Test de acentuación de palabras, Burín, 2000

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Estimation of Premorbid Intelligence: The Word

Accentuation Test - Buenos Aires VersionDebora I. Burin , Ricardo E. Jorge , Raúl A. Arizaga & Jane S. PaulsenPublished online: 09 Aug 2010.

To cite this article: Debora I. Burin , Ricardo E. Jorge , Ral A. Arizaga & Jane S. Paulsen (2000) Estimation of Pre

Intelligence: The Word Accentuation Test - Buenos Aires Version, Journal of Clinical and Experimental Neuropsyc22:5, 677-685

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* We thank two anonymous reviewers for their helpful comments and suggestions on a previous draft of thispaper and Dr. Del Ser for early input in our project.Address correspondence to: D.I. Burin, Programa de Estudios Cognitivos, Instituto de Investigaciones, Facultadde Psicología – UBA, Independencia 3065 3º, Cap. Fed., Argentina. Fax: 54 1 957-5888. E-mail: [email protected] for Publication: April 14, 2000.

Journal of Clinical and Experimental Neuropsychology 1380-3395/00/2205-677$15.002000, Vol. 22, No. 5, pp. 677-685 © Swets & Zeitlinger

Estimation of Premorbid Intelligence:The Word Accentuation Test – Buenos Aires Version*

Debora I. Burin1

, Ricardo E. Jorge2

, Raúl A. Arizaga3

, and Jane S. Paulsen2, 4

1 Facultad de Psicología, Universidad de Buenos Aires, Argentina, The University of Iowa Hospitals & Clin-ics, 2Departments of Psychiatry and 4 Neurology, and 3 Instituto Nacional de Servicios Sociales para Jubilados

y Pensionados, Argentina

ABSTRACT

We have sought to adapt and validate a NART-like Spanish test, the Word Accentuation Test (WAT: DelSer, Montalvo, Espinosa, Villapalos, & Bermejo, 1997) to estimate acquired intelligence in local normalolder adults. The test requires examinees to read aloud infrequent, irregularly stressed Spanish words, asituation that presumably requires lexical knowledge. Results in a sample of 74 participants show that therevised WAT (i.e., the WAT for Buenos Aires) has good concurrent validity with the WAIS Vocabulary

subtest and number of years of formal education, as well as high internal consistency. Performance on thistest was dissociated from age, memory, or frontal/executive measures.

There are numerousclinical, research, and medi-

colegal situations where knowledge of an indi-

vidual’s previous level of intellectual function-

ing is important. Since data on premorbid testing

are rarely available, it becomes necessary to es-

timate an individual’s previous level of func-

tioning. There are at least four general methods

used to estimate premorbid IQ. Lezak (1983)

initially suggested that an individual’s best per-formance be used as the standard against which

all other aspects of the patient’s current perfor-

mance are compared. This ‘‘best performance’’

method has been criticized because of its failure

to consider normal variability among tests, and

often results in an overestimation of IQ (Mor-

tensen & Gade, 1993). As a consequence, an

individual’s deficits are overstated. A second

popular method of estimating previous ability is

to use WAIS-R subtests with demonstrated in-

sensitivity to brain damage (i.e., Vocabulary and

Information). Althoughis it wellestablished that

these subtests are among the most stable on the

WAIS-R, limitations of the estimates exist. For

instance, Vocabulary performance can be af-

fected by a number of clinical conditions and

Information performance is often associated

with educational level (Crawford, 1988; Lezak,

1995).The use of demographicmeasures to esti-

mate previous functioning has also been ac-

cepted by several neuropsychologists, with edu-cation, race, and occupation being powerful pre-

dictors. Although several regression equations

have been developed (Crawford & Allan, 1997;

Reynolds & Gutkin, 1979; Wilson et al., 1978),

the most popular has been that derived by

Barona, Reynolds, and Chastain (1984). Unfor-

tunately, these methods typically have a signifi-

cant amount of error variance associated with

the estimate (Perez, Schlottmann, Holloway, &

Ozolin, 1996). As a consequence, it has been

recommended that demographic indices be used

with caution and be avoided in persons with ex-


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678 DEBORA I. BURIN ET AL.

ceptional abilities, mental retardation, or learn-

ing disabilities (Sweet, Moberg, & Tovian,

1990).

