Nielsen, N.P.; Wiig, E.H.; Bäck, S.; Gustafsson, J. (2017):
Processing speed can monitor stimulant-medication effects in adults with attention deficit disorder with hyperactivity.
Nordic Journal of Psychiatry.
Background: Treatment responses to methylphenidate by adults with ADHD are generally monitored against DSM-IV/DSM-V symptomatology, rating scales or interviews during reviews.
Aims: To evaluate the use of single- and dual-dimension processing-speed and efficiency measures to monitor the effects of pharmacological treatment with methylphenidate after a short period off medication.
Methods: A Quick Test of Cognitive Speed (AQT) monitored the effects of immediate-release methylphenidate in 40 previously diagnosed and medicated adults with ADHD. Processing speed was evaluated with prior prescription medication, without medication after a 2-day period off ADHD medication, and with low-dose (10/20 mg) and high-dose (20/40 mg) methylphenidate hydrochloride (Medikinet IR).
Results: Thirty-three participants responded to the experimental treatments. One-way ANOVA with post-hoc analysis (Scheffe) indicated significant main effects for single dimension colour and form and dual-dimension colour–form naming. Post-hoc analysis indicated statistical differences between the noand high-dose medication conditions for colour and form, measures of perceptual speed. For colour–form naming, a measure of cognitive speed, there was a significant difference between no- and lowdose medication and between no- and high-dose medications, but not between low- and high-dose medications.
Conclusions: Results indicated that the AQT tests effectively monitored incremental effects of the methylphenidate dose on processing speed after a 2-day period off medication. Thus, perceptual (colour and form) and cognitive speed (two-dimensional colour–form naming) and processing efficiency (lowered shift costs) increased measurably with high-dose medication. These preliminary findings warrant validation with added measures of associated behavioural and cognitive changes.
Subirana, Judit (2016):
Valoració del deteriorament cognitiu a través de la velocitat de processament. Adaptació de la prova ‘Quick Test of Cognitive Speed (QTCS)’.
Tesis doctoral, Facultat de Psicologia, CIències de l’Educació i de l’Esport Blanquerna – Universitat Ramon Llull.
The progressive aging of the population justifies a deeper understanding of the aging process and the diseases related to an increased life expectancy. The differentiation between the characteristics of the different types of cognitive impairment that might indicate the onset of a neurodegenerative process and the changes associated to the aging process has become, in recent years, one of the challenges for neurosciences, particularly for the neuropsychologists.
The objectives that direct neuropsychological assessment takes on great importance at this point since the neuropsychological assessment and the cognitive screening are the main tools that provide insight and information about the cognitive, behavioural and emotional aspects of a person. A key point in the neuropsychological assessment is the existence of sufficiently sensitive and validated instruments for the population to which are going to be applied. One of the main causes of under-diagnosis of dementia and mild cognitive impairment is precisely the lack of validated instruments to make good cognitive screenings. The most appropriate tests to screen are brief tests, easy to administer and fast to fill, with good statistical indices of specificity, sensitivity, predictive value and universality.
The Quick Test of Cognitive Speed (QTCS) meets these requirements as it is an objective and easy-to-administer test for its use in clinical settings and research which can detect small changes in cognitive function even in early stages of deterioration, as it assesses speed of information processing. The aim of this study is to adapt and standardise the use of QTCS test for the Spanish population, determining its specificity and sensitivity in order to facilitate the process of cognitive screening. The results of this study indicate that the use of this test in our context allows us to obtain a standardised measure of cognitive processing speed independent of gender and educational level for both Spanish and Catalan-speaking populations. The QTCS has good sensitivity and specificity to indicate the presence of cognitive impairment, even in the milder stages so we can say that the results obtained from the application of this test will be valid for their use as cognitive screening tool of speed of information processing. In conclusion, this test allows, due to the measurement of cognitive processing speed, the detection of cognitive impairment at its very early stages, promoting an early diagnosis of neurodegenerative processes in the aging process
Subirana-Mirete, J.; Bruna, O.; Virgili, C.; Signo, S.; Palma, C. (2014):
Processing speed in the aging process: screening criteria for the Spanish Quick Test of Cognitive Speed.
Perceptual and Motor Skills, 2014 Oct;119(2):417-29. doi: 10.2466/22.PMS.119c22z2. Epub 2014 Sep 22.
A Quick Test of Cognitive Speed was administered to 357 participants without cognitive impairment, aged 18 to 85 years, to explore the effects of age on processing speed variables in Spanish speakers and to provide normative data for the test adapted to this population. Results were consistent with previous findings: correlations between age and naming times were high and statistically significant. Linear regression indicated that cognitive processing speed on this test slows 2 to 4 sec. per decade, depending on the task. Normalized data were provided. The findings concur with several studies that have linked age-cognitive impairment with slowing processing speed. This study attempted to assess the importance of this relation, as information processing speed could be considered a measure of cognitive impairment in everyday clinical screening evaluations.
Fleck, Christy, Wiig, E.H., Corwin, Melinda (2014):
Stroop Interference and AQT Cognitive Speed May Play Complementary Roles in Differentiating Dementias with Frontal and Posterior Lesions.
Community Mental Health Journal 06/2014; 51(3).
Forty neurotypical adults (ages 65-74) were administered three different assessments, as follows: Montreal Cognitive Assessment (MoCA), A Quick Test of Cognitive Speed (AQT), and Stroop Color and Word Test. Correlation coefficients (Pearson r) indicated a significant but moderate association between MoCA scores and AQT dual-dimension processing speed (p < 0.01). AQT color and color-form combination naming correlated significantly with Stroop Color, Word, and Color-Word t-scores, and the observed statistical power was high. Form naming correlated significantly with Stroop Word and Color-Word measures (p < 0.01). The associations between the AQT color, form, and color-form combination and Stroop interference measures were low and non-significant (p > 0.01). Based on evidence of frontal lobe control of inhibition (Stroop) and bilateral temporal-parietal control of dual-dimension processing speed (AQT), results suggest that the AQT dual-dimension processing-speed and Stroop interference tests may complement each other in differentiating dementias associated with frontal and posterior lesions.
