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Updated: Jan 23, 2026

A Machine Learning Approach to Design an Efficient Selective Screening of Mild Cognitive Impairment
Published on: January 11, 2020
Intraindividual variability in verbal fluency performance is moderated by and predictive of mild cognitive
Roee Holtzer1, Sydney Jacobs2, Eleni Demetriou2
1Department of Neurology, Albert Einstein College of Medicine, Yeshiva University.
Objective:
The current study was designed to achieve 2 primary objectives: (a) determine the moderating effect of mild cognitive impairments (MCI) on intraindividual variability in semantic and letter fluency performance taking into account longitudinal annual assessments; and (b) establish predictive utility for intraindividual variability in semantic and letter fluency performance as a risk factor of incident MCI.
Methods:
Participants were community-residing older adults (n = 514; M age = 75.89 ± 6.45; 55.1% female). Sixty participants were diagnosed with MCI at baseline and 50 developed incident MCI during the follow-up. We operationalized intraindividual variability as word generation slopes derived from 3 consecutive time intervals during the standard 1-min administration of both letter and semantic fluency tasks (i.e., 0-20 s, 21-40 s, and 41-60 s).
Results:
Linear mixed effects models revealed significant within task slope effects for semantic (estimate = -8.350; p < .0001; 95% confidence interval [CI] = -8.604, -8.095) and letter (estimate = -5.068; p < .0001; 95% CI [-5.268, -4.869]) fluency indicating that word generation declined over the course of both tasks. The two-way interactions of MCI × Slope were significant for semantic (estimate = 1.34; p = .001; 95% CI [0.551, 2.126]) and letter (estimate = 0.733; p = .020; 95% CI [0.116, 1.350]) fluency indicating attenuated slopes among MCI participants compared to controls taking into account repeated annual assessments. Cox proportional-hazards models revealed that attenuated word generation slope, at baseline, in semantic (hazard ratio [HR] = 2.063; p = .015; 95% = 1.149 to 3.702) but not letter (HR = 0.704; p = .243; 95% CI [0.391, 1.269]) fluency was associated with increased risk of incident MCI.
Conclusion:
Intraindividual variability in verbal fluency performance has clinical and predictive utility; it can be easily incorporated into testing batteries in clinical and research settings. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
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