Standardization of an Arabic-Language Neuropsychological Battery for Epilepsy Surgical Evaluations

Feasibility Study of the Boston Naming Test for the Arab Population

Introduction The Boston Naming Test (BNT) is a widely used US neuropsychological evaluation of confrontation naming for the examination of adults and children with learning disabilities and diagnosis of communication disorders, aphasia, dementia, and acquired brain injury or dysfunction. The purpose of the present study is to evaluate the practicality of the original English version of the 60-item BNT (BNT-60) on an Arab population and the need for a new adaptive Arabic version sensitive to cultural biases and to offer normative data that can serve as a reference for researchers and clinicians in the Gulf region, especially the Kingdom of Saudi Arabia (KSA). Data relating to the familiarity degree of the BNT-60 were also collected. Methods This research involved 105 randomly selected and cognitively healthy college students who were native Arabic speakers recruited in Jeddah. The Montreal Cognitive Assessment (MOCA) was administered with a cutoff score of 26. The participants were examined for naming accuracy, naming agreement, and familiarity in using the BNT-60. The data were then analyzed and compared with the findings from studies conducted in the United States. Results The BNT-60 was administered to 105 university students from the KSA, and the results were compared with the BNT-60 booklet norms (second edition). Their average performance was noticeably below the norms established by the original test standards. Compared with the participants in the US studies, the participants made approximately 65% more errors on the items including pretzel, wreath, beaver, harmonica, acorn, stilts, harp, hammock, knocker, pelican, muzzle, unicorn, funnel, accordion, asparagus, tripod, yoke, and trellis and 25% more errors on the items including seahorse, dart, igloo, sphinx, palette, and abacus. The item "boomerang" was not compared with the US sample because of differences in the version of the BNT, but the errors in naming this item were as frequent as those in naming the other misrecognized items. The internal consistency among the items' degrees of familiarity was also very high (α = 0.966), and a significant connection (r = 0.837, P < 0.001) was observed between object familiarity and naming accuracy. The Arabic-speaking population in the KSA and English-speaking population in the United States showed very different levels of familiarity with numerous items. Conclusion The participants' familiarity with the BNT objects varied depending on their culture and impacted their naming accuracy and overall scores on the test. Accordingly, the possibility of cultural biases should be considered when administering the BNT to the population of the KSA and the possibility of making changes so that the test better reflects the Arab culture as suggested.

Cognitive decline assessment in speakers of understudied languages

Projected trends in population aging have forecasted a massive increase in the number of people with dementia, in particular in sub-Saharan Africa and the Middle East and North Africa (MENA) region. Cognitive decline is a significant marker for dementia, typically assessed with standardized neuropsychological tools that have been validated in some well-researched languages such as English. However, with the existing language diversity, current tools cannot cater to speakers of understudied languages, putting these populations at a disadvantage when it comes to access to early and accurate diagnosis of dementia. Here, we shed light on the detrimental impact of this language gap in the context of the MENA region, highlighting inadequate tools and an unacceptable lack of expertise for a MENA population of a half billion people. Our perspective calls for more research to unravel the exact impact of the language gap on the quality of cognitive decline assessment in speakers of understudied languages.

Highlights

Cognitive decline is a marker for dementia, assessed with neuropsychological tests.There is a lack of culturally valid tests for speakers of understudied languages.For example, suboptimal cognitive tests are used in the Middle East and North Africa region.Linguistic diversity should be considered in the development of cognitive tests.

Adaptation and initial validation of the Arabic version of the Word Memory Test (WMTARB)

BACKGROUND

The feigning of cognitive impairment is common in neuropsychological assessments, especially in a medicolegal setting. The Word Memory Test (WMT) is a forced-choice recognition memory performance validity test (PVT) which is widely used to detect noncredible performance. Though translated to several languages, this was not done for one of the most common languages, Arabic. The aim of the current study was to evaluate the convergent validity of the Arabic adaptation of the WMT (WMT_ARB) among Israeli Arabic speakers.

METHODS

We adapted the WMT to Arabic using the back-translation method and in accordance with relevant guidelines. We then randomly assigned healthy Arabic speaking adults (N = 63) to either a simulation or honest control condition. The participants then performed neuropsychological tests which included the WMT_ARB and the Test of Memory Malingering (TOMM), a well-validated nonverbal PVT.

RESULTS

The WMT_ARB had high split-half reliability and its measures were significantly correlated with that of the TOMM (p < .001). High concordance was found in classification of participants using the WMT_ARB and TOMM (specificity = 94.29% and sensitivity = 100% using the conventional TOMM trial 2 cutoff as gold standard). As expected, simulators' accuracy on the WMT_ARB was significantly lower than that of honest controls. None of the demographic variables significantly correlated with WMT_ARB measures.

CONCLUSION

The WMT_ARB shows initial evidence of reliability and validity, emphasizing its potential use in the large population of Arabic speakers and universality in detecting noncredible performance. The findings, however, are preliminary and mandate validation in clinical settings.

Spatial Binding Impairments in Visual Working Memory following Temporal Lobectomy

Disorders of the medial temporal lobe (MTL) adversely affect visual working memory (vWM) performance, including feature binding. It is unclear whether these impairments generalize across visual dimensions or are specifically spatial. To address this issue, we compared performance in two tasks of 13 epilepsy patients, who had undergone a temporal lobectomy, and 15 healthy controls. In the vWM task, participants recalled the color of one of two polygons, previously displayed side by side. At recall, a location or shape probe identified the target. In the perceptual task, participants estimated the centroid of three visible disks. Patients recalled the target color less accurately than healthy controls because they frequently swapped the nontarget with the target color. Moreover, healthy controls and right temporal lobectomy patients made more swap errors following shape than space probes. Left temporal lobectomy patients, showed the opposite pattern of errors instead. Patients and controls performed similarly in the perceptual task. We conclude that left MTL damage impairs spatial binding in vWM, and that this impairment does not reflect a perceptual or attentional deficit.