Ferdinando Petrazzuoli, F., Palmqvist, S., Thulesius, H., Buono, N., Pirrotta, E., Cuffari, A., Cambielli, M., D’Urso, M., Farinaro, C., Chiumeo, F., Marsala, V., Wiig, E.H. (2014):
A Quick Test of Cognitive Speed: norm-referenced criteria for 121 Italian adults aged 45 to 90 years.
International Psychogeriatrics 05/2014; 26(9):1-8.
A Quick Test of Cognitive Speed (AQT) is a brief test that can identify cognitive impairment. AQT has been validated in Arabic, English, Greek, Japanese, Norwegian, Spanish, and Swedish. The aim of this study was to develop Italian criterion-referenced norms for AQT.
Methods: AQT consists of three test plates where the patient shall rapidly name (1) the color of 40 blue, red, yellow, or black squares (AQT color), (2) the form of 40 black figures (circles, squares, triangles, or rectangles; AQT form), (3) the color and form of 40 figures (consisting of previous colors and forms; AQT color-form). The AQT test was administered to 121 Italian cognitively healthy primary care patients (age range: 45-90 years). Their mean Mini-Mental State Examination (MMSE) score was 28.8 ± 0.9 points (range 26-30 points). AQT naming times in seconds were used for developing preliminary criterion cut-off times for different age groups.
Results: Age was found to have a significant moderate positive correlation with AQT naming times color (r = 0.65, p < 0.001), form (r = 0.53, p < 0.001), color-form (r = 0.63, p < 0.001) and a moderate negative correlation with MMSE score (r = -0.44, p < 0.001) and AQT naming times differed significantly between younger (45-55 years old), older (56-70 years old), and the oldest (71-90 years old) participants. Years of education correlated positively but weakly with MMSE score (r = 0.27, p = 0.003) and negatively but weakly with AQT color (r = -0.16, p = ns), form (r = -0.24, p = 0.007), and color-form (r = -0.19, p = 0.005). We established preliminary cut-off times for the AQT test based on +1 and +2 standard deviations according to the approach in other languages and settings.
Conclusions: This is the first Italian normative AQT study. Future studies of AQT – a test useful for dementia screening in primary care – will eventually refine cut-off times for normality balancing sensitivity and specificity in cognitive diagnostics.
Kvitting, A.S.; Wimo, A.; Johansson, M.M.; Marcusson, J. (2013):
A Quick Test of Cognitive Speed (AQT): Usefulness in dementia evaluations in primary care.
Scandinavian Journal of Primary Health Care, 2013; 31: 13–19.
Objective. To validate A Quick Test of Cognitive Speed (AQT) as an instrument in diagnostic dementia evaluations against final clinical diagnosis and compare AQT with the Mini-Mental State Examination (MMSE) and Clock Drawing Test (CDT) in primary care.
Design. Primary health care cohort survey. Setting. Four primary health care centres and a geriatric memory clinic in Sweden. Patients. 81 patients (age 65 and above) were included: 52 with cognitive symptoms and 29 presumed cognitively healthy. None of the patients had a previous documented dementia diagnosis. All patients performed MMSE, CDT, and AQT at the primary health care clinic and were referred for extensive neuropsychological testing at a memory clinic. AQT was validated against final clinical diagnosis determined by a geriatric specialist and a neuropsychologist. Main outcome measures. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), likelihood ratios, correlation data, and receiver operating characteristic (ROC). Results. For MMSE, sensitivity and specificity was 0.587 and 0.909; CDT 0.261 and 0.879; and AQT 0.783 and 0.667, respectively. For the combination of MMSE and CDT, sensitivity and specificity was 0.696 and 0.788, for MMSE and AQT 0.913 and 0.636. The ROC curve for AQT showed an area under curve (AUC) of 0.773.
Conclusion. Our results suggest AQT is a usable test for dementia assessments in primary care. Sensitivity for AQT is superior to CDT, equivalent to MMSE, and comparable to the combination MMSE and CDT. MMSE in combination with AQT improves sensitivity. Because AQT is user-friendly and quickly administered, it could be applicable for primary care settings.
A Quick Test of Cognitive Speed (AQT): Usefulness in dementia evaluations in primary care. (PDF Download Available)
Kim, S., Chen, S.,, Tannock, R.. (2013):
Visual function and color vision in adults with Attention-Deficit/Hyperactivity Disorder.
J Optom. 2014 Jan-Mar;7(1):22-36. doi: 10.1016/j.optom.2013.07.001. Epub 2013 Aug 16.
Color vision and self-reported visual function in everyday life in young adults with Attention-Deficit/Hyperactivity Disorder (ADHD) were investigated.
Participants were 30 young adults with ADHD and 30 controls matched for age and gender. They were tested individually and completed the Visual Activities Questionnaire (VAQ), Farnsworth-Munsell 100 Hue Test (FMT) and A Quick Test of Cognitive Speed (AQT).
The ADHD group reported significantly more problems in 4 of 8 areas on the VAQ: depth perception, peripheral vision, visual search and visual processing speed. Further analyses of VAQ items revealed that the ADHD group endorsed more visual problems associated with driving than controls. Color perception difficulties on the FMT were restricted to the blue spectrum in the ADHD group. FMT and AQT results revealed slower processing of visual stimuli in the ADHD group.
