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The Clinical Neuropsychologist

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Spanish boston naming test norms

Ricardo F. Allegriab; Aurora Fernandez Villavicencioa; Fernando E. Taraganoa; Sandra Rymbergb; Carlos A. Mangonec; Denise Baumannc a Servicio de Neuropsicologa (SIREN), CEMIC, Buenos Aires, Servicios de Neurologa, b Hospital Municipal Zubizarreta, c Hospital Municipal Santojanni, Buenos Aires, Argentina

To cite this Article Allegri, Ricardo F. , Villavicencio, Aurora Fernandez , Taragano, Fernando E. , Rymberg, Sandra ,

Mangone, Carlos A. and Baumann, Denise(1997) 'Spanish boston naming test norms', The Clinical Neuropsychologist, 11: 4, 416 420 To link to this Article: DOI: 10.1080/13854049708400471 URL: http://dx.doi.org/10.1080/13854049708400471

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The Clinical Neuropsychologist 1997, Vol. 11, NO. 4, pp. 416-420

1385-4046/97/ I 104-416$12.00 0 Swets & Zeitlinger

Spanish Boston Naming Test Norms*

Ricardo F. Allegri , Carlos A. Mangone3 , Aurora Fernandez Villavicencio, Sandra Rymberg, Fernando E. Taragano, and Denise Baumann3
Servicio de Neuropsicologia (SIREN), CEMIC, Buenos Aires, Servicios de Neurologia, 2Hospital Municipal Zubizarreta, and 3Hospital Municipal Santojanni, Buenos Aires, Argentina

ABSTRACT
The Spanish version of the Boston Naming Test (BNT) has enjoyed widespread use in many clinical and research studies since its introduction. However, there are no normative data available for this test, and the original English language order of presentation is maintained. The purpose of this study was to collect normative information in Buenos Aires and to evaluate age and education effects for the BNT. We studied 200 independent healthy controls between 30 and 82 years of age. No subjects had any history of neurological or psychiatric disorders or alcohol abuse. Neuropsychological evaluation included the Mini-Mental State Examination, Signoret Memory Battery, Serial Frontal Test, Phonologic and Semantic Fluency Test, and Hamilton Depression Scale. The Spanish version of the Boston Naming Test was administered according to the standard protocol. We observed that naming abilities remain generally intact throughout advancing age. Results on the BNT were significantly correlated with education @< .001). We generated normative data for the adult population of Buenos Aires and rearranged the order of presentation of the stimulus items according to frequency of correct responses given by our subjects.

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Semantic memory represents our knowledge of concepts, words, and in essence, our knowledge about the world. Cognitive neuropsychology considers semantic memory as a long-term memory sub-system (Squire, 1987). Recent studies of brain-damaged subjects show that semantic memory impairment is a crucial factor in the determination of some neurological syndromes, such as the language disturbances in dementia of the Alzheimer type (Bayles & Tomoeda, 1983), certain types of aphasia (Benson & Geschwind, 1985) and associative visual agnosia (Warrington, 1975). Anomia is an early neuropsychological sign in patients with Alzheimer type dementia. According to some, it is a severe symptom (Kertesz, Appell, & Fisman, 1986) and constitutes clear proof of cortical dementia (Cummings & Benson, 1984, 1992).

Semantic memory can be assessed through verbal fluency tests (Benton, 1968), semantic priming tests (Chertkow & Bub, 1990), vocabulary tests (Wechsler, 1988) and confrontation naming tests (Kaplan, Goodglass, & Weintraub, 1983). Clinical researchers have found that assessing confrontation naming can be important for differential diagnosis between normal aging, cortical and subcortical dementias (Cummings & Benson, 1984, 1992). The Boston Naming Test (BNT; Kaplan, Goodglass, & Weintraub, 1983) is the most frequently used test of confrontation naming in assessment of the aphasias as well as cognitive impairment of other types. As far as we know standards for administration for this test do not exist in Argentina. The BNT is a visual confrontation naming test that consists of 60 schematic figures of objects (Kaplan, Goodglass, & Weintraub, 1983).

