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Diagnostic utility of abbreviated fluency measures in Alzheimer disease and vascular dementia

From the Cognitive Neurology Unit (Drs. Duff Canning and Black, L. Ngo), Sunnybrook and Women’s College Health Sciences Centre; Baycrest Centre for Geriatric Care (Drs. Leach and Stuss); Rotman Research Institute (Drs. Stuss and Black); and Department of Medicine (Dr. Black), University of Toronto, Ontario, Canada.

Address correspondence and reprint requests to Dr. S.E. Black, Cognitive Neurology Unit, Sunnybrook & Women’s College Health Sciences Centre, 2075 Bayview Avenue, Room A421, Toronto, ON Canada M4N 3M5; e-mail: Sandra.Black{at}sw.ca

Background: Several studies indicate semantic fluency more sensitively discriminates patients with Alzheimer disease (AD) from normal elderly persons, with disproportionate impairment of semantic over phonemic fluency.

Objective: To determine the ability of abbreviated fluency measures in the clinic setting (1-minute letter F and animal fluency tests) to detect AD, and to assess whether difference scores between these measures discriminate patients with AD and vascular dementia (VaD) from normal elderly persons.

Methods: The authors studied patients with AD (n = 98) meeting National Institute of Neurological Communicative Disorders and Stroke–Alzheimer’s Disease and Related Disorders Association criteria, VaD patients (n = 18) meeting National Institute of Neurological Disorders and Stroke–Association Internationale pour la Recherche et l’Enseignement en Neurosciences criteria, cognitively impaired but not demented patients (CIND; n = 25), vascular CIND patients (VCIND; n = 24), and normal control subjects (NCs; n = 46).

Results: Analysis of covariance controlling for age, education, and overall impairment indicated all groups generated fewer animal names compared with NCs, whereas only VaD patients generated fewer letter F words compared with NCs. On standardized scores, patients with AD and CIND, unlike those with VCIND and VaD, scored significantly worse on the animal fluency test than on the letter F fluency test. The animal fluency test was superior in discriminating all patient groups from NCs. Positive likelihood ratios (PLRs) revealed animal fluency scores <15 were 20 times more likely in a patient with AD than in an NC (sensitivity = 0.88; specificity = 0.96). Letter F scores <4 discriminated VaD from AD patients (PLR = 4.0; sensitivity = 0.44; specificity = 0.90). Difference scores <0 (i.e., fewer animal than letter F words) discriminated patients with VCIND from those with CIND (PLR = 2.5; sensitivity = 0.32; specificity = 1.00).

Conclusions: A 1-minute semantic fluency test can assist in early detection of dementia in the memory clinic setting.

Received October 31, 2002. Accepted in final form September 23, 2003.

Additional material related to this article can be found on the Neurology Web site. Go to www.neurology.org and scroll down the Table of Contents for the February 24 issue to find the title link for this article.

See also page 534

Presented in part at the 30th Annual Meeting of the International Neuropsychological Society; Toronto, Canada; February 13–16, 2002.

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