Aging, Neuropsychology, and Cognition A Journal on Normal and Dysfunctional Development
ISSN: 1382-5585 (Print) 1744-4128 (Online) Journal homepage: http://www.tandfonline.com/loi/nanc20
TDQ-60 – a color picture-naming test for adults and elderly people: validation and normalization data Joël Macoir, Catherine Beaudoin, Josée Bluteau, Olivier Potvin & Maximiliano A Wilson To cite this article: Joël Macoir, Catherine Beaudoin, Josée Bluteau, Olivier Potvin & Maximiliano A Wilson (2017): TDQ-60 – a color picture-naming test for adults and elderly people: validation and normalization data, Aging, Neuropsychology, and Cognition, DOI: 10.1080/13825585.2017.1372355 To link to this article: http://dx.doi.org/10.1080/13825585.2017.1372355
Published online: 30 Aug 2017.
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Date: 31 August 2017, At: 07:57
AGING, NEUROPSYCHOLOGY, AND COGNITION, 2017 https://doi.org/10.1080/13825585.2017.1372355
ARTICLE
TDQ-60 – a color picture-naming test for adults and elderly people: validation and normalization data Joël Macoira,b, Catherine Beaudoina, Josée Bluteaua, Olivier Potvinb and Maximiliano A Wilsona,b Département de réadaptation, Faculté de médecine, Université Laval, Québec, Canada; bCentre de recherche CERVO - Brain research center, Institut universitaire en santé mentale de Québec, Québec, Canada
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a
ABSTRACT
ARTICLE HISTORY
Word-finding difficulties are usually assessed with picture-naming tests. In this article, we present the TDQ-60, a new test designed to assess acquired lexical access deficits, taking into account semantics and psycholinguistic variables. The article includes three studies. Study 1 describes the development phase of the TDQ-60. In study 2, healthy control participants and individuals with a diagnosis of the semantic variant of primary progressive aphasia were assessed to establish the convergent and discriminant validity of the TDQ-60. Finally, in Study 3, a group of 305 young and elderly French-speaking adults from Quebec were assessed in order to provide normative data. The results demonstrate that the TDQ-60 has good convergent validity and good discriminant validity. This study also provides normative data in which were considered the effect of age and education.The TDQ-60 is a new valid picturenaming test, controlled for psycholinguistic variables and designed to identify the influence of semantics on lexical access in spoken production.
Received 5 December 2016 Accepted 21 August 2017 KEYWORDS
Picture naming; lexical access; semantics; test validity; normative data
1. Introduction Elderly people frequently complain of difficulties retrieving names of people or objects. These lexical access difficulties are one of the most frequent cognitive changes in normal aging (Burke & Shafto, 2004) and become more significant after age 70 (Albert, Heller, & Milberg, 1988; Nicholas, Obler, Albert, & Goodglass, 1985). Word retrieval difficulties or anomia are one of the most frequent manifestations in poststroke aphasia (Goodglass, 2001), primary progressive aphasias (Gorno Tempini et al., 2011), and other neurodegenerative diseases (Macoir, Turgeon, & Laforce, 2015). People experiencing anomia may have difficulty retrieving specific words during conversation or written production. They also present with difficulties in picture-naming tests during clinical assessments. According to cognitive models of spoken production (Caramazza, 1997), the production of words in picture naming is achieved through the activation of specialized interconnected components. The word retrieval process involves two main levels of activation: (1) the concept corresponding to the object or idea to be expressed is first activated at
CONTACT Joël Macoir
[email protected]
© 2017 Informa UK Limited, trading as Taylor & Francis Group
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the conceptual-semantic level; (2) then this nonverbal conceptual representation maps onto a lexical representation, specifying the phonological form of the target word. An assessment process based on such a cognitive model of language production consists of identifying the impaired and preserved processing components. This is done by administering specific tests (e.g., Howard & Patterson, 1992) or batteries (e.g., Macoir, Gauthier, Jean, & Potvin, 2016) aiming at assessing each component of the model. Therefore, the assessment of naming abilities could be performed by administering tasks exploring the conceptual-semantic (e.g., semantic questionnaire) and phonological output lexicon (e.g., picture-naming task that manipulates frequency, controls for concept familiarity, etc.). Important information regarding the level of impairment also comes from error analysis. Thus, anomic behavior could arise from different underlying deficits (e.g., deficits in the activation of conceptual-semantic representations or in the retrieval of phonological forms of words in the output lexicon), leading to distinct types of errors (e.g., semantic substitutions or phonemic errors) (Hillis & Caramazza, 1995; Nickels & Howard, 1994). Word retrieval can be influenced by various psycholinguistic variables. Semantic category is a variable that affects performance in picture naming when semantic memory is impaired. In numerous studies, patients with poststroke aphasia (e.g., Forde, Francis, Riddoch, Rumiati, & Humphreys, 1997), Alzheimer’s disease (e.g., Gonnerman, Andersen, Devlin, Kempler, & Seidenberg, 1997), or the semantic variant of primary progressive aphasia (e.g., Cardebat, Demonet, Celsis, & Puel, 1996) presented with category-specific impairments characterized by differences in naming scores for natural vs. man-made concepts. To date, there is no picture-naming test that can specifically identify such category-specific naming impairments. Concept familiarity (i.e., degree to which a person comes into contact with or thinks about a given concept) is another variable that affects semantic processing and word production. For example, Snodgrass and Yuditsky (1996) showed that concept familiarity significantly influenced picture-naming latencies in healthy individuals. This factor is also known to affect naming performance in patients with the semantic variant of primary progressive aphasia (Hirsh & Funnell, 1995). At the lexical level, it is well known that access to phonological representations is highly influenced by word frequency (i.e., frequency in a particular language). It has been repeatedly observed that picture-naming latencies decrease as word frequency increases (e.g., Barry, Morrison, & Ellis, 1997). Performance in spoken production is also influenced by the age at which words are learned. According to this age-of-acquisition effect, items acquired early in life are more quickly produced than items acquired later. This effect, repeatedly shown in healthy individuals, has also been reported in pathology (e.g., Bell, Davies, Hermann, & Walters, 2000; Hirsh & Funnell, 1995). Subjective frequency (i.e., estimation of the number of times a word is encountered by individuals in its spoken form), also known as lexical familiarity, is another lexical parameter known to be predictive of both lexical decision and wordnaming performance (Thompson & Desrochers, 2009). An impairment at the lexical level has been shown to be the functional source of phonological errors in aphasia (Buckingham, 1987). Such an impairment is directly influenced by word length in terms of number of phonemes (i.e., the more phonemes in a word, the higher the probability of an error) (Nickels, 1995). Picture-naming tasks also involve the cognitive nonlinguistic processes of object recognition, from perceptual stages to the activation of
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structural representations. Visual complexity, which refers to the number of lines and details in a percept (object, drawing), has been found to influence naming latencies (Ellis & Morrison, 1998), although other researchers did not find any advantage of simple over complex visual stimuli (Snodgrass & Yuditsky, 1996). Finally, color is also known to influence ease of naming in terms of speed (Ostergaard & Davidoff, 1985) and accuracy (Zannino et al., 2010) in normal and clinical populations. In clinical settings, anomia is usually assessed with picture-naming tests, such as the Boston Naming Test (BNT) (Kaplan, Goodglass, & Weintraub, 1983), which simply consist of presenting pictures to the person who is asked to name them one by one as precisely as possible. One important source of difficulties in non-English-speaking settings is the use of picture-naming tests that are not culturally and/or linguistically adapted to these populations. Various studies have shown that language and cultural differences have an impact on cognitive tests and particularly on language tests because of differences in sociocultural exposure to certain categories of concepts as well as in differences in wordspecific features (e.g., Sirois, Kremin, & Cohen, 2006; Yoon et al., 2004). To assess picture naming abilities of French-speaking Quebecers, the population of the present study, clinicians generally, use the BNT (Kaplan et al., 1983), the Test de dénomination orale d’images DO-80 (Deloche & Hannequin, 1997) or the picture-naming subtest of the Montreal–Toulouse assessment battery (Nespoulous et al., 1992). Even though the Montreal–Toulouse subtest has been validated (Pagliarin et al., 2014) and normalized (Béland & Lecours, 1990) for the Quebec-French population, there is no control of psycholinguistic variables. The same lack of psycholinguistic control applies to the DO80 and BNT. Moreover, in none of these tests stimuli were selected according to semantic categories (i.e. natural vs. man-made concepts). In this article, we present the Test de Dénomination de Québec-60 images (TDQ-60; Quebec naming test), a new color picture-naming test in which semantic category (i.e., natural vs. man-made concepts) was manipulated and the psycholinguistic variables of concept familiarity, lexical familiarity, word frequency, age-of-acquisition, word length in phonemes, and visual complexity were specifically controlled. The main objective of the study was to develop a sensitive standardized test of picture-naming abilities in French designed to assess spoken production disorders in adults and elderly people. We also studied the tests’s psychometric properties to establish its validity and reliability. Finally, we studied the effects of age, education, and sex in a representative sample of Frenchspeaking adults and elderly people from Quebec, Canada. Based on the results of these analyses, we provide normative data for community-dwelling individuals. Thus, in the first study, we describe the development phase of the TDQ-60. In study 2, we report data on the convergent and discriminant validity of the TDQ-60. Finally, in Study 3, we provide normative data for healthy, community-dwelling, French-speaking people.
