Understanding quantitative and qualitative figural fluency in patients with Parkinson’s disease

Neurological Sciences volume 34, pages1383–1390(2013)Cite this article

Abstract

Figural fluency refers to the ability to internally generate appropriate non-verbal behaviour. Whereas deficits in verbal fluency rank among the most prominent cognitive sequelae in Parkinson’s disease (PD), little is known about figural fluency and its assessment in PD. This is the first comprehensive comparison of the psychometric properties of figural fluency tasks in PD. PD patients (n = 22) and matched normal controls (n = 27) were compared in widely used figural fluency measures. The ability to assess PD-specific cognitive morbidity was assessed via comparison with a matched neurological sample of various aetiologies (n = 22). Construct validity was assessed by means of linear regression analyses of figural fluency measures and an extensive cognitive test battery. PD patients were impaired in all measures of figural fluency tasks. PD-specific impairments were identified regarding perseverative and strategic behaviour. Importantly, only perseverative, but not repetitive, behaviour was able to identify PD-specific cognitive morbidity. Quantitative fluency can be predicted by basic cognitive functions (e.g. visuospatial ability, visuomotor speed) as well as other measures of executive functioning. However, qualitative test scores, especially of the Five-Point Test (FPT), yield important and additional diagnostic information in PD. Qualitative test parameters of figural fluency measures, especially of the FPT, offer the unique possibility to assess PD-specific cognitive impairments in the areas of perseverative and strategic behaviour.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

US$ 39.95

Tax calculation will be finalised during checkout.

References

  1. 1.

    Aarsland D, Bronnick K, Larsen JP, Tysnes OB, Alves G, NPS G et al (2009) Cognitive impairment in incident, untreated Parkinson’s disease: The Norwegian ParkWest study. Neurology 16:1121–1126

    Article  Google Scholar 

  2. 2.

    Alexander G, DeLong MR, Strick PL (1986) Parallel organization of functionally segregated circuits linking basal ganglia and cortex. Annu Rev Neurosci 9:357–381

    PubMed  Article  CAS  Google Scholar 

  3. 3.

    Elgh E, Domellöf M, Linder J, Edström M, Stenlund H, Forsgren L (2009) Cognitive function in early Parkinson’s disease: a population-based study. Eur J Neurol 16:1278–1284

    PubMed  Article  CAS  Google Scholar 

  4. 4.

    Kehagia AA, Barker RA, Robbins TW (2010) Neuropsychological and clinical heterogeneity of cognitive impairment and dementia in patients with Parkinson’s disease. Lancet Neurol 9:1200–1213

    PubMed  Article  Google Scholar 

  5. 5.

    Odhuba RA, van den Broek MD, Johns LC (2004) Ecological validity of measures of executive functioning. Br J Clin Psychol 44(Pt 2):269–278

    Google Scholar 

  6. 6.

    Rodríguez-Ferreiro J, Cuetos F, Herrera E, Menéndez M, Ribacoba R (2010) Cognitive impairment in Parkinson’s disease without dementia. Mov Disord 25:2136–2141

    PubMed  Article  Google Scholar 

  7. 7.

    Zgaljardic DJ, Borod JC, Foldi NS, Rocco M, Mattis PJ, Gordon MF, Feigin AS, Eidelberg D (2007) Relationship between self-reported apathy and executive dysfunction in nondemented patients with Parkinson disease. Cogn Behav Neurol 20:184–192

    PubMed  Article  Google Scholar 

  8. 8.

    Kulisevsky J, Pagonabarraga J (2009) Cognitive impairment in Parkinson’s disease: tools for diagnosis and assessment. Mov Disord 24:1103–1110

    PubMed  Article  Google Scholar 

  9. 9.

    Henry JD, Crawford JR (2004) Verbal fluency deficits in Parkinson’s Disease: a meta-analysis. J Int Neuropsychol Soc 10:608–622

    PubMed  Article  Google Scholar 

  10. 10.

    Fama R, Sullivan EV, Shear PK, Cahn-Weiner DA, Yesavage JA, Tinklenberg JR, Pfefferbaum A (1998) Fluency performance patterns in Alzheimer’s disease and Parkinson’s disease. Clin Neuropsychol 12:487–499

    Article  Google Scholar 

  11. 11.

    Lezak MD, Howieson DB, Loring DW (2004) Neuropsychological assessment, 4th edn. Oxford University Press, New York

    Google Scholar 

  12. 12.

    Uc EY, Rizzo M, Anderson SW, Qian S, Rodnitzky RL, Dawson JD (2005) Visual dysfunction in Parkinson disease without dementia. Neurology 65:1907–1913

    PubMed  Article  CAS  Google Scholar 

  13. 13.

    Jones-Gotman M, Milner B (1977) Design Fluency: the invention of nonsense drawings after focal cortical lesions. Neuropsychologia 15:653–664

    PubMed  Article  CAS  Google Scholar 

  14. 14.

    Regard M, Strauss E, Knapp P (1982) Children’s production on verbal and non-verbal fluency tasks. Percept Mot Skills 55:839–844

    PubMed  Article  CAS  Google Scholar 

  15. 15.

    Ruff RM (1988) Ruff Figural Fluency Test professional manual. Psychological Assessment Resources Inc., Odessa

    Google Scholar 

  16. 16.

    Folstein MF, Folstein SE, McHugh PR (1975) “Mini-Mental-State”: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12:189–198

    PubMed  Article  CAS  Google Scholar 

  17. 17.

    First MB, Spitzer RL, Gibbon M, Williams JBW (1996) Structured clinical interview for DSM-IV axis I disorders—clinician version. American Psychiatric Press, New York

    Google Scholar 

  18. 18.

