Testing of Verbal Fluency in Egyptians: Cultural and Educational Challenges

The importance of verbal fluency tasks as a cornerstone in cognitive assessment is now well acknowledged, as they provide fast, reliable tools for assessment of both verbal and executive function abilities.

To investigate the effect of age and education on verbal fluency and to develop a verbal fluency task that is culture-oriented and non-education-based to overcome the problem of illiteracy in Egypt.

Two groups of participants were recruited, a normal cognition control group (n=79) and a clinically demented group (n=32). Phonemic verbal fluency was tested by asking participants to generate as many words as they could think of starting with the Arabic letter Haa; category fluency was evaluated using four semantic categories (animals, fruits, vegetables, and names).

Animal, vegetable, and name fluency tasks (unlike phonemic fluency and fruit) were not related to age and education, and they had better criterion validity (area under the receiver operating characteristic curve [AUC]=0.96, 0.91, and 0.92, respectively) than did letters and fruits (AUC=0.74 and 0.86, respectively). Our suggested cutoff points are 11 for the animal fluency task (sensitivity=94%, specificity=93%), 11 for vegetables (sensitivity=84%, specificity=88%), and 18 for names (sensitivity=91%, specificity=82%).

Animals, vegetables, and names are reliable and appropriate categories to be used for culture-oriented and non-education-based verbal fluency tests.