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This may be the case in other cultures as well. A study conducted by Agranovich and Puente suggested that American adults performed better than Russian adults on the CCT and other timed tests due to the familiarity of the American participants with timed testing procedures. In fact, most of the children who participated in this study have not been exposed to testing.

Although previous research has suggested a small effect of gender on CCTT performance Llorente et al. This is in contrast with findings reported by Llorente and colleagues , who found that girls complete the CCTT1 more quickly than boys, and also in contrast with those of Williams and colleagues , who found that girls were faster than boys in completing the CCTT2.

However, our results are in agreement with those of Mok and colleagues , who found that the CCTT is not influenced by gender. Finally, it is important to consider that in some variables the magnitude of the differences between the two groups is double. Furthermore, differences between groups should consider standard deviations. For example, if the standard deviation of the Moroccans group in the CCTT1 is used, 9year-old Moroccans children scored 1. At the same time, when using the standard deviation of American children, the Moroccan group scored 3.

We hypothesize that cultural differences may be more robust in children than in adults. This effect can also be seen in the present results. Differences in 11 years old Moroccan and American children are lower than those in 9-year-old groups. The present study does have several limitations. First, the sample was collected only from the city of Chefchaouen, which is located in northern of Morocco and is generally considered a rural area.

The generalizability of these findings to urban children or those living in other areas of the Arab world is not known. Secondly, variables such a socio-economic status and IQ that could conceivably affect CCTT performance were not measured or controlled for in the present study.

Finally, this study was conducted among healthy children and does not include a clinical sample. Nevertheless, this study is the first of its kind to provide data regarding CCTT performance in Moroccan-Arab children. Our results do suggest that cultural factors have an effect on CCTT performance, thus highlighting the need for further development of the CCTT before it is be considered to be truly the culture-free test. These findings also emphasize the need to consider culture-specific tests in clinical neuropsychology.

Finally, this study further supports the need to consider culture as important as other demographic variables, such as age and education, in neuropsychological assessment. Oxford University Press is a department of the University of Oxford.

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It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide. Sign In or Create an Account. Sign In. Advanced Search. Article Navigation. Close mobile search navigation Article Navigation. Volume Article Contents. Conflict of Interest. Is the Color Trails Culture Free? Oxford Academic. Google Scholar. Antonio E. Francisco Cruz-Quintana. Isabel Peralta-Ramirez. Cite Citation. Permissions Icon Permissions.

Abstract Increasingly clinical neuropsychology has been addressing the effects of culture on neuropsychological functioning. Arab Children , Culture , Neuropsychology , Non-verbal test. Open in new tab. The culture of time in neuropsychological assessment: Exploring the effects of culture-specific time attitudes on timed test performance in Russian and American samples. Search ADS. Do Russian and American normal adults perform similarly on neuropsychological tests? Preliminary findings on the relationship between culture and test performance.

Age-related cognitive decline during normal aging: The complex effect of education.

Google Preview. Equivalence of the color trails test and trail making test in nonnative English-speakers. Cross-cultural neuropsychological assessment: A comparison of randomly selected, demographically matched cohorts of English and Spanish-speaking older adults. Preliminary Arabic normative data of neuropsychological tests: The verbal and design fluency.

The impact of language on the equivalence of trail making tests: Findings from three pediatric cohorts with different language dominance.

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Culture or education? Neuropsychological test performance of a Maya indigenous population. The trail making test: Performance in a non-clinical sample of children aged 10 to 15 years. The impact of culture and education on non-verbal neuropsychological measurements: A critical review.

Development of neuropsychological functions of attention in two cultures: A cross-cultural study of attentional performances of Syrian and German children of pre-school and school age. Development and initial validation of an Arabic version of the Expanded Trail Making Test: Implications for cross-cultural assessment. A compendium of neuropsychological tests: Administration, norms, and commentary. Published by Oxford University Press. All rights reserved.

Neuropsychology and Cognition - Volume I / Volume II

The original instructions are as follows: A pilot study was carried out for the application of the translated VF instructions in an elderly group of mixed educational level. The aim of this pilot study was to define a Brazilian Portuguese version with easily understandable instructions for all educational levels from illiterate to higher education.

The investigators administered the direct translation of the instruction to a group of participants. Many participants had difficulty understanding the passages "I don't want you to use the same word with different endings" as well as "give me single words This difficulty probably occurred because most participants had a lower educational level, leading to greater difficulty in understanding the linguistic aspects of words.

Based on these results, we devised a simplified version containing the essential instructions to execute the task. In an application of this adapted version, the participants showed satisfactory comprehension of the task. The final Brazilian Portuguese instructions were as follows: The English translation of the Brazilian Portuguese instructions is: Participants. The inclusion criteria were: Brazilian Portuguese as the first language, at least 60 years of age, and no cognitive complaints. Participants were randomly subdivided into experimental EG and control CG groups.

