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Normative Data for Clustering and Switching on

Verbal Fluency Tasks
Angela K. Troyer
Published online: 09 Aug 2010.

To cite this article: Angela K. Troyer (2000): Normative Data for Clustering and Switching on Verbal Fluency Tasks, Journal
of Clinical and Experimental Neuropsychology, 22:3, 370-378

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 Journal of Clinical and Experimental Neuropsychology 1380-3395/00/2203-370$15.00
2000, Vol. 22, No. 3, pp. 370-378 © Swets & Zeitlinger

Normative Data for Clustering and Switching on Verbal

Fluency Tasks*
Angela K. Troyer
Baycrest Centre for Geriatric Care, Toronto, Canada

ABSTRACT
Downloaded by [University of Western Ontario] at 11:37 11 May 2013

Normative data for clustering and switching on verbal fluency tasks are provided. Four hundred and eleven
healthy adults between the ages of 18 and 91 were given tests of phonemic fluency (FAS or CFL) and
semantic fluency (Animals and Supermarket). Raw scores were corrected for demographic (i.e., age, edu-
cation, and sex) and test (i.e., fluency form) variables that were determined to make sizable contributions
to fluency performance. These normative data should be useful for clinicians and researchers in determin-
ing the nature of the fluency impairment in any given individual.

Tests of verbal fluency or word-list generation
are frequently used in clinical and experimental
examinations of cognitive function. The most
commonly used score from verbal fluency tests
is the total number of words generated. How-
ever, this score provides little information about
the cognitive processes underlying fluency per-
formance and does not answer the question as to
why a particular patient group or experimental
manipulation is associated with reduced test per-
formance. Additional information is needed to
examine the behavioral components that deter-
mine fluency performance.
Optimal fluency performance involves gener-
ating words within a subcategory and, when a
subcategory is exhausted, switching to a new
subcategory. These behavioral components were
identified (Bousfield & Sedgewick, 1944; Grue-
newald & Lockhead, 1980) and operationalized
as clustering and switching, respectively
(Troyer, Moscovitch, & Winocur, 1997). Clus-
tering involves phonemic analysis on phonemic
fluency and semantic categorization on semantic
fluency, and is thought to be a relatively auto-
matic process. Switching involves cognitive
flexibility in shifting from one subcategory to
another and is a relatively effortful process.
These components of fluency performance
are differentially affected by various neurologi-
cal disorders. Clustering is related to temporal-
lobe functioning, as indicated by impaired per-
formance among patients with temporal lobec-
tomy for intractable epilepsy (Troyer, Mos-
covitch, Winocur, Alexander, & Stuss, 1998)
and patients with Alzheimer’s disease (Troyer,
Moscovitch, Winocur, Leach, & Freedman,
1998). Clustering is unaffected by focal frontal
lesions (Troyer, Moscovitch, Winocur, Alexan-
der, et al., 1998). Switching, on the other hand,
is related to frontal functioning. That is, switch-
ing is specifically impaired among patients with
left dorsolateral and superior medial frontal-lobe
lesions (Troyer, Moscovitch, Winocur, Alexan-
der, et al., 1998) and is decreased under condi-
tions of divided attention (Troyer et al., 1997),
an experimental model of frontal dysfunction

