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Comparative Study
. 2006 Sep;19(3):123-9.
doi: 10.1097/01.wnn.0000213912.87642.3d.

Verbal fluency predicts mortality in Alzheimer disease

Stephanie Cosentino  1 , Nikolaos Scarmeas, Steven M Albert, Yaakov Stern
Affiliations
Comparative Study

Verbal fluency predicts mortality in Alzheimer disease

Stephanie Cosentino et al. Cogn Behav Neurol. 2006 Sep.

Abstract

Objectives: To assess the predictive value of neuropsychologic profiles, at diagnosis, for mortality in incident Alzheimer disease (AD).

Background: Rate of AD progression varies significantly across individuals for reasons that are not well understood. Several studies have linked rapid decline with disproportionately impaired executive functioning, presumably reflecting greater impairment of frontal networks. To the extent that differential neuropsychologic profiles reflect various neuropathologic presentations of AD, such profiles may inform survival estimates early in the disease.

Methods: Five neuropsychologic indices were used to characterize performance in 161 individuals at diagnosis of AD during a 15-year, longitudinal, primarily community-based study.

Results: Fifty-two percent of participants reached the mortality end point with a median survival of 5.52 years (95% confidence interval, 4.41-6.63). Cox proportional hazards analyses indicated that older age at diagnosis was associated with higher risk of mortality (risk ratios, 1.08; 95% confidence interval, 1.04-1.12) whereas Hispanic ethnicity predicted lower mortality [0.22 (0.09-0.55)]. Controlling for these 2 demographic variables, higher verbal fluency scores at diagnosis predicted lower mortality [0.69 (0.49-0.96)].

Conclusions: Disproportionate impairment of both category and letter fluency at the earliest stages of AD predicts mortality. The prognostic value of these tests may derive from their general psychometric properties, or may reflect the measures' sensitivity to an early or critical level of compromise to frontal networks.

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Figures

Figure 1
Figure 1. Probability of Survival in Incident AD as a Function of Verbal Fluency at Diagnosis
Tertile values are reported in z-scores; Small Broken Line = 1st tertile (VF < −1.50); Solid Line = 2nd tertile (−1.50 ≤ VF < −0.91); Large Broken Line = 3rd tertile = (VF ≥ −0.91).
Figure 2
Figure 2. Neuropsychological Performance at Diagnosis in Participants with Incident AD
Solid Line = Deceased Group; Broken Line = Living Group; ME = Memory Index; AR = Abstract Reasoning Index; VS = Visuospatial Index; LA = Language Index; VF = Verbal Fluency Index.
See this image and copyright information in PMC

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