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INTRODUCTION
The estimation of previous intelligence is useful for the clinical and neuro-
psychological study of cognitive decline (Delgado & Del Ser, 1994), in aging
(Brayne & Beardsall, 1990), schizophrenia (Crawford, Besson, Bremner, Eb-
meier, Cochrane, & Kirkwood, 1992; O’Carroll, Walker, Dunan, Murray,
Blackwood, Ebmeier, & Goodwin, 1992b), depression (Evans & Katona,
1993), Korsakoff ’s syndrome (O’Carroll, Moffoot, Ebmeier, & Goodwin,
1992a), chronic intoxication (Bolla, Briefel, Spector, Schwartz, Weiler, Her-
ron, Gimenez, 1992), head injury (Moss & Dowd, 1991), AIDS (Egan, Craw-
This study was done in part with the support of two grants from the Fondo de Investigaciones
Sanitarias of the Ministerio de Salud y Consumo of Spain (88/2014 y 89/0203). We are in-
debted to D. Del Ser for English translation and to J. B. Murphy for reviewing the final English
version. Correspondence and requests for reprints should be addressed to Dr. Teodoro Del
Ser Quijano, Sección de Neurologı́a, Hospital Severo Ochoa, Avda. Orellana s/n, Leganés,
28911 Madrid, Spain. Fax: 91-6940717.
343
0278-2626/97 $25.00
Copyright 1997 by Academic Press
All rights of reproduction in any form reserved.
344 DEL SER ET AL.
ford, Brettle, & Goodwin, 1990), and, especially, the diagnosis and classifi-
cation of demented patients (Grober & Sliwinski, 1991; Sharpe & O’Carroll,
1991; Beardsall & Huppert, 1994).
Methods of estimating premorbid intellectual level have been based on
the assessment of vocabulary (Martin & Fedio, 1983; Kendrick, 1964), be-
cause this cognitive function, representative of ‘‘crystallized intelligence,’’
is rather stable and highly correlated with general intelligence. These meth-
ods have usually been unsatisfactory (Miller, 1977; Fuld, 1983; Delgado &
Del Ser, 1994), however, because vocabulary performance declines with age
and brain pathology. In the last decade word reading tests have proved to
be more useful than vocabulary for the estimation of premorbid intelligence
(Delgado & Del Ser, 1994; O’Carroll & Gilleard, 1986). Reading ability is
closely related to intellectual level in both children (Fransella & Gerver,
1965) and adults (Ruddle & Bradshaw, 1982) and is also resistant to mental
deterioration of organic cause (Cummings, Darkins, Mendez, et al., 1988).
The first reading tests designed to estimate premorbid intelligence were
the Schonell Graded Word Reading Test (Nelson & McKenna, 1975) and
the National Adult Reading Test (NART) (Nelson & O’Conell, 1978). The
task in the NART is to read 50 irregular and infrequent English words. Nel-
son & O’Conell (1978) and other authors have demonstrated the resistance to
deterioration of the NART in mild-moderate dementia of different etiologies
(O’Carroll & Gilleard, 1986; Nebes, Martin, & Horn, 1984; Hart, Smith, &
Swash, 1986) and the stability of its scores after 1 year of progressive deterio-
ration in other cognitive functions (O’Carroll, Baikie, & Whittick, 1987).
Since there is no similar tool in Spanish, we have tried to design a reading
test for Spanish-speaking subjects that would be useful in the estimation of
premorbid intelligence and in the diagnosis of mild-moderate dementia.
edge of those words, and that the higher the intellectual level of the subject the better the
result.
We selected 238 Spanish words with difficult accentuation. Subsequently we eliminated the
words that had ambiguous accentuation, were too infrequent, and/or were technical jargon.
Finally, 40 words were selected, with a frequency below 1/70.000 (Juilland & Chang-Rodrí-
guez, 1964), that we considered suitable for the objectives of the test (WAT-40).
