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Spanish boston naming test norms

Ricardo F. Allegri

a b

, Aurora Fernandez Villavicencio ,

a

Fernando E. Taragano , Sandra Rymberg , Carlos A. Mangone

& Denise Baumann

Servicio de Neuropsicologa (SIREN) , CEMIC, Buenos Aires,

Servicios de Neurologa ,
b

Hospital Municipal Zubizarreta ,

Hospital Municipal Santojanni , Buenos Aires, Argentina

Published online: 08 Nov 2007.

To cite this article: Ricardo F. Allegri , Aurora Fernandez Villavicencio , Fernando E. Taragano ,
Sandra Rymberg , Carlos A. Mangone & Denise Baumann (1997) Spanish boston naming test norms,
The Clinical Neuropsychologist, 11:4, 416-420, DOI: 10.1080/13854049708400471
To link to this article: http://dx.doi.org/10.1080/13854049708400471

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

The Clinical Neuropsychologist

1997, Vol. 11, NO. 4, pp. 416-420

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

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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.

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.

417

SPANISH BNT NORMS

Table 1. Demographic Data.

Age (years)
< 39

4049

50-59

6049

> 70

Total

8
18
18
44

9
14
10
33

15
13
22
50

21
17
10
48

8
7
10
24

61
69
70
200

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

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.

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.

MATERIALS AND METHODS

Data Analysis

Two hundred normal, non-institutionalized, independent subjects, between 30 and 82 years of age

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)

5 0-5 9
M(SD)

60-69
M(SD)

> 70
M(SD)

Total
M(SD)
~~

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)

49.0 (3.7)
54.2 (3.6)
55.5 (1.4)
53.4 (4.0)

49.4 (4.2)
52.8 (2.2)
55.0 (3.8)
52.8 (4.2)

47.8 (5.4)
51.8 (4.2)
53.0 (3.4)
50.2 (4.9)

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

48.1 (5.0)
52.2 (3.9)
54.2 (3.1)
51.7 (4.7)

418

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

7
8
9
10

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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

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)

& % ~ ~ ~ ~ m
k) m o c
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)

Note. N=200.

Table 4. Correct Order of Presentation of Items for

Buenos Aires.

% correct

100
100

100
97.7
100
100
100

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

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

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 )

% correct

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

419

SPANISH BNT NORMS

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

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

RESULTS

DISCUSSION

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.

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.

420

RICARDO F. ALLEGRI ET AL

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