Verbal Fluency Predicts Mortality in Alzheimer Disease
Open accessAbstract
OBJECTIVES: To assess the predictive value of neuropsychologic profiles, at diagnosis, for mortality in incident Alzheimer disease (AD). BACKGROUND: Rate of AD progression varies significantly across individuals for reasons that are not well understood. Several studies have linked rapid decline with disproportionately impaired executive functioning, presumably reflecting greater impairment of frontal networks. To the extent that differential neuropsychologic profiles reflect various neuropathologic presentations of AD, such profiles may inform survival estimates early in the disease. METHODS: Five neuropsychologic indices were used to characterize performance in 161 individuals at diagnosis of AD during a 15-year, longitudinal, primarily community-based study. RESULTS: Fifty-two percent of participants reached the mortality end point with a median survival of 5.52 years (95% confidence interval, 4.41-6.63). Cox proportional hazards analyses indicated that older age at diagnosis was associated with higher risk of mortality (risk ratios, 1.08; 95% confidence interval, 1.04-1.12) whereas Hispanic ethnicity predicted lower mortality [0.22 (0.09-0.55)]. Controlling for these 2 demographic variables, higher verbal fluency scores at diagnosis predicted lower mortality [0.69 (0.49-0.96)]. CONCLUSIONS: Disproportionate impairment of both category and letter fluency at the earliest stages of AD predicts mortality. The prognostic value of these tests may derive from their general psychometric properties, or may reflect the measures' sensitivity to an early or critical level of compromise to frontal networks.
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Declines in global cognition and executive function markedly raise the risk of death, dementia, and functional disability.
“Declines in global cognition and executive function markedly raise the risk of death, dementia, and functional disability.39,40,41”
From Sex differences in cognitive decline among US adults (2021) · cites this paper as [41]
The Results (p. 1) link lower verbal fluency at Alzheimer disease diagnosis with higher mortality, supporting part of the executive-function and death claim. But the study examined scores at diagnosis, not cognitive declines; its mortality model found no significant association for global cognition (Table 3, p. 4). It did not assess the risk of developing dementia or functional disability. (LLM, conf=0.88)
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Lexical and clinical predictors of verbal fluency interword intervals preceding cognitive impairment
Murray, O. K., Bushnell, J., Unverzagt, F. W., Gaizo, J. D., Wadley, V. G., Kennedy, R. E., Ayers, M. R., & Clark, D. G. (2026) · Neuropsychologia · doi:10.1016/j.neuropsychologia.2026.109400
Kyoda, K., Yamazaki, N., Takahashi, C., & Matsushita, I. (2026) · Qualitative Research in Communication Differences and Disorders · doi:10.3138/qrcdd-2025-0013
Semantic fluency predicts survival of memory clinic patients
Frings, L., Brumberg, J., & Meyer, P. T. (2026) · Alzheimer s Research & Therapy · doi:10.1186/s13195-026-02152-y
- Authors
- Cosentino, S., Scarmeas, N., Albert, S. M., & Stern, Y.
- Affiliations
- Columbia University Irving Medical Center (US)
- Corresponding author
- Cosentino, Stephanie
- Scarmeas, Nikolaos
- Albert, Steven M.
- Stern, Yaakov
- Venue
- Cognitive and Behavioral Neurology
- Published
- 2006-09
- Volume
- 19
- Issue
- 3
- Pages
- 123-129
- ISSN
- 1543-3633 (ISSN-L)
- PMC
- PMC2441850
- OpenAlex
- W1965951996
- Cited by
- 54
- References
- 46
- Citations by year
- 2026: 3 · 2025: 1 · 2024: 2 · 2023: 8 · 2022: 4 · 2021: 4 · 2020: 1 · 2019: 2 · 2018: 1 · 2017: 1 · 2016: 1 · 2015: 2 · 2014: 1 · 2013: 4 · 2012: 1
- FWCI
- 2.34
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Cognitive and Behavioral Neurology (publishedVersion)
- PubMed (publishedVersion)
- PubMed Central (acceptedVersion)
- Columbia Academic Commons (Columbia University)
- Funders
- American Academy of Neurology
- National Institutes of Health
- National Institute on Aging (AG00261, Z01AG000732, P01AG007232, Z01AG000261, L30 AG026603, T32AG000261)
- National Center for Research Resources (RR 00645, M01RR000645)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Health Sciences › Medicine › Physiology › Alzheimer's disease research and treatments
- Social Sciences › Psychology › Clinical Psychology › Historical and Modern Theater Studies
- Keywords
- Alzheimer's disease, mortality prediction, verbal fluency, semantic fluency, phonemic fluency, executive function, survival estimates, age at diagnosis, Hispanic origin, prognostic factors
- MeSH terms
- Aged, Aged, 80 and over, Alzheimer Disease, Analysis of Variance, Frontal Lobe, Humans, Language Disorders, Language Tests, Longitudinal Studies, Neuropsychological Tests, Phonetics, Predictive Value of Tests, Prognosis, Reference Values, Verbal Behavior, Geriatric Assessment, Proportional Hazards Models
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