Normative data for healthy elderly on the phonemic verbal fluency task - FAS

Machado, Thais Helena; Fichman, Helenice Charchat; Santos, Etelvina Lucas; Carvalho, Viviane Amaral; Fialho, Patrícia Paes; Koenig, Anne Marise; Fernandes, Conceição Santos; Lourenço, Roberto Alves; Paradela, Emylucy Martins de Paiva; Caramelli, Paulo

doi:10.1590/S1980-57642009DN30100011

Abstract

Phonemic verbal fluency tests assess the production of words beginning with specific letters. Of these letters, the most frequently used are F, A and S. It is a sensitive test for assessing frontal lobe functions.

Objective: To provide normative data for the elderly Brazilian population on the FAS test and to investigate the effects of age and schooling on test performance.

Methods: The individuals were divided into three age groups (60-69, 70-79 and ³80 years), and into four groups according to education (1-3, 4-7, 8-11 and ³12 years). All subjects were assessed by the Mini Mental State Examination and the FAS. Data were analyzed with Student's t test, ANOVA, simple linear regression and Spearman's correlation.

Results: We evaluated 345 cognitively healthy volunteers, 66.66% being female, aged 60 to 93 years, with an educational level ranging from one to 24 years. The average (number of items) ±SD for the whole sample was 28.28±11.53. No significant effect of gender was observed (p=0.5). Performance on the MMSE and education exerted a direct influence on FAS scores (p<0.001), with education being the most significant factor. A positive correlation was found between FAS and the MMSE (r=0.404; p<0.001).

Conclusion: The performance of Brazilian elderly on the phonemic verbal fluency tests-FAS is significantly influenced by education, where individuals with higher educational level present better performance than those with fewer years of schooling. Age and gender did not prove significant with the FAS.

Key words: healthy elderly; verbal fluency; educational status; normative data.

Resumo

Testes de fluência verbal fonêmica avaliam a produção de palavras que se iniciam com determinadas letras. Destas, as mais utilizadas são F, A e S. É um teste sensível para avaliar funções do lobo frontal.

Objetivo: Estabelecer dados normativos para a população idosa brasileira no teste de fluência verbal fonêmica FAS e investigar os efeitos da idade e escolaridade no mesmo teste.

Materiais e Métodos: Os sujeitos foram divididos em três grupos de idade (60-69, 70-79 e ³80 anos) e quatro de escolaridade (1-3, 4-7, 8-11, ³12 anos). Todos foram avaliados pelo Mini-Exame do Estado Mental e fluência verbal fonêmica FAS. Os dados foram analisados com o test t de Student, ANOVA, regressão linear simples e correlação de Spearman.

Resultados: Foram avaliados 345 idosos cognitivamente saudáveis, 66,66% do gênero feminino, idade entre 60 e 93 anos e escolaridade entre 01 e 24 anos. A média (número de itens) ±DP na amostra toda foi 28.28±11.53. Não houve influência do gênero nos resultados (p=0.5). A performance no MEEM e o nível educacional exerceram influência direta nos escores do FAS (p<0.001), com a educação sendo o fator mais importante. Uma correlação positiva foi encontrada entre os escores no FAS e MEEM (r=0.404; p<0.001).

Conclusão: O desempenho de idosos brasileiros no Teste de Fluência Verbal Fonêmica - FAS é significativamente influenciado pelo grau de escolaridade, com os indivíduos com nível educacional mais elevado apresentando desempenho superior àqueles com menos tempo de estudo formal. Idade e gênero não apresentaram significância com o FAS.

Palavras-chave: idosos saudáveis; fluência verbal; nível educacional; dados normativos.

