Development of a Screening Algorithm for Alzheimer's Disease Using Categorical Fluency and Confrontational Naming Abilities

OBJECTIVE: Declines in naming ability and semantic memory are well-known features of early Alzheimer's disease (AD). We developed a new screening algorithm for AD using two brief language tests : the Categorical Fluency Test (CFT) and 15-item Boston Naming Test (BNT15). METHODS: We administered the CFT, BNT15, and Mini-Mental State Examination (MMSE) to 150 AD patients with a Clinical Dementia Rating of 0.5 or 1 and to their age- and gender-matched cognitively normal controls. We developed a composite score for screening AD (LANGuage Composite score, LANG-C) that comprised demographic characteristics, BNT15 subindices, and CFT subindices. We compared the diagnostic accuracies of the LANG-C and MMSE using receiver operating curve analysis. RESULTS: The LANG-C was calculated using the logit of test scores weighted by their coefficients from forward stepwise logistic regression models : logit (case)=12.608−0.107×age+1.111×gender+0.089×education−0.314×HS(1st)−0.362×HS(2nd)+0.455×perseveration+1.329×HFCR(2nd)−0.489×MFCR(1st)−0.565×LFCR(3rd). The area under the curve of the LANG-C for diagnosing AD was good (0.894, 95% confidence interval=0.853–0.926 ; sensitivity=0.787, specificity=0.840), although it was smaller than that of the MMSE. CONCLUSION: The LANG-C, which is easy to automate using PC or smart devices and to deliver widely via internet, can be a good alternative for screening AD to MMSE.

PAPDI: Prueba Argentina Psicolingüística de Denominación de Imágenes.: Segunda parte: Estudio de sus propiedades psicométricas / PAPDI: Argentinean Psycholinguistic Image Naming Test.: Second part: Study of psychometric properties

En el presente trabajo se detallan los análisis realizados con el fin de estudiar las propiedades psicométricas la Prueba Argentina Psicolingüística de Denominación de Imágenes (PAPDI). La misma cuenta con dos cualidades que representan un valor agregado frente a las pruebas actualmente disponibles en nuestro país: a) los estímulos fueron seleccionados controlando las variables que afectan las etapas de análisis visual y de representación conceptual de la imagen del objeto y se manipularon las variables que afectan la selección y recuperación de la etiqueta léxica, en base a valores normativos de población argentina; y b) las claves semánticas se elaboraron de acuerdo con normas de producción de atributos semánticos también recolectadas en nuestro país. En este trabajo se analizaron las propiedades psicométricas mediante el estudio de pacientes con demencia tipo Alzheimer, con lesiones cerebrales focales y participantes sin patología neurológica. Se buscaron evidencias de validez de criterio mediante el análisis de grupos contrastados y la correlación con el test de Boston. A su vez, se estudió la confiabilidad de las puntuaciones por dos métodos: consistencia interna y test-retest. También se analizó la capacidad de discriminación entre pacientes con y sin anomia mediante curvas ROC. Se estudiaron además los efectos de las variables manipuladas, se realizó un análisis cualitativo de los errores y se examinó el desempeño en función del uso de las claves. Los resultados de los análisis aportan evidencia de que presenta cualidades psicométricas sumamente aceptables para su uso en nuestra población.

In the current paper we present the psychometric analysis of the Argentinean Psycholinguistic Image Naming Test (PAPDI). This test has two characteristics that makes it different from those currently available in our country: a) the stimuli has been chosen and ordered controlling certain psycholinguistic variables proven to have influence on this task, such as Visual Complexity, Image Agreement, Image Variability, Familiarity, Name Agreement, Age of Acquisition and Frequency of Use, following Argentinean normative data base; and b) semantic cues were elaborated according to semantic feature production norms also from Argentina. We present here the psychometric analysis of its properties. There were analyzed through the study of patients with Alzheimer Disease (n = 25) and focal brain lesions (n = 27) and healthy partici-pants (n = 125). On the first place, in order to study criteria validity a group comparison analysis was carried out. On the one hand Alzheimer Disease patients were compared with healthy participants. On the other hand, two focal brain damaged patients were compared: with and without aphasia. Convergent validity was also studied through the correlation with Boston naming test. In the third place, scores reliability was studied through two methods: internal consistency analysis, for Alzheimer, focal and healthy groups, and test-retest for focal brain damage group. Forth, it was analyzed the capacity to discriminate between patient with and without aphasia through ROC curves analysis. The respective sensitivity and specificity values to detect anomia were established. Fifth, the demographic variables´ influence was analyzed through a regression analysis. Moreover, there were analyzed the effects of two psycholinguistic variables that were taken into account to order the images but were not normalized: Lexical Frequency and Age of Acquisition. Finally, type of errors and response to cues were studied for focal brain damaged patients. The results indicated that the PAPDI presents acceptable psychometric properties to be used as a tool in neuropsychological assessment. It showed evidence of internal and external validity and it was observed scores reliability through internal consistency and test-retest. A suggested cutting point was established to detect anomia. Furthermore a main influence of educational level was reported. There were also detected effects of Lexical Frequency and Age of Acquisition which were observed for Alzheimer and aphasic patients groups. Moreover it was illustrated the response profile analysis for aphasic and nonaphasic focal brain damaged patients regarding a proposed taxonomy of error types. It was also studied the response to semantic and phonological cues and it was observed that both contributed to improve patients´ performance.