2. Study 1. Development phase of the TDQ-60 2.1. Selection of the stimuli In this study, we followed a comprehensive test development approach, including the establishment of translational validity. Translational validity refers to the transformational aspect of construct validity and includes content and face validity (Trochim,
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2001). The content validity of the TDQ-60 was established on the basis of the scientific literature. The research team first determined the number of items that were needed to satisfy the objective of developing a picture-naming test that could be administered in approximately 10–15 min using a computer or electronic tablet. A test comprising 30 pictures corresponding to natural concepts and 30 pictures corresponding to man-made concepts was considered the best option to measure lexical-semantic access in spoken production. Based on a subjective ease of naming, we first selected a subset of 120 color line drawings (Rossion & Pourtois, 2004) derived from the original Snodgrass and Vanderwart set (1980) and comprising 60 pictures of natural concepts and 60 pictures of man-made concepts. The final 60 items of the TDQ-60 were chosen such that each of the 30 pictures depicting manmade and natural concepts were matched according to a number of variables known to affect naming abilities – specifically, concept familiarity, word familiarity, word frequency, age of acquisition, word length, and visual complexity. Concept familiarity was measured by asking 50 healthy participants (aged 18–75) to rate the familiarity of the 120 pictures from the Snodgrass and Vanderwart set on a 5-point scale, presented in random order. They were given similar instructions to those used in the Snodgrass and Vanderwart (1980) study (i.e., how usual or unusual is this object in your experience?). The values for word familiarity (subjective frequency) were taken from Desrochers and Bergeron (2000) (N.B.: missing data for five items). Word frequency was controlled using the Quebec-French values for written word frequency established by Baudot (1992) as well as word frequency values based on film dialogue established by New, Pallier, Brysbaert, and Ferrand (2004). Data on age-of-acquisition are available only for monosyllabic French words (Ferrand et al., 2008), while most of the TDQ-60 items (77%) comprise two and more syllables. Therefore, following the protocol of Morrison et al. (1997), this variable was measured by asking 15 healthy participants (aged 16–72) to estimate the age at which they had learned each word corresponding to the 120 pictures from the Snodgrass and Vanderwart set, presented in random order. They were asked to estimate the age at which they believed they had learned this word, in either spoken or written form, based on a 7-point scale (from 1 = learned at the age of ≤2 years, to 7 = learned at the age of 13+). Word length in phonemes was computed for each of the word stimuli. Finally, the values for visual complexity were taken from Snodgrass and Vanderwart (1980). In the final set, the 30 pictures corresponding to natural concepts (animals = 16; fruits and vegetables = 10; body parts = 3; nature = 1) were equivalent to the 30 pictures corresponding to man-made concepts (tools = 6; kitchen utensils = 5; musical instruments = 4; clothes = 8; vehicles = 7) with respect to concept familiarity, t(58) = −.4, p = .69, word familiarity, t(58) = −1.55, p = .13, word frequency, Baudot: t(58) = .92, p = .36; New et al.: t(58) = .89, p = .38), age-of-acquisition, t(58) = −.52, p = .61), word length in phonemes, t(58) = −1.3, p = .2, as well as visual complexity, t(58) = .59, p = .56. The psycholinguistic characteristics of the TDQ-60 stimuli are presented in Table 1.
2.2. Pilot study Following Phase I, a pilot study was conducted to assess name agreement and other acceptable lexical variations for the images as well as to ensure the appropriateness of
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Table 1. Characteristics of the stimuli used in the TDQ-60 as a function of semantic category (natural and man-made concepts). Characteristic Concept familiarity Word familiarity Lexical frequency (Baudot) Lexical frequency (New et al.) Age-of-acquisition Word length in phonemes Visual complexity
Natural concepts (mean (SD); range) 3.3 3.92 53.37 43.74 2.34 4.47 3.24
(1.12); 5–1.14 (1.65); 5.86–1.41 (122.25); 646–1 (86.59); 413.04 – .08 (.79); 5.07–1.2 (1.07); 6–2 (1.08); 4.77–1.14
Man-made concepts (mean (SD); range) 3.41 4.49 31.7 27.51 2.44 4.93 3.07
(.99); 4.93–1.86 (1.15); 6–2.6 (41.15); 178–1 (49.82); 255.28 – .32 (.70); 4.07–1.07 (1.62); 9–2 (1.16); 4.92–1.07
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Notes: concept familiarity: average on a 5-point scale; word familiarity: average on a 5-point scale; lexical frequency: expressed in occurrences per million; age-of-acquisition: average on a 7-point scale; visual complexity: average on a 5-point scale.
the stimuli and clarity of the protocol and instructions. To do this, we created a Powerpoint presentation with the 60 images, along with the administration protocol and instructions. This version was then administered to 32 healthy participants, native Quebec-French speakers, by two speech-language pathology students. These participants were recruited in the province of Quebec through public advertisements. The mean age of these participants was 45.41 years (SD = 25.56; range: 16–89), their mean level of education was 12.91 years (SD = 3.85; range 6–21), and the sex distribution was 10 males and 22 females. Each participant was asked to name the picture with a single word (i.e., avoid descriptions and multiple attempts) as quickly as possible after it appeared on the computer screen. There was no time limit to complete the test. The total number of pictures correctly named (maximum score = 60) was recorded. Alternative responses reflecting acceptable lexical variations in Quebec French were credited (e.g., pinotte, arachide and cacahuète were all accepted for the picture of a peanut). The average percentage of correct responses on the TDQ-60 was 96.25% for the total score (57.75/60; SD = 3.22), 94% for natural concepts (56.37/60; SD = 3.62), and 98.5% for man-made concepts (59.12/60; SD = .94). The experimenters reported no particular problem with the administration protocol or instructions. However, for 8 of the 32 (25%) healthy controls, the picture of a cloud was mistaken for snow. To prevent this confusion, this picture was replaced by another color line drawing of a cloud found on the Internet. This new drawing was correctly named (10/10) by a new sample of 10 healthy controls (mean age = 52.1 years (SD = 17.01; range: 21–76); mean level of education = 13.9 years (SD = 4.23; range 7–20); sex distribution = 6 males and 4 females). Based on the results of the pilot study, the TDQ-60 was considered optimal. The TDQ-60 test material, administration procedure, instructions, and scoring method are available from the first author upon request. The materials include a scoring sheet corresponding to the order of presentation of all the items. Each item is identified as belonging to “natural” or “man-made” concept categories. This makes it very easy to clinicians to establish the score according to the semantic category of the items.
3. Study 2. Discriminant and convergent validity of the TDQ-60 The purpose of Study 2 was to provide data on the psychometric properties of convergent and discriminant validity of the TDQ-60.