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References

¹ Instituto Brasileiro de Geografia e Estatística (IBGE) 2006.
² Nitrini R. Epidemiologia da doença de Alzheimer no Brasil. Rev Psiquiatria Clin 1999;26:262-267.
³ Damasceno BP. Envelhecimento cerebral: o problema dos limites entre o normal e o patológico. Arch Neuropsiquiatr 1999;57:78-83.
⁴ Yaretsky A, Arzi T, Ben-Nun Y. Word fluency in aging and dementia: principles of relatedness in the generative naming process. Arch Gerontol Geriatr 1999;29:57-60.
⁵ Chan CWY, Lam LCW, Wong TCM, et al. Modified Card Sorting Test Performance among Community Dwelling Elderly Chinese People. Hong Kong J Psychiatry 2003;13:2-7.
⁶ Caffarra P, Vezzadini G, Dieci F, Zonato F, Venneri A. Modified Card Sorting Test: Normative Data. J Clin Exp Neuropsychol 2004;26:246-250.
⁷ Traykov L, Raoux N, Latour F, et al. Executive functions deficit in mild cognitive impairment. Cogn Behav Neurol. 2007;20:219-24
⁸ Nutter-Upham KE, Saykin AJ, Rabin LA, et al. Verbal fluency performance in amnestic MCI and older adults with cognitive complaints. Arch Clin Neuropsychol. 2008;23:229-241.
⁹ Foos PW. Adult age differences in working memory. Psychol Aging 1989;4:269-275.
¹⁰ Budson AE, Price BH. Memory dysfunction. N Engl J Med. 2005; 352:692-699.
¹¹ Fisk JE, Warr P. Age and work memory: the role of perceptual speed, the central executive, and the phonological loop. Psychol Aging 1996;11:316-323.
¹² Duke LM, Kaszniak AW. Executive control functions in degenerative dementias: a comparative review. Neuropsychol Rev 2000;10:75-99.
¹³ Lamar M, Zonderman AB, Resnick S. Contribution of specific cognitive processes to executive functioning in an aging population.Contribution of specific cognitive processes to executive functioning in an aging population. Neuropsychology 2002;16:156-162.
¹⁴ Mcneil J, Goldstein LH. Clinical Neuropsychology: A Practical Guide to Assessment and Management for Clinicians.1st ed. London: J Wiley Professional; 2003.
¹⁵ Kipps CM, Hodges JR. Cognitive assessment for clinicians. J Neurol Neurosurg Psychiatry. 2005;76(Suppl 1):i22-30
¹⁶ Nitrini R, Caramelli P, Bottino CMC, Damasceno BP, Brucki SMD, Anghinah R. Diagnóstico de doença de Alzheimer no Brasil: critérios diagnósticos e exames complementares. Recomendações do Departamento Científico de Neurologia Cognitiva e do Envelhecimento da Academia Brasileira de Neurologia. Arq Neuropsiquiatr 2005;63:713-719.
¹⁷ Alvarez JA, Emory E. Executive function and the frontal lobes: a meta-analytic review. Neuropsychol Rev 2006;16:17-42.
¹⁸ Spreen O, Strauss E. Compendium of Neuropsychological Tests, Administration, Norms and Commentary. Oxford: Oxford University Press; 1998.
¹⁹ Lezak M. Neuropsychological Assessment. New York: Oxford University Press; 1995.
²⁰ Benton AL, Hamsher K, Sivan AB. Multilingual Aphasia Examination. 3rd ed. San Antonio: Psychological Corporation; 1994.
²¹ Vilkki J, Holst P. Speed and flexibility on word fluency tasks after focal brain lesions. Neuropsychologia 1994;32:1257-1262.
²² Ruff RM, Light RH, Parker SB, Levin HS. The psychological construct of word fluency. Brain Lang 1997;57:394-405.
²³ Tombaugh TN, Kozak J, Rees L. Normative data stratified by age and education for two measures of verbal fluency: FAS and animal naming. Arch Clin Neuropsychol 1999;14: 167-177.
²⁴ Sarno MT, Postman WA, Cho YS, Norman RG. Evolution of phonemic word fluency performance in post-stroke aphasia. J Commun Disord 2005;38:83-107.
²⁵ Chandra V, Sharma S, Belle S, Seaberg E, Pandav R. Effects of literacy and education on measures of word fluency. Brain Lang 1998;61:115-122.
²⁶ Dursun SM, Robertson HA, Bird D, Kutcher D, Kutcher SP. Effects of ageing on prefrontal temporal cortical network function in healthy volunteers as assessed by COWA. An exploratory survey. Prog Neuropsychopharmacol Biol Psychiatry 2002;26:1007-1010.
²⁷ Buriel Y, Fombuena NG, Böhm P, Rodés E, Peña-Casanova J. Fluencia verbal - estudio normativo piloto en una muestra española de adultos jóvenes (de 20 a 49 años). Neurologia 2004;19:153-159.
²⁸ Kavé G. Phonemic fluency, semantic fluency, and difference scores: normative data for adult Hebrew speakers. J Clin Exp Neuropsychol 2005;27:690-699.
²⁹ Senhorini MC, Amaro Júnior E, de Mello Ayres A, de Simone A, Busatto GF. Phonemic fluency in Portuguese-speaking subjects in Brazil: ranking of letters. J Clin Exp Neuropsychol 2006;28:1191-1200.
³⁰ Tallberg IM, Ivachova E, Jones Tinghag K, Ostberg P. Swedish norms for word fluency tests: FAS, animals and verbs. Scand J Psychol 2008;49:479-485.
³¹ Folstein M, Folstein S, Mchugh P. Mini-mental state: a practical method for grading the cognitive state off patients for the clinician. J Psychiatr Res 1975;12:189-198.
³² Caramelli P, Carthery-Goulart MT, Porto CS, Charchat-Fichman H, Nitrini R. Category fluency as a screening test for Alzheimer Disease in illiterate e literate patients. Alzheimer Dis Assoc Disord 2007;21:65-67.
³³ Brucki SMD, Nitrini R, Caramelli P, Bertolucci PHF, Okamoto IH. Sugestões para o uso do mini-exame do estado mental no Brasil. Arq Neuropsiquiatr 2003;61:777-781.
³⁴ Smith GE, Ivnik RJ. Normative neuropsychology. In: Petersen RC, editor. Mild Cognitive Impairment. New York: Oxford; 2003. p. 63-88.
³⁵ Verhaeghen P. Aging and vocabulary scores: a meta-analysis. Psychol Aging 2003;18:332-339.
³⁶ Brucki SM, Rocha MS. Category fluency test; effects of age, gender and education on total scores, clustering and switching in Brazilian Portuguese-speaking subjects. Braz J Med Biol Res 2004;37:1771-1777.