A comprehensive investigation of mechanisms underlying visual function and color vision in adults with ADHD is warranted, along with the potential impact of these visual problems on driving performance.
Copyright © 2013 Spanish General Council of Optometry. Published by Elsevier Espana. All rights reserved.
Wiig, E.H., Al-Hales, Yousef (2013):
A quick test of cognitive speed: preliminary screening criteria for arabic-speaking adults, ages 40 to 80 years.
Perceptual and Motor Skills 10/2013; 117(2):615-26.
A Quick Test of Cognitive Speed (AQT) color, form, and color-form scales were administered to 90 educated (5-22 years of education) and 45 uneducated (0-2 years of education) healthy, Arabic-speaking adults. Lognormal (In) transformations of time measures (sec.) were used for statistical analyses. There were statistically significant mean differences for the color-form processing-speed measures between middle-aged (ages 40-50) and older (ages 51-80) educated adults and between educated and uneducated adults (ages 40-78). The study developed preliminary criterion cut-off times for color-form naming for screening educated and uneducated Arabic-speaking adults. The normal, slower-than-normal, and atypical/pathological performance ranges were characterized with frequency distributions and standard deviations. Age and education are factors that must be considered in stratifying samples in future studies to develop valid and reliable criteria for cognitive screening of Arabic speakers with the AQT.
Nielsen, N.P., & Wiig, E.H. (2012):
A Quick Test of Cognitive Speed for Comparing Processing Speed to Differentiate Adult Psychiatric Referrals with and Without Attention-Deficit/Hyperactivity Disorders.
Prim Care Companion CNS Discord 2012,14(0):doi:10.4088/Pcc.11m01273.
This retrospective study used A Quick Test of Cognitive Speed (AQT) to compare processing speed and efficiency measures by adults with attention-deficit/hyperactivity disorder (ADHD) or non-ADHD psychiatric disorders and healthy controls.
Method. Color, form, and color-form combination naming tests were administered to 104 adults, ages 17-55 years, referred for psychiatric evaluation of possible ADHD. Thirty healthy adults were controls. Psychiatric intake procedures identified 64 adults with ADHD (ICD-10 and DSM-IV criteria) and 40 with mild psychiatric disorders without ADHD. The study was conducted from 2008 through 2010.
Results. At intake, color, form, and color-form combination naming times (seconds) were longer and overhead [colorform combination – (color + form)] was larger for patients with ADHD than for non-ADHD patients and controls. In the ADHD group, color and form measures were in the normal range. Color-form combination was in the slower-than-normal speed (60-70 seconds) and overhead, a processing-efficiency measure, in the atypical range (> 10 seconds). In the non-ADHD patient and control groups, all AQT measures were in the normal range. Analysis of variance with post hoc analysis of log-normal values for color, form, and color-form combination and time for overhead indicated significant (Bonferroni P < .01) mean differences between the ADHD and other groups, but not between the non-ADHD and control groups. When using fail criteria for either color-form combination or overhead, the sensitivity for the ADHD group was 89%.
Conclusions. RESULTS support AQT as a possible complement to psychiatric intake procedures to differentiate adults with ADHD from those with mild psychiatric disorders, and they suggest that a controlled prospective study might be productive.
Nielsen, N.P., & Wiig, E.H. (2011):
Validation of the AQT Color-Form Additive Model for Screening and Monitoring Pharmacological Treatment of ADHD.
Journal of Attention Disorders, 17(3) 187-193.
Objective: This retrospective study used A Quick Test of Cognitive Speed (AQT) processing-speed and efficiency measures for evaluating sensitivity and monitoring effects during pharmacological treatment of adults with ADHD.
Method: Color (C), form (F), and color-form (CF) combination naming were administered to 69 adults during outpatient evaluation, and pre- and posttreatment results were compared for 64 adults.
Results: At intake without medication, naming times (s) were significantly longer and overhead, CF – (C + F), larger than after stabilization of ADHD symptoms. Means for single-dimension naming were in the normal range, and for CF and overhead, means were in the atypical ranges. After treatment, CF and overhead improved to within normal ranges. On average, dual-dimension processing speed increased by 31% and efficiency by 73%. Sensitivity at intake was 91%, using fail-criteria for CF and/or overhead.
Conclusion: Results support previous estimates of sensitivity and ability to monitor pharmacological-treatment effects in ADHD. (J. of Att. Dis. 2011; XX(X) 1-XX).
Nielsen, N.P., & Wiig, E.H. (2011).
AQT processing speed and efficiency differentiate adults with and without ADHD: A preliminary study.
International Journal of Psychiatry in Clinical Practice, 15, 1-9.
We evaluated the hypotheses that A Quick Test of Cognitive Speed (AQT) single- and dual-dimension naming speed measures would differentiate normal adults and adults with ADHD before medication and that there would be no differences between groups after stabilization with medication.
Thirty adults with ADHD, aged 18-43, were evaluated with the AQT color (C), form (F) and color-form combination (CF) naming tests before and after medication with methylphenidate. Thirty age- and sexmatched normal adults served as controls.
Among adults with ADHD, pre-medication naming times (s) for C, F, and CF were significantly longer and overhead [CF – (C + F)] significantly larger than post-medication. Before medication, C, F and CF naming and processing efficiency (overhead) (s) differed significantly between ADHD adults and controls. After medication, there were no significant differences between groups. When we used fail criteria for dualdimension naming (> 60 s) and overhead (processing efficiency) (> + 6 s) together the sensitivity was 93% and specificity 100%.
Within the study limitations, findings suggest that the processing-speed and efficiency measures in AQT may be used to screen adults for executive dysfunction and reduced cognitive control associated with ADHD.