*
Thanks to Morris Moscovitch and Kathryn Stokes for conceptual input and comments on the manuscript; Jill
B. Rich, Nicole D. Anderson, and Don Stuss for the provision of fluency protocols; Malcolm Binns for statistical
assistance; and Katy Kamkar for assistance with scoring and data entry.
Address correspondence to: A. Troyer, Psychology Department, Baycrest Centre for Geriatric Care, 3560
Bathurst Street, Toronto, ON, M6A 2E1, Canada. E-mail: a.troyer@utoronto.ca.
Accepted for publication: October 19, 1999.
 NORMATIVE FLUENCY DATA
(Moscovitch, 1994). Decreased switching is also
seen in patient groups with frontal dysfunction
in the context of additional brain dysfunction,
including Parkinson’s disease (Tröster et al.,
1998; Troyer, Moscovitch, Winocur, Leach, et
al., 1998), Huntington’s disease (Rich, Troyer,
Bylsma, & Brandt, 1999), multiple sclerosis
(Tröster et al., 1998), and schizophrenia (Robert
et al., 1998).
Overall, research with these patient groups
has consistently shown distinctions between pa-
tient groups with predominant temporal versus
frontal dysfunction. Some inconsistencies have
Downloaded by [University of Western Ontario] at 11:37 11 May 2013
been obtained, however. Patients with more
widespread brain dysfunction may show impair-
ments in both clustering and switching, although
one impairment tends to predominate. For exam-
ple, patients with Alzheimer’s disease were im-
paired in both clustering and switching on se-
mantic fluency and in only clustering on phone-
mic fluency; furthermore, the clustering impair-
ment was more severe than any switching im-
pairment (Troyer, Moscovitch, Winocur, Leach,
et al., 1998). Despite this complication, on bal-
ance, measures of clustering and switching pro-
vide useful information about the ongoing cog-
nitive processes during performance on tests of
fluency, including information for differential
diagnosis. To increase the usefulness of these
fluency indices in clinical and research settings,
there is a need for normative data from a large
group of healthy adults. The purpose of this pa-
per is to provide these data.
METHODS
Participants
Participants were 411 healthy, community-dwell-
ing adults recruited from university-based subject
pools, a hospital database of outpatients, senior
centres, and advertisements posted in the commu-
nity. Ages ranged from 18 to 91 years (M = 59.8,
SD = 20.7), and level of education ranged from 5
to 21 years (M = 13.9, SD = 2.9). Seventy percent
of participants were women. All participants were
fluent in English. Participants were screened for
neurologic and psychiatric disorders that could
affect cognitive function. To screen for general
cognitive decline, participants aged 60 and older
371
were required either to: (a) obtain scores of 25 or
higher on the Mini Mental Status Examination
(Folstein, Folstein, & McHugh, 1975), or (b) score
within the normal range on an episodic memory
test (Anderson, Craik, & Naveh-Benjamin, 1998).
Fluency Tasks
All testing was conducted in English. Each partic-
ipant was administered three trials of a phonemic
fluency task and one or two trials of a semantic
fluency task. For phonemic fluency, participants
were given either the letters F, A, and S (n = 257)
or C, F, and L (n = 154). Consistent with standard
instructions (e.g., Spreen & Strauss, 1998), partici-
pants were asked to generate as many words as
possible in 60 seconds that began with each letter,
excluding proper names and repetitions of the
same word with different endings.
For semantic fluency, most participants were
given Animal fluency (n = 407), and a subset of
participants was also given Supermarket fluency (n
= 156). On animal fluency, participants were in-
structed to name as many different animals as pos-
sible in 60 seconds. On supermarket fluency, par-
ticipants were instructed to name as many items as
possible that one can find or buy in a supermarket,
as part of the Dementia Rating Scale (Mattis,
1988). Responses were recorded for the full 60
seconds. For tests of both phonemic and semantic
fluency, all errors, including repetitions and intru-
sions, were recorded along with correct words in
the order in which they were generated.
Three scores were obtained from each fluency
task, including the mean cluster size, the raw num-
ber of switches, and the total number of correct
words generated. Detailed rules for scoring cluster
size and switches for phonemic and animal fluency
have been provided previously (Troyer et al.,
1997) and are reprinted in the Appendix. Briefly,
on phonemic fluency, clusters were defined as suc-
cessively generated words that began with the
same first two letters, differed only by a vowel
sound, rhymed, or were homonyms. On animal
fluency, clusters were successively generated
words belonging to the same semantic subcatego-
ries, such as African animals, Australian animals,
North American wild animals, pets, and individual
zoological categories, such as birds, canine, in-
sects, primates, and so forth. On supermarket flu-
ency, clusters included fruits, vegetables, dairy
products, meats, and so forth. These categories
were determined based on the naturally-occurring
clusters in the participants’ protocols. The clusters
used for supermarket fluency are consistent with a
previous scoring system (Tröster, Salmon,
McCullough, & Butters, 1989). On phonemic flu-
 372 ANGELA K. TROYER
ency, only phonemic clusters were counted, and on
semantic fluency, only semantic clusters were
counted. The size of the cluster was counted begin-
ning with the second word in each cluster. The
mean cluster size was calculated by summing the
size of each cluster and dividing by the number of
clusters. Switches were calculated as the number
of transitions between clusters, including single
words. The number of switches, therefore, is the
same as the number of clusters minus the number
of trials administered (e.g., three trials on phone-
mic fluency and two trials on semantic fluency).
For several reasons, the raw number of switches
was chosen as the switching index rather than the
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number of switches corrected for number of words
generated. Conceptually, the raw number of swit-
ches is the behavior of interest, as it indicates the
number of times an individual can generate a new
cluster of responses. This is similar to the raw in-
dex used for the number of words generated.
Knowing the percent of the words generated that
were correct does not provide as much information
as knowing the raw number of words generated
(e.g., 90% could indicate 9 out of 10 or 36 out of
40). As well, because switching is thought to deter-
mine, in part, the number of words generated
(Troyer et al., 1997), correcting switches for total
words generated would be tantamount to correct-
ing a cause for its effect. Another reason that raw
switches were used is because previous experience
has indicated that a corrected switching score does
not produce meaningful information. No patient
groups, including those with mild to moderate de-
mentia, have been found to be impaired in compar-
ison to controls on a corrected switching score,
