Culture-Agnostic and Culture-Specific Analyses of Semantic Fluency in Korean and English Speakers With Alzheimer's Disease

PURPOSE: This study investigated cross-linguistic and cultural influences on semantic fluency in monolingual Korean- and English-speaking individuals with Alzheimer's disease (AD) by contrasting culture-agnostic and culture-specific analytic frameworks. We focused on how culturally grounded schemas, such as the East Asian zodiac, shape clustering and switching patterns and on their associations with global cognition. METHOD: We analyzed semantic fluency in 36 individuals with AD and 30 language-matched older adults using culture-agnostic and culture-specific frameworks. We examined total and first-response proportions of exemplars and compared clustering and switching patterns based on Troyer's taxonomy and a culture-specific scheme that included zodiac animals. All fluency measures were correlated with global cognition. RESULTS: In Korean-speaking individuals with AD, animal fluency was shaped by culture-specific schemas, with zodiac animals frequently produced early and in clusters. This pattern-marked by greater clustering-was unique to the Korean group and was not detected using culture-agnostic analyses, which showed no group differences. Only the Korean group showed positive correlations between fluency and Mini-Mental State Examination scores. CONCLUSIONS: The present findings suggest that culturally grounded schemas may influence both word generation and the organization of clustering and switching in semantic fluency. In Korean-speaking individuals with AD, zodiac animals formed structured clusters and switches that uniquely correlated with global cognition, highlighting the need for culturally informed norms in cross-linguistic neuropsychological assessment. SUPPLEMENTAL MATERIAL: https://doi.org/10.23641/asha.33989638.