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The Use of Profanity During Letter Fluency Tasks in Frontotemporal Dementia and Alzheimer Disease

Ringman, John M. MD, MS; Kwon, Eunice BA; Flores, Deborah L. MD; Rotko, Carol Psy. D; Mendez, Mario F. MD, PhD; Lu, Po Psy. D

Cognitive and Behavioral Neurology: September 2010 - Volume 23 - Issue 3 - p 159-164
doi: 10.1097/WNN.0b013e3181e11392
Original Studies

Objective To assess whether the production of profanity during letter fluency testing distinguishes frontotemporal dementia (FTD) and Alzheimer disease (AD) patients.

Background Alterations in language and social behavior typify FTD spectrum disorders. Nonetheless, in can be difficult to distinguish pathologically defined frontotemporal lobar degeneration (FTLD) from AD clinically. Assessing verbal fluency by having patients generate words beginning with specific letters in a given period of time can yield diverse information of diagnostic use.

Method Words produced during FAS letter fluency testing were reviewed, and instances of the use of “f*ck,” “*ss,” and “sh*t” and other words felt to be inappropriate were sought. The frequency of these words was compared between clinically diagnosed FTD and AD patients using χ2 tests.

Results We found that 6/32 (18.8%) patients with FTD generated the word “f*ck” during the “F” trial as opposed to none of 38 patients with AD (P=0.007). Patients who said “f*ck” had diagnoses of either behavioral variant FTD (3/15), progressive nonfluent aphasia (2/8), or semantic dementia (1/3).

Conclusions Though the specific neuropathology in these cases is uncertain, generation of “f*ck” during letter fluency testing seems to have use in differentiating FTD from AD.

UCLA Department of Neurology, Easton Center for Alzheimer's Disease Research at UCLA, Los Angeles, CA

Support for this study came from the Sidell Kagan Foundation, Alzheimer's Disease Research Center Grant P50 AG-16570 from the National Institute on Aging, the General Clinical Research Centers Program NIH M01-RR00865, an Alzheimer's Disease Research Center of California grant, and the Easton Consortium for Alzheimer's Disease Drug Discovery and Biomarkers.

Reprints: John M. Ringman, MD, MS, UCLA Department of Neurology, Mary S. Easton Center for Alzheimer's Disease Research at UCLA 10911 Weyburn Ave., #200 Los Angeles, CA 90095-7226 (e-mail:

Received for publication May 29, 2009; accepted March 28, 2010

© 2010 Lippincott Williams & Wilkins, Inc.