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Dissociating Semantic and Phonological Verbal Fluency Inaugural - Dissertation zur Erlangung der Doktorwürde der Wirtschafts - und Verhaltenswissenschaftlichen Fakultät der Albert - Ludwigs - Universität Freiburg i. Br. vorgelegt von Charlotte Sophie Schmidt geboren in Dortmund Sommersemester 2018 Dekan: Prof. Dr. Alexander Renkl , Albert - Ludwigs - Universität Freiburg Erstgutachter: Prof. Dr. Markus Heinrichs, Albert - Ludwigs - Universität Freiburg Zweitgutachter: PD Dr. Joseph Krummenacher, Albert - Ludwigs - Universität Freiburg Betreuer: Dr. Christoph P. Kaller, Dipl. - Psych., Universitätsklinikum Freiburg Datum der Disputat ion: 16. November 2018 Acknowledgments Several people have supported me during the completion of this doctoral thesis and I would like to thank everyone who contributed . First of all , my special thanks go to Dr. Christoph Kaller for his close supervision . I am grateful for the amount of time he spent discussing new ideas and open questions with me and for his patience with my w ork. Furthermore, I would like to thank Prof. Heinrichs and Dr. Krummenacher for being my doctorate supervisor s . Many thanks to my colleagues Lena Schumacher, Konrad Schumac her, Kai Nitschke , Sandra Loosli , and Lora Minkova and all people from the Freiburg Brain Imaging Center who helped me with valuable comments and who cre ated a good working atmosphere. In addition, I would like to thank my friends from the University Sports - Club Freiburg who helped me refuel my energy after a long day at work . A big thank you to all the participants, patients , and their families who volunteered to take part in my studies. Without their support it would not have been possible to presen t my results as I am doing now. Furthermore, I would like to thank my family and friends who al ways gave me courage in the comple tion of my thesis . Last but not least my special thanks go to my boyfriend Florian, who supported me the most during the last years and always had a bite of chocolate in strenuous times . Thank you all ! iii Abstract Semantic and phonological verbal fluency tasks, that require the examinee to produce words to a given semantic (i.e. category) or phonological (i.e. letter) cue, are often used in clinical and experimental neuropsychology to assess language abilities and executive functioning. As in the two task variants word generation is believed to involve different types of search processes, it is also implicitly assumed that semantic and phonological verbal fluency differ both in their u nderlying cognitive processes and neural correlates involved for successful retrieval. However, in previously published factor analyses, semantic and phonological verbal fluency loaded on only one common factor. Moreover, the often assumed double dissociat ion between lesions in temporal vs. frontal brain regions and impairments in semantic vs. phonological verbal fluency was neither explicitly tested nor shown. By using exploratory factor analyses in healthy participants and further confirmatory factor anal yses in chronic stroke patients with measures of semantic and phonological verbal fluency only, the first study of this thesis showed that inter - individual differences in semantic and phonological verbal fluency are represented by two factors. These two fa ctors show both common and distinct shares of variance and can therefore be interpreted as evidence for the involvement of both distinct and common cognitive processes. The second study of this thesis used voxel - based lesion - behavior mapping analyses in ch ronic stroke patients and results revealed that a specific impairment in semantic vs. phonological verbal fluency resulted from lesions in temporal vs. frontal brain regions, respectively. Further analyses showed that a specific impairment depends on the e xact localization, especially for lesions in frontal brain areas and that semantic and phonological verbal fluency may be impaired to a similar extent. In order to confirm the clinical utility of the German version of the verbal fluency task, applied in th e previous studies, the third study was concerned with its psychometric properties v by taking particularly the impact of item difficulty into account. Results indicate good test - score reliability, criterion - related concurrent validity, and test - retest relia bility, and reliability clearly benefits from aggregation across multiple items. Overall results demonstrate that semantic and phonological fluency are based on clearly distinct but also common sets of cognitive processes and that they are differentially m ediated by temporal and frontal brain areas, respectively. Furthermore, for a reliable assessment of verbal fluency, item difficulty should be considered. Taken together, this thesis