The feasibility of the WAT-40 was assessed in 17 inpatients of the geriatric ward of the
Hospital Central de la Cruz Roja in Madrid. In this pilot study we examined whether cogni-
tively normal patients could read the words, the examiner could discriminate the proper accen-
tuation, and the obtained scores had a normal distribution according to the Kolmogorov–
Smirnov test.
ity, and interrater agreement were determined. The internal consistency of the WAT was calcu-
lated with Cronbach’s α coefficient. Test–retest reliability was examined in a sample of 10
elderly inpatients from the Hospital de la Cruz Roja, with a mean age of 87 years. The WAT
was applied twice by the same rater with a delay of 30 days. Interrater agreement was examined
in a sample of 23 consecutive elderly outpatients from the geriatric clinic of the Hospital of
Guadalajara, with a mean age of 78 years. The WAT was applied the same day by a geriatric
practitioner and a clinical assistant.
Statistical Methods
Data were analyzed using the statistical packages BMDP (BMDP Statistical Software Inc.,
Los Angeles, CA, PC Version, 1984) and SPSS (SPSS Inc., 1986). The statistical methods used
were the Kolmogorov–Smirnov test to check the normal distribution of a variable, Student’s
t to compare normal quantitative variables, Spearman’s correlation to determine test–retest
WORD ACCENTUATION TEST 347
TABLE 1
Correlationsa of the Word Accentuation Test with External Criteria
WAT-40 WAT Vocabulary
WAIS
Vocabulary 0.842 0.835
Figure completion 0.722 0.712 0.750
Vocabulary 1 figure completion 0.835 0.837 0.952
RAVEN 0.580 0.655 0.663
Mini-Mental State Examination 0.604 0.576 0.632
Years of education 0.571 0.591 0.603
WAT-40, first version of the Word Accentuation Test; WAT, final version of the Word
Accentuation Test; WAIS, Wechsler Adult Intelligence Scale; RAVEN, Raven’s Progressive
Matrices.
a
Pearson’s correlation coefficients; all are statistically significant, p , .0001.
reliability and interrater agreement, Cronbach’s α coefficient to determine the WAT’s internal
consistency, Pearson’s correlation to measure the relation of quantitative variables, tetrachoric
correlation to the item analysis of the WAT-40, and simple linear regression to obtain experi-
mental laws.
RESULTS
Elaboration of the First Version of the WAT
In its initial application to 17 cognitively normal elders, it was verified
that the words could be read, that the examiner could value the correct accen-
tuation, and that the scores had a normal distribution, according to the Kol-
mogorov–Smirnov test (p 5 1).
TABLE 2
Word Accentuation Test
ACULLA ABOGACIA ANOMALO CELIBE
ALELI RABI APATRIDA HUSAR
ALEGORIA MANCHU DIAMETRO MOARE
CONCAVO AMBAR PUGIL POLIGAMO
ACME SILICE GRISU ALBEDRIO
CANON PIFANO TACTIL VOLATIL
DESCORTES DISCOLO BULGARO BALADI
ACOLITO CUPULA
tuate words: 9 with the stress on the last syllable, 9 with stress on the penulti-
mate, and 12 with the stress on the antepenultimate (Table 2).
The test–retest reliability of the WAT applied in 10 elderly subjects with
a delay of 30 days was 0.97. The interrater agreement between a geriatric
physician and a clinical assistant in a sample of 23 patients assessed the
same day was 0.93. Cronbach’s α coefficient of internal consistency was
0.91.
TABLE 3
Comparison of Demented and Control Subjects
Demented Controls
(N 5 20) (N 5 40) χ 2 test
Sex
Male 8 (40%) 16 (40%)
Female 12 (60%) 24 (60%) N.S.
Institutionalized 6 (30%) 12 (30%) N.S.
DISCUSSION
The estimation of premorbid intellectual level is useful in the study of
patients with slight or mild mental deterioration (Delgado & Del Ser, 1994;
350 DEL SER ET AL.
FIG. 1. The receiver operating characteristic curves of the Mini-Mental State Examination
(MMSE), and the discrepancies between predicted and obtained scores on the WAIS (dWAIS)
and RAVEN (dRAVEN). SENS., sensitivity; SPEC., specificity. ■, MMSE; 1, dWAIS; ✴,
dRAVEN.
