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. 2024 Aug;45(8):3767-3774.
doi: 10.1007/s10072-024-07436-5. Epub 2024 Mar 11.

Psychometrics and diagnostics of the Italian version of the Alternate Verbal Fluency Battery (AVFB) in non-demented Parkinson's disease patients

Edoardo Nicolò Aiello  1 , Francesca Mameli  2 , Fabiana Ruggiero  2 , Eleonora Zirone  2 , Stefano Zago  2 , Sylvie Piacentini  3 , Barbara Poletti  1   4 , Maria Rita Reitano  5 , Gabriella Santangelo  6 , Nicola Ticozzi  1   7 , Vincenzo Silani  1   7 , Alberto Priori  5   8 , Roberta Ferrucci  9   10
Affiliations

Psychometrics and diagnostics of the Italian version of the Alternate Verbal Fluency Battery (AVFB) in non-demented Parkinson's disease patients

Edoardo Nicolò Aiello et al. Neurol Sci. 2024 Aug.

Abstract

Background: Verbal fluency (VF) tasks are known as suitable for detecting cognitive impairment (CI) in Parkinson's disease (PD). This study thus aimed to evaluate the psychometrics and diagnostics of the Alternate Verbal Fluency Battery (AVFB) by Costa et al. (2014) in an Italian cohort of non-demented PD patients, as well as to derive disease-specific cut-offs for it.

Methods: N = 192 non-demented PD patients were screened with the Montreal Cognitive Assessment (MoCA) and underwent the AVFB-which includes phonemic, semantic and alternate VF tests (PVF; SVF; AVF), as well as a Composite Shifting Index (CSI) reflecting the "cost" of shifting from a single- to a double-cued VF task. Construct validity and diagnostics were assessed for each AVFB measure against the MoCA. Internal reliability and factorial validity were also tested.

Results: The MoCA proved to be strongly associated with PVF, SVF and AVF scores, whilst moderately with the CSI. The AVFB was internally consistent and underpinned by a single component; however, an improvement in both internal reliability and fit to its factorial structure was observed when dropping the CSI. Demographically adjusted scores on PVF, SVF and AVF tests were diagnostically sound in detecting MoCA-defined cognitive impairment, whilst this was not true for the CSI. Disease-specific cut-offs for PVF, SVF and AVF tests were derived.

Discussion: In conclusion, PVF, SVF and AVF tests are reliable, valid and diagnostically sound instruments to detect cognitive impairment in non-demented PD patients and are therefore recommended for use in clinical practice and research.

Keywords: Cognitive impairment; Language; Executive; Neuropsychology; Parkinson’s disease; Verbal fluency.

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Conflict of interest statement

V. S. received compensation for consulting services and/or speaking activities from AveXis, Cytokinetics, Italfarmaco, Liquidweb S.r.l., Novartis Pharma AG and Zambon and receives or has received research supports from the Italian Ministry of Health, AriSLA and E-Rare Joint Transnational Call. He is in the Editorial Board of Amyotrophic Lateral Sclerosis and Frontotemporal Degeneration, European Neurology, American Journal of Neurodegenerative Diseases, Frontiers in Neurology and Exploration of Neuroprotective Therapy. B.P. received compensation for consulting services and/or speaking activities from Liquidweb S.r.l. B.P is the Associated Editor for Frontiers in Neuroscience. N. T. received compensation for consulting services from Amylyx Pharmaceuticals and Zambon Biotech SA. He is the Associate Editor for Frontiers in Aging Neuroscience.

Figures

Fig. 1
Fig. 1
ROC curves for demographically adjusted AVFB measures. ROC, receiver-operating characteristics; AVFB, Alternate Verbal Fluency Battery; PVF, Phonemic Verbal Fluency; SVF, Semantic Verbal Fluency; AVF, Alternate Verbal Fluency; CSI, Composite Shifting Index. PVF: AUC = 0.91; SE = 0.03; CI 95% [0.84, 0.97]; SVF: AUC = 0.85; SE = 0.05; CI 95% [0.75, 0.94]; AVF: AUC = 0.84; SE = 0.04; CI 95% [0.76, 0.92]; CSI: AUC = 0.58; SE = 0.11; CI 95% [0.37, 0.79]. AVFB measures were demographically adjusted according to Costa et al. [41]
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