The Use of Profanity During Letter Fluency Tasks in Frontotemporal Dementia and Alzheimer Disease

UCLA Department of Neurology, Easton Center for Alzheimer's Disease Research at UCLA, Los Angeles, CA 90095-7226, USA.
Cognitive and behavioral neurology: official journal of the Society for Behavioral and Cognitive Neurology (Impact Factor: 0.95). 09/2010; 23(3):159-64. DOI: 10.1097/WNN.0b013e3181e11392
Source: PubMed


To assess whether the production of profanity during letter fluency testing distinguishes frontotemporal dementia (FTD) and Alzheimer disease (AD) patients.
Alterations in language and social behavior typify FTD spectrum disorders. Nonetheless, in can be difficult to distinguish pathologically defined frontotemporal lobar degeneration (FTLD) from AD clinically. Assessing verbal fluency by having patients generate words beginning with specific letters in a given period of time can yield diverse information of diagnostic use.
Words produced during FAS letter fluency testing were reviewed, and instances of the use of "f*ck," "*ss," and "sh*t" and other words felt to be inappropriate were sought. The frequency of these words was compared between clinically diagnosed FTD and AD patients using χ(2) tests.
We found that 6/32 (18.8%) patients with FTD generated the word "f*ck" during the "F" trial as opposed to none of 38 patients with AD (P=0.007). Patients who said "f*ck" had diagnoses of either behavioral variant FTD (3/15), progressive nonfluent aphasia (2/8), or semantic dementia (1/3).
Though the specific neuropathology in these cases is uncertain, generation of "f*ck" during letter fluency testing seems to have use in differentiating FTD from AD.

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    • "Results of comparative studies and those of imaging techniques show that some dementia types are associated with one or two language deficits. These include, for example, naming and disconnection between immune responses, language dysfunction, letter fluency, and generation of fewer words in AD (Moreno-Martinez, 2010; Han et al., 2010; Ringman et al., 2010; Moreno-Martinez & Montoro., 2010), word-finding/ language impairment in aging individuals (Calley et al., 2010), word processing deficit, anomia and garrulous speech with thematic preservation, semantic paraphasia and poor category fluencies in SD (Pulvermüller et al., 2010; Kashibayashi et al., 2010; Kertesz et al., 2010). "

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    ABSTRACT: Abstract Frontotemporal dementia (FTD) represents a spectrum of non-Alzheimer's degenerative conditions associated with focal atrophy of the frontal and/or temporal lobes. Frontal and temporal regions of the brain have been shown to be strongly involved in executive function, social cognition and language processing and, thus, deficits in these domains are frequently seen in patients with FTD or may even be hallmarks of a specific FTD subtype (i.e. relatively selective and progressive language impairment in primary progressive aphasia). In this review we have attempted to delineate how language, executive function, and social cognition may contribute to the diagnosis of FTD syndromes, namely the behavioural variant FTD as well as the language variants of FTD including the three subtypes of primary progressive aphasia (PPA): non-fluent/agrammatic, semantic and logopenic. This review also addresses the extent to which deficits in these cognitive areas contribute to the differential diagnosis of FTD versus Alzheimer's disease (AD). Finally, early clinical determinants of pathology are briefly discussed and contemporary challenges to the diagnosis of FTD are presented.
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