Assessing executive function in Parkinson disease: The Alternating Names Test. Part I. Reliability, validity, and normative data☆

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Abstract

Objectives

To evaluate psychometric properties (convergent and divergent validity; alternate forms reliability) and provide normative data for the Alternating Names Test (ANT), a new bedside test of set-switching, a component of executive function (EF). The test was specifically designed for use in persons with Parkinson disease (PD).

Design

Cross-sectional study.

Setting

Clinic-based PD Research Registry.

Participants

Data were gathered from two samples: 829 patients with idiopathic PD enrolled in our clinic registry and 253 caregivers and family members of patients.

Measurements

In the ANT, patients are asked to produce the names of children, switching back and forth from boys’ to girls’ names. Outcome measures include the time to complete ten correct pairs and the number of errors made.

Results

Correlations between the ANT and similar constructs were high (mean Spearman rank-order correlation coefficient, rho = .67), indicating good convergent validity. Measures of divergent validity were low (mean Spearman’s rho = .31), demonstrating good divergent validity. Alternate forms reliability was high for time (rho = .76), but low for errors (rho = .37). Normative data are presented in a look-up table.

Conclusion

Our test is a valid and reliable measure of set-switching in PD. Its ease of administration and effectiveness in identifying executive deficits suggests that the test could be useful in clinical practice and warrants further study.

Section snippets

Design

We used a cross-sectional design. A sample of spousal and other family caregivers served as controls to provide normative data. Patient comparison data were obtained from archival data of participants with PD drawn from our PD Research Registry. Patients and controls were tested individually, in private, in the office of our clinic psychologist (T.H.), who has expertise in the field of movement disorders.

Setting

The research took place at the Parkinson Research Institute (PRI), affiliated with the

Data distributions

ANT means, medians, and standard deviations, stratified by group (PD patients vs. controls) are presented in Table 1. In Fig. 1, box-plots showing outliers for ANT scores in patients and controls are presented so readers may evaluate both floor and ceiling effects.

Concurrent and divergent validity/alternate forms reliability

Associations between the ANT and commonly-used EF tests were assessed using Spearman’s rank-order correlation coefficient (rho). These correlations were statistically adjusted for age and education (Table 2) using methods outlined in

Discussion

The ANT is among a few tests of EFs that are responsive to the specific testing needs of persons with PD. For example, the ANT was designed to limit the negative effects on test administration and results that stem from the motor, visual, and cognitive impairments of PD. Further, a goal was to develop a test that places greater demands on set-switching ability, while placing lower demands on other cognitive resources, such as working memory (the WAIS-III Letter Sequencing Test and the

Acknowledgements

The authors gratefully acknowledge the assistance of Kathleen A. Smyth, Ph.D., Linda R. Rechlin, B.A., and Maggie Wallendal, M.S.W. who provided review and comment during the preparation of this manuscript. We also thank Sara M. Debanne, Ph.D., who provided statistical support. The suggestions and comments made by two anonymous reviewers are also greatly appreciated. Finally, the authors thank the many research volunteers who participated in this study, graciously offering their time and

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    The review of this paper was entirely handled by an Associate Editor, R. L. Rodnitzkyi.

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