in both the automatic and inhibition sections, whereas participants with mild AD exhibited impaired performance in the inhibition part, but not in the automatic part. Differences between the groups with mild and moderate AD appeared only in the error scores in the inhibition part, specifically type 3 errors. Error scores in the inhibition part correlated with performance in verbal fluency and working memory tests. The Hayling task may be a useful tool for investigating control of inhibition in different stages of AD because different patterns of responses were observed.