Fluency In Patients Research Articles

Verbal and design fluency in patients with frontal lobe lesions.

The ability to generate items belonging to categories in verbal fluency tasks has been attributed to frontal cortex. Nonverbal fluency (e.g., design fluency) has been assessed separately and found to rely on the right hemisphere or right frontal cortex. The current study assessed both verbal and nonverbal fluency in a single group of patients with focal, frontal lobe lesions and age- and education-matched control participants. In the verbal fluency task, participants generated items belonging to both letter cues (F, A, and S) and category cues (animals and boys' names). In the design fluency task, participants generated novel designs by connecting dot arrays with 4 straight lines. A switching condition was included in both verbal and design fluency tasks and required participants to switch back and forth between different sets (e.g., between naming fruits and furniture). As a group, patients with frontal lobe lesions were impaired, compared to control participants, on both verbal and design fluency tasks. Patients with left frontal lesions performed worse than patients with right frontal lesions on the verbal fluency task, but the 2 groups performed comparably on the design fluency task. Both patients and control participants were impacted similarly by the switching conditions. These results suggest that verbal fluency is more dependent on left frontal cortex, while nonverbal fluency tasks, such as design fluency, recruit both right and left frontal processes.

Verbal fluency in patients with schizophrenia and affective psychoses and their first-degree relatives.

Schizophrenic patients are known to have neuropsychological deficits including impaired verbal fluency, but it is not clear whether this latter deficit is: (a) a consequence of overall intellectual deficit; (b) shared with affective psychotic patients; or (c) shared by the relatives of schizophrenic patients; and (d) shared by the relatives of affective psychotic patients. We administered Thurstone's Verbal Fluency Test to 45 schizophrenic patients and 72 of their relatives, and 30 affective psychotic patients and 53 of their relatives. Subjects were asked to generate as many words as possible beginning with the letters 'C' and 'S' and the total was taken as the dependent variable. Subjects also completed the National Adult Reading Test (NART) to provide a measure of (pre-morbid) IQ. Schizophrenic patients generated significantly fewer words than affective psychotic patients, however adjusting for NART this became non-significant. Schizophrenic (but not affective psychotic) patients generated significantly fewer words than their relatives; again adjusting for NART this became non-significant. Patients who had been exposed to obstetric complications (OC+) and those who had not (OC-) had similarly poor verbal fluency scores. Relatives of OC+ schizophrenic patients had superior verbal fluency than relatives of OC- schizophrenic patients and this remained significant after adjustment for NART. The results suggest that some families transmit impairment in verbal fluency as part of a pattern of lower overall IQ. However, in other families, relatives show largely normal neuropsychological function, and the poorer verbal performance of the schizophrenic member appears to have arisen secondary to his/her exposure to OCs.

The Hippocampal Contribution to Verbal Fluency in Patients with Temporal Lobe Epilepsy

We report the effects of hippocampal and non-hippocampal temporal-lobe dysfunction on verbal fluency performance. Quantitative aspects of semantic and phonemic fluency performance were examined in 46 patients with right- or left-temporal-lobe epilepsy and 20 healthy controls. A pattern of fewer words generated on semantic rather than phonemic fluency tasks was found among patients with damage to hippocampal structures. This pattern was not obtained in patients with non-hippocampal temporal-lobe damage, suggesting that the hippocampus plays a crucial role in semantic fluency performance. An interesting lateralization effect was obtained. Among patients with left temporal-lobe involvement, fluency performance was impaired regardless of whether the hippocampus was involved. In contrast, among patients with right temporal-lobe involvement, fluency performance was impaired only when the hippocampus was involved.

Verbal fluency in schizophrenia: reduction in semantic store.

This is a study of the word production of patients with schizophrenia using a semantic verbal fluency task to address the unresolved issue of retrieval or storage impairment. Twenty-one patients with schizophrenia and 11 matched healthy subjects performed a semantic verbal fluency task on 'food', 'animal' and 'transport' categories in Cantonese for 3 minutes each on five separate trials. Patients generated significantly fewer numbers of words compared with control on each trial. The estimated lexicon size of the patients was significantly smaller than that of the equivalent group. The amount of shared words and variable words generated in all five trials were reduced in the patient group. Our results suggest that poor verbal fluency in patients with schizophrenia may partly be attributable to reduction in semantic store. The importance of temporal lobe involvement on verbal fluency deficits needs to be emphasised as an integral part of the neurobiological basis of schizophrenia research.