* We are indebted to Lydia Artiola I Fortuny, Ph.D. for her helpful and insightful critiques of the manuscript. Address correspondence to: Ricardo F. Allegri , Servicio de Neuropsicologia (SIREN), CEMIC, Galvan 4102, (143 1) Buenos Aires, Argentina. Accepted for publication: March 1, 1997.

SPANISH BNT NORMS

417

Table 1. Demographic Data. Age (years)

< 39
4049 9 14 10 33 50-59 6049 21 17 10 48

> 70
8 7 10 24

Total
61 69 70 200

Education (years) Elementary (less than 7) High school (8 to 12) College (more than 13) Total

8 18 18 44

15 13 22 50

The 60 stimulus figures are presented in order of increasing difficulty. The Spanish version (Kaplan, Goodglass, & Weintraub, 1986) is used frequently in Argentina.The test maintains the order of presentation of the figures of the original English language test. We believe that this causes some difficulties in clinical practice and research with Spanish-speaking populations. Indeed, it cannot be assumed that the Spanish and English languages possess equivalent word frequencies. It is important to note that even though no Spanish language norms exist, the test is widely used in clinical settings and commercially distributed in Argentina. The purpose of this study was to generate normative information for the BNT in Buenos Aires, and to re-order the stimulus cards to reflect the frequency of correct responses. We included a wide range of age and education levels. MATERIALS AND METHODS Two hundred normal, non-institutionalized, independent subjects, between 30 and 82 years of age

were evaluated. These were relatives or caregivers of neurological patients from our clinical departments. All subjects were administered the Mini-Mental State Examination (Folstein, Folstein, & McHugh, 1975), Signorets Memory Evaluation Battery (Signoret, & Whiteley, 1979), the Serial Frontal Test (Luria, 1966), the Verbal Semantic and Phonologic Fluency Test (Benton, 1968), the Hamilton Depression Scale (Hamilton, 1960) and the Boston Naming Test (BNT) (Kaplan, Goodglass, & Weintraub, 1986). The BNT was administered and scored following the procedures recommended by the original authors (Kaplan, Goodglass, & Weintraub, 1983). Subjects with a history of neurologic andl or psychiatric illness, alcoholism, or Mini-Mental State scores (MMS) lower than 26 (Folstein, Folstein, & McHugh, 1975) were excluded, as well as those scoring lower than two standard deviations from the mean in the remainder of the cognitive tests. Illiterates were not included.

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Data Analysis
Spearman correlation coefficient and ANOVA were used, (BMDP 90 Statistical Software, Dixon,
1990)

Table 2. Results of the Boston Naming Test on Normal Subjects Stratified by Age and Education. Age (years)
< 39 M(SD)

40-49 M(SD) 49.0 (3.7) 54.2 (3.6) 55.5 (1.4) 53.4 (4.0)

5 0-5 9 M(SD) 49.4 (4.2) 52.8 (2.2) 55.0 (3.8) 52.8 (4.2)

60-69 M(SD) 47.8 (5.4) 51.8 (4.2) 53.0 (3.4) 50.2 (4.9)

> 70 M(SD)
~~

Total
M(SD) 48.1 (5.0) 52.2 (3.9) 54.2 (3.1) 51.7 (4.7)

Education (years) Elementary (less than 7) High school (8 to 12) College (more than 13) Total

47.7 (7.0) 51.1 (3.8) 54.9 (2.3) 52.0 (4.8)

45.8 (4.0) 50.7 (5.1) 52.8 (1.3) 50.1 (4.5)

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RICARDO E ALLEGRI ET AL.