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3.1. Method 3.1.1. Participants, materials, and procedure Two groups of participants, native Quebec-French speakers, were assessed and compared to establish the convergent and discriminant validity of the TDQ-60: (1) a group of 13 individuals (3 women and 10 men; mean age = 66.08, SD = 9.8 years; mean education = 16, SD = 4.6 years) diagnosed with the semantic variant of primary progressive aphasia (svPPA), based on the criteria proposed by Gorno Tempini et al. (2011); and (2) a group of 22 (6 women and 16 men) healthy control participants (mean age = 65.78, SD = 9.2 years; mean education = 16.73, SD = 3.5 years). These two groups were equivalent in terms of age, t(33) = .091, p = .93, and education, t (33) = −.53, p = .6. To establish convergent validity, in addition to the TDQ-60, both groups of participants were administered: (a) the BNT (Kaplan et al., 1983), another picturenaming test for which a positive correlation with the TDQ-60 was expected; (b) copy of the Rey–Osterrieth Complex Figure (ROCF) (Osterrieth, 1944; Rey, 1941), a test for visuoconstructional abilities and components of executive functions, for which no correlation with the TDQ-60 was expected since they assessed different cognitive abilities. To assess discriminant validity, we tested whether the TDQ-60 score distinguished between the performances of healthy participants and individuals with svPPA.
3.2. Results As expected for convergent validity, the external measure of spoken production that assessed the same construct (BNT) correlated significantly and positively with the TDQ60 (see Table 2) in the two groups. Also as expected, no significant correlation was found in the two groups between the TDQ-60 and copy of the ROCF. With respect to discriminant validity, the mean TDQ-60 score of participants with svPPA was significantly lower than that of healthy controls, t(13) = −8.59, p < .0001) (see Table 2). Compared to healthy controls, their performance was also significantly impaired on the BNT, t(25) = −19.48, p < .0001, while it did not differ on the ROCF test, t(23) = –.37, p = .71. This result is not surprising since visuoconstructional abilities and executive functions are usually unimpaired in svPPA, at least in the early stages of the disease (Gorno Tempini et al., 2011).
Table 2. Performance on external measures and correlations with the TDQ-60 to establish convergent validity. Participants with svPPA Test TDQ-60 (60) BNT (60) ROCF (36)
Mean (SD); range 26.85 (12.5); 3–45 10.08 (6.1); 2–25 31.65 (2.8); 24.5–36
Corr. with TDQ-60 – r = .86** r = –.15NS
Healthy participants Mean (SD); range 57.04 (2.72); 48–60 51.28 (5.9); 35–59 32 (2.5); 28–36
Notes: BNT = Boston Naming Test; ROCF = Rey–Osterrieth Complex Figure. *p < .01; **p < .001; NS = not significant.
Corr. with TDQ-60 – r = .6* r = .22NS
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3.3. Summary According to the analyses, on the whole the TDQ-60 has good convergent validity. The screening test also distinguishes between the performances of healthy participants and participants with svPPA, suggesting good discriminant validity.
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4. Study 3. Normative data The purpose of Study 3 was to provide normative data for the TDQ-60, adapted to adults and elderly people from Quebec. To determine the different difficulty of the items of the TDQ-60, item-by-item correct response rates were also calculated. Finally, acceptable alternative responses were gathered from the responses provided by healthy participants and were verified according to accepted lexical variations for concepts taken from a Quebec-French terminology dictionary (Office québécois de la langue française, 2012).
4.1. Method 4.1.1. Participants A total of 305 healthy community-dwelling adults, whose mother tongue and usual language was French, were recruited in the province of Quebec by speech-language pathology students and speech-language pathologists through public advertisements and among their relatives. Participants were recruited from 14 of the 17 administrative regions of the province of Quebec (no participants from Abitibi-Témiscamingue, Outaouais and Côte-Nord) and from both urban and rural environments. The majority of participants were recruited from the Quebec City and Montreal areas. Any person with a history of neurological (stroke, head trauma, tumor, etc.) or psychiatric illness (such as depression), and a history of drug abuse (e.g., alcohol) or untreated high blood pressure was excluded from the study. This information regarding exclusion criteria was obtained from participants’ self reports, corroborated in many cases by family members. No formal screening test for cognitive functioning was administered. The sample was composed of 144 men (47%) and 161 women (53%), aged between 18 and 94 years, with an education level varying between 6 and 27 years. In addition to sex, we considered age and education level as demographic variables that may have influenced test performance. There was no significant difference between men and women in terms of age (men: M = 49.08 years; SD = 18.63; women: M = 50.73 years; SD = 18.97; t(303) = −.76, p = .44); however, the two groups differed in terms of education (men: M = 15.19 years of schooling; SD = 3.87; women: M = 14.09 years of schooling; SD = 3.22; t(303) = 2.71, p = .007). With respect to the representativeness of the sample, highly educated individuals were overrepresented compared to official demographic data for the province (Institut de la statistique du Québec, 2006) (see Table 3). 4.1.2. Materials and procedure All participants were tested individually in a quiet room at their home or a research center. The TDQ-60 was administered without any time limits using PowerPoint or
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Table 3. Comparison of demographic data between the province of Quebec (%) and the study sample (number and %). Years of education Province of Quebec 18–35 years 36–60 years 61+ years Total
0–12 60.4 56.99 71.5 62.6
Study sample 13+ 39.6 43.01 28.5 37.4
0–12 16 (16.5) 32 (30.2) 41 (40.2) 89 (29)
13+ 81 (83.5) 74 (69.8) 61 (59.8) 216 (71)
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Keynote. The average time to complete the test was 7 min. Response sheets were collected and data were entered manually in an Excel file for the analyses.
4.2. Results Data were analyzed using SPSS19. All data were examined for normality, skewness, and range restriction. The TDQ-60 scores were found to have non-normal distributions and partial Spearman rank correlation coefficients were calculated to assess independent relationships between sociodemographic variables and performance scores. Results showed that performance on the TDQ-60 negatively correlated with age when controlling for education and sex (rs = −.34, p < .001), meaning that performance declines with increasing age. A positive correlation was also found with education when controlling for age and sex (rs = .21, p < .001), meaning that performance on the TDQ-60 increases as education increases. Finally, the score on the TDQ-60 was not significantly correlated with sex (rs = −.09, p = .13). We calculated the 5th, 15th, 25th, and 50th percentiles for the TDQ-60 score for each group, determined as a function of age and education. After visual exploration of the whisker plots and according to usual criteria (Crawford & Garthwaite, 2009), we chose the 5th percentile as the most reliable cutoff score. Thus, a score equal to or below the suggested cutoff score can be considered to be under normal performance limits. We also proposed an alert score based on the 15th percentile. A score below this alert score is not necessarily, but may be considered to be below normal performance limits. Table 4 shows the suggested cutoff and alert scores for each group of participants by age and education. As shown in Table 5, the percentage of correct responses for each of the TDQ-60 items was very high. Except for three items (gilet (87.21%) “vest,” fourmi (85.9%) “ant,” and hippocampe (79.02%) “seahorse”), this percentage was above 90% (ranging from 90.82% to 100%), suggesting that no stimulus picture in the test was too difficult to name for adults without brain damage. All of the picture stimuli were correctly identified, except for orteil “toe,” which 79.34% of the participants confused with the visually similar concept “thumb.” A list of acceptable alternative responses was established, based on the responses produced by at least 5% of the healthy participants. These alternative responses, shown in Table 5, were also validated using a Quebec-French terminology dictionary (Office québécois de la langue française, 2012).
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Table 4. Descriptive statistics (mean and standard deviation) of the six groups of participants for the normative study as a function of age and education. Age 18–35 years
36–60 years
Education ≤12 years
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Age Education % Women N TDQ-60 Alert Cutoff Total N
Mean 24.87 10.44 37.5 16 58.94 58 56 305
SD 4.36 1.26 1.18
Education
13+ years Mean 26.83 16.26 50.6 81 59.26 58 57
61+ years
SD 3.87 1.95 1.01
≤12 years Mean 52.53 10.55 59.4 32 58.41 57 55
SD 5.49 1.40 1.54
Education
13+ years Mean 51.87 18.7 51.35 74 59.11 58 57
SD 7.34 2.5 1.29
≤12 years Mean 73.49 8.08 10.05 2.04 63.4 41 56.34 2.71 53 51
13+ years SD 68.31 16.68 50.8 61 58.39 57 55
4.91 2.93 2.22
Notes: Age: age in years; education: formal education in years; SD = standard deviation; % women: percentage of women; N: number of participants in the group; TDQ-60: Test de dénomination d’images de Québec score/60; Alert: suggested alert score calculated as the 15th percentile (score below it and above the cutoff may indicate “at risk”); cutoff: suggested cutoff score calculated as the 5th percentile (score equal to or below it is under normal performance limits); total N: total number of participants in the normative study.