TABLE 4
Validity of the MMSE and the Discrepancies in the WAIS and RAVEN
for the Diagnosis of Dementiaa
Discrepancies
MMSE WAIS RAVEN
Cutoff 18 6 3
Sensitivity 0.60 0.55 0.72
Specificity 0.92 0.90 0.85
Predictive value
Positive 0.80 0.71 0.72
Negative 0.82 0.81 0.87
Accuracy 0.81 0.79 0.82
Hart et al., 1986; Baddeley, Emslie, & Nimmo-Smith, 1993). The estimated
previous level can be compared with the present level and, if a clear discrep-
ancy is observed, the diagnosis of mental deterioration can be sustained. This
estimation is also useful in some studies of demented patients needing a
retrospective control of this variable (Jorm & Korten, 1988; Oyebode,
Barker, Blessed, et al., 1986; Morales, González-Montalvo, Bermejo, & Del
Ser, 1995).
Reading aloud tests have been proven to be the most useful for the estima-
tion of premorbid intellectual level (Nelson & McKenna, 1975; Nelson &
O’Conell, 1978; Nebes et al., 1984; Hart et al., 1986; O’Carroll et al., 1987;
Baddeley et al., 1993). The best known of these tests is the National Adult
Reading Test designed by Nelson and colleagues (Nelson & O’Conell,
1978), which assesses the reading of a series of irregular English words and
offers a good estimate of the intellectual level of the subject. According to
the authors (Nelson & McKenna, 1975; Nelson & O’Conell, 1978; O’Carroll
et al., 1987), performance on this test is a good indicator of the subject’s
lexical knowledge, a variable strongly correlated to intellectual level (Rud-
dle & Bradshaw, 1982; Baddeley et al., 1993).
Recently the NART has been translated into other languages (Schmand,
Bakker, Saan, & Louman, 1991) and cultures (Grober & Sliwinski, 1991;
Beardsall & Huppert, 1994), and modified for practical purposes (Crawford,
Parker, Allan, Jack, & Morrison, 1991); however, creation of a similar test
for Spanish speakers seems impossible, because in Spanish, unlike in En-
glish, the rules of reading are always regular. Therefore we examined
whether the accentuation of infrequent words, written without accent mark,
would be a good indicator of lexical ability in Spanish and an efficient way
of estimating premorbid intellectual level.
The WAT, designed for this purpose, has proved to be easy to apply,
short, well accepted by subjects, and, most importantly, highly valid for the
estimation of intellectual level. The correlations of the WAT with external
criteria (WAT–WAIS 5 .837, WAT–RAVEN 5 .655) are higher or similar
to the correlations of these criteria with the MMSE (WAIS–MMSE 5 .491,
RAVEN–MMSE 5 .686), or between them (WAIS–RAVEN 5 .700, vo-
cabulary–RAVEN 5 0.633) (see Table 1). In this study the full WAIS was
not used for practical reasons, but we have shown in an independent study
(Martı́nez, Delgado, & Del Ser, unpublished data) that the correlation be-
tween word accentuation and total WAIS score is higher than .80. Therefore,
the first conclusion of this study is that the WAT is a valid estimate of intel-
lectual level in healthy elders.
It could be argued that the ability to correctly accentuate some infrequent
words is dependent mainly on culture and formal education; however, the
WAT correlates with the duration of education (.591) less than with the intel-
ligence tests, in the same range as the vocabulary (.603), usually considered
the most suitable test for the estimation of general intelligence (Martin &
352 DEL SER ET AL.
Fedio, 1983; Kendrick, 1964). These data suggest that this reading ability
is based not only on cultural exposure to the lexical items but also on other
intellectual skills applied to these materials.
The WAT is a very simple but also consistent test; its test–retest and
interrater reliabilities are very high, even more than those for the NART
(O’Carroll, 1987).
The similarity of the WAT scores in demented patients and control sub-
jects indicates that this test, as other reading tests (Crawford, 1989), is resis-
tant to cognitive deterioration; however, this stability in patients with mild-
moderate dementia cannot be extrapolated to more severe degrees of demen-
tia, where reading ability also declines (Cummings, Houlihan, & Hill, 1986;
Murdoch, Chenery, Wilks, & Boyle, 1987). On the other hand, demented
patients score significantly worse than controls on the WAIS and RAVEN,
even in the vocabulary subtest, which has usually been considered a stable
cognitive function (Martin & Fedio, 1983; Kendrick, 1964; Miller, 1977).
The cognitive deterioration produced by dementia is quite heterogeneous,
and some abilities are more affected than others. Nonsemantic verbal abilities
(such as word accentuation) are better preserved than semantic abilities (vo-
cabulary test), and both of these abilities are better preserved than manipula-
tive abilities (figure completion and progressive matrices tests, in our case)
(Bayles & Boone, 1982; Code & Lodge, 1987). The automatic phonologic
component of language is better preserved because, unlike the semantic com-
ponent, it does not need the integrity of higher cognitive processes (Bayles &
Boone, 1982; Code & Lodge, 1987).
