The use of profanity during letter fluency tasks in frontotemporal dementia and Alzheimer disease.

OBJECTIVE

To assess whether the production of profanity during letter fluency testing distinguishes frontotemporal dementia (FTD) and Alzheimer disease (AD) patients.

BACKGROUND

Alterations in language and social behavior typify FTD spectrum disorders. Nonetheless, in can be difficult to distinguish pathologically defined frontotemporal lobar degeneration (FTLD) from AD clinically. Assessing verbal fluency by having patients generate words beginning with specific letters in a given period of time can yield diverse information of diagnostic use.

METHOD

Words produced during FAS letter fluency testing were reviewed, and instances of the use of "f*ck," "ss," and "sht" and other words felt to be inappropriate were sought. The frequency of these words was compared between clinically diagnosed FTD and AD patients using χ(2) tests.

RESULTS

We found that 6/32 (18.8%) patients with FTD generated the word "fck" during the "F" trial as opposed to none of 38 patients with AD (P=0.007). Patients who said "fck" had diagnoses of either behavioral variant FTD (3/15), progressive nonfluent aphasia (2/8), or semantic dementia (1/3).

CONCLUSIONS

Though the specific neuropathology in these cases is uncertain, generation of "f*ck" during letter fluency testing seems to have use in differentiating FTD from AD.