Most recently, a great deal of attention has

been devoted to the use of reading tests for pre-

morbid functioning estimates (Blair & Spreen,

1989; Grober & Sliwinski, 1991; Johnstone,

Callahan, Kapila, & Bouman, 1996; Kareken,

Gur, & Saykin, 1995; Nelson, 1982; Nelson &

O’Connell, 1978). The best-known test for this

approach is the National Adult Reading Test

(NART: Nelson, 1982). It consists of 50 words

to be read aloud. Infrequent and irregular words

are included, so that correct pronunciation re-

flects previous knowledge of the words. Presum-

ably, higher verbal intelligence implies a

broader lexicon; and in fact this test, restan-

dardized and its revised version (NART-R:

Crawford, 1992; Nelson & Willison, 1991) showmedium to high correlations with the Full-Scale

IQ of the WAIS-R and higher correlations with

the Verbal subscale (Filley & Cullum, 1997;

Mockler, Riordan, & Sharma, 1996). In longitu-

dinal studies, the NART was not affected by age

(Korten et al., 1997), predicted Full-Scale IQ

that was obtained one year previously better

than re-test or the Barona (Raguet, Campbell,

Berry, & Schmitt, 1996), and also predicted

Verbal IQ accurately in a 5-year longitudinal

study (Carswell, Graves, Snow, & Tierney,

1997). Although the NART does show the ef-fects of dementia, the decrement is minimal in

contrast to other estimates of premorbid intellect

and does not impact estimations made in the

early stages of disease (Crawford, Parker, &

Besson, 1988; Fromm, Holland, Nebes, &

Oakley, 1991; Maddrey, Cullum, Weiner, &

Filley, 1996; Paque & Warrington, 1995 ; Sharpe

& O’Carroll, 1991).

Despiteits popularity and widespread use, the

NART is not readily adapted to other languages

and cultures. Indeed, there currently exist at

least four separate versions for use in various

countries and cultures (Blair & Spreen, 1989;

Del Ser et al., 1997; Grober & Sliwinski, 1991;

Nelson, 1982). The NART relies on the assump-

tion that correct pronunciation of irregular

words depends on previous encounters with that

word. Spanish, however, is considered to be a

‘‘shallow’’ or ‘‘transparent’’ language because

the correspondence between graphemes and

phonemes is very consistent, although not iso-

morphic as in Serbo-Croatian (Carreiras et al.,

1996; Signorini, 1997). Variations of grapheme-

phoneme transcription are very few and also

subjected to rules. Written words, known or not

known to the reader, and even pseudowords, can

be read aloud by directly generating the sounds

from letters – even by children who have only

recently begun reading (Signorini, 1997). Defi-

cits in phonological awareness are a key factor

in reading disabilities (Jimenez-Gonzalez,

1997). Writing from speech (phoneme-graphe-

me conversion) is more complicated, because

the writer must know when to apply several

complex rules (such as double letters, mute ‘‘h’’

or ‘‘u’’ after ‘‘g,’’ etc.), some of which come

from the preservation of etymological spellings(such as letters ‘‘s,’’ ‘‘c’’, or ‘‘z’’ for the /s/

sound).

In reading Spanish, one source of irregularity

is lexical stress assignment. The most frequent

stress pattern in multi-syllabic words is on the

penultimate syllable, although there are other

regularities (such as words ending in a conso-

nant other than /n/ or /s/, in which case the last

syllable is stressed). Words that do not follow

these regularities have an orthographic stress

mark to signal the accented syllable. Correct

pronunciation of such words requires seeing thestress mark, or previous knowledge of the word

when the accent is not written; for example, in

uppercase letters where orthographic stress is

not required. Del Ser and colleagues (1997) re-

lied on this fact to construct a Spanish version of

the NART, the Word Accentuation Test (WAT).