5. Discussion Word-finding difficulties are among the most frequent symptoms in brain diseases. They are found in all types of poststroke aphasia, neurodegenerative diseases, traumatic brain injury, neuropsychiatric diseases, etc. Although these difficulties could originate from impairment of executive functions such as in transcortical motor aphasia (Alexander, 2006) or schizophrenia (Barr, Bilder, Goldberg, Kaplan, & Mukherjee, 1989), in the majority of cases their functional origin lies in the impairment of semantic and/or lexical representations in long-term memory. In clinical settings, the identification of wordfinding difficulties is assessed during the case history interview and with specific tests such as picture naming. Depending on its semantic or lexical origin, anomia is evidenced by the production of semantic or phonological errors (Hillis & Caramazza, 1995; Nickels & Howard, 1994). In some patients, naming impairment is dependent on the category of concepts, leading to category-specific anomia. In these patients, dissociation in picturenaming performance can occur for superordinate categories (i.e., natural vs. man-made concepts) or be limited to particular subordinate categories, such as fruits and vegetables or body parts (e.g., Farah & Wallace, 1992; Sacchett & Humphreys, 1992). In French, the BNT (Kaplan et al., 1983) and DO-80 (Deloche & Hannequin, 1997) are among the most frequently used picture-naming tests. Clinicians and researchers can also use the picture-naming subtest of the Montreal-Toulouse aphasia battery (Nespoulous et al., 1992). However, as noted in the “Introduction” section, there are limitations in using these tests in the Quebec-French population due to linguistic and cultural considerations. Moreover, stimuli in these tests are not divided into semantic categories and do not control for/manipulate psycholinguistic variables known to influence the ease of naming. In the TDQ60, the 30 pictures corresponding to natural concepts were matched to the 30 pictures corresponding to man-made concepts with respect to concept familiarity, word familiarity, word frequency, age-of-acquisition,
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Table 5. Acceptable alternative responses and percentages of correct responses for each of the TDQ60 stimuli.
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Item 1. accordéon (accordion) 2. œil (eye) 3. cuillère (spoon) 4. écureuil (squirrel) 5. oignon (onion) 6. autobus (bus) 7. avion (airplane) 8. chenille (caterpillar) 9. bouilloire (kettle) 10. clou (nail) 11. violon (violin) 12. hélicoptère (helicopter) 13. fourmi (ant) 14. moto (motorbike) 15. piano (piano) 16. citron (lemon) 17. mouche (fly) 18. vache (cow) 19. camion (truck) 20. céleri (celery) 21. pomme (apple) 22. marteau (hammer) 23. hippocampe (seahorse) 24. bicyclette (bicycle) 25. orange (orange) 26. cerise (cherry) 27. jupe (skirt) 28. pantalon (pants) 29. couteau (knife) 30. mitaine (mitten) 31. orteil (toe) 32. arachide (peanut) 33. renard (fox) 34. ours (bear) 35. gilet (vest) 36. serpent (snake) 37. ananas (pineapple) 38. gant (glove) 39. chandail (sweater) 40. papillon (butterfly) 41. cheval (horse) 42. pinceau (paintbrush) 43. tasse (cup) 44. ceinture (belt) 45. bras (arm) 46. train (train) 47. balai (broom) 48. cravate (tie) 49. poisson (fish) 50. mouffette (skunk) 51. guitar (guitar) 52. tigre (tiger) 53. araignée (spider) 54. rouleau à patisserie (rolling pin) 55. carotte (carrot) 56. fraise (strawberry) 57. tournevis (screwdriver) 58. nuage (cloud) 59. échelle (ladder) 60. chien (dog)
Acceptable alternative responses
autobus scolaire (school bus) aeroplane (aeroplane) théière (teapot); bombe (bomb)
motocyclette; bicycle à gaz (motorcycle)
van (van); truck (truck)
cheval de mer (seahorse) vélo; bicycle; bicycle à pédales (pedal bike)
culotte (pants); jeans (jeans) pouce (thumb) pinotte; cacahuète (peanut) veste; veston (jacket) couleuvre (grass snake) gilet (vest)
locomotive (locomotive)
bête puante (“stinky animal”)
rouleau; rouleau à pate (rolling pin)
% of correct responses 98.36 100 100 99.34 98.36 100 100 95.41 98.03 100 97.70 99.34 85.90 99.02 100 99.67 92.13 100 99.67 97.05 95.08 100 79.02 99.67 99.02 95.08 95.08 100 99.34 96.39 97.38 93.77 90.82 99.67 87.21 99.67 97.71 99.02 99.67 100 99.67 99.67 99.02 99.02 98.03 99.34 99.34 100 100 96.39 97.71 92.79 93.44 99.34 100 100 100 100 97.70 100
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word length in phonemes, and visual complexity. The potential effect of all these variables being controlled, this test is particularly useful to identify category-specific anomia. Since culture has an impact on cognition, it is important to use pictorial stimuli and normative data specific to the population to which they are applied. This is particularly true for the assessment of language functions, given possible psycholinguistic (e.g., word frequency, length) and cultural (e.g., vocabulary, familiarity of concepts) biases. The TDQ-60 was explicitly developed to meet the need for a picture-naming test culturally and linguistically adapted to the French-speaking population of Quebec (Canada), in which these psycholinguistic variables were fully considered. Finally, the use of color pictures is another advantage of the TDQ-60. Color pictures are named more quickly and efficiently than black and white pictures (Ostergaard & Davidoff, 1985; Zannino et al., 2010). In picture naming, their greater naturalness minimizes the influence of concomitant perceptual deficits and therefore enables better identification of lexical-semantic deficits. The results of the present study first demonstrate that the TDQ-60 has good convergent validity and can distinguish between the performances of healthy participants and participants with svPPA, suggesting good discriminant validity. Moreover, clear rules have been established for accepted or incorrect answers in order to strengthen interrater reliability in the case of reassessment. This study also provides norms for the TDQ60, computed from a study sample composed of 305 healthy, community-dwelling, French-speaking adults from the province of Quebec, with a wide range of age and education levels. This large group of participants is a major strength of this study. These normative data also have the advantage of taking into account the effect of age and education level on picture-naming abilities. This study has a few limitations, most importantly that of the overrepresentation of highly educated people in the sample. Compared to current Quebec demographic data (Institut de la statistique du Québec, 2006), this sample includes more individuals with 13 years or more of formal education. Ideally, a random sampling method would have increased the representativeness of this sample. Therefore, clinicians should interpret percentile ranks carefully since some age groups with little education do not comprise a large number of participants. This is the case especially for younger adults. Since the TDQ-60 is a new assessment test, we believe that our sampling method is, at the very least, a practical starting point for establishing norms for the Quebec-French population. Another limitation is associated with administering the TDQ-60 in various settings and conditions (notably, at participants’ homes and at research centers). However, such a testing method also has the advantage of avoiding sample bias linked to the recruitment of highly dedicated volunteers who may not be representative of the general population.
6. Conclusion To conclude, this article describes three studies describing the development phase of the TDQ-60 (Study 1), establishing the convergent and discriminant validity of the TDQ60 (Study 2) and providing normative data for a large sample of French-speaking adults from Quebec (Study 3). Study 1 reported on the development of the TDQ-60, a picture-
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naming test designed to assess lexical-semantic access to words corresponding to natural and man-made concepts, taking into account psycholinguistic variables known to influence ease of naming. Results from Study 2 showed that the TDQ-60 has good convergent and discriminant validity. Finally, results from Study 3 provided normative data for the TDQ-60 in the form of stratified percentiles, according to age and education. These norms, established from a wide sample of 305 French-speaking adults selected from the community, will be useful in identifying spoken production impairments.
