Norms for Letter and Category Fluency: Demographic Corrections for Age, Education, and Ethnicity

Letter and category fluency tasks are used to assess semantic knowledge, retrieval ability, and executive functioning. They appear to be useful in detecting different types of dementia, but accurate detection of neuropsychological impairment relies on appropriate normative data. Multiple regression analysis was used to develop demographically corrected norms for letter and category fluency in 768 normal adults. T-score equations were developed on a base subsample of 403, and crossvalidated on a separate subsample (n = 365). Participants ranged in age from 20 years to 101 years; in educational level from 0 to 20 years; 55% were Caucasian and 45% were African American. Together, age, education, and ethnicity were significant predictors of letter and category fluency performance, accounting for 15% and 25% of variance, respectively. Formulas and tables for converting raw fluency scores to demographically corrected T scores are presented.

[1]  Lewis R. Goldberg,et al.  Man versus model of man: A rationale, plus some evidence, for a method of improving on clinical inferences. , 1970 .

[2]  C. Zalewski,et al.  The relationship between ethnicity and word fluency. , 1998, Archives of clinical neuropsychology : the official journal of the National Academy of Neuropsychologists.

[3]  J. Reddon,et al.  Normative data stratified by age and sex for 12 neuropsychological tests , 1986 .

[4]  Peter Brugger,et al.  A comparison of category and letter fluency in Alzheimer's disease and Huntington's disease. , 1994 .

[5]  L. Squire,et al.  Cognitive impairment following frontal lobe damage and its relevance to human amnesia. , 1989 .

[6]  H. Levin,et al.  Benton Controlled Oral Word Association Test: reliability and updated norms. , 1996, Archives of clinical neuropsychology : the official journal of the National Academy of Neuropsychologists.

[7]  C. Reynolds,et al.  Handbook of Cross-Cultural Neuropsychology , 2000, Critical Issues in Neuropsychology.

[8]  A. Anastasi.  Psychological testing, 6th ed. , 1988 .

[9]  N Butters,et al.  Comparisons of verbal fluency tasks in the detection of dementia of the Alzheimer type. , 1992, Archives of neurology.

[10]  T. Tombaugh,et al.  Normative data stratified by age and education for two measures of verbal fluency: FAS and animal naming. , 1999, Archives of clinical neuropsychology : the official journal of the National Academy of Neuropsychologists.

[11]  M. Crossley,et al.  Letter and category fluency in community-dwelling Canadian seniors: a comparison of normal participants to those with dementia of the Alzheimer or vascular type. , 1997, Journal of clinical and experimental neuropsychology.

[12]  J. Suhr,et al.  Letter and semantic fluency in Alzheimer's, Huntington's, and Parkinson's dementias. , 1998, Archives of clinical neuropsychology : the official journal of the National Academy of Neuropsychologists.

[13]  D. Stuss,et al.  The effects of focal anterior and posterior brain lesions on verbal fluency , 1998, Journal of the International Neuropsychological Society.

[14]  O. Spreen,et al.  A Compendium of Neuropsychological Tests: Administration, Norms, and Commentary , 1991 .

[15]  D. Salmon,et al.  A comparison of the category fluency deficits associated with Alzheimer's and Huntington's disease , 1989, Brain and Language.

[16]  O. Gureje,et al.  Effects of age, education, and gender on CERAD neuropsychological test performance in an African American sample , 1996 .

[17]  Alex Martin,et al.  Word production and comprehension in Alzheimer's diseáse: The breakdown of semantic knowledge , 1983, Brain and Language.

[18]  M. Bleecker,et al.  Predictors of verbal fluency (FAS) in the healthy elderly. , 1990, Journal of clinical psychology.

[19]  E. Tangalos,et al.  Neuropsychological tests' norms above age 55: COWAT, BNT, MAE token, WRAT-R reading, AMNART, STROOP, TMT, and JLO , 1996 .

[20]  R. Heaton,et al.  Cross-Cultural Applications of the Halstead-Reitan Batteries , 2000 .

[21]  C. Cullum,et al.  Generative naming in normal aging: Total output and qualitative changes using phonemic and semantic constraints , 1995 .

[22]  G. K. Henry,et al.  Verbal fluency task equivalence , 1996 .

[23]  F. Darley.  Evaluation of appraisal techniques in speech and language pathology , 1979 .

[24]  A. Kaufman,et al.  Sex, race, residence, region, and education differences on the 11 WAIS-R subtests. , 1988, Journal of clinical psychology.

[25]  R. J. Roberts,et al.  Effects of minority status on facial recognition and naming performance. , 1984, Journal of clinical psychology.

[26]  N Butters,et al.  Episodic and semantic memory: a comparison of amnesic and demented patients. , 1987, Journal of clinical and experimental neuropsychology.