despite large group impairments on other fluency
measures (Troyer, 1997; Tröster et al., 1998).
Importantly, repetitions and intrusions were
included in calculations of cluster size and swit-
ches because they provide information about the
ongoing strategy. Any protocol on which the ex-
aminer failed to record repetitions or intrusions in
the order in which they were generated was dis-
carded from the analyses (six protocols). This was
considered to be important because, otherwise,
both clustering and switching would be under-
reported in patient populations in which perse-
verations are frequent.
Repetitions and intrusions were excluded from
the number of correct words generated. On phone-
mic fluency, consistent with the instructions given
to participants, proper names and repetitions of the
same word with a different ending were also ex-
cluded. On animal fluency, no credit was given for
subcategory labels (e.g., bird) if specific exemplars
were also given (e.g., robin, canary). In addition,
sex-specific and age-specific names of the same
animal species were considered to be the same ani-
mal (e.g., hen and rooster, cat and kitten). In order
to provide consistency between the semantic flu-
ency tasks, on supermarket fluency, no credit was
given for subcategory labels (e.g., fruits) if spe-
cific exemplars were also given (e.g., apple, ba-
nana).
On phonemic fluency, scores from the three tri-
als (i.e., F, A, and S, or C, F, and L) were com-
bined into a single score for each participant. Simi-
larly, on semantic fluency, scores on the two trials
(i.e., Animals and Supermarket) were combined
into a single variable. The benefit of these com-
bined scores is that they are based on a higher
number of responses and are thus presumed to be
more valid and reliable measures of fluency abil-
ity. Because a large number of participants re-
ceived animal but not supermarket fluency, animal
scores alone were also retained.
RESULTS
Raw total mean scores obtained by the entire
sample were 42.5 (SD = 11.7) for FAS and CFL,
19.5 (SD = 5.3) for Animals, and 22.9 (SD =
5.8) for Supermarket fluency. These scores are
consistent with previously published scores
(e.g., Bolla, Lindgren, Bonaccorsy, & Bleecker,
1990; Kozora & Cullum, 1995; Spreen &
Strauss, 1998).
To determine the contributions of demo-
graphic and administrative factors to fluency
performance, a series of regression equations
was performed using age, education, sex, and
phonemic-fluency test form (i.e., CFL or FAS)
to predict cluster size, switches, and total words
generated on the fluency tasks. Effect sizes (i.e.,
f; Cohen, 1988) based on the partial regression
coefficients (Bs) were calculated to determine
which variables made meaningful contributions
to fluency scores. According to Cohen (1988), fs
of .10, .25, .40 correspond to small, medium,
and large effect sizes, respectively.
Age
Age showed a small effect size as a predictor of
switching on phonemic fluency, B = 0.04, t =
–2.05, p = .041, f = .10, and a large effect size as
a predictor of switching on semantic fluency, B
 NORMATIVE FLUENCY DATA
= –.11, t = –5.07, p < .001, f = .42, and animal
fluency, B = –.05, t = –8.28, p < .001, f = .413.
Age had a minimal effect size on clustering on
all tasks, including phonemic, B = 0.001, t =
1.65, p = .099, f = .08, semantic, B = 0.001, t =
0.47, p = .640, f = .03, and animal fluency, B =
0.002, t = 1.12, p = .262, f = .06. For total num-
ber of words generated, age showed a minimal
effect size as a predictor of phonemic fluency, B
= –0.04, t = –1.48, p = .141, f = .07, but a large
effect size for both semantic, B = –0.23, t =
–5.73, p < .001, f = .47, and animal fluency, B =
–0.09, t = –8.29, p < .001 , f = .41. In general,
Downloaded by [University of Western Ontario] at 11:37 11 May 2013
increasing age was associated with slightly
larger cluster sizes and with reduced switches
and words generated.
Education
Number of years of formal education showed
minimal to small effect sizes as a predictor of
clustering on phonemic fluency, B = 0.015, t =
3.34, p = .001, f = .17, semantic fluency, B =
0.012, t = 0.75, p = .454, f = .06, and animal flu-
ency, B = 0.024, t = 2.31, p = .021, f = .12. Edu-
cation had a small effect size as a predictor of
switching on phonemic, B = 0.39, t = 2.53, p =
.012, f = .13, semantic, B = 0.25, t = 1.67, p =
.097, f = .14, and animal fluency, B = 0.17, t =
3.49, p = .001, f = .17. Education showed the
largest effect size (small to medium) as a predic-
tor of total number of words generated, includ-
ing phonemic, B = 1.06, t = 5.06, p < .001, f =
.25, semantic, B = 0.74, t = 2.80, p = .006, f =
.23, and animal fluency, B = 0.51, t = 6.12, p <
.001, f = .31. Higher levels of education were
always associated with better fluency perfor-
mance.
Sex
Sex showed a minimal effect size as a predictor
of every phonemic, semantic, or animal fluency
variable, t’s = 0.08 to 1.25, p’s = .21 to .94, f’s =
.00 to .06, with the exception of a small effect
size on total number of words generated on se-
mantic fluency, B = –2.32, t = –1.55, p = .123, f
= .13.
373
Test Form
Small differences were present in the scores
obtained on the two forms of phonemic fluency
after controlling for demographic variables.
Larger cluster sizes were produced on CFL than
on FAS, B = 0.097, t = 3.63, p < .001, f = .18. In
contrast, number of switches was higher on FAS
than on CFL, B = –2.79, t = –2.99, p = .003, f =
.15. The total number of words generated on the
two forms was similar, B = –2.14, t = –1.70, p =
.090, f = .08.
Calculation of Normative Data
Generally, age, education, and fluency form (but
not sex) were important predictors of fluency
performance. Thus, regression analyses were
performed that included only these three predic-
tor variables. Corrections were then determined
by the B’s, and these corrections were applied to
the original scores in order to calculate norma-
tive test data. The corrections are presented at
the top of Table 1. Age and education correc-
tions were applied for each year of age or formal
education, respectively, and form corrections
were applied for FAS. Percentiles were then cal-
culated based on the actual distribution of the
corrected scores (e.g., 16% of participants in our
sample obtained scores at the 16th percentile or
less). This method was chosen because some
score distributions (i.e., cluster size) were
slightly skewed. Means, standard deviations,
and percentiles for the corrected scores are pre-
sented in the Table.
Percentiles for individual raw scores can be
obtained by adding any relevant corrections and
looking up the corresponding corrected score.
Consider, for example, a hypothetical 50-year-
old woman with 13 years of education. If she
produced a cluster size of 0.35 on FAS, her cor-
rected score would be calculated as 0.35 +
50(–.001) + 13 (–0.015) + 0.094 = 0.20. This
places her at approximately the 50th percentile.
If this same individual generated a total of 35
words on semantic fluency, her corrected score
would be 35 + 50(0.23) + 13 (–0.74) = 36.8,
which places her between the 5th and 16th per-
centiles.
 374 ANGELA K. TROYER