Publication Dates

Publication in this collection
Jan-Mar 2009

History

Received
15 Jan 2009
Accepted
27 Feb 2009

This is an open-access article distributed under the terms of the Creative Commons Attribution License

[1] ¹ Instituto Brasileiro de Geografia e Estatística (IBGE) 2006.

[2] ² Nitrini R. Epidemiologia da doença de Alzheimer no Brasil. Rev Psiquiatria Clin 1999;26:262-267.

[3] ³ Damasceno BP. Envelhecimento cerebral: o problema dos limites entre o normal e o patológico. Arch Neuropsiquiatr 1999;57:78-83.

[4] ⁴ Yaretsky A, Arzi T, Ben-Nun Y. Word fluency in aging and dementia: principles of relatedness in the generative naming process. Arch Gerontol Geriatr 1999;29:57-60.

[5] ⁵ Chan CWY, Lam LCW, Wong TCM, et al. Modified Card Sorting Test Performance among Community Dwelling Elderly Chinese People. Hong Kong J Psychiatry 2003;13:2-7.

[6] ⁶ Caffarra P, Vezzadini G, Dieci F, Zonato F, Venneri A. Modified Card Sorting Test: Normative Data. J Clin Exp Neuropsychol 2004;26:246-250.

[7] ⁷ Traykov L, Raoux N, Latour F, et al. Executive functions deficit in mild cognitive impairment. Cogn Behav Neurol. 2007;20:219-24

[8] ⁸ Nutter-Upham KE, Saykin AJ, Rabin LA, et al. Verbal fluency performance in amnestic MCI and older adults with cognitive complaints. Arch Clin Neuropsychol. 2008;23:229-241.

[9] ⁹ Foos PW. Adult age differences in working memory. Psychol Aging 1989;4:269-275.

[10] ¹⁰ Budson AE, Price BH. Memory dysfunction. N Engl J Med. 2005; 352:692-699.

[11] ¹¹ Fisk JE, Warr P. Age and work memory: the role of perceptual speed, the central executive, and the phonological loop. Psychol Aging 1996;11:316-323.

[12] ¹² Duke LM, Kaszniak AW. Executive control functions in degenerative dementias: a comparative review. Neuropsychol Rev 2000;10:75-99.

[13] ¹³ Lamar M, Zonderman AB, Resnick S. Contribution of specific cognitive processes to executive functioning in an aging population.Contribution of specific cognitive processes to executive functioning in an aging population. Neuropsychology 2002;16:156-162.

[14] ¹⁴ Mcneil J, Goldstein LH. Clinical Neuropsychology: A Practical Guide to Assessment and Management for Clinicians.1st ed. London: J Wiley Professional; 2003.

