Journal of the International Neuropsychological Society

Executive function asymmetry in older adults genetically at-risk for Alzheimer's disease: Verbal versus design fluency

WES S.  HOUSTON  a1 c1 , DEAN C.  DELIS  a2 a3 , AMY  LANSING  a3 , MARK W.  JACOBSON  a2 a3 , KRYSTAL R.  COBELL  a2 , DAVID P.  SALMON  a4 and MARK W.  BONDI  a2 a3
a1 University of Iowa, Department of Neurology, Division of Cognitive Neuroscience, Iowa City, Iowa
a2 VA San Diego Healthcare System, San Diego, California
a3 University of California, San Diego, School of Medicine, Department of Psychiatry, San Diego, California
a4 University of California, San Diego, School of Medicine, Department of Neurosciences, San Diego, California

Article author query
houston ws   [PubMed][Google Scholar] 
delis dc   [PubMed][Google Scholar] 
lansing a   [PubMed][Google Scholar] 
jacobson mw   [PubMed][Google Scholar] 
cobell kr   [PubMed][Google Scholar] 
salmon dp   [PubMed][Google Scholar] 
bondi mw   [PubMed][Google Scholar] 


Recent studies have reported cognitive asymmetries in patients with Alzheimer's disease (AD) and in individuals with apolipoprotein E [varepsilon]4 (APOE [varepsilon]4) genotype who are in the preclinical phase of AD. This increased frequency of cognitive asymmetry, typically defined as a significant discrepancy (in either direction) between verbal and spatial abilities, often occurs despite an absence of differences on traditional measures of central tendency (i.e., mean test scores). We prospectively studied the relationship between APOE genotype and two modality-specific executive-function tasks: The Verbal Fluency and Design Fluency tests of the Delis-Kaplan Executive Function System (D-KEFS) in 52 normal functioning older adult participants who were grouped according to the presence (n = 24) or absence (n = 28) of the APOE [varepsilon]4 allele. Nondemented older adults with the APOE [varepsilon]4 allele demonstrated a greater frequency of cognitive asymmetric profile on the new switching conditions of the Verbal and Design Fluency measures than the APOE non-[varepsilon]4 individuals. This study further supports the utility of assessing cognitive asymmetry for the detection of subtle cognitive differences in individuals at-risk for AD, and suggests that dual-task executive function tests (i.e., fluency plus switching) may serve as a useful preclinical marker of AD. (JINS, 2005, 11, 863–870.)

(Received June 17 2004)
(Revised August 15 2005)
(Accepted August 15 2005)

Key Words: Neuropsychology; APOE; Cognitive discrepancy; Aging; Preclinical; Normal.

c1 Address correspondence to: Wes S. Houston, Ph.D., University of Iowa Hospitals and Clinics, Department of Neurology, 200 Hawkins Drive, 2007 RCP, Iowa City, Iowa 52242-1053. E-mail:

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