Table 3. Percenta e of Correct Answers for Each Item o f (8riginal BNT. Object
1 2 3 4 5
% correct

Table 4. Correct Order of Presentation of Items for Buenos Aires. Object

1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60
% correct

7 8 9 10
11

12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43
44

Cama (Bed) Arbol (Tree) Lkpiz (Pencil) Casa (House) Reloj (Watch) Tijera (Scissors) Peine (Comb) Flor (Flower) Martillo (Hammer) Sacapunta (Pencil sharpener) Helic6ptero (Helicopter) Escoba (Broom) Pulpo (Octo us) Zanahoria (Zarrot) Percha (Perch) Termdmetro (Thermometer) Camello (Camel) Miscara (Mask) Helado (Ice cream) Banco (Bench) Raqueta (Racket) Caracol (Snail) Volcan (Volcano) Pez espada (Sword fish) Dardo (Dart) Canoa (Canoe) Globo (Globe) Corona (Crown) Castor (Beaver) Arm6nica (Harmonica) Rinoceronte (Rhinoceros) Bellota (Acorn) I lU(Iglo0) ancos (Stilts) Domind (Dominoes) Cactus (Cactus) Escalera (Stairway)

100
100

100 97.7 100

100 100

45 46 47 48 49 50 51 52 53 54 55 56 57 58 59 60

& % ~ ~ ~ ~ m m o c k) Cerradura (Lock) Pelicano (Pelican) Estetoscopio (Stethoscope) Pirhmide (Pyramid) Bozal (Muzzle) Unicornio (Unicorn) Embudo (Funnel) Acorde6n (Accordion) Aguja (Needle) Esparrago (Asparagus) Compis (Com ass) Chupete (Paciler) Tripode (Tri od) Pergamino (Farchment) Pinza (Tweezers) Esfinge (Sphinx) Yugo (Yoke) Regadera (Watering can) Paleta (Palette) Transportador (Protractor) Abaco (Abacus)

100 100 98.8 98.2 100 98.8 100 I00 99.4 99.4 98.2 90.7 99.4 99.4 98.8 99.4 98.2 81 97.1 83.2 100 70.5 75.7 89.6 55 89.6 96 86.2 95.4 99.4 98.2 92.5 90.7 83.2 78 99.4 91.3 75.7 97.1 98.8 92 78.7 96 99.4 86.7 84.4 94.8 77.4 34.2 100 87.7 74 88.5

Cama (Bed) Arbol (Tree) LA iz (Pencil) Refoj (Watch) Tijera (Scissors) Peine (Comb) Flor (Flower) Martillo (Hammer) Escoba (Broom) Zanahoria (Carrot) Percha (Perch) Corona (Crown) Regadera (Watering can) Termdmetro (Thermometer) Camello (Camel) Banco (Bench) Raqueta (Racket) Volckn (Volcano) Escalera (Stairway) Pirimide (Pyramid) Chupete (Pacifier) Sacapunta (Pencil sharpener) Pulpo (Octopus) Caracol (Snail) Acorde6n (Accordion) Helic6ptero (Helicopter) Miscara (Mask) Pez es ada (Sword fish) Arpa (Rarp) Casa (House) Canoa (Canoe) Embudo (Funnel) Zancos (Stilts) Compis (Compass) Cactus (Cactus) Pinzas (Tweezers) Hamaca (Hammock) Aguja (Needle) Bozal (Muzzle) Helado (Ice cream) Cerradura (Lock) Rinoceronte (Rhinoceros) Ig16 (Igloo) Abaco (Abacus) Paleta (Palette) Tripode (Tripod) Domin6 (Dominoes) Per amino (Parchment) Glo%o (Globe) Pelicano (Pelican) Dardo (Dart) Espkrrago (As aragus) Estetosco io (hethoscope) EsfinFe (lphinx) Armonica (Harmonica) Unicornio (Unicorn) Transportador (Protractor) Castor (Beaver) Bellota (Acorn) Yugo (Yoke )

100

100 100
100 100

100 100 100 I00 100 100

I00 100

99.4 99.4 99.4 99.4 99.4 99.4 99.4 99.4 99.8 99.8 99.8 99.8 98.2 98.2 98.2 98.2 97.7 97.1 97.1 96 96 95.4 94.8 92.5 92 91.3 90.7 90.7 89.6 89.6 88.5 87.7 86.7 86.2 84.4 83.2 83.2 81 78.7 78 77.4 75.7 75.7 74 70.5 55 34.2

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Note. N=200.

