Is the Boston Naming Test still fit for purpose?

Cross-cultural Diagnostic Validity of the Multilingual Naming Test (MINT) in a Sample of Older Adults

OBJECTIVE

We aimed to evaluate the psychometric properties and diagnostic accuracy of the 32-item version of the Multilingual Naming Test (MINT) in participants from 2 ethnic groups (European Americans [EA; n = 106] and Hispanic Americans [HA; n = 175]) with 3 diagnostic groups (cognitively normal [CN], n = 94, mild cognitive impairment [MCI], n = 148, and dementia, n = 39).

METHOD

An Item Response Theory model was used to evaluate items across ethnicity and language groups (Spanish and English), resulting in a 24-item version. We analyzed the MINT discriminant and predictive validity across diagnostic groups.

RESULTS

A total of 8 items were differentially difficult between languages in the 32-item version of the MINT. EA scored significantly higher than HA, but the difference was not significant when removing those 8 items (controlling for Education). The Receiver Operating Characteristics showed that the MINT had poor accuracy when identifying CN participants and was acceptable in identifying dementia participants but unacceptable in classifying MCI participants. Finally, we tested the association between MINT scores and magnetic resonance imaging volumetric measures of language-related areas in the temporal and frontal lobes. The 32-item MINT in English and Spanish and the 24-item MINT in Spanish were significantly correlated with the bilateral middle temporal gyrus. The left fusiform gyrus correlated with MINT scores regardless of language and MINT version. We also found differential correlations depending on the language of administration.

CONCLUSIONS

Our results highlight the importance of analyzing cross-cultural samples when implementing clinical neuropsychological tests such as the MINT.

Irregular word reading as a marker of semantic decline in Alzheimer's disease: implications for premorbid intellectual ability measurement

BACKGROUND

Irregular word reading has been used to estimate premorbid intelligence in Alzheimer's disease (AD) dementia. However, reading models highlight the core influence of semantic abilities on irregular word reading, which shows early decline in AD. The primary objective of this study is to ascertain whether irregular word reading serves as an indicator of cognitive and semantic decline in AD, potentially discouraging its use as a marker for premorbid intellectual abilities.

METHOD

Six hundred eighty-one healthy controls (HC), 104 subjective cognitive decline, 290 early and 589 late mild cognitive impairment (EMCI, LMCI) and 348 AD participants from the Alzheimer's Disease Neuroimaging Initiative were included. Irregular word reading was assessed with the American National Adult Reading Test (AmNART). Multiple linear regressions were conducted predicting AmNART score using diagnostic category, general cognitive impairment and semantic tests. A generalized logistic mixed-effects model predicted correct reading using extracted psycholinguistic characteristics of each AmNART words. Deformation-based morphometry was used to assess the relationship between AmNART scores and voxel-wise brain volumes, as well as with the volume of a region of interest placed in the left anterior temporal lobe (ATL), a region implicated in semantic memory.

RESULTS

EMCI, LMCI and AD patients made significantly more errors in reading irregular words compared to HC, and AD patients made more errors than all other groups. Across the AD continuum, as well as within each diagnostic group, irregular word reading was significantly correlated to measures of general cognitive impairment / dementia severity. Neuropsychological tests of lexicosemantics were moderately correlated to irregular word reading whilst executive functioning and episodic memory were respectively weakly and not correlated. Age of acquisition, a primarily semantic variable, had a strong effect on irregular word reading accuracy whilst none of the phonological variables significantly contributed. Neuroimaging analyses pointed to bilateral hippocampal and left ATL volume loss as the main contributors to decreased irregular word reading performances.

CONCLUSIONS

While the AmNART may be appropriate to measure premorbid intellectual abilities in cognitively unimpaired individuals, our results suggest that it captures current semantic decline in MCI and AD patients and may therefore underestimate premorbid intelligence. On the other hand, irregular word reading tests might be clinically useful to detect semantic impairments in individuals on the AD continuum.

Naming assessment in bilinguals for epilepsy surgery-adaptation and standardization of Boston Naming Test in India

PURPOSE

Naming difficulty is associated with temporal lobe epilepsy and a decline in naming ability is reported following dominant temporal lobe resections. The Boston Naming Test (BNT) is the most frequently used test for assessing naming ability. Evaluating naming ability in bilingual/multilingual populations is a challenge when participants are restricted to responding in one language. The study aimed to adapt and standardize the BNT as a valid clinical tool for evaluating bilingual/multilingual people undergoing epilepsy surgery in urban India.

RESULTS

Culture-appropriate adaptations were done, and participants were allowed to respond in any language. Data from 197 participants showed a strong education effect. The adaptation showed strong internal consistency, reliability, construct validity, and high sensitivity to left temporal lobe epilepsy performance.

CONCLUSIONS

The adapted version that allowed for flexible use of more than one language is a useful clinical tool for evaluating bilingual people undergoing epilepsy surgery.

Picture naming test through the prism of cognitive neuroscience and linguistics: adapting the test for cerebellar tumor survivors-or pouring new wine in old sacks?

A picture naming test (PNT) has long been regarded as an integral part of neuropsychological assessment. In current research and clinical practice, it serves a variety of purposes. PNTs are used to assess the severity of speech impairment in aphasia, monitor possible cognitive decline in aging patients with or without age-related neurodegenerative disorders, track language development in children and map eloquent brain areas to be spared during surgery. In research settings, picture naming tests provide an insight into the process of lexical retrieval in monolingual and bilingual speakers. However, while numerous advances have occurred in linguistics and neuroscience since the classic, most widespread PNTs were developed, few of them have found their way into test design. Consequently, despite the popularity of PNTs in clinical and research practice, their relevance and objectivity remain questionable. The present study provides an overview of literature where relevant criticisms and concerns have been expressed over the recent decades. It aims to determine whether there is a significant gap between conventional test design and the current understanding of the mechanisms underlying lexical retrieval by focusing on the parameters that have been experimentally proven to influence picture naming. We discuss here the implications of these findings for improving and facilitating test design within the picture naming paradigm. Subsequently, we highlight the importance of designing specialized tests with a particular target group in mind, so that test variables could be selected for cerebellar tumor survivors.

Analyzing direct effects of education level and estimated IQ between cognitively intact Mexican Americans and Non-Hispanic whites on a confrontational naming task

Confrontational naming is widely used in diagnosing neurodegenerative disorders like MCI and dementia, and previous research indicates that healthy Non-Hispanic Whites outperform Hispanics in such tasks. However, understanding the factors contributing to score differences among ethnic groups remains limited. This study focuses on cognitively intact Mexican Americans and Non-Hispanic White older adults from the TARCC Hispanic Cohort project. Hierarchical regression analyses reveal that sex, age, ethnicity, education level, and estimated IQ significantly predict performance on the Boston Naming Test (BNT). Notably, education level and estimated IQ more strongly influence BNT performance in Mexican Americans than in Non-Hispanic Whites. When controlling for education level, estimated IQ has a more pronounced impact on BNT performance in aging Mexican Americans compared to Non-Hispanic Whites. Conversely, after controlling for estimated IQ, the influence of education level is weaker for Mexican Americans than Non-Hispanic Whites. These findings emphasize the need for careful evaluation of confrontational naming task scores in diverse ethnic groups, emphasizing the critical role of education and estimated IQ in understanding performance disparities.