A Test of Odor Fluency in Patients with Alzheimer's and Huntington's Disease

In the present study, an olfactory analog to the verbal fluency test was designed and administered to 40 patients with Alzheimer's disease (AD) and 11 patients with Huntington's disease (HD). Because onset of AD is typically in the sixties while onset of HD is typically in the mid-thirties, the patient groups had their own control group, an older (ONC) and younger (YNC) control group, respectively. Both control groups included 40 participants who were age- and education-matched to their respective patient group. Odor threshold, odor identification, and odor fluency measures were administered to each participant. Results of the study indicate that patients with dementia perform more poorly on all three measures of olfactory functioning. Our results suggest that tests of odor memory show differential performance in healthy and demented patients, leading to the suggestion that tests of olfactory functioning may be useful in detection and diagnosis of neurodegenerative disease.

Verbal and Figural Fluency in Patients with Mass Lesions of the Left or Right Frontal Lobes

Impaired verbal and figural fluency has been shown to be associated with frontal lobe dysfunction. Jones-Gotman and Milner (1977) demonstrated a double dissociation between verbal and nonverbal fluency in a small sample of patients with frontal lesions of the left or right hemisphere. The present study has examined verbal and nonverbal fluency in 25 healthy participants and 95 patients with mass lesions of the left or right frontal lobes. In comparison with healthy participants, verbal fluency was reduced in patients with frontal lesions of the left hemisphere. Patients with right-sided lesions did not differ from either the control group or from the patients with left-sided frontal mass lesions. In the figural fluency task, the performance of the groups did not differ. The finding that patients with left frontal lesions produced fewer words than healthy paticipants suggests an association between left frontal lobe pathology and reduced verbal fluency. The results do not support the hypothesis of a double dissociation between verbal/figural fluency and the side of lesion within the frontal lobes.

Effects of transcutaneous electrical nerve stimulation on memory and behavior in Alzheimer’s disease may be stage-dependent

Background: In previous studies, transcutaneous electrical nerve stimulation (TENS) was shown to result in improvements in nonverbal short-term and long-term memory, verbal long-term memory, and verbal fluency in patients in an early stage of Alzheimer’s disease (AD). In addition, the patients’ physical, social, and affective functioning improved. As AD is a progressive disease, it was examined in the present study whether TENS would still be effective in the midstage of AD. Methods: Sixteen subjects (70–91 years old) met the NINCDS-ADRDA criteria for probable AD, as well as the criteria for stage 6 of the Global Deterioration Scale (midstage AD). To evaluate treatment effects, the subjects underwent a number of neuropsychological tests and two observation scales. Results: Compared to TENS in an early stage, TENS in the midstage of AD appears to yield less beneficial effects, i.e., as for cognition only nonverbal short-term memory improved. No treatment effects were observed for the patients’ physical, social, and affective functioning. Conclusions: In view of the small number of patients, the clinical relevance of TENS in patients in a midstage of AD remains to be confirmed in a larger group, after which more definite conclusions about the stage-dependency of TENS in AD can be drawn.

Letter and category fluency in patients with frontal lobe lesions.

Letter and category fluency in patients with frontal lobe lesions.

Interictal Language Fluency in Temporal Lobe Epilepsy

Mild language production difficulties, particularly in confrontation naming, have been documented previously in patients with left temporal lobe epilepsy (LTLE). These difficulties, however, do not seem to be reflected in the conversational speech of these patients. In order to compare speech fluency in patients with left and right temporal lobe epilepsy (RTLE) experimentally, we studied global pause-to-speech ratios in patients with unilateral temporal lobe epilepsy, using cases with primary generalized epilepsy (PGE) as controls. We hypothesized that left-sides cases would exhibit longer pause durations than right-sided cases. Speech samples were elicited by asking subjects to describe five different New Yorker cartoons, with three repetitions of each description. Phonation was converted to graphic output, and pauses between 200 ms and 4000 ms were summated and divided by total phonation time. This measure did not discriminate significantly between the groups, although the LTLE group tended to pause longer than the RTLE or PGE groups. Increased variability in pause duration in the LTLE group during cycle 1 suggested that some individuals with LTLE are vulnerable to disruption when planning demands are high. A post hoc correlational analysis showed that variation in fluency was primarily explained by orthographically-based lexical retrieval, suggesting that individual differences in fluency are related to limitations in a highlevel capacity relevant to the production of speech. It is unlikely that such limitations are specific to LTLE.

