Recall of Pictures Test included in the European Cross-Cultural Neuropsychological Test Battery

In response our recent paper titled “Brazilian version of the European Cross-Cultural Neuropsychological Test Battery,”¹ Nitrini et al. argue that the Recall of Pictures Test (RPT) is “the color version of the Brief Cognitive Screening Battery (BCSB) memory test”² and claim that Nielsen et al.³ have not given due credit to the original authors of the BSCB memory test.

The RPT was developed for cross-cultural cognitive assessment of minority ethnic groups in Europe and has been used for this purpose since its first publication in 2012.³ The RPT has subsequently been part of several European publications on the European Cross-Cultural Neuropsychological Test Battery (CNTB). Since the initial study validating the RPT, Nitrini et al.⁴ have been consistently cited. The initial paper explicitly states that the RPT is inspired by the BCSB memory test and their work. However, other test paradigms relying on learning and recall of pictures also formed the background for pursuing this approach to the RPT.

When developing the RPT, Nielsen et al. only knew about the BCSB memory test from the international scientific literature. However, upon request Nitrini forwarded all of the BCSB memory test material, and it is only now that Nielsen et al. have had the opportunity to review this material. Although they acknowledge similarities between the two tests, Nielsen et al. also find important differences in their designs, procedures and measures (Table 1). Additionally, the wording of all the instructions differs and there are differences in administration and scoring. Thus, Nielsen et al. respectfully disagree that the RPT is simply a color version of the BCSB memory test, and Table 1 demonstrates these differences.

Table 1
Comparison of design, procedures and measures of the Brief Cognitive Screening Battery memory test and the Recall of Pictures Test

	Brief Cognitive Screening Battery memory test	Recall of Pictures Test
Design
Naming and learning	• 10 black and white drawings (shoe, house, comb, key, airplane, bucket, turtle, book, spoon, tree)	• 10 colorized Snodgrass and Vanderwart pictures (shoe, spoon, comb, tree, turtle, key, airplane, house, book, trash can)
	• Mixed on a standing page	• Organized in two rows on a flat page
Recognition	• 20 black and white drawings (distractors: truck, iron, fruit, leaf, kettle, bicycle, banana, ship, pig, suit jacket	• 20 colorized Snodgrass and Vanderwart pictures (distractors: bicycle, broom, chicken, foot, scissors, train, umbrella, wristwatch, chair, flower)
	• Organized in 5 rows on a standing page	• Organized in 4 rows on a flat page
Procedures
Naming	• Naming of the 10 drawings	• Naming of the 10 pictures
Learning	• Incidental leaning trial followed by two explicit learning trials	• Incidental leaning trial followed by two explicit learning trials
	• Maximum 30 seconds to memorize drawings	• Maximum 30 seconds to memorize pictures
	• Maximum 60 seconds to retrieve drawings	• No time constraint
	• No explicit warning about delayed recall trial	• Explicit warning about delayed recall trial
Delayed recall	• Delay of approximately 5 minutes (usually after Animal Fluency and clock Drawing Test)	• Delay of approximately 10 minutes (usually after Color Trails Test and five Digit Test)
	• Maximum 60 seconds to retrieve drawings	• No time constraint
Recognition	• Identification of 10 target drawings among 10 distractors	• Identification of 10 target pictures among 10 distractors
Measures
Naming	• Number of correctly named drawings	• Number of correctly named pictures
	• 0-10 points	• 0-10 points
	• Error types scored according to Visual perception or Naming errors.	• No scoring of error types
Incidental Recall	• Number of correctly recalled drawings	• Number of correctly recalled pictures
	• 0-10 points	• 0-10 points
Immediate Recall	• Number of correctly recalled drawings	• Mean number of correctly recalled pictures across three learning trials (incidental and immediate recall trials) rounded to the nearest whole number
	• 0-10 points	• 0-10 points
Learning	• Number of correctly recalled drawings	• Not part of the RPT
	• 0-10 points
Delayed Recall	• Number of correctly recalled drawings	• Number of correctly recalled drawings
	• 0-10 points	• 0-10 points
Recognition	• Number of correctly recognized drawings minus false positive responses.	• Number of correctly recognized pictures minus false positive responses.
	• 0-10 points	• 0-10 points (the minimum score is 0)

• Bold type indicates the main differences between the BCSB memory test and the Recall of Pictures Test. All Recall of Pictures Test materials are available upon request from the authors.