Complementary auditory and Visual Naming Tests: Revised and updated for ages 16-55 years

Objective: Historically, naming has been assessed with visual object naming; however, we have found that auditory description naming significantly enhances lateralization and localization of dysfunction. We previously published auditory naming (ANT) and complementary Visual Naming Tests (VNT) for young adults, and recently developed these measures for children (ages 6-15 years) and older adults (ages 56-100 years). Here, we update the original stimuli and more rigorously norm the tests for ages 16-55, addressing prior limitations. Methods: Test stimuli were selected based on item characteristics and preliminary screening, eliminating those with less than 90% name agreement. A sample of 178 healthy individuals ages 16-55 years were administered the updated ANT and VNT, and other standardized measures, either in person (n = 114) or via telehealth (n = 64). Results: With no effect of age, yet a significant influence of education, education-based normative data are provided for accuracy, tips-of-the-tongue (i.e. delayed, accurate responses plus correct responses following phonemic cueing), and an aggregate Summary Score. Internal and test-retest reliability coefficients were reasonable (.67-.90). Conclusions: These measures provide updated and improved naming assessment for ages 16-55 years, contributing to a contiguous set of naming tests for school-aged children through elderly adults. Compared to the original ANT and VNT, these measures were designed to have stimuli longevity, and offer reduced item burden and evidence-based recommendations for performance measures with the greatest clinical sensitivity. The addition of these measures enables continuity in assessment across the age span, facilitating longitudinal assessment related to disease progression or therapeutic intervention.

Irregular word reading as a marker of cognitive and semantic decline in Alzheimer's disease rather than an estimate of premorbid intellectual abilities

Background

Irregular word reading has been used to estimate premorbid intelligence in Alzheimer's disease (AD) dementia. However, reading models highlight the core influence of semantic abilities on irregular word reading, which shows early decline in AD. The general aim of this study is to determine whether irregular word reading is a valid estimate of premorbid intelligence, or a marker of cognitive and semantic decline in AD.

Method

681 healthy controls (HC), 104 subjective cognitive decline, 290 early and 589 late mild cognitive impairment (EMCI, LMCI) and 348 AD participants from the Alzheimer's Disease Neuroimaging Initiative were included. Irregular word reading was assessed with the American National Adult Reading Test (AmNART). Multiple linear regressions were conducted predicting AmNART score using diagnostic category, general cognitive impairment and semantic tests. A generalized logistic mixed-effects model predicted correct reading using extracted psycholinguistic characteristics of each AmNART words. Deformation-based morphometry was used to assess the relationship between AmNART scores and voxel-wise brain volumes, as well as with the volume of a region of interest placed in the left anterior temporal lobe (ATL).

Results

EMCI, LMCI and AD patients made significantly more errors in reading irregular words compared to HC, and AD patients made more errors than all other groups. Across the AD continuum, as well as within each diagnostic group, irregular word reading was significantly correlated to measures of general cognitive impairment / dementia severity. Neuropsychological tests of lexicosemantics were moderately correlated to irregular word reading whilst executive functioning and episodic memory were respectively weakly and not correlated. Age of acquisition, a primarily semantic variable, had a strong effect on irregular word reading accuracy whilst none of the phonological variables significantly contributed. Neuroimaging analyses pointed to bilateral hippocampal and left ATL volume loss as the main contributors to decreased irregular word reading performances.

Conclusions

Irregular word reading performances decline throughout the AD continuum, and therefore, premorbid intelligence estimates based on the AmNART should not be considered accurate in MCI or AD. Results are consistent with the theory of irregular word reading impairments as an indicator of disease severity and semantic decline.

Composite Indices of the Color-Picture Version of Boston Naming Test Have Better Discriminatory Power: Reliability and Validity in a Chinese Sample with Diverse Neurodegenerative Diseases

BACKGROUND

The Boston Naming Test (BNT) is the most widely used measure to assess anomia. However, it has been criticized for failing to differentiate the underlying cognitive process of anomia.

OBJECTIVE

We validated the color-picture version of BNT (CP-BNT) in a sample with diverse neurodegenerative dementia diseases (NDDs). We also verified the differential ability of the composite indices of CP-BNT across NDDs groups.

METHODS

The present study included Alzheimer's disease (n = 132), semantic variant primary progressive aphasia (svPPA, n = 53), non-svPPA (n = 33), posterior cortical atrophy (PCA, n = 35), and normal controls (n = 110). We evaluated psychometric properties of CP-BNT for the spontaneous naming (SN), the percentage of correct responses on semantic cuing and word recognition cuing (% SC, % WR). Receiver operating characteristic analysis was used to examine the discriminatory power of SN alone and the composite indices (SN, % SC, and % WR).

RESULTS

The CP-BNT had sufficient internal consistency, good convergent, divergent validity, and criterion validity. Different indices of CP-BNT demonstrated distinct cognitive underpinnings. Category fluency was the strongest predictor of SN (β= 0.46, p < 0.001). Auditory comprehension tests highly associated with % WR (Sentence comprehension: β= 0.22, p = 0.001; Word comprehension: β= 0.20, p = 0.001), whereas a lower visuospatial score predicted % SC (β= -0.2, p = 0.001). Composite indices had better predictability than the SN alone when differentiating between NDDs, especially for PCA versus non-svPPA (area under the curve increased from 63.9% to 81.2%).

CONCLUSION

The CP-BNT is a highly linguistically relevant test with sufficient reliability and validity. Composite indices could provide more differential information beyond SN and should be used in clinical practice.

The Ability to Use Contextual Information in Object and Scene Recognition in Patients with Mild Cognitive Impairment

BACKGROUND

The ability to understand and make use of object-scene relationships are critical for object and scene recognition.

OBJECTIVE

The current study assessed whether patients with mild cognitive impairment (MCI), possibly in the preclinical phase of Alzheimer's disease, exhibited impairment in processing contextual information in scene and object recognition.

METHODS

In Experiment 1, subjects viewed images of foreground objects in either semantic consistent or inconsistent scenes under no time pressure, and they verbally reported the names of foreground objects and backgrounds. Experiment 2 replicated Experiment 1, except that subjects were required to name scene first. Experiment 3 examined object and scene recognition accuracy baselines, recognition difficulty, familiarity with objects/scenes, and object-scene consistency judgements.

RESULTS

There were contextual consistency effects on scene recognition for MCI and healthy subjects, regardless of response sequence. Scenes were recognized more accurately under the consistent condition than the inconsistent condition. Additionally, MCI patients were more susceptible to incongruent contextual information, possibly due to inhibitory deficits or over-dependence on semantic knowledge. However, no significant differences between MCI and healthy subjects were observed in consistency judgement, recognition accuracy, recognition difficulty and familiarity rating, suggesting no significant impairment in object and scene knowledge among MCI subjects.

CONCLUSIONS

The study indicates that MCI patients retain relatively intact contextual processing ability but may exhibit inhibitory deficits or over-reliance on semantic knowledge.

Naming ability assessment in neurocognitive disorders: a clinician's perspective

BACKGROUND

Detecting impaired naming capacity is valuable in diagnosing neurocognitive disorders (ND). A. clinical practice- oriented overview of naming tests validated in ND is not available yet. Here, features of naming tests with validated utility in ND which are open access or available for purchase are succinctly presented and compared.