Disclosure statement
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No potential conflict of interest was reported by the authors.
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ISSN: 1382-5585 (Print) 1744-4128 (Online) Journal homepage: http://www.tandfonline.com/loi/nanc20
TDQ-60 – a color picture-naming test for adults and elderly people: validation and normalization data Joël Macoir, Catherine Beaudoin, Josée Bluteau, Olivier Potvin & Maximiliano A Wilson To cite this article: Joël Macoir, Catherine Beaudoin, Josée Bluteau, Olivier Potvin & Maximiliano A Wilson (2017): TDQ-60 – a color picture-naming test for adults and elderly people: validation and normalization data, Aging, Neuropsychology, and Cognition, DOI: 10.1080/13825585.2017.1372355 To link to this article: http://dx.doi.org/10.1080/13825585.2017.1372355
Published online: 30 Aug 2017.
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Date: 31 August 2017, At: 07:57
AGING, NEUROPSYCHOLOGY, AND COGNITION, 2017 https://doi.org/10.1080/13825585.2017.1372355
ARTICLE
TDQ-60 – a color picture-naming test for adults and elderly people: validation and normalization data Joël Macoira,b, Catherine Beaudoina, Josée Bluteaua, Olivier Potvinb and Maximiliano A Wilsona,b Département de réadaptation, Faculté de médecine, Université Laval, Québec, Canada; bCentre de recherche CERVO - Brain research center, Institut universitaire en santé mentale de Québec, Québec, Canada
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a
ABSTRACT
ARTICLE HISTORY
Word-finding difficulties are usually assessed with picture-naming tests. In this article, we present the TDQ-60, a new test designed to assess acquired lexical access deficits, taking into account semantics and psycholinguistic variables. The article includes three studies. Study 1 describes the development phase of the TDQ-60. In study 2, healthy control participants and individuals with a diagnosis of the semantic variant of primary progressive aphasia were assessed to establish the convergent and discriminant validity of the TDQ-60. Finally, in Study 3, a group of 305 young and elderly French-speaking adults from Quebec were assessed in order to provide normative data. The results demonstrate that the TDQ-60 has good convergent validity and good discriminant validity. This study also provides normative data in which were considered the effect of age and education.The TDQ-60 is a new valid picturenaming test, controlled for psycholinguistic variables and designed to identify the influence of semantics on lexical access in spoken production.
Received 5 December 2016 Accepted 21 August 2017 KEYWORDS
Picture naming; lexical access; semantics; test validity; normative data
1. Introduction Elderly people frequently complain of difficulties retrieving names of people or objects. These lexical access difficulties are one of the most frequent cognitive changes in normal aging (Burke & Shafto, 2004) and become more significant after age 70 (Albert, Heller, & Milberg, 1988; Nicholas, Obler, Albert, & Goodglass, 1985). Word retrieval difficulties or anomia are one of the most frequent manifestations in poststroke aphasia (Goodglass, 2001), primary progressive aphasias (Gorno Tempini et al., 2011), and other neurodegenerative diseases (Macoir, Turgeon, & Laforce, 2015). People experiencing anomia may have difficulty retrieving specific words during conversation or written production. They also present with difficulties in picture-naming tests during clinical assessments. According to cognitive models of spoken production (Caramazza, 1997), the production of words in picture naming is achieved through the activation of specialized interconnected components. The word retrieval process involves two main levels of activation: (1) the concept corresponding to the object or idea to be expressed is first activated at
CONTACT Joël Macoir
[email protected]
© 2017 Informa UK Limited, trading as Taylor & Francis Group
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the conceptual-semantic level; (2) then this nonverbal conceptual representation maps onto a lexical representation, specifying the phonological form of the target word. An assessment process based on such a cognitive model of language production consists of identifying the impaired and preserved processing components. This is done by administering specific tests (e.g., Howard & Patterson, 1992) or batteries (e.g., Macoir, Gauthier, Jean, & Potvin, 2016) aiming at assessing each component of the model. Therefore, the assessment of naming abilities could be performed by administering tasks exploring the conceptual-semantic (e.g., semantic questionnaire) and phonological output lexicon (e.g., picture-naming task that manipulates frequency, controls for concept familiarity, etc.). Important information regarding the level of impairment also comes from error analysis. Thus, anomic behavior could arise from different underlying deficits (e.g., deficits in the activation of conceptual-semantic representations or in the retrieval of phonological forms of words in the output lexicon), leading to distinct types of errors (e.g., semantic substitutions or phonemic errors) (Hillis & Caramazza, 1995; Nickels & Howard, 1994). Word retrieval can be influenced by various psycholinguistic variables. Semantic category is a variable that affects performance in picture naming when semantic memory is impaired. In numerous studies, patients with poststroke aphasia (e.g., Forde, Francis, Riddoch, Rumiati, & Humphreys, 1997), Alzheimer’s disease (e.g., Gonnerman, Andersen, Devlin, Kempler, & Seidenberg, 1997), or the semantic variant of primary progressive aphasia (e.g., Cardebat, Demonet, Celsis, & Puel, 1996) presented with category-specific impairments characterized by differences in naming scores for natural vs. man-made concepts. To date, there is no picture-naming test that can specifically identify such category-specific naming impairments. Concept familiarity (i.e., degree to which a person comes into contact with or thinks about a given concept) is another variable that affects semantic processing and word production. For example, Snodgrass and Yuditsky (1996) showed that concept familiarity significantly influenced picture-naming latencies in healthy individuals. This factor is also known to affect naming performance in patients with the semantic variant of primary progressive aphasia (Hirsh & Funnell, 1995). At the lexical level, it is well known that access to phonological representations is highly influenced by word frequency (i.e., frequency in a particular language). It has been repeatedly observed that picture-naming latencies decrease as word frequency increases (e.g., Barry, Morrison, & Ellis, 1997). Performance in spoken production is also influenced by the age at which words are learned. According to this age-of-acquisition effect, items acquired early in life are more quickly produced than items acquired later. This effect, repeatedly shown in healthy individuals, has also been reported in pathology (e.g., Bell, Davies, Hermann, & Walters, 2000; Hirsh & Funnell, 1995). Subjective frequency (i.e., estimation of the number of times a word is encountered by individuals in its spoken form), also known as lexical familiarity, is another lexical parameter known to be predictive of both lexical decision and wordnaming performance (Thompson & Desrochers, 2009). An impairment at the lexical level has been shown to be the functional source of phonological errors in aphasia (Buckingham, 1987). Such an impairment is directly influenced by word length in terms of number of phonemes (i.e., the more phonemes in a word, the higher the probability of an error) (Nickels, 1995). Picture-naming tasks also involve the cognitive nonlinguistic processes of object recognition, from perceptual stages to the activation of
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structural representations. Visual complexity, which refers to the number of lines and details in a percept (object, drawing), has been found to influence naming latencies (Ellis & Morrison, 1998), although other researchers did not find any advantage of simple over complex visual stimuli (Snodgrass & Yuditsky, 1996). Finally, color is also known to influence ease of naming in terms of speed (Ostergaard & Davidoff, 1985) and accuracy (Zannino et al., 2010) in normal and clinical populations. In clinical settings, anomia is usually assessed with picture-naming tests, such as the Boston Naming Test (BNT) (Kaplan, Goodglass, & Weintraub, 1983), which simply consist of presenting pictures to the person who is asked to name them one by one as precisely as possible. One important source of difficulties in non-English-speaking settings is the use of picture-naming tests that are not culturally and/or linguistically adapted to these populations. Various studies have shown that language and cultural differences have an impact on cognitive tests and particularly on language tests because of differences in sociocultural exposure to certain categories of concepts as well as in differences in wordspecific features (e.g., Sirois, Kremin, & Cohen, 2006; Yoon et al., 2004). To assess picture naming abilities of French-speaking Quebecers, the population of the present study, clinicians generally, use the BNT (Kaplan et al., 1983), the Test de dénomination orale d’images DO-80 (Deloche & Hannequin, 1997) or the picture-naming subtest of the Montreal–Toulouse assessment battery (Nespoulous et al., 1992). Even though the Montreal–Toulouse subtest has been validated (Pagliarin et al., 2014) and normalized (Béland & Lecours, 1990) for the Quebec-French population, there is no control of psycholinguistic variables. The same lack of psycholinguistic control applies to the DO80 and BNT. Moreover, in none of these tests stimuli were selected according to semantic categories (i.e. natural vs. man-made concepts). In this article, we present the Test de Dénomination de Québec-60 images (TDQ-60; Quebec naming test), a new color picture-naming test in which semantic category (i.e., natural vs. man-made concepts) was manipulated and the psycholinguistic variables of concept familiarity, lexical familiarity, word frequency, age-of-acquisition, word length in phonemes, and visual complexity were specifically controlled. The main objective of the study was to develop a sensitive standardized test of picture-naming abilities in French designed to assess spoken production disorders in adults and elderly people. We also studied the tests’s psychometric properties to establish its validity and reliability. Finally, we studied the effects of age, education, and sex in a representative sample of Frenchspeaking adults and elderly people from Quebec, Canada. Based on the results of these analyses, we provide normative data for community-dwelling individuals. Thus, in the first study, we describe the development phase of the TDQ-60. In study 2, we report data on the convergent and discriminant validity of the TDQ-60. Finally, in Study 3, we provide normative data for healthy, community-dwelling, French-speaking people.