Prueba Argentina Psicolingüística de Denominación de Imágenes (PAPDI): Construcción y desarrollo (Primera parte)* / Argentinean Psycholinguistic Image Naming Test (PAPDI): Design and development (First part)

En la primera parte de este trabajo se presenta la construcción y el desarrollo de la Prueba Argentina Psicolingüística de Denominación de Imágenes (PAPDI). La misma tiene dos características que la diferencian de las pruebas actualmente disponibles en nuestro medio: (a) Los estímulos fueron seleccionados controlando las variables que afectan las etapas de análisis visual y reconocimiento de la imagen (Complejidad visual y Concordancia con la imagen) y el conocimiento conceptual (Variabilidad de la Imagen y Familiaridad) del dibujo del objeto también se manipularon las variables (Frecuencia léxica y Edad de adquisición) que afectan la etapa que busca evaluar la prueba: activación, selección y recuperación de la etiqueta léxica. Los índices que operacionalizan a las variables son dependientes de la cultura y de la lengua de dónde se obtengan, por ello se tomaron sus valores de normas argentinas. (b) Las claves semánticas han sido elaboradas cuidadosamente, siguiendo las normas de producción de atributos semánticos también recolectadas en nuestro país, ya que el uso de las mismas permite generar hipótesis más precisas acerca de la localización del déficit. Por lo tanto, se presenta el proceso de construcción y desarrollo de la prueba mostrando cómo se tuvieron en cuenta estas particularidades, cuáles variables han sido controladas y cuáles manipuladas, y su justificación. Por último, los resultados de la prueba piloto permitieron seleccionar 30 ítems y la constitución de la versión final de la prueba, que es lo suficientemente breve para su uso en la clínica y de libre acceso.

In the current paper, first part, we present the design and development of the Argentinean Psycholinguistic Image Naming Test (PAPDI). This test has two characteristics that make it different from those currently available in our country: (a) the stimuli have been selected by controlling the variables that affect the stages of visual analysis and image recognition (Visual Complexity and Image Agreement) and conceptual knowledge (Image Variability and Familiarity) of the drawing of the object; and the variables (Frequency of Use and Age of Acquisition) that affect the stage that seeks to evaluate the test were manipulated: activation, selection and retrieval of the lexical label (phonological form of the name), to generate a gradient of difficulty in the items of the test. However, the variable Naming Agreement, that also affects this stage, was controlled to selected pictures with only one predominating name. The quantification of these factors by means of specific variables is influenced by the cultural and linguistic context from which they were obtained, consequently we took their values from Argentinean normative data base and (b) semantic cues were elaborated according to semantic feature production norms also from Argentina. The phonological cues corresponded to the first syllable of the object's name. Their use allows to generate more precise hypotheses about the location of the deficit and allows to infer relevant information about the cognitive profile. Therefore, the process of construction and development of the test is presented, showing how these particularities were taken into consideration, which variables were controlled and which were manipulated, and their justification. For the design of the test 62, black and white pictures were originally selected from the 400 pictures taken from Cycowicz's set (of frequent use in Experimental Psychology and Neuropsychology). They correspond to concrete concepts from different semantic categories belonging to both living andnon living domains. The criteria used to include those images were that they were moderately complex (in quantity of lines and details), moderately familiar and that they had a mean image variability value. They had to have a medium to high concordance degree between the mental image and its corresponding representation. Besides, these images had to have a naming agreement superior to 80%. To conform the first version of the test, the 62 images selected were ordered according to the variable Age of Acquisition and each image was assigned its corresponding semantic and phonological cues. The former were extracted from the Argentinean norms considering the most relevant features. The second consisted on the word´s first syllable. A pilot study with healthy population (n = 50), of different ages, both sexes and three educational levels, was carried out through which 30 images were selected that constituted the test´s final version. The deleted items were: figures that did not evokea univocal response, that is, they were easily confused with other objects; figures that had more than one acceptable answer although not all were correct; and items that presented a ceiling effect where the scores accumulated in high scores and did not allow to discriminate the participants' ability to select, retrieve and produce a word (only 25 and 30% of the items were retained). In the test´s final version, the items were reordered according to the Age of Acquisition and Frequency values and their difficulty in naming (following the percentage of successes in the spontaneous response). And images that were contain in another naming tests were deleted. The test is short enough for use in the clinic and freely accessible. The second part of the paper presents the psychometric studies that provide evidence of their relevance and validity.