contributes to a more comprehensive understanding of verbal fluency and i ts underlying cognitive and neural correlates. vi Zusammenfassung Aufgaben zur semantischen und phonologischen Wortflüssigkeit, bei denen Wörter zu vorgegebenen semantischen (i.e. Kategorien) und phonologischen (i.e. Buchstaben) Aufgaben gesagt werden müssen, werden in der klinischen und experimentellen Neuropsychologie häufig zur Erfassung sprachlicher und exekutiver Leistungen eingesetzt. Da man davon ausgeht, dass die Wortgenerierung bei den bei den Aufgabenvarianten von unterschiedlichen Suchprozessen abhängt, wird auch implizit angenommen, dass sich die semantische und phonologische Wortflüssigkeit sowohl in ihren zugrundeliegenden kognitiven Prozessen als auch beteiligten neuralen Korrelaten un terscheiden. Bisher veröffentlichte Faktoranalysen zeigen jedoch, dass Aufgaben zur semantischen und phonologischen Wortflüssigkeit auf nur einem gemeinsamen Faktor laden. Die oft angenommene doppelte Dissoziation zwi schen Läsionen in temporalen vs. fronta len Hirnarealen und semantischer vs. phonologischer Wortflüssigkeit wurde bislang weder explicit getestet noch aufgezeigt. Unter Verwendung explorativer Faktoranalysen in gesunden Probanden und weiterführenden konfirmatorischen Faktoranalysen in chronische n Schlaganfallpatienten, zeigt die erste Studie dieser Arbeit, dass inter - individuelle Unterschiede in semantischer und phonologischer Wortflüssigkeit durch zwei Faktoren abgebildet werden. Die beiden Faktoren zeigen zudem getrennte als auch gemeinsame Var ianzanteile, was als Hinweis auf die Beteiligung unterschiedlicher und auch gemeinsamer kognitiver Prozesse interpretiert werden kann. Die zweite Studie dieser Arbeit verwendet voxel - basierte Läsions - Verhalten Analysen mit Daten chronischer Schlaganfallpa tienten und die Ergebnisse zeigen, dass eine spezifische Beeinträchtigung in semantischer vs. phonologischer Wortflüssigkeit mit Läsionen in links temporalen beziehungsweise links frontalen Hirnarealen einhergeht. Weitere Analysen zeigen, dass die Spezifit ät der Beeinträchtigung, insbesondere bei Läsionen in frontalen vii Hirnarealen, lokalisationsabhängig ist und die semantische und phonologische Wortflüssigkeit auch gleichermaßen beeinträchtigt sein kann. Um den klinischen Nutzen dieser deutschen Version zur Wortflüssigkeit, die in den vorherigen Studien verwendet wurde, zu bestärken, beschäftigt sich die dritte Studie mit seinen psychometrischen Eigenschaften, wobei der Einfluss der Aufgabenschwierigkeit besonders berücksichtigt wurde. Die Ergebnisse zeigen e ine gute Testergebnis - Reliabilität, Konstruktvalidität und Test - Retest Reliabilität. Zudem profitiert die Reliabilität eindeutig von der Aggregation über mehrere Aufgaben hinweg. Insgesamt zeigen die Ergebnisse, dass semantische und phonologische Fluenz auf klar unterschiedlichen aber auch gemeinsamen kognitiven Prozessen basieren und dass sie durch unterschiedliche Regionen im Temporal - beziehungsweise Frontallappen vermittelt werden. Für eine zuverlässige Beurteilung der Reliabilität sollte zudem die Au fgabenschwierigkeit mit berücksichtigt werden. Zusammenfassend trägt diese Arbeit zu einem umfangreicheren Verständnis der Wortflüssigkeit und ihren zugrunde liegenden kognitiven und neuralen Korrelaten bei. viii Content Acknowledgments ................................ ................................ ................................ ..................... iii Abstract ................................ ................................ ................................ ................................ ...... v Zusammenfassung ................................ ................................ ................................ .................... vii Content ................................ ................................ ................................ ................................ ...... ix List of Figures ................................ ................................ ................................ ........................... xi List of Tables ................................ ................................ ................................ ........................... xiii List of Abbrevia tions ................................ ................................ ................................ ............... xiv Chapter 1 ................................ ................................ ................................ ................................ .. 17 Introduction ................................ ................................ ................................ .......................... 17 Chapter 2 ................................ ................................ ................................ ................................ .. 21 Theoretical Background
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