[15] ¹⁵ Kipps CM, Hodges JR. Cognitive assessment for clinicians. J Neurol Neurosurg Psychiatry. 2005;76(Suppl 1):i22-30

[16] ¹⁶ Nitrini R, Caramelli P, Bottino CMC, Damasceno BP, Brucki SMD, Anghinah R. Diagnóstico de doença de Alzheimer no Brasil: critérios diagnósticos e exames complementares. Recomendações do Departamento Científico de Neurologia Cognitiva e do Envelhecimento da Academia Brasileira de Neurologia. Arq Neuropsiquiatr 2005;63:713-719.

[17] ¹⁷ Alvarez JA, Emory E. Executive function and the frontal lobes: a meta-analytic review. Neuropsychol Rev 2006;16:17-42.

[18] ¹⁸ Spreen O, Strauss E. Compendium of Neuropsychological Tests, Administration, Norms and Commentary. Oxford: Oxford University Press; 1998.

[19] ¹⁹ Lezak M. Neuropsychological Assessment. New York: Oxford University Press; 1995.

[20] ²⁰ Benton AL, Hamsher K, Sivan AB. Multilingual Aphasia Examination. 3rd ed. San Antonio: Psychological Corporation; 1994.

[21] ²¹ Vilkki J, Holst P. Speed and flexibility on word fluency tasks after focal brain lesions. Neuropsychologia 1994;32:1257-1262.

[22] ²² Ruff RM, Light RH, Parker SB, Levin HS. The psychological construct of word fluency. Brain Lang 1997;57:394-405.

[23] ²³ Tombaugh TN, Kozak J, Rees L. Normative data stratified by age and education for two measures of verbal fluency: FAS and animal naming. Arch Clin Neuropsychol 1999;14: 167-177.

[24] ²⁴ Sarno MT, Postman WA, Cho YS, Norman RG. Evolution of phonemic word fluency performance in post-stroke aphasia. J Commun Disord 2005;38:83-107.

[25] ²⁵ Chandra V, Sharma S, Belle S, Seaberg E, Pandav R. Effects of literacy and education on measures of word fluency. Brain Lang 1998;61:115-122.

[26] ²⁶ Dursun SM, Robertson HA, Bird D, Kutcher D, Kutcher SP. Effects of ageing on prefrontal temporal cortical network function in healthy volunteers as assessed by COWA. An exploratory survey. Prog Neuropsychopharmacol Biol Psychiatry 2002;26:1007-1010.

[27] ²⁷ Buriel Y, Fombuena NG, Böhm P, Rodés E, Peña-Casanova J. Fluencia verbal - estudio normativo piloto en una muestra española de adultos jóvenes (de 20 a 49 años). Neurologia 2004;19:153-159.

[28] ²⁸ Kavé G. Phonemic fluency, semantic fluency, and difference scores: normative data for adult Hebrew speakers. J Clin Exp Neuropsychol 2005;27:690-699.

[29] ²⁹ Senhorini MC, Amaro Júnior E, de Mello Ayres A, de Simone A, Busatto GF. Phonemic fluency in Portuguese-speaking subjects in Brazil: ranking of letters. J Clin Exp Neuropsychol 2006;28:1191-1200.

[30] ³⁰ Tallberg IM, Ivachova E, Jones Tinghag K, Ostberg P. Swedish norms for word fluency tests: FAS, animals and verbs. Scand J Psychol 2008;49:479-485.

[31] ³¹ Folstein M, Folstein S, Mchugh P. Mini-mental state: a practical method for grading the cognitive state off patients for the clinician. J Psychiatr Res 1975;12:189-198.

[32] ³² Caramelli P, Carthery-Goulart MT, Porto CS, Charchat-Fichman H, Nitrini R. Category fluency as a screening test for Alzheimer Disease in illiterate e literate patients. Alzheimer Dis Assoc Disord 2007;21:65-67.

[33] ³³ Brucki SMD, Nitrini R, Caramelli P, Bertolucci PHF, Okamoto IH. Sugestões para o uso do mini-exame do estado mental no Brasil. Arq Neuropsiquiatr 2003;61:777-781.

[34] ³⁴ Smith GE, Ivnik RJ. Normative neuropsychology. In: Petersen RC, editor. Mild Cognitive Impairment. New York: Oxford; 2003. p. 63-88.

[35] ³⁵ Verhaeghen P. Aging and vocabulary scores: a meta-analysis. Psychol Aging 2003;18:332-339.

[36] ³⁶ Brucki SM, Rocha MS. Category fluency test; effects of age, gender and education on total scores, clustering and switching in Brazilian Portuguese-speaking subjects. Braz J Med Biol Res 2004;37:1771-1777.