Exploring Factors Affecting Verbal Fluency in Healthy Aging

Word-finding difficulties are a hallmark of aging. Verbal fluency tasks are broadly used to measure word-finding difficulties in adults due to their sensitivity and ease of use. However, several questions remain regarding verbal fluency in aging, particularly the strategies that may evolve over time and the role of potentially protective factors, such as cognitive engagement and social interactions, in mitigating age-related cognitive decline. In this study, we investigated verbal fluency in 144 healthy, community-dwelling adults aged 20-87 years. Participants completed both semantic and phonemic fluency tasks and several questionnaires and assessments. We analyzed accuracy and error types, as well as the occurrence of self-talk and filled hesitations and their impact on lexical access. Further, eight factors previously associated with cognitive reserve were examined: education, practice of group singing, social participation, cognitive level, self-reported health, multilingualism, positive outlook, and hearing. While filled hesitations were stable across age, self-talk increased nonlinearly with age. Singing experience, higher educational attainment, and better global cognition were associated with better fluency. However, these factors showed minimal evidence of protection against age-related decline in word retrieval.