2. Study 1. Development phase of the TDQ-60 2.1. Selection of the stimuli In this study, we followed a comprehensive test development approach, including the establishment of translational validity. Translational validity refers to the transformational aspect of construct validity and includes content and face validity (Trochim,
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2001). The content validity of the TDQ-60 was established on the basis of the scientific literature. The research team first determined the number of items that were needed to satisfy the objective of developing a picture-naming test that could be administered in approximately 10–15 min using a computer or electronic tablet. A test comprising 30 pictures corresponding to natural concepts and 30 pictures corresponding to man-made concepts was considered the best option to measure lexical-semantic access in spoken production. Based on a subjective ease of naming, we first selected a subset of 120 color line drawings (Rossion & Pourtois, 2004) derived from the original Snodgrass and Vanderwart set (1980) and comprising 60 pictures of natural concepts and 60 pictures of man-made concepts. The final 60 items of the TDQ-60 were chosen such that each of the 30 pictures depicting manmade and natural concepts were matched according to a number of variables known to affect naming abilities – specifically, concept familiarity, word familiarity, word frequency, age of acquisition, word length, and visual complexity. Concept familiarity was measured by asking 50 healthy participants (aged 18–75) to rate the familiarity of the 120 pictures from the Snodgrass and Vanderwart set on a 5-point scale, presented in random order. They were given similar instructions to those used in the Snodgrass and Vanderwart (1980) study (i.e., how usual or unusual is this object in your experience?). The values for word familiarity (subjective frequency) were taken from Desrochers and Bergeron (2000) (N.B.: missing data for five items). Word frequency was controlled using the Quebec-French values for written word frequency established by Baudot (1992) as well as word frequency values based on film dialogue established by New, Pallier, Brysbaert, and Ferrand (2004). Data on age-of-acquisition are available only for monosyllabic French words (Ferrand et al., 2008), while most of the TDQ-60 items (77%) comprise two and more syllables. Therefore, following the protocol of Morrison et al. (1997), this variable was measured by asking 15 healthy participants (aged 16–72) to estimate the age at which they had learned each word corresponding to the 120 pictures from the Snodgrass and Vanderwart set, presented in random order. They were asked to estimate the age at which they believed they had learned this word, in either spoken or written form, based on a 7-point scale (from 1 = learned at the age of ≤2 years, to 7 = learned at the age of 13+). Word length in phonemes was computed for each of the word stimuli. Finally, the values for visual complexity were taken from Snodgrass and Vanderwart (1980). In the final set, the 30 pictures corresponding to natural concepts (animals = 16; fruits and vegetables = 10; body parts = 3; nature = 1) were equivalent to the 30 pictures corresponding to man-made concepts (tools = 6; kitchen utensils = 5; musical instruments = 4; clothes = 8; vehicles = 7) with respect to concept familiarity, t(58) = −.4, p = .69, word familiarity, t(58) = −1.55, p = .13, word frequency, Baudot: t(58) = .92, p = .36; New et al.: t(58) = .89, p = .38), age-of-acquisition, t(58) = −.52, p = .61), word length in phonemes, t(58) = −1.3, p = .2, as well as visual complexity, t(58) = .59, p = .56. The psycholinguistic characteristics of the TDQ-60 stimuli are presented in Table 1.
2.2. Pilot study Following Phase I, a pilot study was conducted to assess name agreement and other acceptable lexical variations for the images as well as to ensure the appropriateness of
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Table 1. Characteristics of the stimuli used in the TDQ-60 as a function of semantic category (natural and man-made concepts). Characteristic Concept familiarity Word familiarity Lexical frequency (Baudot) Lexical frequency (New et al.) Age-of-acquisition Word length in phonemes Visual complexity
Natural concepts (mean (SD); range) 3.3 3.92 53.37 43.74 2.34 4.47 3.24
(1.12); 5–1.14 (1.65); 5.86–1.41 (122.25); 646–1 (86.59); 413.04 – .08 (.79); 5.07–1.2 (1.07); 6–2 (1.08); 4.77–1.14
Man-made concepts (mean (SD); range) 3.41 4.49 31.7 27.51 2.44 4.93 3.07
(.99); 4.93–1.86 (1.15); 6–2.6 (41.15); 178–1 (49.82); 255.28 – .32 (.70); 4.07–1.07 (1.62); 9–2 (1.16); 4.92–1.07
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Notes: concept familiarity: average on a 5-point scale; word familiarity: average on a 5-point scale; lexical frequency: expressed in occurrences per million; age-of-acquisition: average on a 7-point scale; visual complexity: average on a 5-point scale.
the stimuli and clarity of the protocol and instructions. To do this, we created a Powerpoint presentation with the 60 images, along with the administration protocol and instructions. This version was then administered to 32 healthy participants, native Quebec-French speakers, by two speech-language pathology students. These participants were recruited in the province of Quebec through public advertisements. The mean age of these participants was 45.41 years (SD = 25.56; range: 16–89), their mean level of education was 12.91 years (SD = 3.85; range 6–21), and the sex distribution was 10 males and 22 females. Each participant was asked to name the picture with a single word (i.e., avoid descriptions and multiple attempts) as quickly as possible after it appeared on the computer screen. There was no time limit to complete the test. The total number of pictures correctly named (maximum score = 60) was recorded. Alternative responses reflecting acceptable lexical variations in Quebec French were credited (e.g., pinotte, arachide and cacahuète were all accepted for the picture of a peanut). The average percentage of correct responses on the TDQ-60 was 96.25% for the total score (57.75/60; SD = 3.22), 94% for natural concepts (56.37/60; SD = 3.62), and 98.5% for man-made concepts (59.12/60; SD = .94). The experimenters reported no particular problem with the administration protocol or instructions. However, for 8 of the 32 (25%) healthy controls, the picture of a cloud was mistaken for snow. To prevent this confusion, this picture was replaced by another color line drawing of a cloud found on the Internet. This new drawing was correctly named (10/10) by a new sample of 10 healthy controls (mean age = 52.1 years (SD = 17.01; range: 21–76); mean level of education = 13.9 years (SD = 4.23; range 7–20); sex distribution = 6 males and 4 females). Based on the results of the pilot study, the TDQ-60 was considered optimal. The TDQ-60 test material, administration procedure, instructions, and scoring method are available from the first author upon request. The materials include a scoring sheet corresponding to the order of presentation of all the items. Each item is identified as belonging to “natural” or “man-made” concept categories. This makes it very easy to clinicians to establish the score according to the semantic category of the items.
3. Study 2. Discriminant and convergent validity of the TDQ-60 The purpose of Study 2 was to provide data on the psychometric properties of convergent and discriminant validity of the TDQ-60.