METHODS

Searches were carried out across Pubmed, Medline and Google Scholar. Additional studies were identified by searching reference lists. Only peer-reviewed journal articles were eligible. A narrative- and tabullar synthesis was used to summarize different aspects of the naming assessment instruments used in patients with ND such as stimuli type, administration time, assessment parameters and accessibility. Based on computational word frequency calculations, the tests were compared in terms of the average frequency of their linguistic content.

RESULTS

Twelve naming tests, relying either on visual or auditory stimuli have been validated in ND. Their content and administration time vary between three and 60 items and one and 20 minutes, respectively. The average frequency of the words of each considered test was two or lower, pointing to low frequency of most items. In all but one test, scoring systems are exclusively based on correctly named items. Seven instruments are open access and four are available in more than one language.

CONCLUSIONS

Gaining insights into naming tests' characteristics may catalyze the wide incorporation of those with short administration time but high diagnostic accuracy into the diagnostic workup of ND at primary healthcare and of extensive, visual or auditory ones into the diagnostic endeavors of memory clinics, as well as of secondary and tertiary brain healthcare settings.

Elevated Anxious and Depressed Mood Relates to Future Executive Dysfunction in Older Adults: A Longitudinal Network Analysis of Psychopathology and Cognitive Functioning

Vulnerability models posit that executive-functioning (EF) problems centrally affect future common (vs. rare) psychopathology symptoms. Conversely, scar theory postulates that depression/anxiety (vs. other psychopathology) symptoms centrally influence reduced EF. However, most studies so far have been cross-sectional. We used cross-lagged panel network analysis to determine temporal and component-to-component relations on this topic. Community older adults participated across four time points. Cognitive tests and the caregiver-rated Neuropsychiatric Inventory assessed nine psychopathology and eight cognitive-functioning nodes. Nodes with the highest bridge expected influence cross-sectionally were agitation and episodic memory. Episodic memory had the strongest inverse relation with age. Agitation had the strongest negative association with global cognition. EF nodes tended to be centrally affected by prior depressed and anxious moods rather than influential on any future nodes. Heightened anxious and depressed mood (vs. other nodes) centrally predicted future decreased EF-related (vs. non-EF-related) nodes in older adults, supporting scar (vs. vulnerability) theory.

Correspondence of the Boston Naming Test and Multilingual Naming Test in identifying naming impairments in a geriatric cognitive disorders clinic

Confrontation naming measures are commonly used for both diagnostic and clinical research purposes in populations of known or suspected neurodegenerative disorders. The Boston Naming Test (BNT) is the most widely used measure of confrontation naming but has been criticized for outdated and culturally biased content. A new naming measure, the Multilingual Naming Test (MiNT), has been developed that may address these limitations, but research regarding its validity and diagnostic performance relative to existing instruments is limited. The current study examined how the BNT and MiNT performed in a sample of older adults evaluated in an interprofessional memory disorders clinic. Eighty-six individuals (50.0% women) met the inclusion criteria and were included in the study. The average age of participants was 74.2 years (SD = 7.7), and the average education was 16.7 years (SD = 2.5). Most participants were non-Hispanic White (94.2%), and the remaining participants were Hispanic or Black. All participants completed a comprehensive evaluation in English and were administered both the BNT and the MiNT. The strength of agreement as indexed by CCC (.67) was modest for the sample as a whole. Eighty-seven-point five percent classification agreement for impaired vs. normal naming performance was obtained. Eleven cases showed disagreement between BNT and MiNT classification of impairment, with seven of these being borderline score cases. Overall, the results suggest that the MiNT performs similarly at the identification of naming impairments as the BNT, though performance may diverge across different diagnostic groups and may be influenced by age.

The Rapid Naming Test: Development and initial validation in typically aging adults

ObjectiveProgressive word-finding difficulty is a primary cognitive complaint among healthy older adults and a symptom of pathological aging. Classic measures of visual confrontation naming, however, show ceiling effects among healthy older adults. To address the need for a naming test that is sensitive to subtle, age-related word-finding decline, we developed the Rapid Naming Test (RNT), a computerized, one-minute, speeded visual naming test.MethodFunctionally intact older (n = 145) and younger (n = 69) adults completed the RNT. Subsets of older adults also completed neuropsychological tests, a self-report scale of functional decline, amyloid-β PET imaging, and repeat RNT administration to determine test-retest reliability.ResultsRNT scores were normally distributed and exhibited good test-retest reliability. Younger adults performed better than older adults. Within older adults, lower scores were associated with older age. Higher scores correlated with measures of language, processing speed, and episodic learning and memory. Scores were not correlated with visuospatial or working memory tests. Worse performance was related to subjective language decline, even after controlling for a classic naming test and speed. The RNT was also negatively associated with amyloid-β burden.ConclusionsThe RNT appears to be a reliable test that is sensitive to subtle, age-related word-finding decline. Convergent and divergent validity are supported by its specific associations with measures relying on visual naming processes. Ecological validity is supported by its relationship with subjective real-world language difficulties. Lastly, worse performance was related to amyloid-β deposition, an Alzheimer's disease biomarker. This study represents a key step toward validating a novel, sensitive naming test in typically aging adults.

A Color-Picture Version of Boston Naming Test Outperformed the Black-and-White Version in Discriminating Amnestic Mild Cognitive Impairment and Mild Alzheimer's Disease

Despite the ubiquity of the Boston naming test (BNT) in clinical practice and research, concerns have been expressed about its poor quality pictures, insufficient psychometric properties, and cultural bias in non-English language backgrounds. We modified the black-and-white BNT with a set of color pictures since color effects have been suggested to improve naming accuracy in the visual naming test. This study aimed to examine and compare the reliability and validity of the color-picture version of BNT (CP-BNT) and the black-and-white version of BNT (BW-BNT) to differentiate amnestic mild cognitive impairment (aMCI) or mild Alzheimer's disease (AD) from the cognitive normals. This study included two subgroups, and each subgroup had 101 normal controls, 51 aMCI, and 52 mild AD. One subgroup undertook BW-BNT and the other conducted CP-BNT. The reliability, convergent and discriminant validity, and the diagnostic accuracy of two versions of BNT were evaluated. The CP-BNT showed a greater area under the curve (AUC) than the BW-BNT for aMCI (80.3 vs.s 69.4%) and mild AD (93.5 vs. 77.6%). The CP-BNT also demonstrated better convergent validity with CDR global scores and better reliability (Cronbach's coefficient 0.66 for the CP-BNT vs. 0.55 for the BW-BNT). At the optimal cutoff value of spontaneous naming, the CP-BNT demonstrated improved sensitivity and specificity for differentiating mild AD from NC with a higher positive predictive value, negative predictive value, and lower false-positive rate. Compared with BW-BNT, CP-BNT is a more reliable and valid test to assess cognitive and naming impairment.

Boston Naming Test: Lose the Noose

OBJECTIVE

Administering the noose item of the Boston Naming Test (BNT) has been questioned given the cultural, historical, and emotional salience of the noose in American culture. In response, some have modified the BNT by skipping/removing this item and giving the point as if the examinee responded correctly. It is unknown, however, whether modifying standardized administration and scoring in this manner affects clinical interpretation. In the present study, we examined the prevalence of noose item failure, whether demographic and clinical characteristics differed between those who responded correctly versus failed the item, and whether giving a point to those who failed affected clinical interpretation.

METHOD

Participants included a mixed clinical sample of 762 adults, ages 18-88 years, seen for neuropsychological evaluation at one of five sites within the USA.