In reading aloud three different mechanisms have been described (Coslett,
Rothi, & Heilman, 1985; Katz & Sevush, 1987). (1) The ‘‘phonologic mech-
anism’’ applies regular and fixed grapheme–phoneme translation rules, is
slow, and does not require previous knowledge or actual understanding of
the read text. If this were the reading mechanism in WAT, most words would
be stressed on the penultimate syllable, because this is the most common
accentuation in Spanish. (2) The ‘‘lexical–semantic’’ mechanism uses the
meaning of the word to produce the correct pronunciation. This mechanism
requires the use of systems of high lexical integration and is impaired early
by the dementia process. (3) The ‘‘writing–sound association’’ nonsemantic
mechanism allows the subject to read correctly the words he has previously
managed, without activating their meaning or applying the slow phonologic
rules. In this way demented patients can correctly read aloud words they
were familiar with but no longer understand. In some types of dementia
(O’Carroll & Gilleard, 1986) the lexical–semantic mechanism can be selec-
tively impaired, while the phonologic and writing–sound association is pre-
served (Sevush, 1984; Rapcsak, Arthur, Bliklen, & Rubens, 1989). The in-
tegrity of this writing–sound association is the basis of the application of
word reading tests to the estimation of premorbid intelligence.
According to our results the WAT score is not affected by the dementia
WORD ACCENTUATION TEST 353
REFERENCES
American Psychiatric Association 1987. Diagnostic and statistical manual of mental disorders.
Third edition revised. Washington, DC: American Psychiatric Association. 1993.
Baddeley, A., Emslie, H., Nimmo-Smith, I. 1993. The Spot the Word Test: A robust estimate
of verbal intelligence based on lexical decision. British Journal of Clinical Psychology,
32, 55–65.
Bayles, K. A., & Boone, D. R. 1982. The potential of language tasks for identifying senile
dementia. Journal of Speech and Hearing Disorders, 47, 210–217.
Beardsall, L., & Huppert, F. A. 1994. Improvement in NART word reading in demented and
normal older persons using the Cambridge Contextual Reading Test. Journal of Clinical
and Experimental Neuropsychology, 16, 232–242.
Bermejo, F. 1993. Nivel de salud y deterioro cognitivo en los ancianos. Madrid: SG. editores.
Bolla, K. I., Briefel, G., Spector, D., Schwartz, B. S., Wieler, L., Herron, J., & Gimenez, L.
1992. Neurocognitive effects of aluminum. Archives of Neurology, 49, 1021–1026.
Brayne, C., & Beardsall, L. 1990. Estimation of verbal intelligence in an elderly community:
an epidemiological study using NART. British Journal of Clinical Psychology, 29, 217–
223.
354 DEL SER ET AL.
Code, C. H., & Lodge, B. 1987. Language in dementia of recent referal. Age and Ageing, 16,
366–372.
Coslett, H. B., Rothi, L. G., & Heilman, K. M. 1985. Reading: Dissociation of the lexical
and phonologic mechanisms. Brain and Language, 24, 20–35.
Crawford, J. R. 1989. Estimation of premorbid intelligence: A review of recent developments.
In Crawford & Parker (Eds.): Developments in clinical and experimental neuropsychol-
ogy. New York: Plenum Press. Pp. 275–278.
Crawford, J. R., Besson, J. A., Bremner, M., Ebmeier, K. P., Cochrane, R. H., & Kirkwood,
K. 1992. Estimation of premorbid intelligence in schizophrenia. British Journal of Psychi-
atry, 161, 69–74.
Crawford, J. R., Parker, D. M., Allan, K. M., Jack A. M., & Morrison, F. M. 1991. The Short
NART: Cross-validation, relationship to IQ and some practical considerations. British
Journal of Clinical Psychology, 30, 223–229.
Cummings, J. L., Darkins, A., Mendez, M., et al. 1988. Alzheimer’s disease and Parkinson’s
disease: Comparison of speech and language alterations. Neurology, 38, 680–684.