Nielsen, N.P., & Wiig, E.H. (2011).
An additive model for relations between AQT single- and dual-dimension naming speed.
Perceptual & Motor Skills, 112, 1-10.
Color-form naming in A Quick Test of Cognitive Speed (AQT) is used to assess processing speed on three rapid automatic naming tasks, two of which measure single-dimension and the third of which measures dualdimension naming speed. These tests have been used to identify changes in processing speed associated with normal aging.
The present study evaluated whether a simple additive model could explain the normally expected relation between scores on measures of single- and dual-dimension naming speed. The AQT color (C), form (F), and color-form (CF) naming tests were administered individually to 270 adults (ages 18 to 70 yr.). Paired-sample t tests mean comparisons of C+F and CF naming times for the total group and for three age cohorts (ages 18 to 34, 35 to 54, and 55 to 70), each with 90 adults, indicated significant mean differences between these processing-speed measures for the total group and for the 18- to 34- and 35- to 54-year age cohorts. Thus, a simple additive model does not explain the relationship between single- and dual-dimension naming speed across ages. To provide a better description, an additive model with “overhead” (a measure of processing efficiency) was proposed and norm-referenced for using the AQT tests to assess normal and atypical ranges for dual-dimension processing efficiency (overhead). ANOVA with post hoc analysis (Scheffé) compared AQT C + F, CF, and overhead means across age cohorts.
The results indicated significant mean differences for the CF and overhead measures, but not for the C+F measure. Normative ranges for typical overhead sizes were established for each age cohort. In clinical practice, an overhead larger than typical or normal for a given age would suggest executive dysfunction, involving attention, visual working memory, and set shifting.
Conclusion: Results support previous estimates of sensitivity and ability to monitor pharmacological-treatment effects in ADHD. (J. of Att. Dis. 2011; XX(X) 1-XX).
Palmqvist, Sebastian (2011).
Validation of brief cognitive tests in mild cognitive impairment, Alzheimer’s disease and dementia with Lewy bodies.
Publication/Series: Lund University, Faculty of Medicine Doctoral Dissertation Series. Volume: 2011:64
Background. It is estimated that 34 million people suffer from dementia, costing society US$422 billion each year. Alzheimer’s disease (AD) is the most common dementia and the global prevalence is predicted to increase to over 100 million people by the year 2050, with the greatest increase in developing countries. Therefore, inexpensive and efficient instruments are required for investigation and evaluation.
Aim. To evaluate the brief cognitive tests cube copying, clock drawing, the Mini-Mental State Examination (MMSE) and A Quick Test of Cognitive Speed (AQT) in the early diagnosis, treatment evaluation and differential diagnosis of dementias.
85 patients with AD.
33 patients with dementia with Lewy bodies (DLB) and 66 with AD.
75 patients with AD.
99 patients with mild cognitive impairment (MCI).
Findings. Cube copying was found useful for evaluating treatment with acetylcholinesterase inhibitors (AChEI) in patients with AD.
Easy and quick interpretations of the MMSE, clock drawing and cube copying differentiated patients with DLB from patients with AD.
AQT was twice as sensitive as the MMSE in detecting treatment response to AChEI in patients with AD.
The MMSE, AQT and clock drawing were as accurate as cerebrospinal fluid biomarkers (tau, Aβ42 and P-tau) in predicting development of AD and dementia in mild cognitive impairment during an average of five years.
Conclusion. This thesis has improved the validity of brief cognitive tests and contributed with results that can be clinically relevant for evaluating treatment of AD, differentiating DLB from AD, and predicting development of AD and other dementias.
Palmqvist, S., Minthon, L., Wattmo, C., Londos, E., Hansson, O:
A Quick Test of cognitive speed is sensitive in detecting early treatment response in Alzheimer’s disease.
Alzheimer’s Research & Therapy 2010, 2:29
There is a great need for quick tests that identify treatment response in Alzheimer’s disease (AD) to determine who benefits from the treatment. In this study, A Quick Test of cognitive speed (AQT) was compared with the mini-mental state examination (MMSE) in the evaluation of treatment outcome in AD.
75 patients with mild to moderate AD at a memory clinic were assessed with AQT and the MMSE at a pretreatment visit, at baseline and after 8 weeks of treatment with cholinesterase inhibitors (ChEI) initiated at baseline. Changes in the mean test scores before and after treatment were compared, as well as the number of treatment responders detected by each test, according to a reliable change index (RCI).
After 8 weeks of treatment, the AQT improvement, expressed as a percentage, was significantly greater than that of the MMSE (P = 0.026). According to the RCI, the cut-offs to define a responder were ≥16 seconds improvement on AQT and ≥3 points on the MMSE after 8 weeks. With these cut-offs, both tests falsely classified ≤5% as responders during the pretreatment period. After 8 weeks of treatment, AQT detected significantly more responders than the MMSE (34% compared with 17%; P = 0.024). After 6 months of treatment, the 8-week AQT responders still showed a significantly better treatment response than the AQT nonresponders (22.3 seconds in mean difference; P < 0.001).
AQT detects twice as many treatment responders as the MMSE. It seems that AQT can, already after 8 weeks, identify the AD patients who will continue to benefit from ChEI treatment.
Esterman, M., Chui, Y., Tamber-Rosenau, B.J., & Yantis, S. (2009).
Decoding cognitive control in human parietal cortex.
Proceedings of the National Academy of Science, 106, 17974-17979.