RESULTS

Those who failed the item (13.78%) were more likely to be female, non-White, and have primary diagnoses of major neurocognitive disorder, epilepsy, or neurodevelopmental disorder. Noose item failure was associated with lower BNT total score, fewer years of education and lower intellectual functioning, expressive vocabulary, and single word reading. Giving a point to those who failed the item resulted in descriptor category change for 17.1%, primarily for patients with poor overall BNT performance.

CONCLUSIONS

Only a small percentage of patients fail the noose item, but adding a point for these has an impact on score interpretation. Factors associated with poorer overall performance on the BNT, rather than specific difficulty with the noose item, likely account for the findings.

Prediction of the clinical and naming status after anterior temporal lobe resection in patients with epilepsy

By assessing the cognitive capital, neuropsychological evaluation (NPE) plays a vital role in the perioperative workup of patients with refractory focal epilepsy. In this retrospective study, we used cutting-edge statistical approaches to examine a group of 47 patients with refractory temporal lobe epilepsy (TLE), who underwent standard anterior temporal lobectomy (ATL). Our objective was to determine whether NPE may represent a robust predictor of the postoperative status, two years after surgery. Specifically, based on pre- and postsurgical neuropsychological data, we estimated the sensitivity of cognitive indicators to predict and to disentangle phenotypes associated with more or less favorable outcomes. Engel (ENG) scores were used to assess clinical outcome, and picture naming (NAM) performance to estimate naming status. Two methods were applied: (a) machine learning (ML) to explore cognitive sensitivity to postoperative outcomes; and (b) graph theory (GT) to assess network properties reflecting favorable vs. less favorable phenotypes after surgery. Specific neuropsychological indices assessing language, memory, and executive functions can globally predict outcomes. Interestingly, preoperative cognitive networks associated with poor postsurgical outcome already exhibit an atypical, highly modular and less densely interconnected configuration. We provide statistical and clinical tools to anticipate the condition after surgery and achieve a more personalized clinical management. Our results also shed light on possible mechanisms put in place for cognitive adaptation after acute injury of central nervous system in relation with surgery.

Deficits in or preservation of basic number processing in Parkinson's disease? A registered report

Neurodegenerative diseases such as Parkinson's disease (PD) have a huge impact on patients, caregivers, and the health-care system. To date, the diagnosis of mild cognitive impairments in PD has been established based on domain-general functions such as executive functions, attention, or working memory. However, specific numerical deficits observed in clinical practice have not yet been systematically investigated. PD-immanent deterioration of domain-general functions and domain-specific numerical areas suggests the mechanisms of both primary and secondary dyscalculia. The current study will systematically investigate basic number processing performance in PD patients for the first time, targeting domain-specific cognitive representations of numerosity and the influence of domain-general factors. The overall sample consists of patients with a diagnosis of PD, according to consensus guidelines, and healthy controls. PD patients will be stratified into patients with normal cognition or mild cognitive impairment (level I-PD-MCI based on cognitive screening). Basic number processing will be assessed using transcoding, number line estimation, and (non)symbolic number magnitude comparison tasks. Discriminant analysis will be employed to assess whether basic number processing tasks can differentiate between a healthy control group and both PD groups. All participants will be subjected to a comprehensive numerical and a neuropsychological test battery, as well as sociodemographic and clinical measures. Study results will give the first broad insight into the extent of basic numerical deficits in different PD patient groups and will help us to understand the underlying mechanisms of the numerical deficits faced by PD patients in daily life.

Removing the noose item from the Boston naming test: A step toward antiracist neuropsychological assessment

Objective: The Boston Naming Test-Second Edition (BNT-2), the "gold-standard" assessment of confrontation naming used to diagnosis disorders such as dementia, includes aculturally insensitive item, the noose. Given calls to stop structural racism in psychology, this study examined changes in scores and performance classification if the noose item were omitted from the BNT-2. Methods: Participants were 291 Black, White, and Latinx adults who were administered the BNT-2 within a comprehensive neuropsychological evaluation. Ethnoracial differences in BNT-2 scores with and without the noose item and percentages of participants answering the noose item incorrectly were investigated. Results: Significant differences were found between ethnoracial groups in BNT-2 raw scores, T-scores, and percentage of participants incorrectly answering the noose item. Follow-up analyses revealed White participants obtained significantly higher raw scores and had significantly fewer participants answer the noose item incorrectly than Black and Latinx groups, who did not differ significantly. For T-scores, Black participants obtained significantly higher scores than White participants who obtained significantly higher scores than Latinx participants. Despite these differences, giving credit for the omitted noose item changed performance classification for only 10 participants (3.4%). Conclusions: Performance classification did not change significantly for the vast majority of a large ethnoculturally diverse sample when giving credit for the noose item as if it were not administered. Therefore, the non-noose BNT-2remains accurate while reducing cultural insensitivity towards Black populations, emphasizing a step in working towards anti-racism and fostering culturally-competent services within psychology.

Expanded Exploration of the Auditory Naming Test in Patients with Dementia

BACKGROUND

Auditory naming tests are superior to visual confrontation naming tests in revealing word-finding difficulties in many neuropathological conditions.

OBJECTIVE

To delineate characteristics of auditory naming most likely to reveal anomia in patients with dementia, and possibly improve diagnostic utility, we evaluated a large sample of patients referred with memory impairment complaints.

METHODS

Patients with dementia (N = 733) or other cognitive impairments and normal individuals (N = 69) were evaluated for frequency of impairment on variables of the Auditory Naming Test (ANT) of Hamberger & Seidel versus the Boston Naming Test (BNT).

RESULTS

Naming impairment occurred more frequently using the ANT total score (φ= 0.41) or ANT tip-of-the tongue score (TOT; φ= 0.19) but not ANT mean response time compared to the BNT in patients with dementia (p < 0.001). Significantly more patients were impaired on ANT variables than on the BNT in Alzheimer's disease (AD), vascular dementia (VaD), mixed AD/VaD, and multiple domain mild cognitive impairment (mMCI) but not in other dementias or amnestic MCI (aMCI). This differential performance of patients on auditory versus visual naming tasks was most pronounced in older, well-educated, male patients with the least cognitive impairment. Impaired verbal comprehension was not contributory. Inclusion of an ANT index score increased sensitivity in the dementia sample (92%). Poor specificity (41%) may be secondary to the inherent limitation of using the BNT as a control variable.

CONCLUSION

The ANT index score adds diagnostic utility to the assessment of naming difficulties in patients with suspected dementia.