They selected low-frequency words (below

1/70,000 according to Juillard & Chang-Rodri-

guez, 1964) to be read aloud; these were then

printed in uppercase letters without their graphic

accents. The final, 30-item WAT had high and

significant correlations with Vocabulary and

Picture Completion, and lower but significant

correlations with the Raven Matrices (Raven,

1960) and the Mini Mental State Examination

(Folstein, Folstein, & McHugh, 1975), in a sam-

ple of 81 normal older adults. The WAT also

had high reliability coef ficients in terms of test-


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WORD ACCENTUATION TEST 679

retest and internal consistency (Del Ser et al.,

1997). A comparison between 40 controls and

20 mild to moderate participants with dementia

did not find significant differences in WAT per-

formance (Del Ser et al., 1997).

Since Spanish has marked geographical dif-

ferences, in this paper we present the develop-

ment of a local version of the WAT, the Word

Accentuation Test – Buenos Aires (WAT-BA)

version. The trans-cultural adaptation of a test

has to show the psychometric equivalence of

both versions, which includes examining

whether the items are measuring the same di-

mension or ability and with similar psychomet-

ric properties (Berry, Poortinga, Segall, &

Dasen, 1992). In our case this is of particular

importance since the test relies on lexical

knowledge, which has marked regional varia-

tions within Spanish-speakingcommunities. Forexample, a word included in the Spanish ver-

sion, ‘‘abogací a’’ (‘‘legal profession’’ or

‘‘law’’), is a very common word in Buenos Ai-

res, and presumably will offer no dif ficulty re-

garding its stress. We added 42 more words to

the original 30-item Spanish version, following

Del Ser and colleagues’ criteria (low frequency

and variation in the stressed syllable). We have

tested the 72 words in a sample of normal older

adults to develop a locally valid and reliable ver-

sion of the WAT. The current paper provides

reliability and concurrent and discriminativevalidity of this newly devised version. A com-

parison of both versions’ psychometric proper-

ties in this sample is included to emphasize the

importance of the local adaptation of some tests.

METHOD

ParticipantsThe participants recruited were urban older adultswho lived in the community. Each participant wasscreened for the following exclusion criteria: (1)

Age < 65 years old; (2) Mini Mental State Exami-nation (Folstein et al., 1975) < 26; (3) Diagnosedneurologic or psychiatric condition currently af-fecting cognitive functions; (4) Abnormal perfor-mance (> 2 SD for age norms) on any of the neuro-psychological tests (described in next section). Thestudy was conducted at the Memory Study Pro-

gram,Neuroepidemiology Area, Epidemiology andPrevention Division, Health Attention, NationalInstitute of Social Services for the Retired in Bue-nos Aires.

Eighty-five individuals volunteered to partici-pate in the study, all of whom were given feedback

following their performance. Eleven met exclusioncriteria upon assessment, leaving 74 participants(15 male, 59 female) in the final sample. The aver-age age was 73.2 years old (SD = 4.9; range = 65-85) and the average number of years of formal ed-ucation was 9.8 (SD = 4.2; range = 1-20).

MaterialsParticipants completed a semi-structured interviewconcerning demographic variables, medical his-tory, and problems with memory and daily activi-ties. Participants were administered the followingneuropsychological battery: (1) Mini Mental StateExamination (CAED, 1995; Folstein, et al., 1975);(2) Rey Auditory Verbal Learning Test, Totallearning, Delayedrecall,and Recognition(adaptedfrom Lezak, 1995); (3) Rey-Osterrieth Figure,Copy and Delayed recall (adapted from Lezak,1995); (4) WAIS Vocabulary Subtest (Wechsler,1955, [1984]); (5) Word Accentuation Test – Bue-nos Aires, experimental version; (6) Trail MakingTest (Reitan & Wolfson, 1993); (7) Stroop Test(Golden, 1978, [1994]); (8) Letter (P, L, M) andCategory (animals) Fluency (adapted from Lezak,1995).