Development and validity of Huashan Naming Test / 中华行为医学与脑科学杂志

Objective To present the development of the Naming test tool ( Huashan Naming Test, HNT)for Chinese cultural and by amnestic mild cognitive impairment ( aMCI ) and mild Alzheimer' s disease (AD) between the detection of memory decline,and to analyze the validity of its trial.Methods 100 normal elders from communities in Shanghai, 100 patients with amnestic mild cognitive impairment (aMCI), and 95 patients with mild Alzheimer's disease (AD) who received an education of junior high school or above and were evaluated by neuropsychological tests including mini mental state examination ( MMSE), auditory verbal memory test, Huashan Naming tests etc.8 cognitive tests.The groups of MCI and AD patients finished cranial MRI.100 items with HNT including 20 animals,10 vegetables,10 fruits ,20 tools ,20 household , 10 vehicles, 10 stationery.Results 1.HNT items to determine: 22 items were excluded due to the completion of the three groups were not significantly different; 8 items were excluded due to the completion of the normal elderly group was lower than 75%; 10 items were excluded from the analysis of variance Fvalue of the minimum value.The remaining 60 items,according to the size of the arrangement and completion rates were divided into two versions of odd and even, respectively HNT-Ⅰ and HNT-Ⅱ.2.HNT characteristics:in normal elderly group age, sex were found to had no significant factors affecting overall scores of HNT-Ⅰ and HNT-Ⅱ but level of education, MMSE score was significantly correlated (P ＜0.05).As cut-off score ≤ 26 for spontaneous naming of HNT,the sensitivities of HNT-Ⅰ for aMCI ,mild AD were 44%, 84% respectively, specificities were all around 84%; the sensitivities of HNT-Ⅱ for aMCI , mild AD were 56% ,83% respectively,specificities were all around 80%.Conclusion HNT is a Chinese cultural background,time-consuming short and good name validity test,and it is worth further promoting the application.

Different Performances on a Confrontational Naming Test in Patients with Alzheimer's Disease and Mild Cognitive Impairment

BACKGROUND: We analyzed the performance on a naming test and the correlations between the scores on the naming test and neuropsychological test scores in patients with mild cognitive impairment (MCI) and mild Alzheimer's disease (AD). METHODS: The subjects included 69 patients with MCI and 33 patients with mild AD. We performed general cognitive functions, the Korean version of the Boston Naming Test (K-BNT), the digit span test, the Rey figure copy test (RCFT), the Seoul Verbal Learning Test (SVLT), and frontal function tests. The detailed items of the K-BNT were analyzed for the two subject groups, and the correlations between the K-BNT scores and those of the neuropsychological tests were examined. RESULTS: Significant differences were observed on the item for the number of correct answers after two syllables on the K-BNT task in patients with AD and MCI (p<0.05). A qualitative analysis of the incorrect K-BNT responses showed that both the AD and MCI groups made semantic errors more than visuoperceptual and phonemic errors. Significant correlations were found among the Mini-Mental State Examination, the Global Deterioration Scale, clinical dementia rating, digit span, SVLT delayed recall, RCFT and RCFT delayed recall, and the Stroop test color reading items (p<0.01). CONCLUSION: Our result suggests that semantic errors gradually increase with the progress of cognitive disability in the state preceding AD among patients with MCI.

Development of an adapted version of the Boston Naming Test for Portuguese speakers / Desenvolvimento de uma versão adaptada do Boston Naming Test para a língua portuguesa

OBJECTIVE: To present the development of an adapted version of the Boston Naming Test for Portuguese speakers, and to investigate the effects of age, education and gender on both the original and the adapted Boston Naming Test in respect of Brazilian Portuguese speakers. METHOD: Eighty items, including the 60 original ones and 20 adapted items were administered to 739 healthy Brazilian subjects aged between 6 and 77 years who received 0 to 17 years of education. RESULTS: The coefficients of the General Linear Model estimation suggested that both age and education were statistically significant to predict total scores. In addition, score variances, justified by such predictors, were 41.20 percent in the original Boston Naming Test against 25.84 percent in the adapted Boston Naming Test. These results suggest that the scores from the original BNT are more dependent on age and education than those from the adapted Boston Naming Test. CONCLUSION: These findings demonstrated the suitability of the adapted Boston Naming Test version for the Brazilian population and described provisional norms for the original and adapted Boston Naming Test for Portuguese speakers.

