72 Boston Naming Test Performance Improves with Increasing Age: What's Wrong with this Picture?

Abstract

Objective:

As word finding or "naming" impairment is a symptom of multiple neurological conditions, naming assessment is an integral component of most neuropsychological evaluations. For decades, the Boston Naming Test (BNT) has been, and remains, the most widely used measure of naming. Although it has been shown that naming is generally stable from young adulthood through middle age, we have observed, clinically, that young adults tend to have greater difficulty on the BNT than older adults. Considering that the BNT was developed more than 50 years ago, and that language and culture change over time, we hypothesized that 1) increasing age would be associated with stronger performance on the BNT, whereas 2) there would be no association between age and naming performance on more recently developed naming measures.

Participants and Methods:

Participants were healthy adults who served as normative subjects in the revision study of the Auditory (ANT) and Visual Naming (VNT) Tests. Due to known effects of education level on BNT performance, we excluded those with less than 16 years of education, targeting young adults through middle age, resulting in 118 adults, 20 through 50 years of age (mean age: 32.9 ± 9.2 years; mean education: 16.8 ± 1.2 years; mean FSIQ: 106.0 ± 12. 6). All participants were native English speakers or learned English by age 5 and were fully educated in English. Untimed accuracy (i.e., response within 20 seconds) is the standard performance measure for the BNT; the ANT and VNT additionally include tip-of-the-tongue (TOT) scores, which incorporate response time and reliance on phonemic cueing (TOT score = number of items named in > 2 seconds but < 20 seconds, plus items named correctly after 20 seconds, following a phonemic cue). Pearson correlations examined the relation between age and naming performance on the BNT, ANT and VNT.

Results:

Pearson correlations revealed a small but significant, positive correlation between age and BNT performance (r =.22, p = .017), yet no correlation between age and performance on the ANT (ANT Accuracy: r = .05, p=.60, ANT-TOT: r = -.14, p = .12) or VNT (VNT Accuracy: r = .04, p=.67, VNT-TOT; r = -.03, p = .72).

Conclusions:

In this sample of healthy adults, naming performance improved with increasing age on the BNT; however, while vocabulary knowledge may broaden, naming efficiency should not improve with age. By contrast, we found no relation between age and naming performance on the more recently developed ANT and VNT. Results underscore the need to revise test stimuli on verbal measures, particularly those that assess naming, and suggest caution in interpreting BNT performance in young adults, as poor BNT performance might not accurately represent their true naming ability.