The Boston Naming Test (BNT) (Kaplan, Goodglass, & Weintraub, 1983) is the most commonly used test of confrontation naming in neuropsychology (Rabin, Barr, & Burton, 2005). However, there are significant criticisms of the BNT which suggest that it might not be the assessment measure of choice. These criticisms are that the BNT has poor psychometric properties, is not adequately standardized, and has inadequate norms. It is further suggested that when considered in the context of contemporary conceptualizations of the neuropsychology of naming, the BNT does not adequately capture the processes known to be required for successful naming, and does not sample widely enough from the content domain of "naming". These criticisms suggest that the BNT is flawed as a measure of naming, and are discussed in detail in this review. Other stand-alone visual confrontation naming tasks are reviewed to evaluate whether any might be viable substitutes for the BNT in clinical neuropsychology. The Naming Test from the Neuropsychological Assessment Battery (Stern & White, 2009) was identified as a possible alternative to the BNT, however, neither of these tests was designed with reference to models of the neuropsychology of naming, and development of a new test of naming is indicated.

Is the Boston Naming Test Still Fit For Purpose

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.

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

Amyotrophic Lateral Sclerosis (ALS) is a rapid and fatal neurodegenerative
disease marked by progressive muscle weakness and wasting. Approximately
50% of people with ALS experience changes in cognition and behaviour.
Previous research has been mixed as to whether cognition declines over the
course of ALS, or whether it is related to proxies of disease progression (e.g.,
functional disability scales). However, this research has suffered from limitations
including the use of inappropriate measures of cognition, imprecise measures of
disease progression, high attrition, practice effects, and biased analytic
approaches. Fortunately, recent advances in clinical assessment have provided
accurate measures of neuropsychological functioning and disease progression,
namely, the Edinburgh Cognitive and Behavioural ALS Screen (ECAS) and the
King’s Clinical Disease Staging.
The present study aims to utilise recent advances in ALS disease metrics
to overcome previous limitations and explore the evolution of cognitive and
behavioural dysfunction over the course of ALS. Specifically, the aims of the
present project are to 1) develop alternate forms of the ECAS to accommodate
repeated longitudinal assessment; 2) examine how cognition and behaviour
relate to clinical disease stages in ALS; 3) evaluate how cognitive and
behavioural symptoms evolve over the course of the disease in ALS; and 4)
explore clinicians’ attitudes toward cognitive and behavioural screening in ALS.
To achieve Aim 1, two new versions of the ECAS (ECAS-B and ECAS-C)
were developed and administered to a group of age, education, and gender
matched controls to that of the original ECAS-A validation study. Results
demonstrate that the alternate forms of the ECAS (B and C) were equivalent to
the original ECAS-A, reducing practice effects and possessing excellent inter-rater
reliability. The ECAS forms were administered longitudinally to a separate
group of healthy controls. Over an interval of 4 months, the ECAS-A-B-C showed
no evidence of practice effects and excellent test-retest reliability validating their
utility in the longitudinal monitoring of cognition in ALS.
The ECAS forms were then used in an international multi-centre clinical
sample of 161 ALS patients and 80 matched controls to achieve Aim 2. Patients
were grouped into their King’s Clinical Disease Stage at time of testing. Analysis
revealed a significant cross-sectional relationship between disease stage and
ALS-Specific cognitive functions, driven by a decline in verbal fluency
performance. A significant relationship was also observed between disease stage
and behavioural features. By end-stage disease 80% of patients demonstrated
neuropsychological impairment.
Participants were followed up longitudinally to explore the progression of
cognitive and behavioural symptoms. Latent Growth Curve models of the ECAS
subdomains (utilising the alternate versions) demonstrated a significant decline
in ALS Specific cognitive, but not behavioural, functioning over time. This decline
was explained by advancing disease stage, the presence of the C9orf72 repeat
expansion, and years of education. Rate of change in ALS Non-Specific functions
was dependent on baseline performance. Visuospatial functions and
perseveration declined at similar rates and were distinct from language, fluency,
apathy, and disinhibited behaviour. Cluster analysis of patients revealed a three-cluster
solution with one group demonstrating no significant decline, a second
group with mild cognitive and behavioural decline, and a third group with more
severe neuropsychological decline. When data was restructured by diseases
stage, rather than time, longitudinal results were similar to cross-sectional
findings.
To examine clinician’s attitudes to cognitive and behavioural screening.
Fourteen Health Care Professionals (HCP) working in ALS (Neurologists,
Psychologists, and Clinical Care Specialists) were interviewed. Thematic
analysis revealed that HCPs recognised the importance of cognitive and
behavioural screening in ALS, but that it is not common practice. Important
barriers to screening were reported including other members of staff, a lack of
resources, and issues concerning patients and their families. Participants
suggested increasing training and psychology input, and making screening a
standardised protocol to all patients may alleviate these barriers.
Cognition and behaviour are critically related to advancing disease stage,
both cross-sectionally and longitudinally. Declining cognitive and behavioural
symptoms has important implications for clinical practice, caregiver impact, and
end-of-life decision making. However, clinicians report that cognitive and
behavioural screening is not common practice and that significant barriers exist.
The newly developed alternate forms of the ECAS provide an accurate, effective,
and clinically useful means of monitoring cognitive function over the course of the
disease in ALS.

Neuropsychological functioning across the ALS disease course and its assessment

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.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.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.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. 

/pdf/naming-ability-assessment-in-neurocognitive-disorders-a-6xr24om3.pdf

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

Background: Standardized tools for the assessment of language and cognition for French Canadians are limited, especially for those living outside of Quebec, making it difficult for clinicians to di...

Boston Naming Test performance in French-speaking Acadians

Naming Test of the Neuropsychological Assessment Battery: Reliability and Validity in a Sample of Patients with Acquired Brain Injury

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Naming Test of the Neuropsychological Assessment Battery: Reliability and Validity in a Sample of Patients with Acquired Brain Injury