The experimental version of the Word Accentu-ation Test – Buenos Aires (WAT-BA) included the30 words from the original WAT. With the help of a linguist, 42 low-frequency words (below 23 /

2,000,000 according to Alameda & Cuetos, 1995)were added, 17 stressed on the antepenultimate, 20on the penultimate, and 5 on the final syllable.Standardsfor administration,including the instruc-tions, examples, and scoring, were developed. In-structions tell the examinee to ‘‘read aloud cor-rectly, without consideration of the word’s mean-ing.’’ Each participant starts with an example con-sisting of a word printed in capital letters, whichthe participant must read aloud; if he or she fails,the examiner corrects him or her and repeats theinstruction. The participant is then handed a cardwith the 72 experimental words, printed in capitalletters (graphic accents in Spanish are generally

omitted above uppercase letters), which are to beread aloud without feedback. The examiner has aresponse sheet with the same words, accentuatedcorrectly, and scores 1 (correct) or 0 (incorrect) foreach word. Total score is the number of words readaccurately.


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Table 1. Demographic and Neuropsychological Characteristics of the Study Sample.

Variable M (SD) Range

AgeEducMMSEVocabularyWAT-BARLT TRLT RecRLT RcnRLT RcnEFigCopyFigRecTMT ATMT BPFlCFl

173.23119.82128.15159.92134.76140.97117.77112.11112.70131.70114.46150.77122.53134.88116.52

1(4.97)1(4.19)1(1.19)(10.44)1(8.67)1(7.74)1(1.29)1(2.16)1(2.93)1(4.43)1(5.05)(18.49)(50.50)(10.69)1(4.23)

20 (65 – 85)19 (1 – 20)

4 (26 – 30)51 (28 – 79)37 (7 – 44)34 (22 – 56)

9 (5 – 13)9 (6 – 15)

15 (0 – 15)19.5 (16.5 – 36)27.5 (2 – 29.5)107 (23 – 130)255 (45 – 300)

48 (11 – 59)21 (7 – 28)

Note. Educ = Years of Formal Education; MMSE = Mini-Mental State Exam; Vocabulary = WAIS – Vocabularysubtest; WAT-BA = Word Accentuation Test – Buenos Aires Version; RLT T = Rey Auditory Verbal LearningTest Total Words; RLT Rec = Rey Auditory Verbal Learning Test Delayed Recall; RLT Rcn = Rey AuditoryVerbal Learning Test Delayed Recognition; RLT RcnE = Rey Auditory Verbal Learning Test Delayed Recogni-tion Errors; Fig Copy = Rey Osterrieth Complex Figure Copy; FigRec = Rey Osterrieth Complex Figure DelayedRecall; TMT A = Trail Making Test A; TMT B = Trail Making Test B; PFl = Phonological Fluency; SFl = Cate-gorical Fluency.

ProcedureParticipants were invited to ‘‘check their mem-ory’’ in the context of a research study at the Me-mory Study Program. After consent was obtained,volunteers were tested individually in a 1 1/2 hoursession and were given feedback on their overall

performance in the battery. Statistical analyseswere performed with SPSS software, version 4.0for Macintosh.

RESULTS

Descriptive statistics of participants’ perfor-

mance in the neuropsychological battery are

shown in Table 1.

All participants understood and could follow

the instructions without problems. No partici-

pant required more than five minutes to read the

words.Given that we wanted to prioritize concurrent

validity with vocabulary tasks, items for the fi-

nal version of the WAT-BA were chosen on the

basis of their correlation with the WAIS Vocab-

ulary test. Forty-four items of the original 72

had a significant correlation ( p < 0.01). These 44

items together accounted for 92% (85% after

adjusting for sample size and number of vari-

ables) of the Vocabulary variance (r 2 =0.92, r 2

adj. = 0.85, SE = 3.9, p < 0.001) in a standard

multiple correlation/regression. Twenty-one of

the original 30 Spanish items were retained. The

original WAT items accounted for 40% (12%

after adjusting for sample size and number of

variables) of the Vocabulary variance (r 2 =0.40,

r 2 adj. = 0.12, SE = 9.8, ns). These results sup-

port the need to develop a local version.

The final version of the WAT-BA consisted

of 44 words: 20% stressed on the last syllable,

25% on the penultimate, and 55% on the ante-

penultimate. In comparison, of the words in-

cluded in the original WAT, 30% were stressed

on the last syllable, 30% on the penultimate, and

40% on the antepenultimate.Reliability of the final WAT-BA was high

(internal consistency using Cronbach’s alpha =

0.94).

