Understanding Verbal Fluency in Healthy Aging, Alzheimer's Disease, and Parkinson's Disease

Joan McDowd, Lesa Hoffman, Ellen Rozek, Kelly E. Lyons, Rajesh Pahwa, Jeffrey Burns, Susan Kemper

Research output: Contribution to journalArticlepeer-review

161 Scopus citations


Verbal fluency measures are frequently part of batteries designed to assess executive function (EF), but are also used to assess semantic processing ability or word knowledge. The goal of the present study was to identify the cognitive components underlying fluency performance. Method: Healthy young and older adults, adults with Parkinson's disease, and adults with Alzheimer's disease performed letter, category, and action fluency tests. Performance was assessed in terms of number of items generated, clustering, and the time course of output. A series of neuropsychological assessments were also administered to index verbal ability, working memory, EF, and processing speed as correlates of fluency performance. Results: Findings indicated that regardless of the particular performance measure, young adults performed the best and adults with Alzheimer's disease performed most poorly, with healthy older adults and adults with Parkinson's disease performing at intermediate levels. The exception was the action fluency task, where adults with Parkinson's disease performed most poorly. The time course of fluency performance was characterized in terms of slope and intercept parameters and related to neuropsychological constructs. Speed of processing was found to be the best predictor of performance, rather than the efficiency of EF or semantic knowledge. Conclusions: Together, these findings demonstrate that the pattern of fluency performance looks generally the same regardless of how performance is measured. In addition, the primary role of processing speed in performance suggests that the use of fluency tasks as measures of EF or verbal ability warrants reexamination.

Original languageEnglish (US)
Pages (from-to)210-225
Number of pages16
Issue number2
StatePublished - Mar 2011
Externally publishedYes


  • AD
  • Aging and verbal fluency
  • Measuring fluency
  • PD

ASJC Scopus subject areas

  • Neuropsychology and Physiological Psychology


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