Verbal Fluency

Frontal lobe impairment can also produce deficits in a person's ability to rapidly generate words. The Controlled Oral Word Association Test (COWAT), also known as the "FAS," is a commonly used neuropsy-chological measure of verbal fluency. The COWAT consists of three word conditions. The subjects' task is to produce as many words as he can that begin with the given letter (F, A, or S) within a 1-min time period.

Subjects are also instructed to exclude proper nouns, numbers, and the same word with a different suffix.

The COWAT and other measures of verbal fluency have proven to be sensitive indicators of frontal lobe dysfunction. In 1989, Jerry Janowsky, Arthur Shima-mura, and Larry Squire found that patients with circumscribed left or bilateral frontal lobe lesions produced significantly fewer words than did control subjects. Other researchers found that left frontal lesions resulted in lower word production than right frontal ones. Similarly, regional cerebral blood flow findings have shown left-sided frontal activation during the performance of verbal fluency tasks.

Frontal lobe damage can also impair performance on visual or design fluency tasks. Design fluency tests were developed as visual analogs to verbal fluency measures such as the FAS. The subjects' task is to generate as many unique designs as they can within a given time period. Although the left prefrontal region appears to be specialized in using verbal material, Christina Elfgren and Jarl Risberg reported bilateral frontal lobe activation during the performance of visual generation tasks.

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