Cummings, J. L., Houlihan, J. P., & Hill, M. A. 1986. The pattern of reading deterioration
in dementia of the Alzheimer type: Observations and implications. Brain and Language,
29, 315–323.
Delgado Villapalos, C., & Del Ser, T. 1994. Métodos de estimación del deterioro mental. In
T. Del Ser & J. Peña-Casanova (Eds.): ‘‘Evaluación neuropsicológica y funcional de la
demencia. Barcelona: J. R. Prous. Pp. 63–71.
Egan, V. G., Crawford, J. R., Brettle, R. P., & Goodwin, G. M., 1990. The Edinburgh cohort
of HIV-positive drug users: Current intellectual function is impaired, but not due to early
AIDS dementia complex. AIDS, 4, 651–656.
Evans, S., & Katona, C. 1993. Epidemiology of depressive symptoms in elderly primary care
attenders. Dementia, 4, 327–333.
Folstein, M. F., Folstein, S. E., & McHugh, P. R. 1975. Mini-Mental State: A practical method
for grading the cognitive state of patients for the clinician. Journal of Psychiatric Re-
search, 12, 189–198.
Fransella, F., & Gerver, D. 1965. Multiple regression equations for predicting reading age
from chronological age and WISC Verbal I.Q. British Journal of Educational Psychology,
35, 86–89.
Fuld, P. A. 1983. Psychometric differentiation of the dementias: An overview. In B. Reisberg
(Ed.): Alzheimer’s disease: The Stanford reference. New York: Free Press. Pp. 201–210.
Grober, E., & Sliwinski, M. 1991. Development and validation of a model for estimating
premorbid verbal intelligence in the elderly. Journal of Clinical and Experimental Neuro-
psychology, 13, 933–949.
Hart, S., Smith, C. M., & Swash, M. 1986. Assessing intellectual deterioration. British Journal
of Clinical Psychology, 25, 119–124.
Jorm, A. F., & Korten, A. E. 1988. Assessment of cognitive decline in the elderly by Informant
Interview. British Journal of Psychiatry, 152, 209–213.
Juilland, A., & Chang-Rodrı́guez, E. 1964. Frequency dictionary of Spanish words. The
Hague: Mouton.
Katz, R. B., & Sevush, S. 1987. Accurate reading by nonlexical means: A case study. Brain
and Language, 31, 252–266.
Kendrick, D. C. 1964. Assessment of pre-morbid intelligence of elderly patients with diffuse
brain pathology. Psychological Reports, 15, 188.
Martin, A., & Fedio, P. 1983. Word production and comprehension in Alzheimer’s Disease:
The breakdown of semantic knowledge. Brain and Language, 19, 124–141.
Martı́nez Espinosa, S., Delgado Villapalos, C., & Del Ser, T. Estimación del nivel intelectual
previo mediante una prueba de acentuación de palabras en sujetos normales y con deteri-
oro cognitivo leve. Unpublished data.
McKhann, G., Drachman, D., Folstein, M., et al. 1984. Clinical diagnosis of Alzheimer’s
Disease: Report of the NINCDS–ADRDA Work Group under the auspices of Department
WORD ACCENTUATION TEST 355
of Health and Human Services Task Force on Alzheimer’s Disease. Neurology, 34, 939–
944.
Miller, E. 1977. The psychological assessment of the patient with possible dementia. In: Ab-
normal ageing. The psychology of senile and presenile dementia. London: Wiley. Pp.
104–120.
Morales, J. M., González-Montalvo, J. I., Bermejo, F., & Del-Ser, T. 1995. The screening
of mild dementia with a shortened Spanish version of the ‘‘Informant Questionnaire on
Cognitive Decline in the Elderly.’’ Alzheimer Disease and Associated Disorders, 9, 105–
111.
Moss, A. R., & Dowd, T. 1991. Does the NART hold after head injury? A case report. British
Journal of Clinical Psychology, 30, 179–180.
Murdoch, B. E., Chenery, H. J., Wilks, V., & Boyle, R. S. 1987. Language disorders in demen-
tia of the Alzheimer type. Brain and Language, 31, 122–137.
Nebes, R. D., Martin, D. C., & Horn, L. C., 1984. Sparing of semantic memory in Alzheimer’s
disease. Journal of Abnormal Psychology, 3, 321–330.