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3.1. Method 3.1.1. Participants, materials, and procedure Two groups of participants, native Quebec-French speakers, were assessed and compared to establish the convergent and discriminant validity of the TDQ-60: (1) a group of 13 individuals (3 women and 10 men; mean age = 66.08, SD = 9.8 years; mean education = 16, SD = 4.6 years) diagnosed with the semantic variant of primary progressive aphasia (svPPA), based on the criteria proposed by Gorno Tempini et al. (2011); and (2) a group of 22 (6 women and 16 men) healthy control participants (mean age = 65.78, SD = 9.2 years; mean education = 16.73, SD = 3.5 years). These two groups were equivalent in terms of age, t(33) = .091, p = .93, and education, t (33) = −.53, p = .6. To establish convergent validity, in addition to the TDQ-60, both groups of participants were administered: (a) the BNT (Kaplan et al., 1983), another picturenaming test for which a positive correlation with the TDQ-60 was expected; (b) copy of the Rey–Osterrieth Complex Figure (ROCF) (Osterrieth, 1944; Rey, 1941), a test for visuoconstructional abilities and components of executive functions, for which no correlation with the TDQ-60 was expected since they assessed different cognitive abilities. To assess discriminant validity, we tested whether the TDQ-60 score distinguished between the performances of healthy participants and individuals with svPPA.
3.2. Results As expected for convergent validity, the external measure of spoken production that assessed the same construct (BNT) correlated significantly and positively with the TDQ60 (see Table 2) in the two groups. Also as expected, no significant correlation was found in the two groups between the TDQ-60 and copy of the ROCF. With respect to discriminant validity, the mean TDQ-60 score of participants with svPPA was significantly lower than that of healthy controls, t(13) = −8.59, p < .0001) (see Table 2). Compared to healthy controls, their performance was also significantly impaired on the BNT, t(25) = −19.48, p < .0001, while it did not differ on the ROCF test, t(23) = –.37, p = .71. This result is not surprising since visuoconstructional abilities and executive functions are usually unimpaired in svPPA, at least in the early stages of the disease (Gorno Tempini et al., 2011).
Table 2. Performance on external measures and correlations with the TDQ-60 to establish convergent validity. Participants with svPPA Test TDQ-60 (60) BNT (60) ROCF (36)
Mean (SD); range 26.85 (12.5); 3–45 10.08 (6.1); 2–25 31.65 (2.8); 24.5–36
Corr. with TDQ-60 – r = .86** r = –.15NS
Healthy participants Mean (SD); range 57.04 (2.72); 48–60 51.28 (5.9); 35–59 32 (2.5); 28–36
Notes: BNT = Boston Naming Test; ROCF = Rey–Osterrieth Complex Figure. *p < .01; **p < .001; NS = not significant.
Corr. with TDQ-60 – r = .6* r = .22NS
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3.3. Summary According to the analyses, on the whole the TDQ-60 has good convergent validity. The screening test also distinguishes between the performances of healthy participants and participants with svPPA, suggesting good discriminant validity.
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4. Study 3. Normative data The purpose of Study 3 was to provide normative data for the TDQ-60, adapted to adults and elderly people from Quebec. To determine the different difficulty of the items of the TDQ-60, item-by-item correct response rates were also calculated. Finally, acceptable alternative responses were gathered from the responses provided by healthy participants and were verified according to accepted lexical variations for concepts taken from a Quebec-French terminology dictionary (Office québécois de la langue française, 2012).
4.1. Method 4.1.1. Participants A total of 305 healthy community-dwelling adults, whose mother tongue and usual language was French, were recruited in the province of Quebec by speech-language pathology students and speech-language pathologists through public advertisements and among their relatives. Participants were recruited from 14 of the 17 administrative regions of the province of Quebec (no participants from Abitibi-Témiscamingue, Outaouais and Côte-Nord) and from both urban and rural environments. The majority of participants were recruited from the Quebec City and Montreal areas. Any person with a history of neurological (stroke, head trauma, tumor, etc.) or psychiatric illness (such as depression), and a history of drug abuse (e.g., alcohol) or untreated high blood pressure was excluded from the study. This information regarding exclusion criteria was obtained from participants’ self reports, corroborated in many cases by family members. No formal screening test for cognitive functioning was administered. The sample was composed of 144 men (47%) and 161 women (53%), aged between 18 and 94 years, with an education level varying between 6 and 27 years. In addition to sex, we considered age and education level as demographic variables that may have influenced test performance. There was no significant difference between men and women in terms of age (men: M = 49.08 years; SD = 18.63; women: M = 50.73 years; SD = 18.97; t(303) = −.76, p = .44); however, the two groups differed in terms of education (men: M = 15.19 years of schooling; SD = 3.87; women: M = 14.09 years of schooling; SD = 3.22; t(303) = 2.71, p = .007). With respect to the representativeness of the sample, highly educated individuals were overrepresented compared to official demographic data for the province (Institut de la statistique du Québec, 2006) (see Table 3). 4.1.2. Materials and procedure All participants were tested individually in a quiet room at their home or a research center. The TDQ-60 was administered without any time limits using PowerPoint or
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Table 3. Comparison of demographic data between the province of Quebec (%) and the study sample (number and %). Years of education Province of Quebec 18–35 years 36–60 years 61+ years Total
0–12 60.4 56.99 71.5 62.6
Study sample 13+ 39.6 43.01 28.5 37.4
0–12 16 (16.5) 32 (30.2) 41 (40.2) 89 (29)
13+ 81 (83.5) 74 (69.8) 61 (59.8) 216 (71)
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Keynote. The average time to complete the test was 7 min. Response sheets were collected and data were entered manually in an Excel file for the analyses.
4.2. Results Data were analyzed using SPSS19. All data were examined for normality, skewness, and range restriction. The TDQ-60 scores were found to have non-normal distributions and partial Spearman rank correlation coefficients were calculated to assess independent relationships between sociodemographic variables and performance scores. Results showed that performance on the TDQ-60 negatively correlated with age when controlling for education and sex (rs = −.34, p < .001), meaning that performance declines with increasing age. A positive correlation was also found with education when controlling for age and sex (rs = .21, p < .001), meaning that performance on the TDQ-60 increases as education increases. Finally, the score on the TDQ-60 was not significantly correlated with sex (rs = −.09, p = .13). We calculated the 5th, 15th, 25th, and 50th percentiles for the TDQ-60 score for each group, determined as a function of age and education. After visual exploration of the whisker plots and according to usual criteria (Crawford & Garthwaite, 2009), we chose the 5th percentile as the most reliable cutoff score. Thus, a score equal to or below the suggested cutoff score can be considered to be under normal performance limits. We also proposed an alert score based on the 15th percentile. A score below this alert score is not necessarily, but may be considered to be below normal performance limits. Table 4 shows the suggested cutoff and alert scores for each group of participants by age and education. As shown in Table 5, the percentage of correct responses for each of the TDQ-60 items was very high. Except for three items (gilet (87.21%) “vest,” fourmi (85.9%) “ant,” and hippocampe (79.02%) “seahorse”), this percentage was above 90% (ranging from 90.82% to 100%), suggesting that no stimulus picture in the test was too difficult to name for adults without brain damage. All of the picture stimuli were correctly identified, except for orteil “toe,” which 79.34% of the participants confused with the visually similar concept “thumb.” A list of acceptable alternative responses was established, based on the responses produced by at least 5% of the healthy participants. These alternative responses, shown in Table 5, were also validated using a Quebec-French terminology dictionary (Office québécois de la langue française, 2012).
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Table 4. Descriptive statistics (mean and standard deviation) of the six groups of participants for the normative study as a function of age and education. Age 18–35 years
36–60 years
Education ≤12 years
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Age Education % Women N TDQ-60 Alert Cutoff Total N
Mean 24.87 10.44 37.5 16 58.94 58 56 305
SD 4.36 1.26 1.18
Education
13+ years Mean 26.83 16.26 50.6 81 59.26 58 57
61+ years
SD 3.87 1.95 1.01
≤12 years Mean 52.53 10.55 59.4 32 58.41 57 55
SD 5.49 1.40 1.54
Education
13+ years Mean 51.87 18.7 51.35 74 59.11 58 57
SD 7.34 2.5 1.29
≤12 years Mean 73.49 8.08 10.05 2.04 63.4 41 56.34 2.71 53 51
13+ years SD 68.31 16.68 50.8 61 58.39 57 55
4.91 2.93 2.22
Notes: Age: age in years; education: formal education in years; SD = standard deviation; % women: percentage of women; N: number of participants in the group; TDQ-60: Test de dénomination d’images de Québec score/60; Alert: suggested alert score calculated as the 15th percentile (score below it and above the cutoff may indicate “at risk”); cutoff: suggested cutoff score calculated as the 5th percentile (score equal to or below it is under normal performance limits); total N: total number of participants in the normative study.