OBJETIVO: Apresentar o desenvolvimento de uma versão adaptada do Boston Naming Test para a língua portuguesa e investigar os efeitos da idade, escolaridade e gênero nas versões original e adaptada do Boston Naming Test. MÉTODO: 80 itens foram administrados incluindo os 60 originais e 20 itens adaptados em 739 brasileiros saudáveis com idades entre 6 e 77 anos e escolaridade entre 0 e 17 anos. RESULTADOS: Os coeficientes de estimação do Modelo Linear Geral sugeriram que a idade e escolaridade eram preditores significativos do resultado total. Além disto, as variâncias dos resultados explicadas por estes preditores no Boston Naming Test original era de 41,20 por cento, enquanto que no adaptado era de 25,84 por cento. Estes achados sugerem que os resultados do Boston Naming Test original são mais dependentes de idade e escolaridade do que os do adaptado. CONCLUSÃO: Estes achados demonstram a adequação do Boston Naming Test adaptado para a população brasileira e descrevem normas provisionais da versão original e adaptada do Boston Naming Test para a língua portuguesa.

Parallel Short Forms for the Korean-Boston Naming Test (K-BNT)

BACKGROUND: The Korean-Boston Naming Test (K-BNT) is a popular measure of the confrontational naming ability. It is particularly sensitive to the early cognitive changes in Alzheimer's disease (AD) and Vascular dementia (VaD). The current study was conducted to develop parallel short forms for the K-BNT used in repeated assessments as well as in situations where the administration of the complete K-BNT is not practical. METHODS: Four 15-item short forms were newly constructed based on the item difficulties of the K-BNT measured from 565 normal elderly aged over 55. The K-BNT was administered to 130 dementia patients (75 AD, 55 VaD) and 130 healthy community-dwelling elderly whose age, sex, and education level were matched with the dementia patients. Scores for the short forms were derived by dividing up the items of the K-BNT. RESULTS: On each short form, normal elderly performed better than dementia patients, and scores on each could be extrapolated to a complete 60-item K-BNT score. Significant correlations were found between short forms and the K-BNT. To compare the probabilities of correctly identifying dementia, the areas under Receiver Operating Characteristic (ROC) curves of each form and the K-BNT were compared. It was found that all the short forms were as efficient as the 60-item K-BNT in identifying dementia. CONCLUSIONS: These results confirm that the four 15-item short forms developed in the current study are parallel and valid as the short forms of the K-BNT.

Boston Naming Test in Chinese Elderly, Patient with Mild Cognitive Impairment and Alzheimer's Dementia / 中国心理卫生杂志

Objective: To investigate applicability for Boston naming test (30 items) (BNT) in Chinese elderly and identify effect for mild cognitive impairment (MCI) and Alzheimer's dementia(AD) using BNT. Methods:100 normal elderly, 38 amnesic MCI, 34 mild AD and 38 moderate AD were evaluated by neuropsychological tests (include BNT, mini mental state examination and auditory verbal memory test, etc). MMSE total score of 4 groups were 28.4?1.5, 26.1?2.6, 20.7?1.7, and 15.6?3.3, respectively. Results: Age, sex, level of education were found to be significant factors affecting overall scores of spontaneous naming in normal elderly group. Spontaneous naming score for participants of elementary, high school and college groups were 22.2?3.3, 25.5?2.5 and 26.3?1.8, respectively. Scoring of male participants higher than that of females. Spontaneous naming score of 4 groups were 24.9?3.0, 20.9?3.6, 18.7?4.0 and 15.7?4.2, respectively. As cut-off ≤22 score of spontaneous naming of BNT, the sensitivities for MCI, mild AD and moderate AD were 61%, 79% and 95% respectively; the specificities were all around 81%. Selective impairment of unfamiliar items occurred MCI and mild AD and hold of familiar item across diagnostic groups. Semantic cue naming and recognition ability by BNT showed there was progressive damage in AD patients, but less than that of spontaneous naming of BNT. Conclusion: The ability of naming is influenced by age, gender and educational level. Patients with MCI or mild AD have impairment in naming.