Table 1. Corrections, Demographically Corrected Descriptive Data, and Percentiles for Fluency Scores.

Phonemic Semantic Animals

Cluster Switches Total Cluster Switches Total Cluster Switches Total

Age (years) –0.001 +0.05 +0.04 –0.001 +0.11 +0.23 –0.002 +0.05 +0.09
Education (years) –0.015 –0.38 –1.06 –0.012 –0.25 –0.74 –0.023 –0.17 –0.51
Form (FAS) +0.094 –2.67 –2.18 NA NA NA NA NA NA

Mean 0.24 23.9 28.6 0.94 23.4 46.9 0.75 9.8 18.1
SD 0.23 8.2 11.1 0.47 4.4 7.9 0.57 2.7 4.6

1st percentile –0.16 6.6 4.3 0.24 13.4 28.3 –0.24 3.9 8.3
5th percentile –0.06 10.2 11.4 0.40 16.2 34.4 0.01 5.8 10.9
16th percentile 0.01 15.6 17.0 0.60 18.9 39.4 0.23 7.3 13.5
25th percentile 0.08 18.7 20.6 0.66 20.5 40.7 0.40 7.9 14.9
Downloaded by [University of Western Ontario] at 11:37 11 May 2013

50th percentile 0.19 23.3 28.7 0.91 22.7 46.3 0.64 9.6 17.9
75th percentile 0.35 29.7 36.6 1.18 26.5 52.5 1.12 11.6 21.2
84th percentile 0.44 32.3 39.3 1.44 27.5 56.6 1.39 12.4 22.8
95th percentile 0.73 37.6 47.6 2.02 31.3 60.7 1.89 14.7 26.7
99th percentile 0.97 43.2 57.4 2.37 34.0 62.4 2.43 16.7 29.3

