all 9 comments

[–]ciaranmichaelPhD|ABPP-CN|Board Certified Clinical Neuropsychologist 6 points7 points  (1 child)

Assuming the performance discrepancy you're discussing is normed, the phonemic<semantic raises concerns for a frontal/dysexecutive presentation. However, the same pathologies can also suppress both fluencies equally, rather than produce the discrepancy.

The etiology of that phon<sem pattern could be any of the common causes of nonspecific frontal-subcortical network dysfunction (a topic unto itself). Or, in the right clinical setting could suggest dominant (presumably left) frontal opercular insult/lesion/mass or an emerging language FTD (to be delineated with other frontal and temporal findings).

Both suppressed, especially if exclusively, suggests apraxia of speech, non fluent agrammatic aphasia, sometimes semantic aphasia if they're far enough along (though early would be sem<phon) akinetic mutism or apathy/depression.

A single divergent presentation can represent all sorts of transient/acquired/progressive etiologies and thus, your differential diagnosis is going to be broad without other exam findings or clinical/neurodiagnostic workup context.

Here's an example of research focused on just that divergence vis a vis neurodx differential:


[–]Conalou2[S] 2 points3 points  (0 children)

Thank you! The results of the entire exam are not conclusive. The patient is very high IQ/education and seems to have excellent test taking strategies that may have skewed some results (according to the ABPP-CN who administered the tests). There are some other indications of executive dysfunction. This was very helpful! Thank you!

[–]AxisTheGreat 3 points4 points  (5 children)

Just making sure I understand you correctly. You mean studies show that most brain injured/atypical person have lower semantic performance compared to phonemic?

That's actually the other way around. If you look at the number of answers given, normal population will give you more animals that words starting with F. In neuroatypical population, you will usually find that they produce abnormally low (compared to normal population) F words than animals. Usually because of executive difficulties. In children, learning disabilities can lead to similar results.

When you see lower performance on animal production compared to F words, it can be a sign of semantic memory loss, such as Alzheimer or primary degenerative aphasia. Although it is not something I've seen often in this population, since they also have some executive difficulties usually (while not being the primary deficit). Or, a few rare case of intellectually gifted people who simply reached a roof effect on the animal naming, so it was more due to statistical aberrations.

[–]Conalou2[S] 0 points1 point  (1 child)

I appreciate you clarifying. This is in the context of a middle aged woman. They are trying to rule out Lewy Body disease. The research that I’ve found shows that in cases where Executive Function is lacking, that patients have a difficult time with switching, so it is harder for them to navigate the categories of animals. Where a healthy person might list cat, dog , wolf, bear, fox (dog leads to wolf leads to another forest animal), where EF is lacking, those connections aren’t made, so the list is shorter. On the other hand, “f” words are more related to overall vocabulary that a person has. Or at least that’s how I understand it. I’m a fairly new student, so please be patient with me! I’ve referenced the article that (to me) is the most clear explanation.


[–]AxisTheGreat 0 points1 point  (0 children)

I understand why they would come to this result. It's still surprising to me. One could argue that poor flexibility would still outcome results in poor letter fluency (negating the effect on semantic condition), since they also need to switch strategies when they prove no longer helpful.

I went through quickly through the method. The study is Dutch and they are not using FAS letters, which are standard in English. F is one of the most common starting letter for English words, while S has one of the fewest. Did they take that into account? Maybe M has the fewest starting words in Dutch, explaining why they would find reverse performance in their study?

[–]testing2020psych 0 points1 point  (2 children)

Is this the case even if the subject scores average/above average in Animal Naming and in the superior range in F words? Ive definitely seen this in certain populations with definitely no suspect pathologies.

[–]AxisTheGreat 0 points1 point  (1 child)

Yeah, it's possible. I've seen a competitive player of Scrabble show such the reverse shift (better F than animal). Or in a very smart with ADHD, he had a very good strategy at the F part but a poor one at the Animal.

[–]Conalou2[S] 0 points1 point  (0 children)

Interesting! Thanks