Radanovic Marcia, Carthery-Goulart Maria Teresa, Charchat-Fichman Helenice, Herrera Emílio, Lima Edson Erasmo Pereira, Smid Jerusa, Porto Cláudia Sellitto, Nitrini Ricardo
MD, MSc, PhD in Neurology, Behavioral and Cognitive Neurology Unit, Department of Neurology, University of São Paulo School of Medicine, São Paulo, Brazil.
MSc in Neuroscience, PhD in Neurology, Behavioral and Cognitive Neurology Unit, Department of Neurology, University of São Paulo School of Medicine, São Paulo, Brazil.
Dement Neuropsychol. 2007 Jan-Mar;1(1):37-45. doi: 10.1590/S1980-57642008DN10100007.
Lexical access difficulties are frequent in normal aging and initial stages of dementia.Verbal fluency tests are valuable to detect cognitive decline, evidencing lexico-semantic and executive dysfunction.
To establish which language tests can contribute in detecting dementia and to verify schooling influence on subject performance.
74 subjects: 33 controls, 17 Clinical Dementia Rating (CDR) 0.5 and 24 (Brief Cognitive Battery - BCB e Boston Naming Test - BNT) 1 were compared in tests of semantic verbal fluency (animal and fruit), picture naming (BCB and BNT) and the language items of Mini Mental State Examination (MMSE).
There were significant differences between the control group and both CDR 0.5 and CDR 1 in all tests. Cut-off scores were: 11 and 10 for animal fluency, 8 for fruit fluency (in both), 8 and 9 for BCB naming. The CDR 0.5 group performed better than the CDR 1 group only in animal fluency. Stepwise multiple regression revealed fruit fluency, animal fluency and BCB naming as the best discriminators between patients and controls (specificity: 93.8%; sensitivity: 91.3%). In controls, comparison between illiterates and literates evidenced schooling influence in all tests, except for fruit fluency and BCB naming. In patients with dementia, only fruit fluency was uninfluenced by schooling.
The combination of verbal fluency tests in two semantic categories along with a simple picture naming test is highly sensitive in detecting cognitive decline. Comparison between literate and illiterate subjects shows a lesser degree of influence of schooling on the selected tests, thus improving discrimination between low performance and incipient cognitive decline.
词汇通达困难在正常衰老和痴呆症初期很常见。语言流畅性测试对于检测认知衰退很有价值，可证明词汇语义和执行功能障碍。
确定哪些语言测试有助于检测痴呆症，并验证受教育程度对受试者表现的影响。
比较74名受试者：33名对照组、17名临床痴呆评定量表（CDR）评分为0.5的患者以及24名（简易认知成套测验 - BCB和波士顿命名测验 - BNT）评分为1的患者，进行语义语言流畅性测试（动物和水果）、图片命名测试（BCB和BNT）以及简易精神状态检查表（MMSE）的语言项目测试。
在所有测试中，对照组与CDR评分为0.5和1的两组之间均存在显著差异。临界值分别为：动物流畅性测试为11和10，水果流畅性测试为8（两者皆是），BCB命名测试为8和9。CDR评分为0.5的组仅在动物流畅性测试中表现优于CDR评分为1的组。逐步多元回归显示，水果流畅性、动物流畅性和BCB命名是区分患者和对照组的最佳指标（特异性：93.8%；敏感性：91.3%）。在对照组中，文盲和有文化者之间的比较表明，除水果流畅性和BCB命名测试外，受教育程度对所有测试均有影响。在痴呆症患者中，只有水果流畅性测试不受受教育程度的影响。
两个语义类别的语言流畅性测试与简单的图片命名测试相结合，在检测认知衰退方面具有高度敏感性。有文化和文盲受试者之间的比较表明，受教育程度对所选测试的影响较小，从而提高了对低表现和早期认知衰退的区分度。