DISCUSSION Crossley et al., 1997). There were no differences

These normative data can be used when standard
fluency instructions and recording procedures
are used. However, it is important that the exam-
iner record repetitions and intrusions – as well
as correct words – in the order that they are gen-
erated in order to use these data. This is crucial
because repetitions and intrusions were included
in the normative calculations of cluster size and
switches, and because a failure to do so will re-
sult in an underestimate of both cluster size and
switches, especially in groups in which repeti-
tions and intrusions occur frequently.
The present findings regarding the total num-
ber of words generated are consistent with sev-
eral other reports. That is, age was more
strongly related to the number of words gener-
ated on semantic fluency than phonemic fluency
(Crossley, D’Arcy, & Rawson, 1997; Kozora &
Cullum, 1995). Education was related to the
number of words generated on both phonemic
and semantic fluency (Crossley et al., 1997;
Kempler, Teng, Dick, Taussig, & Davis, 1998).
We found no sex differences on the number of
words generated on phonemic or semantic flu-
ency (Kozora & Cullum, 1995), although there
have been some reports of better performance by
women on phonemic fluency (Bolla et al., 1990;
in the number of words generated on FAS versus
CFL, consistent with previous reports (Lacy et
al., 1996).
The effect of age on clustering and switching
was examined in a previous report (Troyer et al.,
1997). In contrast to previous findings, in the
present study, increasing age was not associated
with significantly larger cluster sizes on phone-
mic fluency. A trend in that direction was ob-
tained, but the effect size was not meaningful (p
= .099, f = .08). Thus, although older adults have
a tendency to produce slightly larger clusters
than younger adults, in large groups of partici-
pants, this is an extremely small effect. Findings
regarding switching are consistent with our pre-
vious report. That is, increasing age was associ-
ated with decreased switching on animal flu-
ency.
An examination of the demographic correc-
tions suggests that both clustering and switching
influence the number of words generated; simi-
larly, neither index alone accounts for the num-
ber of words generated. A higher level of educa-
tion, for example, was associated with a larger
cluster size and more words generated on phone-
mic fluency. Presumably, those participants pro-
ducing larger cluster sizes consequently gener-
ated more words overall. In contrast, higher edu-
 NORMATIVE FLUENCY DATA
cation was associated with more switches and
more words generated on animal fluency. In this
case, more frequent switching presumably re-
sulted in more words generated. Thus, both clus-
tering and switching are necessary to account for
variations in the number of words generated.
The usefulness of these fluency scores in as-
sessment and diagnosis can be demonstrated
with the following sample patient profiles. SR is
a 56-year-old woman with a university-level
education and a one- to two-year history of
memory decline. A comparison of her demo-
graphically-corrected fluency component scores
Downloaded by [University of Western Ontario] at 11:37 11 May 2013
indicated consistently lower clustering than
switching performance. On phonemic fluency,
clustering was at the low end of average (score
= 0.09, 25th percentile), and switching was aver-
age to high average (score = 25.3, 50th to 75th
percentile). On semantic fluency, clustering was
impaired (score = 0.06, below the 1st percen-
tile), and switching was average to high average
(score = 24.9, 50th to 75th percentile). The total
number of words generated was average on pho-
nemic fluency (corrected score = 25.2, 25th to
50th percentile) and impaired on semantic flu-
ency (corrected score = 30.3, below the 1st per-
centile). This pattern of poorer clustering than
switching is consistent with Alzheimer’s dis-
ease, as indicated by previous research (Troyer,
Moscovitch, Winocur, Leach, et al., 1998), and,
indeed, SR’s history and performance on other
neuropsychological tests met NINCDS-ADRDA
criteria for Alzheimer’s disease (McKhann et
al., 1984). This profile can be contrasted with
LS, who is an 88-year-old woman with 12 years
of formal education and a six-year history of
memory impairment. Corrected fluency scores
showed that clustering was generally better than
switching. On phonemic fluency, clustering was
average (score = 0.26, 50th to 75th percentile)
and switching was impaired (score = 10.2, 5th
percentile). On animal fluency, clustering was
average to low average (score = 0.54, 25th to
50th percentile), and switching was just below
average (score = 7.4, 16th percentile). Total
number of words generated was impaired on
both phonemic (score = 7.6, 1st to 5th percen-
