Letter and Category Fluency: Normative Data for Lebanese Older Adults

Article type: Research Article

Authors: El-Hayeck, Rita^{a; k; *} | Wehbé, Amine^{a; k} | Baddoura, Rafic^{b; k} | Khoury, Rita^{c; d} | Bassil, Nazem^e | Abou Khaled, Karine^{f; k} | Koussa, Salam^{g; k} | Richa, Sami^{h; k} | Alameddine, Abbasⁱ | Sellal, François^j

Affiliations: [a] Department of Geriatrics, Saint Joseph University School of Medicine, Beirut, Lebanon | [b] Department of Epidemiology and Public Health, Saint Joseph University School of Medicine, Beirut, Lebanon | [c] Department of Psychiatry, American University of Beirut, Faculty of Medicine & The Medical Center, Beirut, Lebanon | [d] Department of Psychiatry and Behavioral Neuroscience, Saint Louis University School of Medicine, MO, USA | [e] Department of Internal Medicine, Division of Geriatric Medicine, American University of Beirut, Lebanon | [f] Department of Neurology, Saint Joseph University School of Medicine, Beirut, Lebanon | [g] Department of Neurology, Lebanese University, Lebanese Hospital Geitaoui - UMC, Beirut, Lebanon | [h] Department of Psychiatry, Saint Joseph University School of Medicine, Beirut, Lebanon | [i] Department of Psychiatry, Hôtel-Dieu de France Hospital, Beirut, Lebanon | [j] Department of Neurology, Hôpitaux Civils de Colmar and INSERM U-1118, School of Medicine, Strasbourg University, Strasbourg, France | [k] Working Group on Dementia at Saint Joseph University: Groupe de Travail sur les Démences de l’USJ (GTD-USJ), Saint Joseph University, Beirut, Lebanon

Correspondence: [*] Correspondence to: Rita El-Hayeck M.D., Department of Geriatrics, School of Medicine, Saint Joseph University of Beirut, B.P.11.5076 Riad El Solh, Beirut, Lebanon. Tel.: +961 3263603;E-mails: [email protected] and [email protected].

Abstract: Background:Verbal fluency tasks are frequently used for neuropsychological assessment in clinical practice and research. It consists of two tasks namely category and letter fluency tests. Objective:To determine normative values in category (animals, vegetables, fruits) and letter fluency [Mim () “M”, Alif () “A”, Baa () “B”] tasks in Arabic language in 60 s. Methods:This study was a cross-sectional national survey and included 859 community-dwelling, cognitively intact Lebanese residents aged ≥55 years. Norms were presented according to age (55–64 years, 65–74 years, ≥75 years), sex and level of education (illiterate, no diploma, primary certificate, baccalaureate or higher). Results:Level of education had the most significant positive effect on verbal fluency tasks performance amongst Lebanese older adults. The negative effect of older age was more prominent in the category fluency task compared to the letter fluency task. Women outperformed men in vegetables and fruits categories. Conclusion:This study provides clinicians with normative scores of category and letter fluency tests, which can be used for neuropsychological assessment of older Lebanese patients being evaluated for cognitive disorders.

Keywords: Cognitive aging, dementia, language tests, Lebanon, neuropsychological tests, reference standards

DOI: 10.3233/JAD-221121

Journal: Journal of Alzheimer's Disease, vol. 93, no. 1, pp. 321-332, 2023