William Milberg. Department of Psychiatry, Massachusetts General Hospital,. Harvard Medical School, and the Geriatric Research,. Education, and Clinical ...
Psychology and Aging 1988, Vol. 3, No. 2, 173-178
Copyright 1988 by the American Psychological Association Inc OS82-7974/88/S00.75
Changes in Naming Ability With Age Marilyn S. Albert and Hope S. Heller
William Milberg Department of Psychiatry, Massachusetts General Hospital, Harvard Medical School, and the Geriatric Research, Education, and Clinical Center of the West Roxbury Veterans Administration Medical Center, Boston
This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
Departments of Psychiatry and Neurology, Massachusetts General Hospital, Division on Aging, Harvard Medical School
We administered to 80 optimally healthy subjects, 30-80 years old, the Boston Naming Test, a test of confrontation naming. Results indicated that naming ability remains fairly stable across the adult life span until individuals are in their 70s, at which point there is a significant decline in performance (p ^ .0001). Semantic errors (i.e., circumlocutions, semantically related associates, and nominalizations) and perceptual errors increase with age. Lexical errois (i.e., phonologically related real words and phonologically related nonwords) do not increase with age. Results of multiple regressions that included other neuropsychological variables indicate that estimated IQ, but not new learning ability, predicts a subject's naming score.
Older individuals frequently complain of an alteration in naming ability. They report that names very well learned and frequently used at a younger age are more difficult to retrieve
jects, and all of the investigations included individuals with systemic illnesses such as hypertension and cardiovascular disease. To determine the impact of age alone on naming ability, it is
as one grows older (Burke & Light, 1981;Hebb, 1978). Indeed,
necessary to examine only optimally healthy older subjects. It
older subjects are significantly slower than younger individuals in producing the name of an object. This is true whether the
may be that optimally healthy subjects have a less striking nam-
stimulus is either a picture of the object (Thomas, Fozard, & Waugh, 1977) or a verbal description of it (Bowles & Poon, 1985). Older individuals are also less accurate than younger subjects in naming an object when it has been described
that seen in individuals with chronic medical or neurologic illness.
(Bowles & Poon, 1985).
Failure to accurately name an object may be determined by a
Several groups of investigators (Borod, Goodglass, & Kaplan, 1980; Goodglass, 1980; LaBarge, Edwards & Knesevich, 1986;
number of cognitive factors. Some are specific to the integrity of the language system. Others, related to general intelligence,
Obler, Albert, & Goodglass, 1981) have also reported that scores on a test of confrontation naming decrease with age. There is, however, variation among the studies regarding the
even adequately represented names are retrieved. Examination of the relation between naming and memory is particularly im-
ing impairment or a different pattern of errors (or both) from
In examining naming ability, one must also determine the variables that are contributing to the accuracy of performance.
memory, or verbal fluency, may limit the efficiency with which
performance of subjects in the younger age ranges. Borod et al. (1980) and Goodglass (1980) reported a decrease in performance between the 30- and 50-year-olds, whereas Obler et al,
portant because of the theoretical relation between the two do-
(1981) found significant declines only among the 70-year-olds. Results of the error analysis varied as well. Borod et al. (1980)
between semantic and episodic memory, with the latter includ-
and Goodglass (1980) reported that community-dwelling el-
Waugh & Norman, 1965). Naming is often thought of as an
mains. Memory theorists distinguish between several subtypes of memory. The most widely investigated model differentiates ing both primary and secondary memory (Tulving, 1972;
derly subjects made more semantic errors and self-corrections,
example of semantic memory, but it is unclear whether the re-
whereas Obler et al. (1981) found an increase in circumlocu-
trieval mechanisms for naming and other memory subtypes differ.
tions but not semantic associations. These differences may relate to variations in health status be-
The present investigation was therefore undertaken to exam-
tween the subject populations. Although an effort was made to
ine age-related differences in naming ability in optimally
choose subjects who were cognitively sound, some of the studies
healthy individuals and to determine how these differences in-
collected limited data concerning the health status of the sub-
teract with cognitive functions in other domains. The Boston Naming Test (Kaplan, Goodglass, & Weiutraub, 1976), a test of confrontation naming, was administered to 80 individuals,
This study was supported in part by National Institute on Aging Grant P01-AG04953. The authors would like to thank Kenneth Jones and Mary Hyde for their invaluable assistance with the statistical analysis. Correspondence concerning this article should be addressed to Marilyn Albert, Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts 02114.
