Does verbal fluency test administration order impact performance?: Neuropsychology/early detection of cognitive decline with neuropsychological tests

Background Verbal Fluency Tests measure the ability to produce words in a given time. Semantic fluency (SF) is related to the production of words within a category and phonological fluency (PF) with words that start with the same letter 1 . These tests are frequently used in the standard neuropsychological evaluation. Age, education 2,3 and the order of administration 4,5 can affect the performance. This study aims to evaluate the impact in the order of administration on verbal fluences performance in spanish. Method Cross‐sectional analytical study.52 healthy adults participated in this study. Participants were divided into two groups (G1 and G2) matched by age (M 64.48 DS 9.37), education (M 13.21 SD 4.65), gender (F: 31 M: 17) and estimated CI level based on years of education and their performance on a word accentuation test (WAT‐R) 6 . In G1 it was applied first SF and later PF. In G2 the order of presentation was inverted. T test and Pearson correlations were calculated in SPSS statistical program. Result Two outliers were found in G1. Taking out outliers and their matches, no significant effect in the order of application was observed when comparing both groups in the SF ( t = 888 p = .379) and PF ( t = ‐1.510 p = .138). When analyzing whether the order of fluencies administration varied the performance in G1 and G2, no differences were found for gender but a correlation with education was observed (SF: r = .30 p = .037; PF: r = .60 p <.001) and age (SF: r = .40 p = .005; PF r = .32 p = .027). When making a more detailed analysis of the groups, significant effect was observed for the years of education and FP ( p = .002): the group with less than 7 years of schooling differed from groups from 8 to 12 ( p =. 012) and more than 12 years of schooling ( p =. 003). Conclusion The results suggest that the performance in verbal fluences of older adults may be influenced by normal aging and years of education. This must be taken into account when choosing standards and interpreting the results of neuropsychological tests.