Recovery of Apraxia of Speech and Aphasia in Patients With Hand Motor Impairment After Stroke

Objective: Aphasia and apraxia of speech (AOS) after stroke frequently co-occur with a hand motor impairment but few studies have investigated stroke recovery across motor and speech-language domains. In this study, we set out to test the shared recovery hypothesis. We aimed to (1) describe the prevalence of AOS and aphasia in subacute stroke patients with a hand motor impairment and (2) to compare recovery across speech-language and hand motor domains. In addition, we also explored factors predicting recovery from AOS. Methods: Seventy participants with mild to severe paresis in the upper extremity were assessed; 50% of these (n = 35) had left hemisphere (LH) lesions. Aphasia, AOS and hand motor assessments and magnetic resonance imaging were conducted at 4 weeks (A1) and at 6 months (A2) after stroke onset. Recovery was characterized in 15 participants showing initial aphasia that also had complete follow-up data at 6 months. Results: All participants with AOS and/or aphasia had LH lesions. In LH lesioned, the prevalence of aphasia was 71% and of AOS 57%. All participants with AOS had aphasia; 80% of the participants with aphasia also had AOS. Recovery in aphasia (n = 15) and AOS (n = 12) followed a parallel pattern to that observed in hand motor impairment and recovery correlated positively across speech-language and motor domains. The majority of participants with severe initial aphasia and AOS showed a limited but similar amount of recovery across domains. Lesion volume did not correlate with results from behavioral assessments, nor with recovery. The initial aphasia score was the strongest predictor of AOS recovery. Conclusion: Our findings confirm the common occurrence of AOS and aphasia in left hemisphere stroke patients with a hand motor impairment. Recovery was similar across speech-language and motor domains, even in patients with severe impairment, supporting the shared recovery hypothesis and that similar brain recovery mechanisms are involved in speech-language and motor recovery post stroke. These observations contribute to the knowledge of AOS and its relation to motor and language functions and add information that may serve as a basis for future studies of post stroke recovery. Studies including neuroimaging and/or biological assays are required to gain further knowledge on shared brain recovery mechanisms.

Is Attention-Deficit/Hyperactivity Disorder a Risk Syndrome for Parkinson's Disease?

Recent epidemiological evidence indicates that diagnosis of attention-deficit/hyperactivity disorder (ADHD) is associated with increased risk for diseases of the basal ganglia and cerebellum, including Parkinson's disease (PD). The evidence reviewed here indicates that deficits in striatal dopamine are a shared component of the causal chains that produce these disorders. Neuropsychological studies of adult ADHD, prodromal PD, and early-stage PD reveal similar deficits in executive functions, memory, attention, and inhibition that are mediated by similar neural substrates. These and other findings are consistent with the possibility that ADHD may be part of the PD prodrome. The mechanisms that may mediate the association between PD and ADHD include neurotoxic effects of stimulants, other environmental exposures, and Lewy pathology. Understanding the nature of the association between PD and ADHD may provide insight into the etiology and pathogenesis of both disorders. The possible contribution of stimulants to this association may have important clinical and public health implications.

Neurocognitive profile of patients with X-linked dystonia-parkinsonism

X-linked dystonia-parkinsonism (XDP) is a debilitating movement disorder endemic to the Panay Island, Philippines. Most studies focus on motor symptoms, hence we reviewed the neurocognitive profile of XDP patients. Neurocognitive testing of XDP patients focused on five domains: general intellectual functioning, episodic memory, language, attention and executive function, and affect. Twenty-nine genetically confirmed patients were included. Twenty-six (89.6%) had impairments in one or more domains, while only three had no impairment in any domain. Attention and executive function was the most commonly affected domain (n = 23, 79.3%). Deficits in general intellect, episodic memory, attention and executive function and affect were seen in our subset of XDP patients. The striatal pathology affecting the frontostriatal circuitry mandating these cognitive processes is mainly implicated in these impairments. The results of our study provided further evidence on the extent of cognitive impairment in XDP using a select battery of neurocognitive tests.

Salivary cortisol is associated with cognitive changes in patients with fibromyalgia

Fibromyalgia (FM) is a stress-related chronic pain disorder with common cognitive complaints. This study characterized cognitive dysfunction in patients with FM and explored whether these changes are linked to altered cortisol levels. Consecutive 44 patients with FM and 48 healthy controls were enrolled for the assessments of subjective and objective cognitive functions and diurnal levels of salivary cortisol (sampled at awakening, 30 min after awakening, 3 pm, and bedtime). All measurements were compared between the groups and evaluated for clinical correlation. The FM group had more subjective cognitive complaints and performed poorer in objective cognitive testing in memory (delayed recall in Chinese Version Verbal Learning Test and Taylor Complex Figure Test), language (Boston Naming Test), and executive domains (Wisconsin Card Sorting Test) after adjustments for education. The diurnal cortisol levels of patients with FM tended to be lower, especially at 30 min after awakening and bedtime. Moreover, moderate positive correlations existed between the Chinese Version Verbal Learning Test, Boston Naming Test and the morning cortisol levels within the FM group. We suggested the altered cognitive function in FM may be linked to stress maladaptation. Future studies are warranted to elucidate whether stress management improves cognitive performance in patients with FM.

Psychometric Equivalence of Standard and Prorated Boston Naming Test Scores

This study compared prorated Boston Naming Test (BNT-P; omitting the noose item) and standard administration (BNT-S) scores in physical medicine and rehabilitation patients ( N = 480). The sample was 34% female and 91% White with average age and education of 46 ( SD = 15) and 14 ( SD = 3) years, respectively. BNT-P was calculated by summing correct responses excluding item 48 and estimating the 60-item score with cross multiplication and division. BNT-P and BNT-S scores were compared via concordance correlation (CC) coefficients; reflected and log transformed data were examined with equivalence tests. BNT-P and BNT-S scores showed almost perfect agreement (CC = .99). Transformed scores demonstrated equivalence (±1.1 points). Raw and scaled score differences were 0 in 88% and 96% of cases, respectively. Race and ethnicity accounted for item 48 outcomes while controlling for age and education. Findings support the utility of prorated BNT scores in rehabilitation patients.

Constraint-induced aphasia therapy for patients with aphasia: A systematic review

Objectives

This study aimed to systematically evaluate the effects of constraint-induced aphasia therapy (CIAT) for aphasic patients reported by randomized controlled trials.

Methods

Relevant randomized controlled trials were retrieved from 11 electronic databases. A methodological quality assessment was conducted in accordance with the Cochrane Handbook, and meta-analyses were performed by using RevMan 5.2. A descriptive analysis was conducted when the included trials were not suitable for a meta-analysis.

Results

A total of 12 trials were included. A statistically significant group difference was shown from the meta-analysis in the results measured by the Western Aphasia Battery (random-effects model, MD = 1.23, 95% CI = 0.31 to 2.14, P < 0.01). However, there were no statistically significant differences shown in the results of the Boston Naming Test (fixed-effects model, MD = −1.79, 95% CI = −11.19 to 7.62, P > 0.05) and Aachen Aphasia Test (fixed-effects model, MD = −1.11, 95% CI = −4.49 to 2.27, P > 0.05). The descriptive analysis showed positive results in language performances of naming, repetition, and comprehension.

Conclusion

This systematic review indicated that CIAT was efficient for improving language performance with regard to naming, comprehension, repetition, written language, and oral language based on the current evidence. And this review provides some meaningful guides for clinical practice: expand the therapy duration to 2 or 3 h per day, focus on naming, and choose the best assessment tool. It also indicates a need for more rigorous, large-scale, and high-quality trials in the future.

Assessment of semantic memory in mild cognitive impairment: The psychometric properties of a novel semantic battery

Semantic memory is stable in healthy older adults but shows decline in mild cognitive impairment (MCI). Current measures of semantic function do not assess multiple aspects of semantic function and/or are time-consuming to administer. Here we report the psychometric properties of a battery to detect semantic impairment that we recently developed and published. Study 1 determined the face validity of the battery; interviews were conducted with five professionals with expertise in MCI and language. Face validity interviews suggested the battery appropriately assesses semantic impairments. Study 2 assessed convergent validity and reliability (inter-rater reliability, test-retest reliability, and internal consistency). Participants included 102 healthy older adults and 60 people with MCI who completed a four-task semantic battery. Results demonstrate that performance on the semantic battery correlates with traditional measures of semantic function, inter-rater reliability and internal consistency was high, and there was no significant change in mean scores between participants' first and second testing sessions. The present findings suggest that the semantic battery is a reliable and valid assessment of semantic function. It is currently recommended for research use only.