In a further evaluation of validity, we exam-

ined the contribution of Vocabulary perfor-


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Table 2. Hierarchical Regression of WAIS – Vocabulary (W-Voc), Years of Formal Education (Educ), and Ageas Predictors with the WAT-BA as Criterion.

Variables B 95% conf.interv.

§ r r 2 increase

W-VocEducAgeIntercept

–0.58–0.46–0.03–1.79

–0.44 – 0.71–0.12 – 0.80–0.24 – 0.17

–19.28 – 15.69

–0.69–0.22–0.02

–0.85–0.71–0.16

0.72*0.03*

nsns

* p < 0.001.

mance, years of formal education, and age as

predictors of the WAT-BA in a hierarchical re-

gression (see Table 2).

Both Vocabulary and education had a high

correlation with WAT-BA, but age did not (r

Vocabulary, WAT-BA

= 0.85, p < 0.01; r Education, WAT-

BA = 0.71, p < 0.01; r Age, WAT-BA= –0.16, ns ).

Vocabulary accounted for 73% of the WAT-BA

variance. Given the high correlation of the

WAT-BA with the Vocabulary subtest, the addi-

tion of education added a statistically significant

but clinically irrelevant percentage (3%) to the

prediction of the WAT-BA variance. For predic-

tion purposes, regression coef ficients ( B), confi-

dence intervals, and standardized regression co-

ef ficients (§ ) are reported.

F i n a l l y, w e e x a m i n e d c o n v e r g e nt -

discriminant validity with factor analysis. We

included age, WAT-BA, Vocabulary, education,Rey Auditory Verbal Learning Test Delayed

Recall and Delayed Recognition, Rey Osterrieth

Complex Figure Copy and Delayed Recall, and

Trail Making Test A and B. We employed prin-

c i p al c o m p on e n ts e x tr a c t io n , r e t a in i n g

eigenvalues greater than 0.9, with Varimax rota-

tion. After rotation, three orthogonal factors

emerged that accounted for 68% of the variance

(see Table 3).

Factor 1 is defined by high loadings of Vo-

cabulary, WAT-BA, and education, so it may

represent a crystallized intelligence factor. ReyOsterrieth Complex Figure Copy also loads

heavily on this factor. The second factor is

represented by Trail Making Test A and B. We

interpreted this factor as a speed/executive fac-

tor. Factor 3 has high loadings of Rey Auditory

Verbal Learning Test Delayed Recall and Rec-

ognition, Rey Osterrieth Complex Figure De-

layed Recall, and age. This third factor appeared

to be a delayed memory factor, and to have a

moderate negative correlation with age. Boththe

WAT-BA and the Vocabulary subtest exhibited

very low correlations with the latter two factors.

DISCUSSION

We have sought to adapt and validate a NART-

like Spanish test, the WAT, to estimate intelli-

gence in older adults from the Buenos Aires

area. While our selection of items accounted for

92% of the WAIS Vocabulary’s variance (85%

if adjusted for sample size and measurement

error), items from the original WAT only ac-

counted for 40% of the same variance, 12% if adjusted. This is a clear indication that a local

adaptation of the WAT was necessary. These

findings suggest that care should be maximized

when using tests initially developed in samples

that differ from the one currently seen. More

specifically, transporting a neuropsychological

test to a different cultural environment may re-

quire more than language translation and new

norms. Some specific tests and/or test items can

have a different meaning or can rely upon differ-

ent abilities in different cultural contexts. Since

it is not an uncommon practice to simply trans-late tests from English, or employ a test devel-

oped in another culture, the current findings sug-

gest that increased caution is requiredwhen tests

are used across cultures. Future clinical and re-

search practices may need to more carefully


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Table 3. Communalities (h2) and Factor Loadings for Factor Analysis on Age, Education, and Neuropsychologi-cal Variables.

