How to Assess Executive Functions in a Low-Educated and Multicultural Population Using a Switching Verbal Fluency Test (the TFA-93) in Neurodegenerative Diseases?

Abstract

Few neuropsychological tests are available to assess executive dysfunction in low-educated and multicultural populations. To address this issue, the TFA-93, a switching verbal fluency test to assess cognitive flexibility, was administered to 70 healthy controls, 57 patients with a clinical diagnosis of Alzheimer’s disease, and 21 with a clinical diagnosis of a neurodegenerative disease associated with frontal disorders. Most of the participants were low-educated and nonnative French speakers. The TFA-93 comprises 2 categorical fluency tasks (animals and fruits) and a fluency task in which participants have to switch between animals and fruits. Correct responses and errors were collected, and a flexibility index expressed the switching cost. Results showed that correct responses were lower, and the switching cost was greater in both patient groups. In low-educated and multicultural populations, the TFA-93 seems to be a good alternative to assess flexibility compared to the standard neuropsychological tools based on academic abilities.

Epilepsy-associated neurocognitive disorders (EAND) in an onchocerciasis-endemic rural community in Cameroon: A population-based case–control study

“…The relatively low level of education in this sample may have contributed to the impairment of verbal fluency. This is important as subjects perform poorer on verbal fluency tests when they are conducted in a language different from their mother tongue [62]. Assessing the participants in the Sanaga language would have probably yielded more precise results.…”

Cross-cultural neuropsychological assessment in Europe: Position statement of the European Consortium on Cross-Cultural Neuropsychology (ECCroN)

“…Several of such widely-applicable instruments have already been developed over the years across Europe, such as the aforementioned European Cross-Cultural Neuropsychological Test Battery (CNTB, Nielsen et al, 2018), the Multicultural Cognitive Examination (MCE, Nielsen et al, 2019), the Cross-Cultural Dementia Screening (CCD, Goudsmit et al, 2017), the computerized EMBRACED battery (Ibanez-Casas et al, in press), the computerized Battery for Neuropsychological Evaluation of Children (BENCI, Fasfous et al, 2015), an innovative verbal fluency-switching task (TFA-93, Narme et al, 2019) and a number of culturally -or regionally -appropriate picture-based memory tests, such as the Recall of Pictures Test (RPT, Nielsen et al, 2012), modified Visual Association Test (mVAT, Franzen et al, 2019), TMA-93 (Maillet et al, 2017), and TNI-93 (Maillet et al, 2016). A normative data and validation study was carried out for European majority groups, Pakistani/Indian, Polish, Turkish, and to a lesser extent Moroccan and Former yugoslavian participants for CNTB (using multilingual research assistants or trained interpreters); for the CCD, the normative data and validation study was conducted among native Dutch, Moroccan-Arabic, Moroccan-Amazigh (Berber), Turkish, Surinamese-Creole, and Surinamese-Hindustani participants (assessed by bilingual, bicultural neuropsychologists); a general multicultural immigrant population as well as native French individuals were studied for the normative data and validity studies of the .…”

Cross-cultural neuropsychological assessment in the European Union: a Delphi expert study

“…2000a ; Rait et al. 2000b ) were used in the UK; the modified Visual Association Test ( Franzen et al., 2019 ), a literacy screener (unpublished), and the Stick Design Test ( Baiyewu et al., 2005 ) in the Netherlands; the computerized EMBRACED battery (unpublished) in Spain; the Cross-Linguistic Naming Test ( Ardila, 2007b ), the WHO/UCLA adaptation of the Rey Auditory Verbal Learning Test ( Maj et al., 1993 ), and the Multicultural Cognitive Examination ( Nielsen et al., 2019a ) in Denmark; and the TNI-93 ( Maillet et al., 2016 ), TMA-93 ( Maillet et al., 2017 ), TFA-93 ( Narme et al., 2019 ), and Montreal Cognitive Assessment ( Nasreddine et al., 2005 ) in France.…”