tile) and animal (score = 11.8, 5th to 16th per-
375
centile) fluency. This pattern is not consistent
with Alzheimer’s disease, and instead implicates
frontal dysfunction, perhaps related to vascular
or frontal dementia. Indeed, vascular dementia
was the most likely diagnosis for LS, given her
history (stable impairment over the last year)
and brain imaging (periventricular white matter
changes on CT). Thus, an examination of clus-
tering and switching scores may be useful in
discriminating between different causes of cog-
nitive impairment.
REFERENCES
Anderson, N. D., Craik, F. I. M., & Naveh-Benjamin,
M. (1998). The attentional demands of encoding
and retrieval in younger and older adults: Evidence
from divided attention costs. Psychology and Ag-
ing, 13, 405-423.
Bolla, K. I., Lindgren, K. N., Bonaccorsy, C., &
Bleecker, M. L. (1990). Predictors of verbal flu-
ency (FAS) in the healthy elderly. Journal of Clini-
cal Psychology, 46, 623-628.
Bousfield, W. A., & Sedgewick, C. H. W. (1944). An
analysis of restricted associative responses. Jour-
nal of General Psychology, 30, 149-165.
Cohen, J. (1988). Statistical power analysis for the
behavioral sciences (2nd ed.). Hillsdale, NJ: Law-
rence Erlbaum.
Crossley, M., D’Arcy, C., & Rawson, N. S. B. (1997).
Letter and category fluency in community-dwell-
ing Canadian seniors: A comparison of normal par-
ticipants to those with dementia of the Alzheimer
or vascular type. Journal of Clinical and Experi-
mental Neuropsychology, 19, 52-62.
Folstein, M. F., Folstein, S. E., & McHugh, P. R.
(1975). Mini-Mental State: A practical method for
grading the cognitive state of patients for the clini-
cian. Journal of Psychiatric Research, 12, 189-
198.
Gruenewald, P. J., & Lockhead, G. R. (1980). The
free recall of category examples. Journal of Exper-
imental Psychology: Human Learning and Mem-
ory, 6, 225-240.
Kempler, D., Teng, E. L., Dick, M., Taussig, I. M., &
Davis, D. S. (1998). The effects of age, education,
and ethnicity on verbal fluency. Journal of the In-
ternational Neuropsychological Society, 4, 531-
538.
Kozora, E., & Cullum, C. M. (1995). Generative nam-
ing in normal aging: Total output and qualitative
changes using phonemic and semantic constraints.
The Clinical Neuropsychologist, 9, 313-325.
 376 ANGELA K. TROYER
Lacy, M. A., Gore Jr., P. A., Pliskin, N. H., Henry, G.
K., Heilbronner, R. L., & Hamer, D. P. (1996).
Verbal fluency task equivalence. The Clinical Neu-
ropsychologist, 10, 305-308.
Mattis, S. (1988). Dementia Rating Scale. Odessa, FL:
Psychological Assessment Resources.
McKhann, G., Drachmann, D., Folstein, M., Katzman,
R., Price, D., & Stadlan, E. M. (1984). Clinical
diagnosis of Alzheimer’s disese. Neurology, 34,
939-944.
Moscovitch, M. (1994). Cognitive resources and dual-
task interference effects at retrieval in normal peo-
ple: The role of the frontal lobes and medial tem-
poral cortex. Neuropsychology, 8, 524-534.
Rich, J. B., Troyer, A. K., Bylsma, F. W., & Brandt, J.
Downloaded by [University of Western Ontario] at 11:37 11 May 2013
(1999). Longitudinal analysis of phonemic cluster-
ing and switching during word list generation in
Huntington’s disease. Neuropsychology, 13, 525-
531.
Robert, P. H., Lafont, V., Medecin, I., Berthet, L.,
Thauby, S., Baudu, C., & Darcourt, G. (1998).
Clustering and switching strategies in verbal flu-
ency tasks: Comparison between schizophrenic and
healthy subjects. Journal of the International Neu-
ropsychological Society, 4, 539-546.
Spreen, O., & Strauss, E. (1998). A compendium of
neuropsychological tests: Administration, norms,
and commentary (2nd ed.). New York: Oxford
University Press.
Tröster, A. I., Fields, J. A., Testa, J. A., Paul, R. H.,
Blanco, C. R., Hames, K. A., Salmon, D. P., &
Beatty, W. W. (1998). Cortical and subcortical in-
fluences on clustering and switching in the perfor-
mance of verbal fluency tasks. Neuropsychologia,
36, 295-304.
Tröster, A. I., Salmon, D. P., McCullough, D., & But-
ters, N. (1989). A comparison of the category flu-
ency deficits associated with Alzheimer’s and
Huntington’s disease. Brain and Language, 37,
500-513.
Troyer, A. K. (1997). [Alternate indices of verbal flu-
ency clustering and switching]. Unpublished raw
data.
Troyer, A. K., Moscovitch, M., & Winocur, G.
(1997). Clustering and switching as two compo-
nents of verbal fluency: Evidence from younger
and older healthy adults. Neuropsychology, 11,
138-146.
Troyer, A. K., Moscovitch, M., Winocur, G., Alexan-
der, M. P., & Stuss, D. (1998). Clustering and
switching on verbal fluency: The effects of focal
frontal- and temporal-lobe lesions. Neuropsy-
chologia, 36, 449-504.
Troyer, A. K., Moscovitch, M., Winocur, G., Leach,
L., & Freedman, M. (1998). Clustering and switch-
ing on verbal fluency tests in Alzheimer’s and Par-
kinson’s disease. Journal of the International Neu-
ropsychological Society, 4, 137-143.
 NORMATIVE FLUENCY DATA 377