5. Discussion Word-finding difficulties are among the most frequent symptoms in brain diseases. They are found in all types of poststroke aphasia, neurodegenerative diseases, traumatic brain injury, neuropsychiatric diseases, etc. Although these difficulties could originate from impairment of executive functions such as in transcortical motor aphasia (Alexander, 2006) or schizophrenia (Barr, Bilder, Goldberg, Kaplan, & Mukherjee, 1989), in the majority of cases their functional origin lies in the impairment of semantic and/or lexical representations in long-term memory. In clinical settings, the identification of wordfinding difficulties is assessed during the case history interview and with specific tests such as picture naming. Depending on its semantic or lexical origin, anomia is evidenced by the production of semantic or phonological errors (Hillis & Caramazza, 1995; Nickels & Howard, 1994). In some patients, naming impairment is dependent on the category of concepts, leading to category-specific anomia. In these patients, dissociation in picturenaming performance can occur for superordinate categories (i.e., natural vs. man-made concepts) or be limited to particular subordinate categories, such as fruits and vegetables or body parts (e.g., Farah & Wallace, 1992; Sacchett & Humphreys, 1992). In French, the BNT (Kaplan et al., 1983) and DO-80 (Deloche & Hannequin, 1997) are among the most frequently used picture-naming tests. Clinicians and researchers can also use the picture-naming subtest of the Montreal-Toulouse aphasia battery (Nespoulous et al., 1992). However, as noted in the “Introduction” section, there are limitations in using these tests in the Quebec-French population due to linguistic and cultural considerations. Moreover, stimuli in these tests are not divided into semantic categories and do not control for/manipulate psycholinguistic variables known to influence the ease of naming. In the TDQ60, the 30 pictures corresponding to natural concepts were matched to the 30 pictures corresponding to man-made concepts with respect to concept familiarity, word familiarity, word frequency, age-of-acquisition,
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Table 5. Acceptable alternative responses and percentages of correct responses for each of the TDQ60 stimuli.
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Item 1. accordéon (accordion) 2. œil (eye) 3. cuillère (spoon) 4. écureuil (squirrel) 5. oignon (onion) 6. autobus (bus) 7. avion (airplane) 8. chenille (caterpillar) 9. bouilloire (kettle) 10. clou (nail) 11. violon (violin) 12. hélicoptère (helicopter) 13. fourmi (ant) 14. moto (motorbike) 15. piano (piano) 16. citron (lemon) 17. mouche (fly) 18. vache (cow) 19. camion (truck) 20. céleri (celery) 21. pomme (apple) 22. marteau (hammer) 23. hippocampe (seahorse) 24. bicyclette (bicycle) 25. orange (orange) 26. cerise (cherry) 27. jupe (skirt) 28. pantalon (pants) 29. couteau (knife) 30. mitaine (mitten) 31. orteil (toe) 32. arachide (peanut) 33. renard (fox) 34. ours (bear) 35. gilet (vest) 36. serpent (snake) 37. ananas (pineapple) 38. gant (glove) 39. chandail (sweater) 40. papillon (butterfly) 41. cheval (horse) 42. pinceau (paintbrush) 43. tasse (cup) 44. ceinture (belt) 45. bras (arm) 46. train (train) 47. balai (broom) 48. cravate (tie) 49. poisson (fish) 50. mouffette (skunk) 51. guitar (guitar) 52. tigre (tiger) 53. araignée (spider) 54. rouleau à patisserie (rolling pin) 55. carotte (carrot) 56. fraise (strawberry) 57. tournevis (screwdriver) 58. nuage (cloud) 59. échelle (ladder) 60. chien (dog)
Acceptable alternative responses
autobus scolaire (school bus) aeroplane (aeroplane) théière (teapot); bombe (bomb)
motocyclette; bicycle à gaz (motorcycle)
van (van); truck (truck)
cheval de mer (seahorse) vélo; bicycle; bicycle à pédales (pedal bike)
culotte (pants); jeans (jeans) pouce (thumb) pinotte; cacahuète (peanut) veste; veston (jacket) couleuvre (grass snake) gilet (vest)
locomotive (locomotive)
bête puante (“stinky animal”)
rouleau; rouleau à pate (rolling pin)
% of correct responses 98.36 100 100 99.34 98.36 100 100 95.41 98.03 100 97.70 99.34 85.90 99.02 100 99.67 92.13 100 99.67 97.05 95.08 100 79.02 99.67 99.02 95.08 95.08 100 99.34 96.39 97.38 93.77 90.82 99.67 87.21 99.67 97.71 99.02 99.67 100 99.67 99.67 99.02 99.02 98.03 99.34 99.34 100 100 96.39 97.71 92.79 93.44 99.34 100 100 100 100 97.70 100
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word length in phonemes, and visual complexity. The potential effect of all these variables being controlled, this test is particularly useful to identify category-specific anomia. Since culture has an impact on cognition, it is important to use pictorial stimuli and normative data specific to the population to which they are applied. This is particularly true for the assessment of language functions, given possible psycholinguistic (e.g., word frequency, length) and cultural (e.g., vocabulary, familiarity of concepts) biases. The TDQ-60 was explicitly developed to meet the need for a picture-naming test culturally and linguistically adapted to the French-speaking population of Quebec (Canada), in which these psycholinguistic variables were fully considered. Finally, the use of color pictures is another advantage of the TDQ-60. Color pictures are named more quickly and efficiently than black and white pictures (Ostergaard & Davidoff, 1985; Zannino et al., 2010). In picture naming, their greater naturalness minimizes the influence of concomitant perceptual deficits and therefore enables better identification of lexical-semantic deficits. The results of the present study first demonstrate that the TDQ-60 has good convergent validity and can distinguish between the performances of healthy participants and participants with svPPA, suggesting good discriminant validity. Moreover, clear rules have been established for accepted or incorrect answers in order to strengthen interrater reliability in the case of reassessment. This study also provides norms for the TDQ60, computed from a study sample composed of 305 healthy, community-dwelling, French-speaking adults from the province of Quebec, with a wide range of age and education levels. This large group of participants is a major strength of this study. These normative data also have the advantage of taking into account the effect of age and education level on picture-naming abilities. This study has a few limitations, most importantly that of the overrepresentation of highly educated people in the sample. Compared to current Quebec demographic data (Institut de la statistique du Québec, 2006), this sample includes more individuals with 13 years or more of formal education. Ideally, a random sampling method would have increased the representativeness of this sample. Therefore, clinicians should interpret percentile ranks carefully since some age groups with little education do not comprise a large number of participants. This is the case especially for younger adults. Since the TDQ-60 is a new assessment test, we believe that our sampling method is, at the very least, a practical starting point for establishing norms for the Quebec-French population. Another limitation is associated with administering the TDQ-60 in various settings and conditions (notably, at participants’ homes and at research centers). However, such a testing method also has the advantage of avoiding sample bias linked to the recruitment of highly dedicated volunteers who may not be representative of the general population.
6. Conclusion To conclude, this article describes three studies describing the development phase of the TDQ-60 (Study 1), establishing the convergent and discriminant validity of the TDQ60 (Study 2) and providing normative data for a large sample of French-speaking adults from Quebec (Study 3). Study 1 reported on the development of the TDQ-60, a picture-
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naming test designed to assess lexical-semantic access to words corresponding to natural and man-made concepts, taking into account psycholinguistic variables known to influence ease of naming. Results from Study 2 showed that the TDQ-60 has good convergent and discriminant validity. Finally, results from Study 3 provided normative data for the TDQ-60 in the form of stratified percentiles, according to age and education. These norms, established from a wide sample of 305 French-speaking adults selected from the community, will be useful in identifying spoken production impairments.
Disclosure statement
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No potential conflict of interest was reported by the authors.
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