Executive functioning skills, which are essential to performing activities of daily living, are increasingly impaired in the Alzheimer’s disease (AD) process. The Five Point Test measures the executive functions of design fluency and the strategies used in generating the designs. This study examined strategy use during design fluency in healthy older controls, mild cognitive impairment (MCI), and AD.

Participants included healthy older adults (n=58), individuals with MCI (n=65), and persons with AD (n=18).  In the Five Point Test, participants were instructed to generate unique designs, with one trial involving a switching component. The use of a Rotational Strategy was measured by examining whether participants generated a new design by rotating the previous spatial configuration or pattern. The use of an Enumerative Strategy was measured by examining whether participants generated a pattern by consecutively adding or deleting a line from the previous design.

There were no significant group differences in age or education. ANOVAs conducted on the role of diagnosis on design fluency performances revealed that the healthy older control and MCI groups generated more unique designs than the AD group. Similar analyses conducted on the impact of diagnosis on strategy use showed that the healthy older control group employed a Rotational Strategy more frequently than the MCI and AD groups. When a switching component was added to generating designs, the healthy older control and MCI groups employed a Rotational Strategy more frequently than the AD group. No group differences were found in the use of an Enumerative Strategy.

Overall, our results indicated that participants with AD had difficulty in the executive skill of design fluency compared to healthy older controls and persons with MCI. Interestingly, in a design fluency condition with higher executive demand (requiring switching), the AD group also used a Rotational Strategy less frequently than the control and MCI groups. Our findings suggest that poorer utilization of strategies may impact executive functioning performance.