Boston Naming Test: Lose the Noose

OBJECTIVE

Administering the noose item of the Boston Naming Test (BNT) has been questioned given the cultural, historical, and emotional salience of the noose in American culture. In response, some have modified the BNT by skipping/removing this item and giving the point as if the examinee responded correctly. It is unknown, however, whether modifying standardized administration and scoring in this manner affects clinical interpretation. In the present study, we examined the prevalence of noose item failure, whether demographic and clinical characteristics differed between those who responded correctly versus failed the item, and whether giving a point to those who failed affected clinical interpretation.

METHOD

Participants included a mixed clinical sample of 762 adults, ages 18-88 years, seen for neuropsychological evaluation at one of five sites within the USA.

RESULTS

Those who failed the item (13.78%) were more likely to be female, non-White, and have primary diagnoses of major neurocognitive disorder, epilepsy, or neurodevelopmental disorder. Noose item failure was associated with lower BNT total score, fewer years of education and lower intellectual functioning, expressive vocabulary, and single word reading. Giving a point to those who failed the item resulted in descriptor category change for 17.1%, primarily for patients with poor overall BNT performance.

CONCLUSIONS

Only a small percentage of patients fail the noose item, but adding a point for these has an impact on score interpretation. Factors associated with poorer overall performance on the BNT, rather than specific difficulty with the noose item, likely account for the findings.

Comparing Boston naming test short forms in a rehabilitation sample

The Boston Naming Test (BNT) has multiple short forms that do not include the noose item that have been primarily examined in dementia populations. This study compared BNT short forms with standard administration (BNT-S) in physical medicine and rehabilitation patients who underwent outpatient evaluation. The sample (N = 480) was 34% female and 91% white with average age of 46 years (SD = 15) and average education of 14 years (SD = 3). Five 15-item short forms were calculated: Consortium to Establish a Registry for Alzheimer's disease (CERAD-15); Lansing; and Mack 1, 2, and 4 (Mack-15.1, -15.2). Three 30-item short forms were calculated: Mack A, Saxon A, and BNT odd items. BNT-S and short forms were compared with Spearman correlations. Cronbach's alpha was calculated for all BNT forms. Impaired BNT scores were determined with norm-referenced scores (T < 36 and T < 40). Area under the curve (AUC) values were compared across short forms with impaired BNT as criterion. BNT-S showed strong correlations with 30-item (rho = 0.92-0.93) and 15-item short forms (rho = 0.80-0.87) except for CERAD-15 (rho = 0.69). Internal consistency was acceptable for all short forms (alpha = 0.72-0.86). BNT-S was impaired in 17% and 33% of participants at 35 T and 39 T cutoffs, respectively. BNT short forms showed excellent to outstanding classification accuracy predicting impairment using both cutoffs. BNT short forms warrant further study in rehabilitation settings.