Efficient execution of perceptual-motor tasks requires rapid voluntary reconfiguration of cognitive task sets as circumstances unfold. Such acts of cognitive control, which are thought to rely on a network of cortical regions in prefrontal and posterior parietal cortex, include voluntary shifts of attention among perceptual inputs or among memory representations, or switches between categorization or stimulus-response mapping rules. A critical unanswered question is whether task set shifts in these different domains are controlled by a common, domain-independent mechanism or by separate, domain-specific mechanisms. Recent studies have implicated a common region of medial superior parietal lobule (mSPL) as a domain-independent source of cognitive control during shifts between perceptual, mnemonic, and rule representations. Here, we use fMRI and event-related multivoxel pattern classification to show that spatial patterns of brain activity within mSPL reliably express which of several domains of cognitive control is at play on a moment-bymoment basis. Critically, these spatiotemporal brain patterns are stable over time within subjects tested several months apart and across a variety of tasks, including shifting visuospatial attention, switching categorization rules, and shifting attention in working memory.
Wiig, E.H., P. Annas, H. Basun, N. Andreasen, L. Lannfelt, H. Zetterberg, K. Blennow. L. Minthon (2009).
The stability of AQT processing speed, ADAS‐Cog and MMSE during acetylcholinesterase inhibitor treatment in Alzheimer’s disease.
Acta Neurologica Scandinavica 09/2009; 121(3):186-93.
To explore the longitudinal stability of measures of cognition during treatment with acetylcholinesterase inhibitors (AchEI) in patients with Alzheimer’s disease (AD).
Cognitive status was measured in a cohort of 60 patients at 6 months after initiation of treatment with AchEI (baseline) and after an additional 6 months of treatment (endpoint). A Quick Test of Cognitive Speed (AQT), Alzheimer’s Disease Assessment Scale-Cognitive Subscale (ADAS-Cog), and MMSE were administered concurrently.
Correlations (rho) between age and AQT processing speed were non-significant, but were significant for ADAS-Cog and Mini Mental State Examination (MMSE). AQT and ADAS-Cog means did not differ significantly between baseline and endpoint. There was a small, significant reduction in MMSE point scores. Measures of stability (Spearman’s rho) were moderate-to-high for all tests. Means for subgroups did not differ as a function of medication type.
AQT processing speed, ADAS-Cog, and MMSE measures proved stable during the second 6 months of treatment with AChEI.
Wiig, Elisabeth H., Niels P. Nielsen, Lennart Minthon, James Jacobson (2008).
AQT: Efficacy of a new paradigm for cognitive screening.
Alzheimer’s and Dementia 07/2008; 4(4).
Background: A Quick Test of Cognitive Speed (AQT) (Wiig, Nielsen, Minthon & Warkentin, 2002, 2003) is a processing-speed test for measuring performance of cognitive functions. Unlike current test paradigms, which rely on determining verbal memory for cognitive content, AQT uses time required for identification and recall as performance measures. Subjects name highly familiar colors and forms to measure perceptual speed (reaction and response time) and color-form combinations to measure cognitive speed (cognitive overhead—attention, visual working memory, set-shifting). Methods: Research supports the viability of this paradigm for cognitive screening and longitudinal monitoring. This assertion is supported by statistical characteristics, neuroimaging and clinical research. Results: Among AQT’s statistical characteristics are high test-retest reliability (low to mid 90% range), minimal age effects (about 1 sec. per decade), and absence of gender and age effects above Grade 8 (i.e., literacy) (Jacobson, Nielsen, Minthon et al., 2004; Nielsen & Wiig, 2006; Wiig, Nielsen & Jacobson, 2007). Sensitivity and specificity measures are high (upper 90%), and reduction of AQT cognitive speed can be observed earlier in the disease process than with tests of functional abilities (Nielsen, Wiig, Warkentin & Minthon, 2004; Warkentin, Tsantali, Kiosseoglou et al., 2005; Ross-Swain & Wiig, 2008). AQT facilitates differentiation of Alzheimer’s disease and dementia with Lewy bodies (Anderson, Wiig, Londos & Minthon, 2007). AQT color-form measures correlate with ADAS-Cog measures, are highly stable longitudinally and relate to β-amyloid levels (Wiig, Annas, Basun et al., in process). Regional cortical blood-flow (rCBF) patterns during AQT color-form naming indicate that normal performance is mediated by activation of temporal-parietal areas bilaterally with concurrent suppression in frontal regions (Wiig et al., 2002). In slight-to-moderate AD, rCBF patterns during color-form naming indicate suppressed blood flow to temporal-parietal regions. Behavioral observations indicate progressive increases in pauses, but not in articulation time (Warkentin, Erikson & Janciauskiene, 2007). Conclusions: AQT provides a valid paradigm for first-line cognitive screening and longitudinal monitoring of medication or cognitive training. Preliminary evidence suggests that this test of processing speed shows potential for incorporation in differential diagnostic assessments of dementia. AQT’s cost- and time-effectiveness, objectivity, reliability and sensitivity are among potential public benefits.
Ross-Swain, Deborah, Elisabeth H Wiig (2008).
Reductions in ‘Ross Information Processing Test-Geriatric’ information processing and ‘A Quick Test of Cognitive Speed’ processing speed in Alzheimer’s disease: Which lead and which follow?
International Journal of Rehabilitation Research 04/2008; 31(1):81-4.
Our objective was to obtain preliminary evidence for an order of emergence of measurable reductions in cognitive-linguistic abilities and processing/naming speed.
A total of 22 patients with mild-to-moderate Alzheimer’s disease (AD) or mild cognitive impairment and 22 age- and sex-matched controls participated. Ross Information Processing Test-Geriatric (RIPA-G) evaluated functional information processing and A Quick Test of Cognitive Speed (AQT) measured naming speed (s) for familiar single-dimension (e.g. colors, forms) and dual-dimension (e.g. color-form combinations) visual stimuli.