Variable h2 F1 F2 F3

VocabularyWAT-BA

EducAgeRLT RecRLT RcnEFigCopyFigRecTMT ATMT B

0.810.80

0.630.490.690.530.650.510.780.82

0.840.81

0.67–0.21–0.08–0.21

0.790.22

–0.30–0.30

0.250.30

0.430.070.35

–0.050.090.40

–0.81–0.85

0.200.24

0.04–0.66

0.75–0.70

0.170.55

–0.14–0.12

Note. Vocabulary = WAIS – Vocabulary subtest; WAT-BA = Word Accentuation Test – Buenos Aires Version;Educ = Years of Formal Education; RLT Rec = Rey Auditory Verbal Learning Test Delayed Recall; RLT RcnE= Rey Auditory Verbal Learning Test Delayed Recognition Errors; Fig Copy = Rey Osterrieth Complex FigureCopy; FigRec = Rey Osterrieth Complex Figure Delayed Recall; TMT A = Trail Making Test A; TMT B = TrailMaking Test B.

consider the methodological issues raised by the

findings of this study. Literal equivalence is not

the same as psychometric equivalence.

Findings from thecurrent studyalso argue for

the superiority of reading tests over educational

estimations of intellect. In this study, both Vo-

cabulary and the WAT-BA had high co rrelations

with the number of years of formal education,

although this correlation was lower than that of

the relationship with the other WAIS subtests.

Thus, our findings are consistent with otherswho prefer vocabulary tasks to estimate pre-

morbid intelligence because of their preserva-

tion in aging. Vocabulary explained at least 85%

of the variance in the final version of the WAT-

BA reading test. Formal education is not the

only source of acquired or crystallized intelli-

gence, so a psychometric test is more desirable

to estimate intelligencethan a demographic vari-

able such as ‘‘years of formal education.’’

The estimation of reliability used in the cur-

rent study was high. Given that Cronbach’s al-

pha coef ficient is used as an estimate of the cor-

relation of two parallel tests, two different ad-

ministrations of the same test, or any split-half

reliability coef ficient (Crocker & Algina, 1986),

we expect other types of reliability to be high.

Reliability of the WAT-BA is likely to remain

high given the ease of its administration and

scoring.

Concurrent-discriminant validity was also

determined to be good for the WAT-BA. We

have shown that performance on the WAT-BA

loaded heavily on a factor that also reflected

performance on the Vocabulary subtest and

years of education. This factor was unrelated to

age, memory, or frontal/executive measures that

seemed to load on two other different factors, so

we defined it as a crystallized intelligence fac-tor. It should be noted that the Rey-Osterrieth

Complex Figure Copy also had a moderate cor-

relation with this factor; other researchers have

found that performance on the complex figure is

influenced by education (Rosselli & Ardila,

1991). The second factor was defined by Trail

Making Tests A and B, and it also exhibited

lower correlations with delayed recall and rec-

ognition errors in delayed recall, so we specu-

lated that it could be a frontal/executive func-

tions factor with effects on memory. The third

factor was a delayed memory one, in which a

moderate negative loading showed its deteriora-

tion with advancing age.

In summary, we have developed a reading

test to estimate acquired intelligence in normal

older adults local to Buenos Aires. It is easy and


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fast to administer and score, and has good valid-

ity and reliability. Future research can concen-

trate on its psychometric properties in larger and

more diverse samples, and its usefulness with

clinical samples.

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APPENDIX 1

Stimuli for the final WAT-BA version

MASTIN (example)

CANON DIAMETRO

ACULLA HELICOIDE CELIBE

CONCAVO DESCORTES ISOTOPO

ALELI POLIGAMO TACTIL

SILICE LAUDANO ACME

ANOMALO DISCOLO PROCONSUL

SISTOLE AMBAR SUPERSTITE

BALADI VOLATIL PERONE

GELIDO TORRIDO RETRUECANO

ALEGORIA ZAHORI GRISU

NEOFITO ACOLITO LOBREGO

SANDALO HIPERBOLE INVEROSIMIL

INFULAS APATRIDA METROPOLI

HIPERBATON ALBEDRIO BULGAROPARONIMO PECORA SALOBRE

Test de acentuación de palabras, Burín, 2000

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