HSE Researchers Propose New Method of Verbal Fluency Analysis for Early Detection of Cognitive Impairment
Researchers from the HSE Center for Language and Brain and the Mental Health Research Centre have proposed a new method of linguistic analysis that enables the distinction between normal and pathological ageing. Using this approach, they showed that patterns in patients’ word choices during verbal fluency tests allow clinicians to more accurately differentiate clinically significant impairments from subjective memory complaints. Incorporating this type of analysis into clinical practice could improve the accuracy of early dementia diagnosis. The results have been published in Applied Neuropsychology: Adult.
As people age, many begin to complain of declining memory and attention, but these symptoms do not always indicate the onset of dementia. One of the main tasks of clinicians and neuropsychologists is to identify objective cognitive impairments as early as possible, as they may serve as markers of serious conditions such as Alzheimer’s disease. One of the simplest and most widely used tools in clinical practice for assessing cognitive functioning is the verbal fluency test, in which a person is asked to name as many words as possible from a given category—such as animals or fruits—or words beginning with a specific letter within a one-minute time frame.
Traditionally, verbal fluency tests assess only the total number of correctly named words. However, a team of researchers from HSE University suggests that the key to more accurate diagnosis lies not in the number of words but in the structure of the response—specifically, in how a person organises the search for words in their memory.
In the study, 127 participants over the age of 50—either reporting subjective cognitive decline (SCD), such as memory loss, or already showing objectively detectable but still mild cognitive impairment (MCI)—completed phonemic and semantic verbal fluency tests. In the phonemic fluency task, participants were asked to name as many words as possible beginning with a given letter within a limited time, while in the semantic fluency task, they were asked to produce words belonging to a specific semantic category. The researchers then analysed the responses to determine how the ways participants organised the words were related to their cognitive status.
The researchers identified clusters in the participants’ responses based on how individuals grouped the words. For example, participants might generate a semantic cluster such as 'tiger, lion, leopard' (animals from the cat family), or a phonemic cluster such as ‘carrot, cabbage, capibara,' which share similar initial sounds.
Ekaterina Rodionova
'We were interested in whether analysing the subtle semantic and phonetic clusters could help better predict the cognitive status of an older adult. After all, the process of searching for words is a complex cognitive operation that requires coordinated work of language functions, planning, memory, and cognitive control,' explains study author Ekaterina Rodionova, Research Assistant at the HSE Center for Language and Brain.
It was found that the larger the mean phonetic cluster size—that is, the longer the sequences of words with similar sounds—the better the overall cognitive functioning of the study participants.
Svetlana Malyutina
'When a person produces words in writing while more actively grouping those with similar sounds into a cluster before switching to another, it indicates that cognitive functions are well preserved. For example, in a semantic fluency task, the sequence "cat, bat, rat, cow, sow" (five words forming two phonetic clusters) is preferable to "cow, elephant, mole, mouse, capybara" (also five words, but without a clear phonetic cluster),' comments study author Svetlana Malyutina, Deputy Director of the HSE Center for Language and Brain.
Moreover, this pattern was observed in both phonemic and semantic fluency tasks: participants with better-preserved cognitive functions also produced longer sequences of phonetically related words.
Nikita Cherkasov
'Our findings show that by observing how a person produces words, it is possible to distinguish clinically significant impairments from subjective memory complaints more accurately. Incorporating this type of analysis into clinical practice and screening studies could improve the accuracy of early dementia risk profiling, which is crucial for timely intervention,' says study author Nikita Cherkasov, Junior Research Fellow at the HSE Center for Language and the Mental Health Research Centre.
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