Patient age was not a significant factor. Means for RIPA-G information processing were in the normal range. AQT means for most perceptualspeed (e.g. form naming) and all cognitive-speed measures (e.g. color-form naming) were in the atypical/ pathological range. Correlations between information processing and processing speed were moderate, negative and mostly nonsignificant. RIPA-G memory and organization identified that about a third of patients performed below the normal range. AQT dual-dimension naming identified that all 19 patients with mild-tomoderate AD performed in the atypical range (i.e. slower than +2 SD of the mean).
The findings provide preliminary evidence that reductions in perceptual and cognitive speed precede reductions in cognitivelinguistic abilities and functional information processing in mild-to-moderate AD. AQT can assess short-term changes in cognitive functioning and monitor intervention. RIPA-G can provide broad-based functional measures at baseline and over the longer term. The combined use of AQT and RIPA-G can provide health professionals with broadly based clinical information, relevant for making team-based rehabilitation, living and other decisions for patients with AD.
Wiig, E.H., Nielsen, N.P., Minthon, L., & Jacobson, J.A. (2008).
AQT screening for cognitive speed impairments is a viable paradigm.
Poster presentation. International Conference on Alzheimer’s Disease, Chicago, ILL.
Associations between A Quick Test of Cognitive Speed (AQT) perceptual and cognitive speed and neuropsychological tests, including the Wechsler Adult Intelligence Scale-Third Edition (WAIS-III),
Mini Mental State Examination (MMSE), and the Trail Making Test (TMT), were evaluated in 41 neuropsychiatric patients. Neuropsychological and neurological tests, including CT scan, were administered to all of the patients. AQT was also administered to 75 controls.
All AQT means differed significantly for patients and controls. Dual-dimension naming time means in the patient group were in the atypical range and indicated generally reduced cognitive speed, whereas controls performed in the normal range. In the patient group, WAIS-III verbal, performance, and full-scale IQ means were in the normal range. AQT perceptual and cognitive speed correlated negatively with WAIS-III P IQ and MMSE scores, and the relationships were nonlinear.
The findings support that AQT dual-dimension naming evaluates cognitive speed (i.e., attention, set shifting, working memory) and can be used for first-line or complementary screening for mild or progressive cognitive impairments.
Maria Andersson · Elisabeth H Wiig · Lennart Minthon · Elisabet Londos (2007).
A Quick Test for Cognitive Speed: A Measure of Cognitive Speed in Dementia With Lewy Bodies.
American Journal of Alzheimer s Disease and Other Dementias 09/2007; 22(4):313-8.
The purpose of this article is to investigate how patients with dementia with Lewy bodies (DLB) perform on A Quick Test for Cognitive Speed (AQT) compared with patients with Alzheimer’s disease (AD) and age- and sex-matched controls and to see whether this test might be helpful in distinguishing DLB from AD at comparable cognitive levels.
Twenty-three patients with DLB, 18 patients with AD, and 24 controls were included. The time in seconds to complete the AQT was recorded for the 3 independent study groups according to standard directives.
The DLB patients had significantly longer reading times than the AD patients at equivalent and relatively high Mini-Mental State Examination levels. We suggest that slow performance on the AQT at relatively high Mini-Mental State Examination levels could be one way of distinguishing DLB from AD. This may have clinical implications for treatment as well as for understanding the neuropathological properties of the disease.
Niels Peter Nielsen · Roland Ringström · Elisabeth H Wiig · Lennart Minthon.
Associations between AQT Processing Speed and Neuropsychological Tests in Neuropsychiatric Patients.
American Journal of Alzheimer s Disease and Other Dementias 07/2007; 22(3):202-10.
Associations between A Quick Test of Cognitive Speed (AQT) perceptual and cognitive speed and neuropsychological tests, including the Wechsler Adult Intelligence Scale-Third Edition (WAIS-III), Mini Mental State Examination (MMSE), and the Trail Making Test (TMT), were evaluated in 41 neuropsychiatric patients. Neuropsychological and neurological tests, including CT scan, were administered to all of the patients. AQT was also administered to 75 controls. All AQT means differed significantly for patients and controls. Dual-dimension naming time means in the patient group were in the atypical range and indicated generally reduced cognitive speed, whereas controls performed in the normal range. In the patient group, WAIS-III verbal, performance, and full-scale IQ means were in the normal range. AQT perceptual and cognitive speed correlated negatively with WAIS-III P IQ and MMSE scores, and the relationships were nonlinear. The findings support that AQT dual-dimension naming evaluates cognitive speed (i.e., attention, set shifting, working memory) and can be used for first-line or complementary screening for mild or progressive cognitive impairments.
Wiig, E.H., Nielsen, N.P., & Jacobson, J.A. (2007).
A quick test of cognitive speed: group patterns of aging from 15 to 85.
Perceptual and Motor Skill, 104, 1067-1075.
A Quick Test of Cognitive Speed color, form, and color-form naming were administered to 300 normal participants (ages 15-95 years) to explore the effects of age on perceptual (single-dimension naming) and cognitive speed (dual-dimension naming).
Naming time means (sec.) were consistent with previous findings. Correlations between age and naming time were low, but significant. Linear regression with age as a factor indicated time increases of 1 sec. per decade for colors and color-form combination naming and of 6 sec. per decade for form naming. Participants were divided into age cohorts, each covering a decade, and naming times were transformed to normalized z scores. The normalized means were similar for color, form, and color-form naming and increased by about 1 SD between ages 15-25 and 75-85 years. The ranges were similar across cohorts, about 2 SD.
The findings concur with age patterns for visual-pattern comparison speed, fluid intelligence, and working memory reported by Salthouse in 2004.