APPENDIX

Scoring Rules for Clustering and Switching1

Total number of correct words generated. This was calculated as the sum of all words produced,
excluding errors and repetitions.
Mean cluster size. Cluster size was counted starting with the second word in a cluster. That is, a
single word was given a cluster size of 0, two words had a cluster size of 1, three words had a cluster
size of 2, and so forth. Errors and repetitions were included. The mean cluster size was computed
across the three phonemic trials and across the one or two semantic trials.
Number of switches. This was calculated as the total number of transitions between clusters, in-
cluding single words, for the three phonemic trials combined and for the one or two semantic trials
combined. Errors and repetitions were included.
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Phonemic fluency
Clusters on phonemic fluency trials consisted of successively generated words which shared any of
the following phonemic characteristics:
First letters: words beginning with same first two letters, such as ‘‘arm’’ and ‘‘art’’
Rhymes: words that rhyme, such as ‘‘sand’’ and ‘‘stand’’
First and last sounds: words differing only by a vowel sound, regardless of the actual spelling,
such as ‘‘sat,’’ ‘‘seat,’’ ‘‘soot,’’ ‘‘sight,’’ and ‘‘sought’’
Homonyms: words with two or more different spellings, such as ‘‘some’’ and ‘‘sum,’’ as indicated
by the participant

Semantic fluency
Clusters on semantic fluency trials consisted of successively generated words belonging to the same
subcategories, as specified below. Commonly generated examples are listed for each subcategory,
although listings are not exhaustive.

Animals
African animals: aardvark, antelope, buffalo, camel, chameleon, cheetah, chimpanzee, cobra,
eland, elephant, gazelle, giraffe, gnu, gorilla, hippopotamus, hyena, impala, jackal, lemur, leopard,
lion, manatee, mongoose, monkey, ostrich, panther, rhinoceros, tiger, wildebeest, warthog, zebra
Australian animals: emu, kangaroo, kiwi, opossum, platypus, Tasmanian devil, wallaby, wombat
Arctic/Far North animals: auk, caribou, musk ox, penguin, polar bear, reindeer, seal
Farm animals: chicken, cow, donkey, ferret, goat, horse, mule, pig, sheep, turkey
North America animals: badger, bear, beaver, bobcat, caribou, chipmunk, cougar, deer, elk, fox,
moose, mountain lion, puma, rabbit, raccoon, skunk, squirrel, wolf
Water animals: alligator, auk, beaver, crocodile, dolphin, fish, frog, lobster, manatee, muskrat,
newt, octopus, otter, oyster, penguin, platypus, salamander, sea lion, seal, shark, toad, turtle, whale
Beasts of burden: camel, donkey, horse, llama, ox
Animals used for their fur: beaver, chinchilla, fox, mink, rabbit
Pets: budgie, canary, cat, dog, gerbil, golden retriever, guinea pig, hamster, parrot, rabbit
Birds: budgie, condor, eagle, finch, kiwi, macaw, parrot, parakeet, pelican, penguin, robin, toucan,
woodpecker
Bovine: bison, buffalo, cow, musk ox, yak
Canine: coyote, dog, fox, hyena, jackal, wolf
Deers: antelope, caribou, eland, elk, gazelle, gnu, impala, moose, reindeer, wildebeest
Feline: bobcat, cat, cheetah, cougar, jaguar, leopard, lion, lynx, mountain lion, ocelot, panther,
puma, tiger
 378 ANGELA K. TROYER