    Zigmond AS, Snaith RP (1983) The Hospital Anxiety and Depression Scale. Acta Psychiatr Scand 67:361–370

    PubMed  Article  CAS  Google Scholar 

  19. 19.

    Goldberg E (1986) Varieties of perseveration: a comparison of two taxonomies. J Clin Exp Neuropsychol 8:710–726

    PubMed  Article  CAS  Google Scholar 

  20. 20.

    Rainer G, Asaad WF, Miller EK (1998) Selective representation of relevant information by neurons in the primate prefrontal cortex. Nature 393:577–579

    PubMed  Article  CAS  Google Scholar 

  21. 21.

    Ross TP, Foard EL, Hiott FB, Vincent A (2003) The reliability of production strategy scores for the Ruff Figural Fluency Test. Arch Clin Neuropsychol 18:879–891

    PubMed  Google Scholar 

  22. 22.

    Lehrl S (1975) Mehrfachwahl-Wortschatztest MWT-B. Perimed Verlag, Erlangen

    Google Scholar 

  23. 23.

    Leonhart R (2004) Effektgrößenberechnung bei Interventionsstudien. Die Rehabil 43:241–246

    Article  CAS  Google Scholar 

  24. 24.

    Metz CE (1978) Basic principles of ROC analysis. Semin Nucl Med 8:283–298

    PubMed  Article  CAS  Google Scholar 

  25. 25.

    Suchy Y, Kraybill ML, Gidley Larson JC et al (2010) Understanding design fluency: motor and executive contributions. J Int Neuropsychol Soc 16:26–37

    PubMed  Article  Google Scholar 

  26. 26.

    Stuss DT, Alexander MP, Benson DF, Trimble MR, Cummings JL (1997) Frontal lobe functions. In: Trimble MR, Cummings JL (eds) Contemporary behavioural neurology. Butterworth-Heinemann, Woburn

    Google Scholar 

  27. 27.

    Ridley RM (1994) The psychology of perserverative and stereotyped behaviour. Prog Neurobiol 44:221–231

    PubMed  Article  CAS  Google Scholar 

  28. 28.

    dos Santos CM, Balardin JB, Irigaray TQ, Schroder N, Rieder CR, Bromberg E (2010) Incidental encoding strategies did not improve contextual memory in Parkinson’s disease patients. Neurorehabil Neural Repair 24:450–456

    PubMed  Article  Google Scholar 

  29. 29.

    Goebel S, Mehdorn HM, Leplow B (2009) Strategy instruction in Parkinson’s disease: influence on cognitive performance. Neuropsychologia 48:574–580

    PubMed  Article  Google Scholar 

  30. 30.

    Gescheidt T, Czekoova K, Urbanek T, Marecek R, Mikl M, Kubikova R, Telecka S, Andrlova H, Husarova I, Bares M (2012) Iowa Gambling Task in patients with early-onset Parkinson’s disease: strategy analysis. Neurol Sci. doi:10.1007/s10072-012-1086-x

  31. 31.

    Bloem BR, Grimbergen YA, van Dijk JG, Munneke M (2006) The “posture second” strategy: a review of wrong priorities in Parkinson’s disease. J Neurol Sci 248:196–204

    PubMed  Article  Google Scholar 

  32. 32.

    Johnson AM, Pollard CC, Vernon PA, Tomes JL, Jog MS (2005) Memory perception and strategy use in Parkinson’s disease. Parkinsonism Relat Disord 11:111–115

    PubMed  Article  Google Scholar 

  33. 33.

    Sinforiani E, Banchieri L, Zucchella C, Pacchetti C, Sandrini G (2004) Cognitive rehabilitation in Parkinson’s disease. Arch Gerontol Geriatr Suppl 9:387–391

    PubMed  Article  Google Scholar 

  34. 34.

    Reijnders JS, Ehrt U, Lousberg R, Aarsland D, Leentjens AF (2009) The association between motor subtypes and psychopathology in Parkinson’s disease. Parkinsonism Relat Disord 15:379–382

    PubMed  Article  CAS  Google Scholar 

  35. 35.

    Czernecki V, Pillon B, Houeto JL, Pochon JB, Levy R, Dubois B (2002) Motivation, reward, and Parkinson’s disease: influence of dopatherapy. Neuropsychologia 40:2257–2267

    PubMed  Article  CAS  Google Scholar 

  36. 36.

    Leplow B, Friege L (1998) Eine Sozialformel zur Schätzung der prämorbiden Intelligenz. Zeitschrift für Klinische Psychologie 27:1–8

    Google Scholar 

Download references

Conflict of interest

The authors have nothing to disclose concerning any source of financial support and funding in relation to this manuscript.

Author information

Affiliations

  1. Department of Neurosurgery, University Hospital Schleswig-Holstein, Schittenhelmstr. 10, 24105, Kiel, Germany

    Simone Goebel, Lubomir Atanassov & H. Maximilian Mehdorn

  2. Institute for Psychology, University of Kiel, Olshausenstr. 62, 24114, Kiel, Germany

    Günter Köhnken

  3. Institute for Psychology, University of Halle, Brandbergweg 23c, 06120, Halle (Saale), Germany

    Bernd Leplow

Authors
  1. Simone Goebel
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lubomir Atanassov
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Günter Köhnken
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. H. Maximilian Mehdorn
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Bernd Leplow
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Simone Goebel.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Goebel, S., Atanassov, L., Köhnken, G. et al. Understanding quantitative and qualitative figural fluency in patients with Parkinson’s disease. Neurol Sci 34, 1383–1390 (2013). https://doi.org/10.1007/s10072-012-1245-0

Download citation

Keywords

  • Figural fluency
  • Parkinson’s disease
  • Neuropsychological assessment
  • Cognition
  • Executive functioning