Nielsen, N.P., & Wiig, E.H. (2006).
Alzheimer’s quick test screening criteria for West African speakers of Krio.
Age & Ageing, 35, 503-507.
To obtain normative data for Alzheimer’s Quick Test (AQT) measures of perceptual and cognitive speed from West African speakers of Krio.
Normal adults, who were functionally independent, from Sierra Leone (n = 164) aged 25-79 years. Perceptual and cognitive speed were measured with AQT single- and dual-dimension colour-number (C-N) and colour-animal (C-A) naming tasks. Tests were administered individually in the participants’ communities. Men and women performed similarly (P>0.05), whereas literate speakers used significantly less time than preliterate peers (P<0.01). Correlations between age and colour naming were low (P<0.01) and speed decreased by +2 SD) performance. AQT C-N and C-A naming are time efficient (3-5 min each), objective and reliable and can be administered in Krio to West African adults in Africa, Europe or North America to screen for cognitive impairments and facilitate referral for medical workup.
Warkentin, S., Tsantali, E., Kiosseoglou, G., Minthon, L., Wiig, E.H., Nielsen, N.P., Londos, E., Tsolaki, M. (2005).
The AQT © as a useful short screening test for dementia. Evidence from two European cultures.
Alzheimer’s and Dementia 07/2005; 1(1).
Background: Alzheimer′s disease (AD) is the most common cause of dementia in the growing elderly po-pulation in many countries. The quests for symptomatic relief and prospects of pharmacological treat-ments of AD, call for sensitive and reliable screening tests which can be easily used by general practitio-nares in different countries and cultural settings. General criteria for such screening tests should include easy administration and unequivocal scoring, and independence of factors known to be related to cultural settings and educational level. The AQT is a novel screening test designed to assess cognitive proces-sing speed.
Three sets of universal stimuli are presented to patients in a fixed protocol. The administration takes 3 – 5 minutes and the clinical outcome measure is the time (seconds) it takes to perform the test. The AQT is standardised and validated in the USA and in Sweden. It is used by general practitionares and hospital staff throughout Sweden as a supplementary test to the MMSE in the assessment of dementia.
Objective(s): We performed a collaborative research study between two European countries, Sweden and Greece, in order to establish the validity and reliability of the AQT, and to further evaluate whether test results meet the criteria of being independent of language and educational level.
Methods: The Swe-dish participants were 97 patients with AD, and 59 healthy subjects, while the Greek participants were 75 patients with AD, and 29 healthy subjects, respectively. All patients met the NINCDS-ADRDA and the DSM-IV criteria for dementia. The patients educational level ranged from 2 to 17 years, MMSE: mean 22.6. The AQT and the MMSE were assessed in all subjects by experienced psychiatrists and neuropsy-chologists in routine clinical settings in both countries. The discriminatory values of the AQT and the MMSE for the two countries is presented in the Table.
Conclusions: The results demonstrate that cogniti-ve processing speed is a general and very sensitive measure which clearly separates mild dementia from normal aging. The usefulness of the AQT in dementia assessment is suggested by the striking similarity of findings in different cultural settings.
Sensitivity, specificity, predictive values (%)
AQT Sweden: — 93.1 — 99.9 — 99.9
AQT Greece: — 98.7 — 96.6 — 98.7
MMSE Sweden: — 88.7 — 95.5 — 97.2
MMSE Greece: — 93.3 — 69.0 — 88.6
Langdon, H.W., Wiig, E.H., Nielsen, N.P. (2005).
Dual-Dimension Naming Speed and Language-Dominance Ratings by Bilingual Hispanic Adults.
Bilingual Research Journal 07/2005; 29(2):319-336.
This study compared the efficacy of measures of naming speed, verbal fluency and self-ratings for establishing language dominance in 25 bilingual English–Spanish adults with college degrees.
Naming speed was measured by total naming times (in seconds) for five Alzheimer’s Quick Test tasks (Wiig, Nielsen, Minthon & Warkentin, 2002) and verbal fluency with the Word Listing by Domain (Lambert, Havelka, & Crosby, 1958; Fishman & Cooper, 1969). Self-ratings of English–Spanish competence (listening, speaking, reading, and writing) and frequency of use of each spoken language served as standards for comparisons.
For the aggregate sample, color–form, color–animal, and color–object naming times were significantly shorter for English than Spanish (p < .01). There was 100% agreement in language-dominance judgments between self-ratings of language competence and frequency of use, and color–form, color–animal, and color–object naming-time differences in the two languages. Word Listing by Domain quotients for language dominance showed a lower degree of agreement (52%) with self-ratings and naming-time differences.
The findings suggest that cross-linguistic comparisons of naming times for color–form, color–animal, and color– object naming may be helpful in screening adults for language dominance for psychoeducational assessment purpos.
Nielsen, N.P., Wiig, E.H., Warkentin, S., Minthon, L. (2005).
Clinical utility of color-form naming in Alzheimer’s disease: preliminary evidence.
Perceptual and Motor Skills 01/2005; 99(3 Pt 2):1201-4.
Performances on Alzheimer’s Quick Test color-form naming and Mini-Mental State Examination were compared for 38 adults with Alzheimer’s disease and 38 age- and sex-matched normal controls. Group means differed significantly and indicated longer naming times by adults with Alzheimer’s disease. The specificity for AQT color-form naming was 97% and sensitivity 97%, i.e., 3% false negatives. The specificity for Mini-Mental State Examination was 100% and sensitivity 84%, i.e., 16% false negatives. These findings, while supporting AQT color-form naming as a screening test for reductions in cognitive speed associated with Alzheimer’s disease, are preliminary given the relatively small sample.