Normative Data for Test of Verbal Fluency and Naming on Ecuadorian Adult Population

Objective: To generate normative data for verbal fluency and naming test in an Ecuadorian adult population. Methods: The sample consisted of 322 healthy adults (18-84 years old) recruited from Quito, Ecuador. The verbal fluency and Boston Naming Test (BNT) were administered as part of a larger comprehensive neuropsychological battery. Multiple linear regression analyses were used to generate the normative data taking into account age, education, and sex. Results: For phonological verbal fluency, results indicated that only education was significantly related to the performance of the letters "A," "S," and "M." However, the performance on the letter "F" was significantly associated with age and education. For semantic fluency, the performance on "animals" was significantly influenced by age, quadratic age, and education, whereas that for "fruits" was explained by quadratic age, education, and sex. The performance on the BNT was significantly influenced by age and education. A Microsoft Excel-based calculator was created to help clinicians to obtain the normative data on this test. Conclusion: This normative data will help neuropsychologist in Ecuador to use these tests both in research and in their clinical practice to improve the diagnosis of cognitive deficits in the population.

Psychometric Properties of the National Institute of Neurological Disorders and Stroke and Canadian Stroke Network Neuropsychological Battery in an Asian Older Adult Sample

OBJECTIVE

Despite the wide usage of the National Institute of Neurological Disorders and Stroke and Canadian Stroke Network (NINDS-CSN) neuropsychological battery for the detection of vascular cognitive impairment, its reliability and validity have not been established. Therefore, the present study established the psychometric properties of the battery in cognitively normal older adults in a clinical setting in Singapore.

DESIGN

Longitudinal study.

SETTING AND PARTICIPANTS

A total of 105 cognitively normal older adults age 50 years and older were assessed in a memory clinic setting.

METHODS

The 60-minute NINDS-CSN and 5-minute protocol were administered to participants at baseline and 3-month follow-up. Raw scores were transformed into standardized z scores. Test-retest reliability, concurrent validity and construct (convergent and discriminant) validity were reported.

RESULTS

Moderate-to-excellent test-retest reliability (r = 0.36-0.87), concurrent validity, and construct validity (r = 0.41-0.83) were found in both protocols over 3 months (all Ps < 0.01). Although the 5-minute protocol showed moderate validity (r = 0.41), the 60-minute protocol had excellent concurrent validity against a locally validated neuropsychological battery (r = 0.83).

CONCLUSION AND IMPLICATIONS

The NINDS-CSN is reliable and valid in assessing cognitive function. The 60-minute protocol demonstrates great utility beyond its current usage in vascular cognitive impairment populations to the general older adult population. The 5-minute protocol can be used as a brief cognitive screening tool in primary healthcare and the community, due to its brevity and accuracy. Future research should further examine the generalizability of the NINDS-CSN battery in other dementias and cognitive disorders.

Multivariate analysis reveals anatomical correlates of naming errors in primary progressive aphasia

Primary progressive aphasia (PPA) is an overarching term for a heterogeneous group of neurodegenerative diseases which affect language processing. Impaired picture naming has been linked to atrophy of the anterior temporal lobe in the semantic variant of PPA. Although atrophy of the anterior temporal lobe proposedly impairs picture naming by undermining access to semantic knowledge, picture naming also entails object recognition and lexical retrieval. Using multivariate analysis, we investigated whether cortical atrophy relates to different types of naming errors generated during picture naming in 43 PPA patients (13 semantic, 9 logopenic, 11 nonfluent, and 10 mixed variant). Omissions were associated with atrophy of the anterior temporal lobes. Semantic errors, for example, mistaking a rhinoceros for a hippopotamus, were associated with atrophy of the left mid and posterior fusiform cortex and the posterior middle and inferior temporal gyrus. Semantic errors and atrophy in these regions occurred in each PPA subtype, without major between-subtype differences. We propose that pathological changes to neural mechanisms associated with semantic errors occur across the PPA spectrum.

Remembering a name: Neuropsychological validity studies and a computer proposal for detection of anomia

There are contradictory results or lack of validity studies concerning the naming function and brain laterality. Although anomia is a frequent symptom of memory impairment, and the most relevant symptom of aphasia, few studies have been conducted to evaluate its validity for detecting patients with left-hemisphere damage (LD), as per the MeSH definition.

A new revised Graded Naming Test and new normative data including older adults (80-97 years)

The Graded Naming Test (GNT) is commonly used in clinical and research settings to assess nominal functions. However, normative data for the GNT is over 20 years old and norms for the older adult population are rather limited. Hence, confounding factors such as generational familiarity due to cultural changes need to be considered when applying the currently available norms. Moreover, normative data for the older population (80-97) are virtually absent. Such factors can be powerful confounds that can lead to incorrect interpretation of test scores. We gathered data for the GNT from 326 healthy controls aged between 18 and 97 years. Surprisingly, we found no decline in performance for older adults, even for the cohort aged 80-97 years (N = 40). In contrast, the youngest cohort (aged 18-29 years) performed unexpectedly below the whole sample mean. An item-by-item analysis revealed that five test items were unfamiliar to the youngest age cohort. To account for this generational familiarity effect, we created a revised 25-item GNT. The performance of the youngest cohort on the 25-item GNT was no longer below the whole sample mean. The performance of the oldest cohort (80-97 years old) on the revised GNT was characterized by a significant decline in performance for the oldest cohort with an average NART IQ. By contrast, those with a NART IQ above the average range did not show a decline. This suggests that factors such cognitive reserve arrested the decline in performance in the oldest age cohort with higher premorbid IQ.

Comparing the Boston Naming Test With the Neuropsychological Assessment Battery-Naming Subtest in a Neurodegenerative Disease Clinic Population

The Boston Naming Test-Second edition (BNT-2) and the Neuropsychological Assessment Battery-Naming (NAB-N) subtest are two commonly used confrontation naming tests used to evaluate word-finding ability in individuals suspected of neurodegenerative disease. The BNT-2 and NAB-N are designed to measure the same construct; however, observations in practice suggest these two tests provide divergent estimates of naming ability. This study sought to systematically investigate the level of agreement between performance on the BNT-2 and NAB-N. Records from 105 consecutive referrals seen for neuropsychological evaluation as part of routine care in an outpatient memory disorders clinic were reviewed. Discrepancy scores, concordance correlation coefficients, and root mean squared differences were calculated between demographically adjusted T-scores on the BNT-2 and NAB-N. Results indicated that estimates of word finding ability generated by the BNT-2 and NAB-N have a strong linear relationship but systematically generate scores that are inconsistent. Despite similar task demands, the BNT-2 and NAB-N provide different information about naming ability and further research is needed to understand these differences and inform clinicians on interpreting the naming estimates provided by each test.