Nelson, H. E., & McKenna, P. 1975. The use of current reading ability in the assessment of
dementia. British Journal of Social and Clinical Psychology, 14, 259–267.
Nelson, H. E., & O’Conell, A. 1978. Dementia: The estimation of premorbid intelligence
levels using the New Adult Reading Test. Cortex, 14, 234–244.
O’Carroll, R. E. 1987. The inter-rater reliability of the National Adult Reading Test (NART):
A pilot study. British Journal of Clinical Psychology, 26, 229–230.
O’Carroll, R. E., Baikie, E. M., & Whittick, J. E. 1987. Does the National Adult Reading
Test hold in dementia? British Journal of Clinical Psychology, 26, 315–316.
O’Carroll, R. E., & Gilleard, C. J. 1986. Estimation of premorbid intelligence in dementia.
British Journal of Clinical Psychology, 24, 157–158.
O’Carroll, R. E., Moffoot, A., Ebmeier, K. P., & Goodwin, G. M. 1992a. Estimating pre-
morbid intellectual ability in the Alcoholic Korsakoff Syndrome. Psychological Medicine,
22, 903–909.
O’Carroll, R. E., Walker, M., Dunan, J., Murray, C., Blackwood, D., Ebmeier, K. P., & Good-
win, G. M. 1992b. Selecting controls for schizophrenia research studies: The use of the
National Adult Reading Test (NART) is a measure of premorbid ability. Schizophrenia
Research, 8, 137–141.
Oyebode, J. R., Barker, W. A., Blessed, G., et al. 1986. Cognitive functioning in Parkinson’s
disease: In relation to prevalence of dementia and psychiatric diagnosis. British Journal
of Psychiatry, 149, 720–725.
Rapcsak, S. Z., Arthur, S. A., Bliklen, D. A., & Rubens, A. B. 1989. Lexical agraphia in
Alzheimer’s disease. Archives of Neurology, 46, 65–68.
Raven, J. C. 1985. Test de Matrices Progresivas para la medida de la Capacidad Intelectual.
Escala General. Manual Buenos Aires: Editorial Paidos.
Ruddle, H. V., & Bradshaw, C. M. 1982. On the estimation of premorbid intellectual function-
ing: Validation of Nelson & McKenna formula, and some new normative data. British
Journal of Clinical Psychology, 21, 159–165.
Sackett, D. L., Haynes, B. R., Guyatt, G. H., & Tugwell, P. 1991. Clinical epidemiology. A
basic science for clinical medicine. Boston: Little, Brown.
Sevush, S. 1984. Oral versus reading in Alzheimer’s disease. Neurology, 34 (Suppl. 1), 102.
Schmand, B., Bakker, D., Saan, R., & Louman, J. 1991. De Nederlandse Leestest voor Volwas-
senen: een maat voor het premorbide intelligentieniveau. Tijdschrift voor Gerontologie
en Geriatrie, 22, 15–19.
Sharpe, K., & O’Carroll, R. 1991. Estimating premorbid intellectual level in dementia using
the National Adult Reading Test: a Canadian study. British Journal of Clinical Psychol-
ogy, 30, 381–384.
SPSS Inc. 1986. SPSS user’s guide. New York: McGraw & Hill.
Strub, R. L., & Black, F. W. 1985. The Mental Status Examination in Neurology. Philadelphia:
Davis.
356 DEL SER ET AL.
Tolosa, E., Alom, J., & Forcadell, F. 1987. Criterios diagnósticos y escalas evaluativas en la
enfermedad de Alzheimer. Revista Clinica Espanola, 181 (Suppl. 1), 56–59.
Van den Broek, M. D., & Bradshaw, C. M. 1994. Detection of acquired deficits in general
intelligence using the National Adult Reading Test and Raven’s Standard Progressive
Matrices. British Journal of Clinical Psychology, 33, 509–515.
Wechsler, D. 1958. The measurement and appraisal of adult intelligence. (4th ed.). Baltimore:
Williams & Wilkins, Spanish translation. 1982. Madrid: TEA Ediciones S.A.
Williams, B. W., Mack, W., & Henderson, V. W. 1989. Boston Naming Test in Alzheimer’s
disease. Neuropsychologia, 27, 1073–1079.
Yates, A. J. 1956. The use of vocabulary in the measurement of intellectual deterioration: A
review. Journal of Mental Science, 428 (New Series No. 392), 409–440.