SPANISH BNT NORMS

419

Table 5. Boston NamingTest Results Stratified by Education.

Education (years) Elementary (less than 7) High school (8 to 12)

College (more than 13)

48.1 (5.1)

52.2(3.9) 54.2(3.1)

38 44

48

Note. Cut off= limit value at two standard deviations below mean.

RESULTS Age and education distribution of the population are shown in Table 1. Correlation between BNT scores, age, and education showed that only education correlated significantly with naming test scores (r= .52; p < .01). Age- and educationstratified normative information (mean and standard deviation) for the BNT is shown in Table 2. The decline in performance after age 60 is not statistically significant. However, the effects of education on BNT scores were significant (F=35.7; p < .OOl). Based on the frequency of correct responses obtained by normal controls on each stimulus (Table 3), we re-ordered the presentation of the stimuli (Table 4). Because BNT total scores were significantly affected by education, we divided our population into three educational groups: elementary school, high school, and college. For each group, we calculated cutoff scores at two standard deviations below the mean. This allowed inclusion of 96.4% of the normal subjects with elementary school, 94.36% with high school, 97.1 % with college education (Table 5). We observed that there was only a slight variance due to education in the first 40 items. After the 41st item, variance was much higher. The importance of education and the weaker effect of age led us to suggest the use of cutoff scores listed in Table 5.

DISCUSSION
This study presents normative data on the BNT for an Argentinian population. Additionally, a more linguistically appropiate order of presentation of the original BNT stimulus cards is suggested for use with this Spanish-speaking population. Our results show a significant correlation between performance on the BNT and education. The English language literature does not report this difference (Kaplan, Goodglass, & Weintraub, 1983; La Barge, Edward, & Knesevich,1986; Van Gorp, Satz, Kiersch, & Henry, 1986). We believe that population differences as well as methodological issues may be responsible for that difference. Of the 84 patients in Kaplan et al. (1983), only 15 had less than 12 years of education. In La Barge et al. (1988), out of 58 patients only 8 had less than 8 years of education and in Van Grop et al. (1986) all 78 patients had 13 to 15 years of education. It is possible that in studies with more highly educated patients, education-related differences in the BNT are not as frequently observed. Because most of our population has low levels of formal education, we need to adapt the test to our environment. A number of authors (Kaplan et al., 1983; La Barge et a1.,1986; Van Gorp et al., 1986) have reported no significant correlation between BNT performance and age. In the current study, as well as in that of Van Gorp et al. (1986), there was only a slight trend towards decline after 60 years of age. Studies of older populations may provide further more powerful evidence of this trend.

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Kaplan, E.F., Goodglass, H., & Weintraub, S . (1983). The Boston Naming Test (2nd ed.) Philadelphia: Lea & Febiger. Kaplan, E.F., Goodglass, H., & Weintraub, S . (1 986). Test de Vocabulario de Boston. Madrid: Panamericana. Kertesz, A., Appell, J., & Fisman, M. (1986). The dissolution of language in Alzheimers disease. Canadian Journal of Neurological Sciences, 13, 415418. La Barge, E., Edward, D., & Knesevich, J.W. (1986). Performance of normal elderly on Boston Naming Test. Brain and Language, 27,380-384. Luria, A.R. (1966). Human brain and psychological processes. New York: Harper & Row. Signoret, J.L., & Whiteley, A. (1979). Memory battery scale. Internal Neuropsychological Society Bulletin, 2-26. Squire, L.R. (1987). Memory and brain. New York: Oxford University Press. Van Gorp, W.G., Satz, P., Kiersch, M.E., & Henry, R. (1986). Normative data on the Boston Naming Test for a group of normal older adults. Journal of Clinical and Experimental Neuropsychology, 8, 702705. Warrington, E.K. (1975). The selective impairment of semantic memory. Quarterly Journal of Experimental Psychology, 27, 635-657. Wechsler, D. (1988). Test de inteligenciapara adultos (WA.1.S.) Buenos Aires, Argentina, Paidos.