The Association of Sociodemographic Factors With Total and Item-Level Semantic Fluency Metrics

Objective: We aimed to estimate the association of age, education, and sex/gender with semantic fluency performance as measured by the standard total number of words as well as novel item-level metrics and to descriptively compare associations across cohorts with different recruitment strategies and sample compositions. Method: Cross-sectional data from 2,391 individuals from three cohorts were used: Washington Heights/Inwood Columbia Aging Project, a community-based cohort; Second Manifestations of ARTerial disease-Magnetic Resonance, a clinic-based cohort; and African American Alzheimer's Disease Genetics Study, a volunteer-based cohort. Total number of correct words and six item-level semantic fluency metrics were included as main outcomes: average cluster size, number of cluster switches, lexical/Zipf frequency, age of acquisition, and lexical decision response time. General linear models were run separately in each cohort to model the association between sociodemographic variables and semantic fluency metrics. Results: Across cohorts, older age was associated with a lower total score and fewer cluster switches. Higher level of education was associated with naming more words, performing more cluster switches, and naming words with a longer lexical decision response time, lower frequency of occurrence, or later age of acquisition. Being female compared to male was associated with naming fewer words, smaller cluster sizes, naming words with a longer lexical decision response time, and lower age of acquisition. The effects varied in strength but were in a similar direction across cohorts. Conclusions: Item-level semantic fluency metrics-similar to the standard total score-are sensitive to the effects of age, education, and sex/gender. The results suggest geographical, cultural, and cross-linguistic generalizability of these sociodemographic effects on semantic fluency performance. Key Points Question: How are age, educational level, and sex/gender related to semantic fluency test performance in geographically, culturally, and linguistically diverse cohorts? Findings: Semantic fluency test performance varied in individuals with differing ages, educational level attainments, and sexes/genders in a similar manner across cohorts. Importance: Differences in age, educational level, and sex/gender need to be considered when rating semantic fluency test performance based on item-level metrics. Next Steps: Future studies are recommended to focus on creating normat