Jacobson, J., Nielsen, N.P., Minthon, L., Warkentin, S., & Wiig E.H. (2004).
Multiple rapid naming measures of cognition: Normal performance and effects of aging.
Perceptual & Motor Skills, 98,739-753.
Rapid automatic naming tasks are clinical tools for probing brain functions that underlie normal cognition.
To compare performance for various stimuli in normal subjects and assess the effect of aging, we administered six single-dimension stimuli (color, form, number, letter, animal, and object) and five dual-dimension stimuli (color-form, color-number, color-letter, color-animal, and color-object) to 144 normal volunteers who ranged in age from 15 to 85 years.
Rapid automatic naming times for letters and numbers were significantly less than for forms, animals, and objects. Rapid automatic naming times for color-number and color-letter stimuli were significantly less than for color-form, color-animal, or color-object stimuli. Age correlated significantly with rapid automatic naming time for each single-dimension stimulus and for color-form, color-number, coloranimal, and color-object stimuli. Linear regression showed that rapid automatic naming times increased with age for aggregated color stimuli, aggregated single-dimension stimuli, and aggregated dual-dimension stimuli. This age effect persisted in subgroups less than 60 years of age and greater than 60 years of age.
We conclude that normal performance time is dependent on the task, with letter and number stimuli eliciting most rapid responses, and that most rapid automatic naming times increase with age.
Wiig, E. H., Nielsen, N. P., Minthon, L., McPeek, D., Said, K., & Warkentin, S. (2002).
Parietal lobe activation in rapid, automatized naming by adults.
Perceptual & Motor Skills, 94, 1230-1244.
Three automatic naming tasks (Wiig & Nielsen, 1999) were administered to 60 normally functioning adults. The mean time required for naming 40 single-dimension (colors, forms, numbers, and letters) and 40 dualdimension stimuli (color-form, color-number, and color-letter combinations) were compared in young (17-38 yr.) and older (40-68 yr.) men and women. Analysis of variance for the combined groups indicated significant naming-time differences for age but not for sex. There were no significant interaction effects. For men there was a significant naming time difference between age groups for forms, and for women for colors and forms. The sex-specific analyses indicated no significant differences in naming time based on age groups for colorform, color-number, or color-letter combinations. In a second study of adult subjects (n = 14), functional brain activity was measured with regional cerebral blood flow during the performance of the color, form, and colorform naming tasks. One subject was repeatedly measured during the performance of each task, whereas 13 subjects were measured during the performance of color-form naming. In comparison to normal reference values for rest and FAS verbal fluency, blood-flow measurements showed a consistent parietal-lobe activation during form and color-form naming, but only a slight activation during color naming. During all naming tasks, a significant frontal and frontotemporal flow decrease was seen in comparison to both rest and verbal fluency reference values. This functional brain activation pattern of a parietal increase and a frontotemporal decrease was consistently confirmed across subjects during the color-form naming task.
Wiig, E.H., Langdon, H.W., Flores, N. (2001).
Nominación rápida y automática en niños hispanohablantes bilingües y monolingües.
Revista de Logopedia, Foniatria y Audiologia 01/2001; 21(3):106–117.
The Rapid,Automatic Naming subtest of CElf-3 Spanish (Semel,Wiig, & Secord), (1997) was administered to (a) 1,050 bilingual students living in the United States, (b) 315 monolingual, Spanish-speaking students living outside of the United States (the international sample) with normal language development (non-LD) (ages 6 to 21 yrs.), and (c) 86 bilingual Spanish-speaking U.S. students with primary language disorders (LD) (ages 6, 9, and 12 yrs.). Color-form naming time decreased monotonically between ages 6 and 17 in the international (117.32 to 44.40 sec.) and normative U.S. samples (141.09 to 52.06 sec.). The trajectory for naming time in the LD group was elevated and parallel to the times obtained for normally developing students in the U.S. Naming time (sec.) and naming accuracy (number of errors) differed significantly in the three groups. In bilingual, age-matched non-LD and LD groups (n ??78) naming accuracy (errors) differed significantly, while naming speed (time) did not. The developmental trajectories for naming speed in the Spanish-speaking, non-LD groups were similar to that reported for English-speaking children slowere naming speed (longer time) differenciated students with language disorders from their age-matched controls while naming errors did not. This suggests a difference in the manifestation of rapid, automatic-naming deficits in monolingual English-speaking and bilingual Spanish-speaking students with language disorders.
Wiig, E. H., Zureich, P., & Chan, H. H. (2000).
A clinical rationale for assessing rapid naming abilities in children with language disorders.
Journal of Learning Disabilities, 33, 359-374.
Three continuous rapid naming tasks (Semel, Wiig, & Secord, 1995) were administered to 2,450 American, English-speaking, academically achieving individuals with typical language development and intellectual ability (ages 6 to 21 years) and 136 individuals with primary language disorders (LD; ages 6, 7, 9, 11, 12, 15-16).
Naming time in seconds differed significantly (p < .01) between the groups for color naming (Task 1) at age 12, shape naming (Task 2) at age 6, and color-shape naming (Task 3) at ages 6, 7, 9, and 12. Naming accuracy did not differ significantly (p > .01) between groups at the majority of the age levels compared. In the normative group, naming speed increased with age in a monotonic progression. The developmental trajectory in the LD group was essentially parallel, but elevated. The percentages of individuals who failed the naming-time criteria for Task 3 (color-shape naming) differed significantly in the two groups at all ages compared (p < .05).
These findings indicate that the requirements for two-dimensional, continuous naming (Task 3 color-shape naming) resulted in reduced naming speed (longer total times) and interference with fluency in language production in about half of the clinical sample.