Niels Peter Nielsen

Multiple rapid automatic naming measures of cognition: Normal performance and effects of aging

Rapid automatic naming tasks are clinical tools for probing brain functions that underlie normal cognition. To compare performance for various stimuli in normal subjects and assess the effect of aging, we administered six single-dimension stimuli (color, form, number, letter, animal, and object) and five dual-dimension stimuli (color-form, color-number, color-letter, color-animal, and color-object) to 144 normal volunteers who ranged in age from 15 to 85 years. Rapid automatic naming times for letters and numbers were significantly less than for forms, animals, and objects. Rapid automatic naming times for color-number and color-letter stimuli were significantly less than for color-form, color-animal, or color-object stimuli. Age correlated significantly with rapid automatic naming time for each single-dimension stimulus and for color-form, color-number, color-animal, and color-object stimuli. Linear regression showed that rapid automatic naming times increased with age for aggregated color stimuli, aggregated single-dimension stimuli, and aggregated dual-dimension stimuli. This age effect persisted in subgroups less than 60 years of age and greater than 60 years of age. We conclude that normal performance time is dependent on the task, with letter and number stimuli eliciting most rapid responses, and that most rapid automatic naming times increase with age.

Parietal lobe: Activation in rapid, automatized naming by adults

Three automatic naming tasks (Wiig & Nielsen, 1999) were administered to 60 normally functioning adults. The mean time required for naming 40 single-dimension (colors, forms, numbers, and letters) and 40 dual-dimension stimuli (color-form, color-number, and color-letter combinations) were compared in young (17–38 yr.) and older (40–68 yr.) men and women. Analysis of variance for the combined groups indicated significant naming-time differences for age but not foe sex. There were no significant interaction effects. For men there was a significant naming time difference between age groups for forms, and for women for colors and forms. The sex-specific analyses indicated no significant differences in naming time based on age groups for color-form, color-number, or color-letter combinations. In a second study of adult subjects (n = 14), functional brain activity was measured with regional cerebral blood flow during the performance of the color, form, and color-form naming tasks. One subject was repeatedly measured during the performance of each task, whereas 13 subjects were measured during the performance of color-form naming. In comparison to normal reference values for rest and FAS verbal fluency, blood-flow measurements showed a consistent parietal-lobe activation during form and color-form naming, but only a slight activation during color naming. During all naming tasks, a significant frontal and frontotemporal flow decrease was seen in comparison to both rest and verbal fluency reference values. This functional brain activation pattern of a parietal increase and a frontotemporal decrease was consistently confirmed across subjects during the color-form naming task.

Clinical utility of color-form naming in Alzheimer's disease: Preliminary evidence

Performances on Alzheimers Quick Test color–form naming and Mini-Mental State Examination were compared for 38 adults with Alzheimers disease and 38 age- and sex-matched normal controls. Group means differed significantly and indicated longer naming times by adults with Alzheimers disease. The specificity for AQT color–form naming was 97% and sensitivity 97%, i.e., 3% false negatives. The specificity for Mini-Mental State Examination was 100% and sensitivity 84%, i.e., 16% false negatives. These findings, while supporting AQT color–form naming as a screening test for reductions in cognitive speed associated with Alzheimers disease, are preliminary given the relatively small sample.

Quality of life and cognitive function in Fontan patients; a population-based study.

BACKGROUND After the Fontan procedure patients are at risk for reduced quality of life (QoL) and cognitive function. We aimed to assess these important factors in Danish Fontan patients and to compare the results with a group of healthy controls. METHODS All Fontan patients living in Denmark were identified and invited to participate. QoL was evaluated using the Pediatric Quality of Life Inventory (PedsQL) version 4.0 generic core module in patients <16 years and the Short Form 36 questionnaire (SF-36) in patients ≥16 years. Cognitive function was evaluated in all patients ≥6 years using the Quick Test of Cognitive Speed. To evaluate if QoL correlated with exercise capacity, patients performed a symptom-limited bicycle test. RESULTS 158 of 179 eligible patients (88%) consented to participate. Median age was 13.9 years (IQR: 10.2-19.3). PedsQL scores increased with age but were significantly lower among patients than among controls. SF-36 physical scores were significantly lower in patients compared to controls while psychosocial scores were similar. Cognitive speed was significantly reduced in patients at all ages compared to controls. No significant difference in PedsQL-/SF-36 scores or cognitive speed was found between hypoplastic left heart syndrome (HLHS) and non-HLHS Fontan patient. PedsQL-/SF-36 scores in patients ≥10 years correlated significantly to cognitive speed but not to peak exercise capacity. CONCLUSION QoL is reduced in Fontan children compared to their healthy counterparts whereas in patients ≥16 years only physical, but not psychosocial QoL is reduced. Cognitive speed was significantly lower in patients at all ages compared to controls.