Examination of the reliability and validity of the NAB Naming Test in a diverse clinical sample

Objective: The Boston Naming Test, Second Edition (BNT-2) and the Neuropsychological Assessment Battery (NAB) Naming Test are common measures to assess visual confrontation naming ability. The comparably newer NAB Naming Test is a potential alternative to the BNT-2, given the latter's history of criticism. A recent psychometric investigation of the NAB Naming Test demonstrated sufficient reliability and validity in a large clinical sample; however, their study was limited by a lack of ethnic, racial, and language diversity, all of which can impact scores on naming tests.Method: The present study examined convergent and discriminant validity and internal consistency of the NAB Naming Test in a diverse clinical sample comprised of 225 veterans (87.6% men, 51.1% White/Caucasian, 29.3% bilingual, 64.0% with cognitive impairment). All but three participants identified as White/Caucasian, Hispanic/Latino or Black/African American. These psychometric properties were examined for the overall sample and for monolingual (English) and bilingual (English/Spanish) participants separately.Results: As expected, the NAB Naming Test demonstrated sufficient internal consistency and a negatively skewed distribution for the overall sample and monolingual and bilingual participants. Evidence for adequate convergent and discriminative validity was also established for monolingual and bilingual participants separately.Conclusion: In a diverse clinical sample with differing levels of self-reported language status, the NAB Naming Test demonstrated adequate psychometric properties. Although it represents a viable option in neuropsychological practice, continued awareness of patient-specific factors that could impact performance is recommended.

Confirmatory Factor Analysis of Neurocognitive Measures in Healthy Young Adults: The Relation of Executive Functions with Other Neurocognitive Functions

OBJECTIVE

The present study aimed to investigate the factor structure of a set of neurocognitive tests theoretically assessing executive functions (EF), verbal abilities (VA), and processing speed (PS). This study extended previous research by analyzing if each test is better explained by the specific factor to which it theoretically belongs or by a more general neurocognitive factor; and also by analyzing the relations between the neurocognitive factors.

METHODS

Using confirmatory factor analysis (CFA) we examined the factor structure of nine neurocognitive tests (EF: Working Memory, Tower, Divided Attention, Stroop, and Verbal Fluency tests; VA: Word List and Confrontation Naming tests; PS: Coding and Telephone Search tests) in a nonclinical sample (N = 90; 18-33 years old, 76 women). We tested five factor models of neurocognitive functioning: a one-factor model; two models with two-correlated factors; and two models with three-correlated factors.

RESULTS

A three-correlated-factor model, with EF, VA, and PS factors, was the most suitable for our neuropsychological data. The Verbal Fluency test was better explained by the VA factor rather than by the EF factor. The EF factor was correlated with the PS factor, but not with the VA factor.

CONCLUSIONS

Most of the neurocognitive measures used in the present study loaded in the expected factors (with the exception of the Verbal Fluency that was apparently more related to VA). EF and PS represent related but separable functions. Our results highlight the need for a careful interpretation of test scores since performance on one test usually requires multiple functions.

The BNT-38: Applying Rasch Analysis to Adapt the Boston Naming Test for Use With English and French Monolinguals and Bilinguals

Purpose Currently, there is no reliable instrument to measure naming abilities in bilingual speakers of English and French. The Boston Naming Test (BNT; Kaplan, Goodglass, & Weintraub, 1983 )is a widely used scale for clinical assessments of language function, but it is not suitable to assess bilinguals. Rasch analysis provides a unique and powerful method to establish measurement invariance across language groups that improves reliability of measurement. Method Rasch analysis was applied to a sample ( n = 215) of English or French monolingual and bilingual speakers completing the BNT in either language. Participants included English-French bilinguals ( n = 83), English monolinguals ( n = 72), and French monolinguals ( n = 60). Results The best overall Rasch model fit was obtained after the removal of 22 misfitting items, resulting in a 38-item BNT solution (BNT-38), with a modification of 7 items that showed differential item functioning by language factor. To increase the clinical utility of the BNT-38 in French speakers and bilinguals, we generated ordinal-to-interval conversion tables for monolinguals and bilinguals in English and French. Conclusions Use of the BNT-38 and the associated conversion tables will allow valid comparisons of naming abilities across bilingual and monolingual English and French speakers of different age groups. Applying these tools increases accuracy in measurement of naming ability and higher diagnostic precision in French and English monolinguals and bilinguals.

Italian norms and naming latencies for 357 high quality color images

In the domain of cognitive studies on the lexico-semantic representational system, one of the most important means of ensuring effective experimental designs is using ecological stimulus sets accompanied by normative data on the most relevant variables affecting the processing of their items. In the context of image sets, color photographs are particularly suited to this purpose as they reduce the difficulty of visual decoding processes that may emerge with traditional image sets of line drawings. This is especially so in clinical populations. In this study we provide Italian norms for a set of 357 high quality image-items belonging to 23 semantic subcategories from the Moreno-Martínez and Montoro database. Data from several variables affecting image processing were collected from a sample of 255 Italian-speaking participants: age of acquisition, familiarity, lexical frequency, manipulability, name agreement, typicality and visual complexity. Lexical frequency data were derived from the CoLFIS corpus. Furthermore, we collected data on image oral naming latencies to explore how the variance in these latencies could be explained by these critical variables. Multiple regression analyses on the naming latencies show classical psycholinguistic phenomena, such as the effects of age of acquisition and name agreement. In addition, manipulability was also a significant predictor. The described Italian normative data and naming latencies are available for download as supplementary material.

Effects of Antiparkinson Medication on Cognition in Parkinson's Disease: A Systematic Review

OBJECTIVE

This study aimed to systematically review the effects of currently prescribed antiparkinson medication on cognition in patients with mild-to-moderate Parkinson's disease (PD) who were either cognitively intact or mildly impaired.

METHODS

English- and French-language studies published between 1969 and 2017 were accessed via MedLine, PsychNET, EMBASE and EBSCO databases. Methodological quality (MQ) was evaluated with the quality assessment instrument of the Cochrane Collaboration Depression, Anxiety and Neurosis Review (scores from 0% to 44% indicate very low quality; scores from 45% to 64% indicate low quality; scores from 65% to 84% indicate medium quality; and scores from 85% to 100% indicate high quality). Hedges' g and Student's t-test were performed on all cognitive outcome measures reported.

RESULTS

In total, 14 studies assessed the cognitive effects of levodopa (L-D), pramipexole (PRX), selegiline (SEL) and rasagiline (RAS) in mild-to-moderate non-demented PD patients. The MQ was overall low, with an average score of 49.1%. Results for L-D showed deleterious effects on a test of cognitive inhibition, as well as benefits on tests of attention/processing speed/working memory, executive functions and episodic memory. Pramipexole was associated with a worsening of episodic memory and impulse control. Results on SEL indicated a deterioration of global cognition over time and of concept formation. Rasagiline had some benefits on working memory and verbal fluency.

CONCLUSION

Antiparkinson medications can have deleterious (L-D; PRX; SEL) and beneficial (L-D; RAS) effects on cognition. However, randomized double-blind placebo-controlled trials with larger sample sizes are required to better elucidate this issue.

