Extended verbal fluency in older adults: Results of a 2-minute test across animal, object, and food categories with frequently listed words

Background: Verbal fluency tests are widely used to assess cognitive function in dementia and evaluate word retrieval in stroke, typically within one minute. Although extending the test duration improves sensitivity to cognitive decline, 2-minute data in older Thai adults remain limited. Objectives: This study aimed to evaluate the performance of older adults in Nonthaburi on a 2-minute verbal fluency test across animal, object, and food categories, reporting frequently listed words and exploring influential factors such as age, gender, and education. Materials and Methods: This cross-sectional study recruited 147 healthy adults aged 60-89, categorized into three age groups: 60-69, 70-79, and 80-89. All participants were Central Thai speakers, had no history of neurological disorders, scored above 23 on the Thai Mental State Examination (TMSE), and underwent an oral reading of the Noo Jaew Passage and an oral motor examination by speech-language pathologists. Participants completed a 2-minute verbal fluency task in three categories: animal, object, and food. Responses were transcribed and analyzed using one-way ANOVA, independent t-tests, and regression analysis to examine the relationships between verbal fluency performance and relevant variables. Inter-rater reliability was assessed using the Intraclass Correlation Coefficient (ICC). Results: Participants had an average age of 70.6 (SD=7.3) years, and 75% were females. The average TMSE score was 28.3 (SD=1.5), and the average years of education was 13.4 (SD=4.6). The 2-minute test yielded an average of 26.3 (SD=7.0) animals, 32.0 (SD=10.2) objects, and 24.2 (SD=7.3) foods. Significant differences were found across age groups (p≤0.001), with the 60-69 group outperforming older groups in the animal category. Gender influenced performance only in the food category. ICC values ranged from 0.982 to 0.997, indicating excellent inter-rater reliability. Conclusion: This study reported the performance of older Thai adults on a 2-minute verbal fluency test, highlighting the effects of age, education, gender, and language-specific scoring. Frequently listed words may inform culturally relevant assessments and training materials. Future research should investigate alternative measures beyond word count to enhance cognitive assessments in clinical settings.