Clonidine infusion increases uptake of 99mTc-Exametazime in anterior cingulate cortex in Korsakoff's psychosis

The effects upon regional brain function of infusing either saline or clonidine (1.5 microgram/kg) has been examined in 18 patients with alcoholic Korsakoff's psychosis using 99mTc-hexamethylpropyleneamineoxime (99mTc-HMPAO or 99mTc-Exametazime) and Single Photon Emission Tomography (SPET or SPECT). The hypothesis tested was that frontal lobe function would be increased by adrenoceptor stimulation. This was confirmed by an increase in the uptake of 99mTc-Exametazime into anterior cingulate regions of the frontal lobes. Patients were scanned before and after saline or clonidine infusion during performance of a verbal fluency task. There was a significantly increased performance of verbal fluency in patients given clonidine. This effect was variable and could not be unequivocably distinguished from increases in performance in the saline treated group. Nevertheless, the increase in neuropsychological performance was also correlated with increased function in left dorsolateral frontal cortex within the clonidine treated group. An exploratory examination of other brain areas suggested that relative increases in posterior cingulate cortex and changes in the symmetry of function within the thalamus may also be produced by acute infusion of clonidine in Korsakoff patients. The findings support the idea that adrenergic mechanisms may modulate cognitive performance by actions on attentional systems within the brain. These appear to be located primarily within limbic cortex. It is, of course, notable that this can occur in patients with profound and disabling amnesia.

Verbal and nonverbal fluency in patients with probable Alzheimer's disease.

Verbal and nonverbal fluency in patients with probable Alzheimer's disease.

Verbal and nonverbal fluency in patients with probable Alzheimer's disease.

Verbal and nonverbal fluency in patients with probable Alzheimer's disease.

Fluency of speech and self‐awareness of memory deficit in alzheimer's disease

AbstractAlthough gradual global progression is one of the cardinal features of primary degenerative dementia of the Alzheimer type, clinical observation of patients suggested that there is some variability in the degree and rapidity of decline of different symptoms of this illness. In particular, it appeared that language fluency and self‐awareness of memory problems did not decline simultaneously. This study was designed to test the hypothesis that an inverse relationship exists between self‐awareness and fluency in patients with Alzheimer's disease. Thirty‐two patients suffering from Alzheimer's disease were divided into two groups on the grounds of presence or absence of self‐awareness of memory handicaps. These patients were also assessed in regard to fluency using a three‐point scale devised for this purpose. A significant inverse association was found between self‐awareness and fluency. This appeared to be a specific relationship, unrelated to global indicators of function including Mini‐Mental Status Evaluation, Aphasia Screening Test scores or demographic features. Possible implications of this with reference to intracerebral localization issues in mild‐moderate Alzheimer's disease are discussed.

Word fluency in patients with early dementia of Alzheimer type.

The relative fluency with which 15 patients with Alzheimer-type dementia (DAT) retrieved words with specified first letters and belonging to semantically defined categories was assessed. Patients with DAT were always less fluent than controls but, like the 12 normal elderly subjects, they were more efficient in accessing words belonging to semantic categories. Their deficit in retrieving words with specified first letters was greater than that predicted on the basis of verbal intellectual ability. No differences in word fluency were detected in presenile and senile patients. These data support the conclusion that word fluency may prove useful in the detection of early dementia.

Verbal memory deficits associated with major affective disorders: a comparison of unipolar and bipolar patients

The verbal learning and fluency of patients with unipolar and bipolar depression were compared to those of normal controls and patients with Huntington's disease. The data demonstrated that the recall and recognition performance of both groups of depressed patients were imparred relative to the performance of normal control subjects. The bipolar patients, however, were more impaired than the unipolar patients on both tasks ( P<0.024 and P<0.022, respectively). In addition, the unipolar patients generated more correct responses on a test of verbal fluency ( P<0.04). The performance of the bipolar patients was, in fact, similar to that of patients with Huntington's disease, a progressive degenerative disorder that primarily affects subcortical areas.