Language and alexithymia: Evidence for the role of the inferior frontal gyrus in acquired alexithymia

The clinical relevance of alexithymia, a condition associated with difficulties identifying and describing one's own emotion, is becoming ever more apparent. Increased rates of alexithymia are observed in multiple psychiatric conditions, and also in neurological conditions resulting from both organic and traumatic brain injury. The presence of alexithymia in these conditions predicts poorer regulation of one's emotions, decreased treatment response, and increased burden on carers. While clinically important, the aetiology of alexithymia is still a matter of debate, with several authors arguing for multiple 'routes' to impaired understanding of one's own emotions, which may or may not result in distinct subtypes of alexithymia. While previous studies support the role of impaired interoception (perceiving bodily states) in the development of alexithymia, the current study assessed whether acquired language impairment following traumatic brain injury, and damage to language regions, may also be associated with an increased risk of alexithymia. Within a sample of 129 participants with penetrating brain injury and 33 healthy controls, neuropsychological testing revealed that deficits in a non-emotional language task, object naming, were associated with alexithymia, specifically with difficulty identifying one's own emotions. Both region-of-interest and whole-brain lesion analyses revealed that damage to language regions in the inferior frontal gyrus was associated with the presence of both this language impairment and alexithymia. These results are consistent with a framework for acquired alexithymia that incorporates both interoceptive and language processes, and support the idea that brain injury may result in alexithymia via impairment in any one of a number of more basic processes.

Performance discrepancies on the Boston Naming Test in African-American and non-Hispanic White American young adults

The Boston Naming Test (BNT) is one of the most commonly used naming measures in neuropsychology. Although research in the older adult population has shown that African-American (AA) adults perform more poorly on the BNT than non-Hispanic White American (WA) adults, these findings have yet to be replicated in younger adults. The BNT and measures of word reading (WJ-Letter Word ID) and vocabulary (Wechsler Abbreviated Scale of Intelligence Vocabulary) were administered to 50 WA and 33 AA young adults. Performance was age-normed based on published norms and transformed into z-scores. Despite being matched on age, gender, SES, and level of education, the AA group performed more poorly on the BNT (z = - 1.01(1.09)) than the WA group (z = - .28(.92)), t(104) = 3.44, p < .01, d = 0.73. AAs (18%) were more likely to perform in the impaired range than WAs (4%) when impairment cutoff was z-score≤ - 2. Healthy AA young adults are more likely to perform poorly on the BNT despite vocabulary and word reading being well within normal limits. Average BNT performance in both groups were at least one z-score lower than average vocabulary z-scores. Clinicians should interpret poor scores on the BNT with caution, and within the context of individual vocabulary or word reading performance.

Aerobic exercise for Alzheimer's disease: A randomized controlled pilot trial

BACKGROUND

There is increasing interest in the role of physical exercise as a therapeutic strategy for individuals with Alzheimer's disease (AD). We assessed the effect of 26 weeks (6 months) of a supervised aerobic exercise program on memory, executive function, functional ability and depression in early AD.

METHODS AND FINDINGS

This study was a 26-week randomized controlled trial comparing the effects of 150 minutes per week of aerobic exercise vs. non-aerobic stretching and toning control intervention in individuals with early AD. A total of 76 well-characterized older adults with probable AD (mean age 72.9 [7.7]) were enrolled and 68 participants completed the study. Exercise was conducted with supervision and monitoring by trained exercise specialists. Neuropsychological tests and surveys were conducted at baseline,13, and 26 weeks to assess memory and executive function composite scores, functional ability (Disability Assessment for Dementia), and depressive symptoms (Cornell Scale for Depression in Dementia). Cardiorespiratory fitness testing and brain MRI was performed at baseline and 26 weeks. Aerobic exercise was associated with a modest gain in functional ability (Disability Assessment for Dementia) compared to individuals in the ST group (X2 = 8.2, p = 0.02). There was no clear effect of intervention on other primary outcome measures of Memory, Executive Function, or depressive symptoms. However, secondary analyses revealed that change in cardiorespiratory fitness was positively correlated with change in memory performance and bilateral hippocampal volume.

CONCLUSIONS

Aerobic exercise in early AD is associated with benefits in functional ability. Exercise-related gains in cardiorespiratory fitness were associated with improved memory performance and reduced hippocampal atrophy, suggesting cardiorespiratory fitness gains may be important in driving brain benefits.

TRIAL REGISTRATION

ClinicalTrials.gov NCT01128361.

The Cognitive Change Index as a Measure of Self and Informant Perception of Cognitive Decline: Relation to Neuropsychological Tests

BACKGROUND

The perception of cognitive decline by individuals and those who know them well ("informants") has been inconsistently associated with objective cognitive performance, but strongly associated with depressive symptoms.

OBJECTIVE

We investigated associations of self-report, informant-report, and discrepancy between self- and informant-report of cognitive decline obtained from the Cognitive Change Index (CCI) with cognitive test performance and self-reported depressive symptoms.

METHODS

267 participants with normal cognition, mild cognitive impairment (MCI), or mild dementia were included from a cohort study and memory clinic. Association of test performance and self-rated depression (Geriatric Depression Scale, GDS) with CCI scores obtained from subjects (CCI-S), their informants (CCI-I), and discrepancy scores between subjects and informants (CCI-D; CCI-S minus CCI-I) were analyzed using correlation and analysis of covariance (ANCOVA) models.

RESULTS

CCI-S and CCI-I scores showed high internal consistency (Cronbach alpha 0.96 and 0.98, respectively). Higher scores on CCI-S and CCI-I, and lower scores on the CCI-D, were associated with lower performance on various cognitive tests in both univariate and in ANCOVA models adjusted for age, gender, and education. Adjustment for GDS slightly weakened the relationships between CCI and test performance but most remained significant.

CONCLUSION

Self- and informant-report of cognitive decline, as measured by the CCI, show moderately strong relationships with objective test performance independent of age, gender, education, and depressive symptoms. The CCI appears to be a valid cross-sectional measure of self and informant perception of cognitive decline across the continuum of functioning. Studies are needed to address the relationship of CCI scores to longitudinal outcome.

The effect of perceptual reasoning abilities on confrontation naming performance: An examination of three naming tests

INTRODUCTION

Confrontation naming tests are a common neuropsychological method of assessing language and a critical diagnostic tool in identifying certain neurodegenerative diseases; however, there is limited literature examining the visual-perceptual demands of these tasks. This study investigated the effect of perceptual reasoning abilities on three confrontation naming tests, the Boston Naming Test (BNT), Neuropsychological Assessment Battery (NAB) Naming Test, and Visual Naming Test (VNT) to elucidate the diverse cognitive functions underlying these tasks to assist with test selection procedures and increase diagnostic accuracy.

METHOD

A mixed clinical sample of 121 veterans were administered the BNT, NAB, VNT, and Wechsler Adult Intelligence Scale-4th Edition (WAIS-IV) Verbal Comprehension Index (VCI) and Perceptual Reasoning Index (PRI) as part of a comprehensive neuropsychological evaluation.

RESULTS

Multiple regression indicated that PRI accounted for 23%, 13%, and 15% of the variance in BNT, VNT, and NAB scores, respectively, but dropped out as a significant predictor once VCI was added. Follow-up bootstrap mediation analyses revealed that PRI had a significant indirect effect on naming performance after controlling education, primary language, and severity of cognitive impairment, as well as the mediating effect of general verbal abilities for the BNT (B = 0.13; 95% confidence interval, CI [.07, .20]), VNT (B = 0.01; 95% CI [.002, .03]), and NAB (B = 0.03; 95% CI [.01, .06]).

CONCLUSIONS

Findings revealed a complex relationship between perceptual reasoning abilities and confrontation naming that is mediated by general verbal abilities. However, when verbal abilities were statistically controlled, perceptual reasoning abilities were found to have a significant indirect effect on performance across all three confrontation naming measures with the largest effect noted with the BNT relative to the VNT and NAB Naming Test.