Expanded Exploration of the Auditory Naming Test in Patients with Dementia

Abstract

Background: Auditory naming tests are superior to visual confrontation naming tests in revealing word-finding difficulties in many neuropathological conditions. Objective: To delineate characteristics of auditory naming most likely to reveal anomia in patients with dementia, and possibly improve diagnostic utility, we evaluated a large sample of patients referred with memory impairment complaints. Methods: Patients with dementia (N = 733) or other cognitive impairments and normal individuals (N = 69) were evaluated for frequency of impairment on variables of the Auditory Naming Test (ANT) of Hamberger & Seidel versus the Boston Naming Test (BNT). Results: Naming impairment occurred more frequently using the ANT total score (φ= 0.41) or ANT tip-of-the tongue score (TOT; φ= 0.19) but not ANT mean response time compared to the BNT in patients with dementia (p < 0.001). Significantly more patients were impaired on ANT variables than on the BNT in Alzheimer’s disease (AD), vascular dementia (VaD), mixed AD/VaD, and multiple domain mild cognitive impairment (mMCI) but not in other dementias or amnestic MCI (aMCI). This differential performance of patients on auditory versus visual naming tasks was most pronounced in older, well-educated, male patients with the least cognitive impairment. Impaired verbal comprehension was not contributory. Inclusion of an ANT index score increased sensitivity in the dementia sample (92%). Poor specificity (41%) may be secondary to the inherent limitation of using the BNT as a control variable. Conclusion: The ANT index score adds diagnostic utility to the assessment of naming difficulties in patients with suspected dementia.

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

“…Danish, Korean, Spanish, Swedish) and has been validated in different cohorts [46][47][48][49][50][51]. Of note, BNT performance is inversely correlated to age, positively correlated to education and intelligence and is generally higher among cognitively healthy males [6,52]. BNT has been criticized for including a culturally insensitive item (the noose) [53] as well as for suffering from high false negative rates, inadequate standardization and norms and susceptibility to bias stemming from deficits in visual recognition, visuospatial abilities and/or limited expressive vocabulary of the individual [14,52,[54][55][56][57].…”

“…ANT validity was initially supported by observations that patients with left temporal lobe epilepsy, who manifest naming difficulties, performed worse on auditory but not on visual naming tasks compared to patients with right temporal epilepsy, which is not characterized by dysnomia [68]. ANT has been validated in several different, relatively large studies [6,45]. The ANT index score enables the simultaneous consideration of correct item response scores, tip-ofthe tongue extended latency scores and reaction time per response.…”

“…The ANT index score enables the simultaneous consideration of correct item response scores, tip-ofthe tongue extended latency scores and reaction time per response. Compared to BNT, ANT is particularly sensitive in detecting naming difficulties in patients with MiND, who do not exclusively suffer from memory deficits, in patients with MaND due to AD, cerebrovascular disease or mixed etiologies [6,45]. No sex related effects on performance on ANT have been unveiled in cognitively healthy older adults, while a positive correlation between education and performance on ANT was detected in healthy individuals aged 50-59 years and 60-69 years [69].…”

“…Moreover, individuals with lower intellectual and/or education level or with severe cognitive impairment are more likely to become frustrated or fatigued during a lengthy and demanding naming assessment [63]. Nonetheless, very short instruments may not detect mild cognitive deficits, which characterize the early stages of ND [5,6,8,10,11,14]. For instance, the naming subtest of the MoCA is administered in a few seconds, but it fails to detect dysnomia in more than 50% of individuals with MaND.…”

“…Even though a mild decline in word-finding capacity is related to aging [1,2], more severe naming deficits embody core symptoms of a number of ND. For instance, in Alzheimer's disease (AD) [3,4] dysnomia is a symptom that appears early in the symptomatic stages of the disease as indicated by the reported significant dysnomia in patients with mild neurocognitive disorder (MiND) due to AD [5][6][7]. In addition, dysnomia is the leading symptom in the semantic and logopenic variants of primary progressive aphasia (PPA), the language variant of frontotemporal lobar degeneration (FTLD) [8], and is frequently observed even in the behavioral FTLD form [9].…”