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      Age and Verbal Fluency: The Mediating Effect of Speed of Processing

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          Abstract

          Background and Purpose

          Cognitive decline is a function of normal aging; however, the effect of age on various domains is differential. This study examined the effect of age on verbal fluency and showed how speed of processing modifies fluency performance in healthy older adults compared to younger individuals.

          Methods

          Three age groups, 62 young (17–40 years), 30 middle-aged (41–59 years), and 38 older adults (60–78 years), were studied using the Controlled Oral Word Association Test, National Adult Reading Test, and speed-of-processing composite score. The study examined the effect of age on fluency before and after controlling for processing speed and intelligence quotient.

          Results

          The young group performed better than the older group on category fluency as measured by animal category ( p < .001) and on processing speed composite score ( p < .001). However, the older group performed better than the young group on the National Adult Reading Test ( p < .05) and on letter fluency after controlling for the decline in processing speed ( p < .05). Processing speed had a significant effect on both category and letter fluency ( p < .01) in older adults.

          Conclusions

          This study suggests that aging adversely affects some but not all cognitive domains and that age-related decline in processing speed contributes to age-related changes in fluency.

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          Most cited references23

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          The National Adult Reading Test as a measure of premorbid intelligence: a comparison with estimates derived from demographic variables.

          Since its publication in 1982, the National Adult Reading Test (NART; Revised Version, NART-R) has become a widely accepted method for estimating premorbid levels of intelligence in neuropsychological research. However, the assumption that NART/NART-R performance is relatively independent of brain damage has been increasingly challenged in recent years. In a number of conditions, including Alzheimer dementia and Korsakoff's syndrome, studies have indicated a deterioration in reading ability, leading to an underestimated premorbid IQ. In a reaction to these studies, some researchers have advocated the use of demographic variables as a more suitable foundation for accurately predicting premorbid intelligence. We addressed this issue by calculating IQ estimates on the basis of NART/NART-R, demographic variables, and a combination of the two approaches and by comparing these with current WAIS/WAIS-R IQ in patients with Korsakoff's syndrome, Alzheimer dementia, frontal or temporal lobe lesions, and in healthy controls. Estimated premorbid IQs did not differ across groups, whether derived from NART/NART-R or demographic variables. Those based on NART/NART-R demonstrated higher correlations with current WAIS/WAIS-R IQ in controls and patients than those derived from demographic variables. An equation combining NART scores with demographic variables did not significantly increase the amount of variance in IQ explained by NART only, either in patients or controls. The data offer reassurance regarding the continued use of NART as a valid estimate of premorbid intelligence in a number of conditions.
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            Increase in periventricular white matter hyperintensities parallels decline in mental processing speed in a non-demented elderly population.

            To investigate the influence of deep white matter hyperintensities (DWMH) and periventricular white matter hyperintensities (PVWMH) on progression of cognitive decline in non-demented elderly people. All data come from the nested MRI sub-study of the PROspective Study of Pravastatin in the Elderly at Risk (PROSPER). We performed a 3 year follow up study on 554 subjects of the PROSPER study using both repeated magnetic resonance imaging and cognitive testing. Cognitive decline and its dependency on WMH severity was assessed using linear regression models adjusted for sex, age, education, treatment group, and test version when applicable. We found that the volume of PVWMH at baseline was longitudinally associated with reduced mental processing speed (p = 0.0075). In addition, we found that the progression in PVWMH volume paralleled the decline in mental processing speed (p = 0.024). In contrast, neither presence nor progression of DWMH was associated with change in performance on any of the cognitive tests. PVWMH should not be considered benign but probably underlie impairment in cognitive processing speed.
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              Understanding verbal fluency in healthy aging, Alzheimer's disease, and Parkinson's disease.

              Verbal fluency measures are frequently part of batteries designed to assess executive function (EF), but are also used to assess semantic processing ability or word knowledge. The goal of the present study was to identify the cognitive components underlying fluency performance. Healthy young and older adults, adults with Parkinson's disease, and adults with Alzheimer's disease performed letter, category, and action fluency tests. Performance was assessed in terms of number of items generated, clustering, and the time course of output. A series of neuropsychological assessments were also administered to index verbal ability, working memory, EF, and processing speed as correlates of fluency performance. Findings indicated that regardless of the particular performance measure, young adults performed the best and adults with Alzheimer's disease performed most poorly, with healthy older adults and adults with Parkinson's disease performing at intermediate levels. The exception was the action fluency task, where adults with Parkinson's disease performed most poorly. The time course of fluency performance was characterized in terms of slope and intercept parameters and related to neuropsychological constructs. Speed of processing was found to be the best predictor of performance, rather than the efficiency of EF or semantic knowledge. Together, these findings demonstrate that the pattern of fluency performance looks generally the same regardless of how performance is measured. In addition, the primary role of processing speed in performance suggests that the use of fluency tasks as measures of EF or verbal ability warrants reexamination. (c) 2011 APA, all rights reserved
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                Author and article information

                Journal
                Can Geriatr J
                Can Geriatr J
                CGJ
                Canadian Geriatrics Journal : CGJ
                Canadian Geriatrics Society
                1925-8348
                September 2011
                11 November 2011
                : 14
                : 3
                : 66-72
                Affiliations
                [1 ]Faculty of Applied Health Sciences, University of Waterloo, Waterloo
                [2 ]Schlegel-UW Research Institute for Aging, Kitchener, ON
                Author notes
                Correspondence to: Safa A. Elgamal, MBBCh, PhD, Faculty of Applied Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, ON N2L3G1. Email: selgamal@ 123456uwaterloo.ca
                Article
                cgj-14-3-66
                10.5770/cgj.v14i3.17
                3516352
                23251316
                dc67a7ae-c86f-49c0-a8f6-dde405b96ad7
                © 2011 Author(s). Published by the Canadian Geriatrics Society.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial No-Derivative license ( http://creativecommons.org/licenses/by-nc-nd/2.5/ca/), which permits unrestricted non-commercial use and distribution, provided the original work is properly cited.

                History
                Categories
                Original Research

                Geriatric medicine
                aging,verbal fluency,speed of processing,cognitive function,premorbid iq,verbal knowledge

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