It is important to highlight that Nielsen et al. have no commercial interests in the RPT, which is made freely available to the international clinical and research community. In fact, Yassuda, one coauthor of the letter was given full access to all RPT materials in 2014, when she contacted Nielsen to ask permission to include the RPT and other CNTB tests in her research.

It is remarkable that Nitrini et al. argue against the suggestion that color information may improve recognition of pictures in low-educated or illiterate people. This suggestion is an old one⁵ and has been supported by several studies, including two by one of the signers of the letter.⁶,⁷ Interestingly, Ortega et al.⁶ directly compared tests included in the BCSB and the CNTB and stated that “data from the present study suggest that the use of colored stimuli seems to be a relevant strategy in the evaluation of memory among people with low schooling, as they may facilitate encoding.” It is noteworthy, that the name of the RPT was changed to the “Colored Figure Memory Test” in this publication.

We have the deepest respect for Nitrini et al., their excellent and longstanding commitment to improving cognitive assessment in low-educated and illiterate populations, and for introducing the test paradigm used in the BCSB memory test. There is no doubt that the RPT was inspired by Nitrini et al.’s seminal study, and this has always been recognized by Nielsen et al.

• How to cite this article: Araujo NB, Nielsen TR, Laks J. Recall of Pictures Test included in the European Cross-Cultural Neuropsychological Test Battery. Braz J Psychiatry. 2020;00:000-000. http://dx.doi.org/10.1590/1516-4446-2020-1558

References

• ¹
  Araujo NB, Nielsen TR, Barca ML, Engedal K, Marinho V, Deslandes AC, et al. Brazilian version of the European Cross-Cultural Neuropsychological Test Battery (CNTB-BR): diagnostic accuracy across schooling levels. Braz J Psychiatry. 2020;42:286-94.
• ²
  Nitrini R, Caramelli P, Brucki SMD, Yassuda MS. The memory test of the Brief Cognitive Screening Battery is the same as the Recall of Pictures Test of the European Cross-Cultural Neuropsychological Test Battery. Braz J Psychiatry. 2020;00:000-000. http://dx.doi.org/10.1590/1516-4446-2020-1520
  » http://dx.doi.org/10.1590/1516-4446-2020-1520
• ³
  Nielsen TR, Vogel A, Waldemar G. Comparison of performance on three neuropsychological tests in healthy Turkish immigrants and Danish elderly. Int Psychogeriatr. 2012;24:1515-21.
• ⁴
  Nitrini R, Caramelli P, Herrera Junior E, Porto CS, Charchat-Fichman H, Carthery MT, et al. Performance of illiterate and literate nondemented elderly subjects in two tests of long-term memory. J Int Neuropsychol Soc. 2004;10:634-8.
• ⁵
  Reis A, Faisca L, Ingvar M, Petersson KM. Color makes a difference: two-dimensional object naming in literate and illiterate subjects. Brain Cogn. 2006;60:49-54.
• ⁶
  Ortega LV, Aprahamian I, Martinelli JE, Cecchini MA, Cação JdC, Yassuda MS. Diagnostic accuracy of usual cognitive screening tests versus appropriate tests for lower education to identify Alzheimer disease. J Geriatr Psychiatry Neurol. 2020 Sep 24;891988720958542. doi: http://10.1177/0891988720958542 Online ahead of print.
  » http://10.1177/0891988720958542
• ⁷
  Yassuda MS, da Silva HS, Lima-Silva TB, Cachioni M, Falcão DV, Lopes A, et al. Normative data for the Brief Cognitive Screening Battery stratified by age and education. Dement Neuropsychol. 2017;11:48-53.

Publication Dates

• Publication in this collection
  23 Nov 2020
• Date of issue
  Mar-Apr 2021

History

• Received
  9 Oct 2020
• Accepted
  23 Oct 2020