A QUICK TEST OF COGNITIVE SPEED: PATTERNS OF AGE GROUPS 15 TO 95 YEARS '

A Quick Test of Cognitive Speed color, form, and color-form naming were administered to 300 normal participants (ages 15–95 years) to explore the effects of age on perceptual (single-dimension naming) and cognitive speed (dual-dimension naming). Naming time means (sec.) were consistent with previous findings. Correlations between age and naming time were low, but significant. Linear regression with age as a factor indicated time increases of 1 sec. per decade for colors and color-form combination naming and of 6 sec. per decade for form naming. Participants were divided into age cohorts, each covering a decade, and naming times were transformed to normalized z scores. The normalized means were similar for color, form, and color-form naming and increased by about 1 SD between ages 15–25 and 75–85 years. The ranges were similar across cohorts, about 2 SD. The findings concur with age patterns for visual-pattern comparison speed, fluid intelligence, and working memory reported by Salthouse in 2004.

Associations between AQT Processing Speed and Neuropsychological Tests in Neuropsychiatric Patients

Associations between A Quick Test of Cognitive Speed (AQT) perceptual and cognitive speed and neuropsychological tests, including the Wechsler Adult Intelligence Scale-Third Edition (WAIS-III), Mini Mental State Examination (MMSE), and the Trail Making Test (TMT), were evaluated in 41 neuropsychiatric patients. Neuropsychological and neurological tests, including CT scan, were administered to all of the patients. AQT was also administered to 75 controls. All AQT means differed significantly for patients and controls. Dual-dimension naming time means in the patient group were in the atypical range and indicated generally reduced cognitive speed, whereas controls performed in the normal range. In the patient group, WAIS-III verbal, performance, and full-scale IQ means were in the normal range. AQT perceptual and cognitive speed correlated negatively with WAIS-III P IQ and MMSE scores, and the relationships were nonlinear. The findings support that AQT dual-dimension naming evaluates cognitive speed (i.e., attention, set shifting, working memory) and can be used for first-line or complementary screening for mild or progressive cognitive impairments.

Dual-Dimension Naming Speed and Language-Dominance Ratings by Bilingual Hispanic Adults.

Abstract This study compared the efficacy of measures of naming speed, verbal fluency and self-ratings for establishing language dominance in 25 bilingual English–Spanish adults with college degrees. Naming speed was measured by total naming times (in seconds) for five Alzheimers Quick Test tasks (Wiig, Nielsen, Minthon & Warkentin, 2002) and verbal fluency with the Word Listing by Domain (Lambert, Havelka, & Crosby, 1958; Fishman & Cooper, 1969). Self-ratings of English–Spanish competence (listening, speaking, reading, and writing) and frequency of use of each spoken language served as standards for comparisons. For the aggregate sample, color–form, color–animal, and color–object naming times were significantly shorter for English than Spanish (p < .01). There was 100% agreement in language-dominance judgments between self-ratings of language competence and frequency of use, and color–form, color–animal, and color–object naming-time differences in the two languages. Word Listing by Domain quotients for language dominance showed a lower degree of agreement (52%) with self-ratings and naming-time differences. The findings suggest that cross-linguistic comparisons of naming times for color–form, color–animal, and color–object naming may be helpful in screening adults for language dominance for psychoeducational assessment purposes.