30-80 years old. Additional neuropsychological tests were administered so that cognitive variables that could potentially contribute to naming performance in the elderly, such as general intelligence, memory, and verbal fluency, could be assessed. Spontaneous naming performance and its relation to neuropsychological measures in other cognitive domains was examined.
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M. ALBERT, H. HELLER, AND W. MILBERG
Errors in spontaneous naming and response to cueing were also evaluated.
word, usually with the letters er included (e.g., "swinger" for "pendulum"). 5. Morphological invention—a response that is an invented word, or a compound word made up of real words, but is not itself a real word
Method
(e.g., "hourcup" for "hourglass"). 6. Phonologically related real word—a real word that is phonologi-
Subjects Included in the investigation were 80 community-dwelling male subjects ranging in age from 30 to 80 years. They were divided into four decade groups: 30-39 (n = 16), 50-59 (« = 20), 60-69 (n = 21), and
cally related to the target word, but is not a semantic associate of the target word (e.g., "haddock" for "hammock"). 7. Phonologically related nonword—a nonword that is phonologically related to the target word and derives from a clear attempt to produce it (e.g., "abatrakus" for "abacus").
This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
70-80 (K = 23). All of the subjects 50 years of age and older, and many of the 30-year-old subjects, were members of the Normative Aging Study (NAS; Bell, Rose, & Damon, 1966) at the Boston Veterans Administration Outpatient Clinic. As such, they had received periodic medical checkups for the previous 20 years. After examining their medical records and then questioning them, we excluded individuals with a history of alcoholism, psychiatric illness, learning disabilities, severe head trauma, epilepsy, hypertension, chronic lung disease, kidney disease, coronary artery disease, or cancer. Subjects who were not members of the NAS were also carefully screened for these conditions. Participants included both white- and blue-collar workers and, in general, represented a socioeconomic cross-section of the population. Their education ranged from 10 to 22 years, with a mean of approximately 15 yeais for all of the groups. A one-way analysis of variance (ANOVA) with planned comparisons determined that there was no significant difference between the scores of the groups, F(3,76) = 1.78,p - .16.
Additional Neuropsychological Testing All of the subjects were also administered a battery of neuropsychological tests that measured several other aspects of cognitive function including memory, verbal fluency, and verbal intelligence. These were assessed by the Wechsler Memory Scale (WMS; Wechsler, 1945), the Controlled Word Association Test (Benton & Hamsher, 1976), and the Vocabulary subtest of the Wechsler Adult Intelligence Scale (WAIS; Wechsler, 1958). The WMS assesses orientation, attention, and immediate memory for paragraphs, line drawings, and paired associates. Delayed memory for the latter three tasks was also evaluated. Three measures from the WMS were used in the subsequent analysis: digit span forward (a measure intended to estimate primary memory) and the immediate and delayed memory of the paragraphs (two measures of secondary memory). The Controlled Word Association Test consisted of three word-
Assessment of Naming Ability
finding trials, using the letters F, A, and S. The subject was asked to produce as many words as possible in 1 min, beginning with each of the
The Boston Naming Test (Kaplan et al. 1976) was administered to all
target letters. The total of these three 1-min trials was used as a measure
of the subjects. The test consists of 85 outline drawings of objects that
of verbal fluency. The subject was also asked to list as many proper
vary in ease of recognition (i.e., from tree to trellis). Subjects were shown one picture at a time and were asked to supply the name of the
names as possible in 1 min. The score for the production of proper names was used as a separate fluency measure. The Vocabulary subtest
object. Stimulus items were presented in order of difficulty, and no time
of the WAIS was used to assess general verbal ability and as an estimate
limits for responding were given. If the stimulus item was misperceived (e.g., the subject said "apron" instead of "flippers"), a stimulus cue sup-
oflQ.
plying conceptual information about the object was given (i.e., "this is
Results
something used for swimming"). If the object was correctly perceived but not spontaneously named, a phonemic cue, consisting of the sound of the first few letters of the name (e.g., "the beginning of the word sounds like 'IT "), was provided. All spontaneous responses, as well as responses to cues, were recorded verbatim.
Data were analyzed by ANOVA, chi-square, and multiple regression techniques. Differences between the age groups in naming ability were analyzed by ANOVA. The number of items spontaneously correct on the Boston Naming Test for the 30-, 50-, 60-, and 70-year-olds was first compared. The overall
Error Analysis of Naming Performance Three types of naming errors were examined: perceptual errors, semantic errors, and lexical errors. Semantic and lexical errors were further subdivided into several categories. Semantic errors included circumlocutions, semantically related associates, morphological inven-
difference between the age groups was significant, F{3, 76) = 13.82, p
