Language in Alzheimer's Disease
J Clin Psychiatry 2008;69(8):1223-1227
© Copyright 2014 Physicians Postgraduate Press, Inc.
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Objective: To ascertain the clinical utility
of language examination by psychiatrists in
evaluating Alzheimer's disease (AD) patients.
Method: Data collected between 1986
and 2003 from a standardized psychiatric examination and neuropsychological testing of
probable AD patients (diagnosed according to the
criteria of the National Institute of Neurological
and Communicative Disorders and Stroke and the Alzheimer's Disease and Related Disorders
Association) were gathered from the database of
the University of Texas Southwestern Alzheimer's Disease Center, Dallas. The variables
studied were articulation, word-finding ability, hypofluency, hyperfluency, repetition,
confrontational naming, and semantic (category)
fluency. Articulation, word-finding ability,
hypofluency, hyperfluency, repetition, and
confrontational naming were rated as normal or abnormal.
Semantic fluency was scored numerically as the number of animals named in a minute.
Cognitive impairment was assessed with the
Mini-Mental State Examination (MMSE) and global
impairment by the Clinical Dementia Rating (CDR) scale.
Results: There was a significant association
(p < .0001) between MMSE and CDR scores for all language measures except hyperfluency.
The MMSE scores were higher in the group with responses rated as normal compared to those
with abnormal responses. Patients with greater
cognitive and global impairment named fewer
animals in a minute.
Conclusion: Abnormal articulation and
repetition of words were unusual and therefore would not be useful for early detection, but
when present, were associated with more advanced
disease. Impairment in fluency, animal naming, and confrontational naming were common and
increased in frequency with greater cognitive and global impairment. Because animal naming is
a numerical measure, changes in the number of animals named in a minute can be used to
monitor disease progression.