The EG comprised 32 participants who were administered the semantic 21,22 and phonemic fluency FAS 23 tasks before administration of the VF task. Thirty participants comprised the CG to whom the VF task was administered alone. Educational level, age, gender and handedness were matched between groups to ensure group homogeneity.

Demographic data were similar between groups Table 1. The final score on each verbal fluency task was the total number of correct items produced during one minute. Perseverations repetition or inflection of a previously generated response, including the participant's self-generated word as the example or the example used in the instructions and intrusions words from other grammatical classes or neologisms were scored separately to verify the errors produced by the participants. Data analyses. The continuous variables were expressed as mean, standard deviation, range, and median while categorical variables were expressed as absolute and relative frequencies.

The one-sample Shapiro-Wilk test was conducted to evaluate normality. The t- test was performed for the continuous variables with normal distribution, and Mann-Whitney or Kruskal-Wallis test for the continuous variables without normal distribution. The categorical variables were analyzed using the Chi-square association test. Education, age, and type of errors were evaluated with correlational analyses Spearman's correlation.

Subsequently, education was classified into subgroups low, medium and high. A critical alpha of. Since the previous application of the verbal fluency tasks did not affect the VF, we used data from the total sample for subsequent analyses. The distribution of VF total correct score, intrusions and perseverations are given in Table 3.

The analysis of f semantic and phonemic verbal fluency performance was not the aim of the study, therefore the reverse order verbal fluency after VF was not investigated. The VF scores were similar in both groups, demonstrating no effect of the application of verbal fluency tasks prior to the VF task. Verbal fluency tasks demand a fast search of words in the lexical-semantic storage. In addition, other cognitive processes are also important, such as working memory and executive functions.

Verbs are more complex than nouns because they have more inflexions, more syntactic relationships with other words in the sentence, are acquired later in the process of language acquisition, have a less hierarchic semantic network, a greater number of high frequency words and are associated with longer reaction times in naming than nouns. Verbs are a grammatical class of words referring to concepts of actions and have a syntactic relationship with nouns.

In the event of administration of semantic and phonemic verbal fluency tasks prior to the VF task, the activation caused by nouns from semantic and phonemic fluency tasks in the semantic or lexical networks might propagate and activate syntactic networks or concepts of actions possibly associated with the nouns from the previous fluency tasks. The prior application of verbal fluency tasks may therefore facilitate retrieval of a higher number of verbs in the last task as an effect of practice or priming, consistent with the concept of the semantic network theory 26, On the other hand, the presentation of the verbal fluency tasks before the VF task might hamper performance on the latter task as a consequence of fatigue.

However, no effect of the prior administration of the verbal fluency task on the VF task was found in this investigation. We observed significant correlation of education with VF total scores, as well as a significant difference between high and low education subgroups.


The median observed was 7. Participants with high educational level produced a greater number of verbs on this task. The effect of education on the VF task has been demonstrated in elderly populations. However, these populations typically had a higher educational level than that of the present sample. Education as an indicator of cognitive reserve has been investigated in different clinical conditions and in normal aging, showing a protective effect.

We also observed a significant negative correlation of intrusions with VF total scores. The more verbs generated, the fewer intrusions registered, i. We assume that intrusions may reflect difficulty in understanding the instructions of the task or difficulty accessing the grammatical class required.

Language and the brain: Aphasia and split-brain patients - MCAT - Khan Academy

Higher intrusions may be a sign of disruption of VF processing due to the aging process. However, this relationship needs to be better investigated by studying VF errors in different clinical conditions. On the other hand, perseverations can represent memory difficulty or attempts to fill time when new words do not come to mind.

However, we found no correlation of perseveration with VF performance in this sample of healthy elderly. The present investigation showed the lack of influence of other verbal fluency tasks on the performance of the VF task in elderly individuals, which allows the use of this order of administration in clinical and research settings. A strong influence of educational level on VF task performance was also observed, reinforcing the need for further studies in different populations.

The cultural and demographic profile of North American or European populations is very different from those observed in developing countries such as Brazil. To our knowledge, apart from some studies in Brazilian patients with clinical conditions, 24, this is the first study focusing on the application of the VF task in a healthy elderly Brazilian population.

Future studies should explore VF performance in younger population and other neurological disorders.

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Author contributions. Pekkala S. Verbal Fluency Tasks and the Neuropsychology of Language. In: Miriam Faust Editor. The Handbook of the Neuropsychology of Language. Blackwell Publishing Ltd. Action verb fluency in schizophrenia: Getting a grip on odd speech. Schizophr Res ; Action versus animal naming fluency in subcortical dementia, frontal dementias, and Alzheimer's disease. Neurocase ; Action and noun fluency testing to distinguish between Alzheimer's disease and dementia with Lewy bodies.

J Clin Exp Neuropsychol ; Understanding verbal fluency in healthy aging, Alzheimer's disease, and Parkinson's disease.