The role of language ability in verbal fluency of individuals with multiple sclerosis

•Language ability is a significant predictor of verbal fluency in multiple sclerosis.•Executive function did not predict verbal fluency in multiple sclerosis.•Impaired verbal fluency in multiple sclerosis may reflect impaired language.•Language in multiple sclerosis should be more extensively evaluated. While cognitive deficits in memory and processing speed have been well-documented in individuals with multiple sclerosis (MS), language is largely considered to be intact. Verbal fluency deficits observed in MS are often attributed to impaired processing speed and executive functions rather than language ability. The current study evaluates the contribution of various cognitive factors to verbal fluency including language ability, oral-motor speed, processing speed, and executive functions. We analyzed pre-existing data from seventy-four (74) individuals with MS who completed a battery of neuropsychological tests designed to assess individual ability for various cognitive factors. We conducted linear multiple regression analyses with letter and category verbal fluency as outcome variables and performance on other cognitive domains (e.g., processing speed, executive functioning) as predictors. Both vocabulary and processing speed predicted letter fluency while only vocabulary predicted category fluency. These findings suggest that the observed verbal fluency deficits in MS may reflect both impaired language ability and processing speed. We propose that further research on language ability in MS is needed to determine if comprehensive neuropsychological test batteries for persons with MS should include tests of language ability to fully understand the cognitive profile of any given patient. Given the importance of language ability, it may be necessary to conduct a more thorough assessment of language in individuals with MS who experience a deficit in this domain.