Serial Recall Order of Category Fluency Words: Exploring Its Neural Underpinnings

Background: Although performance on the category fluency test (CFT) is influenced by many cognitive functions (i.e., including language, executive functioning and speed of processing), item-level scoring methods of CFT performance might be a promising way to capture aspects of semantic memory that are less influenced by intervenient abilities. One such approach is based on the calculation of correlation coefficients that quantify the association between item-level features and the serial order with which words are recalled (SRO). Methods: We explored the neural underpinnings of 10 of these correlational indices in a sample of 40 healthy adults who completed a classic 1-min CFT and an MRI protocol inclusive of T1-weighted (analysed with voxel-based morphometry) and resting-state fMRI sequences for the evaluation of the default-mode network (DMN). Two sets of linear models were defined to test the association between neural maps and each correlational index: a first set in which major demographic and clinical descriptors were controlled for and a second set in which, additionally, all other 9 correlational indices were regressed out. Results: In the analysis of the DMN, 'SRO-frequency', 'SRO-dominance' and 'SRO-body-object interaction' correlational indices were all negatively associated with the anterior portion of the right temporoparietal junction. The 'SRO-frequency' correlational index was also negatively associated with the right dorsal anterior cingulate and the 'SRO-dominance' correlational index with the right lateral prefrontal cortex. From the second set of models, the 'SRO-typicality' correlational index was positively associated with the left entorhinal cortex. No association was found in relation to grey matter maps. Conclusion: The ability to retrieve more difficult words during CFT performance as measured by the correlational indices between SRO and item-level descriptors is associated with DMN expression in regions deputed to attentional reorienting and processing of salience of infrequent stimuli and dominance status. Of all item-level features, typicality appears to be that most closely linked with entorhinal functioning and may thus play a relevant role in assessing its value in testing procedures for early detection of subtle cognitive difficulties in people with suspected Alzheimer's degeneration. Although exploratory, these findings warrant further investigations in larger cohorts.