Fish: bass, guppy, salmon, trout

Insects: ant, beetle, cockroach, flea, fly, praying mantis
Insectivores: aardvark, anteater, hedgehog, mole, shrew
Primates: ape, baboon, chimpanzee, gibbon, gorilla, human, lemur, marmoset, monkey, orangutan,
shrew
Rabbits: coney, hare, pika, rabbit
Reptiles/Amphibians: alligator, chameleon, crocodile, frog, gecko, iguana, lizard, newt, salaman-
der, snake, toad, tortoise, turtle
Rodents: beaver, chinchilla, chipmunk, gerbil, gopher, groundhog, guinea pig, hamster, hedgehog,
marmot, mole, mouse, muskrat, porcupine, rat, squirrel, woodchuck
Weasels: badger, ferret, marten, mink, mongoose, otter, polecat, skunk

Supermarket Items
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Fruits: applesauce, bananas, cranberries, juice, mango, nectarines, peaches, raisins

Vegetables: avocado, beans, carrots, eggplant, olives, pickles, tomatoes, zucchini
Dairy case items: cheese, cream, cream cheese, eggs, milk, sour cream, yogurt
Meats: bacon, chicken, fish, hamburger, hot dogs, pork, salmon, sausage, tuna
Beverages: coffee, juice, lemonade, milk, orange juice, pop, tea, water, wine
Condiments: jelly, ketchup, marmalade, mayonnaise, pickles, relish, salad dressing
Flavourings: chives, cinnamon, parsley, pepper, sage, salt, vanilla, vinegar
Sweets and snacks: candy, cake, crackers, donuts, gum, ice cream, pie, popcorn, pudding, torte
Grain products: barley, bread, cereal, corn meal, flour, macaroni, meal, muffins, oats, rice
Baking supplies: baking powder, cornstarch, eggs, flour, salt, shortening, spices, vanilla
Specific meals/dishes: coffee, eggs, syrup, waffles; spaghetti, tomato sauce; lettuce, onions, rad-
ishes, salad dressing; pork, beans
Household goods: ammonia, detergent, disinfectant, gift wrap, Kleenex, magazines, mop, pans,
paper bags, paper towels, stamps, tin foil, toilet paper, wax paper
Personal toiletries: aspirin, comb, deodorant, medicine, mouthwash, toothpaste, vitamins
Infrastructure: aisles, basket, butcher, cash register, cashier, grocery bags, pharmacy, price tags,
shelves, shopping cart

General Scoring Rules

In the case where two categories overlapped, with some items belonging to both categories, some
items belonging exclusively to the first category, and some items belonging exclusively to the second
category, the overlapping items were assigned to both categories. For example, for ‘‘dog, cat, tiger,
lion,’’ the first two items were scored as pets, and the last three items were scored as feline. ‘‘Cat’’
was included in both the pet category and the feline category.
In the case where smaller clusters were embedded within larger ones, or two categories over-
lapped, but all items could correctly be assigned to a single category, only the larger, common cate-
gory was used. For example, for ‘‘sly, slit, slim, slam’’ all begin with ‘‘sl,’’ but an additional cluster
was not scored for the last two words which differ only by a vowel sound.

Note. From ‘‘Clustering and switching as two components of verbal fluency: Evidence from younger
and older healthy adults,’’ by A. K. Troyer, M. Moscovitch, & G. Winocur, 1997, Neuropsychology,
11, p. 145-146. Copyright 1997 by the American Psychological Association. Adapted by permission
of the publisher.