The AQT© as a useful short screening test for dementia. Evidence from two European cultures

Background: Alzheimer s disease (AD) is the most common cause of dementia in the growing elderly population in many countries. The quests for symptomatic relief and prospects of pharmacological treatments of AD, call for sensitive and reliable screening tests which can be easily used by general practitionares in different countries and cultural settings. General criteria for such screening tests should include easy administration and unequivocal scoring, and independence of factors known to be related to cultural settings and educational level. The AQT is a novel screening test designed to assess cognitive processing speed. Three sets of universal stimuli are presented to patients in a fixed protocol. The administration takes 3 5 minutes and the clinical outcome measure is the time (seconds) it takes to perform the test. The AQT is standardised and validated in the USA and in Sweden. It is used by general practitionares and hospital staff throughout Sweden as a supplementary test to the MMSE in the assessment of dementia. Objective(s): We performed a collaborative research study between two European countries, Sweden and Greece, in order to establish the validity and reliability of the AQT, and to further evaluate whether test results meet the criteria of being independent of language and educational level. Methods: The Swedish participants were 97 patients with AD, and 59 healthy subjects, while the Greek participants were 75 patients with AD, and 29 healthy subjects, respectively. All patients met the NINCDS-ADRDA and the DSM-IV criteria for dementia. The patients educational level ranged from 2 to 17 years, MMSE: mean 22.6. The AQT and the MMSE were assessed in all subjects by experienced psychiatrists and neuropsychologists in routine clinical settings in both countries. The discriminatory values of the AQT and the MMSE for the two countries is presented in the Table. Conclusions: The results demonstrate that cognitive processing speed is a general and very sensitive measure which clearly separates mild dementia from normal aging. The usefulness of the AQT in dementia assessment is suggested by the striking similarity of findings in different cultural settings.

AQT cognitive speed and processing efficiency differentiate adults with and without ADHD: A preliminary study

Abstract Objective. We evaluated the hypotheses that A Quick Test of Cognitive Speed (AQT) single- and dual-dimension naming speed measures would differentiate normal adults and adults with ADHD before medication and that there would be no differences between groups after stabilization with medication. Methods. Thirty adults with ADHD, aged 18–43, were evaluated with the AQT color (C), form (F) and color–form combination (CF) naming tests before and after medication with methylphenidate. Thirty age- and sex-matched normal adults served as controls. Results. Among adults with ADHD, pre-medication naming times (s) for C, F, and CF were significantly longer and overhead [CF – (C + F)] significantly larger than post-medication. Before medication, C, F and CF naming and processing efficiency (overhead) (s) differed significantly between ADHD adults and controls. After medication, there were no significant differences between groups. When we used fail criteria for dual-dimension naming (>60 s) and overhead (processing efficiency) (>+6 s) together the sensitivity was 93% and specificity 100%. Conclusions. Within the study limitations, findings suggest that the processing-speed and efficiency measures in AQT may be used to screen adults for executive dysfunction and reduced cognitive control associated with ADHD.

An additive model for relations between AQT single- and dual-dimension naming speed.

Color-form naming in A Quick Test of Cognitive Speed (AQT) is used to assess processing speed on three rapid automatic naming tasks, two of which measure single-dimension and the third of which measures dual-dimension naming speed. These tests have been used to identify changes in processing speed associated with normal aging. The present study evaluated whether a simple additive model could explain the normally expected relation between scores on measures of single- and dual-dimension naming speed. The AQT color (C), form (F), and color-form (CF) naming tests were administered individually to 270 adults (ages 18 to 70 yr.). Paired-sample t tests mean comparisons of C + F and CF naming times for the total group and for three age cohorts (ages 18 to 34, 35 to 54, and 55 to 70), each with 90 adults, indicated significant mean differences between these processing-speed measures for the total group and for the 18- to 34- and 35- to 54-year age cohorts. Thus, a simple additive model does not explain the relationship between single- and dual-dimension naming speed across ages. To provide a better description, an additive model with “overhead” (a measure of processing efficiency) was proposed and norm-referenced for using the AQT tests to assess normal and atypical ranges for dual-dimension processing efficiency (overhead). ANOVA with post hoc analysis (Scheffé) compared AQT C + F, CF, and overhead means across age cohorts. The results indicated significant mean differences for the CF and overhead measures, but not for the C + F measure. Normative ranges for typical overhead sizes were established for each age cohort. In clinical practice, an overhead larger than typical or normal for a given age would suggest executive dysfunction, involving attention, visual working memory, and set shifting.