The most frequently used tests for assessing executive functions in
               aging

Faria, Camila de Assis; Alves, Heloisa Veiga Dias; Charchat-Fichman, Helenice

doi:10.1590/1980-57642015DN92000009

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Dementia & Neuropsychologia

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Original Articles • Dement. neuropsychol. 9 (2) • Apr-Jun 2015 • https://doi.org/10.1590/1980-57642015DN92000009 copy

The most frequently used tests for assessing executive functions in aging

Os testes neuropsicológicos mais utilizados para avaliar funções executivas no envelhecimento

Authorship SCIMAGO INSTITUTIONS RANKINGS

There are numerous neuropsychological tests for assessing executive functions in aging, which vary according to the different domains assessed.

OBJECTIVE:

To present a systematic review of the most frequently used instruments for assessing executive functions in older adults with different educational levels in clinical and experimental research.

METHODS:

We searched for articles published in the last five years, using the PubMed database with the following terms: "neuropsychological tests", "executive functions", and "mild cognitive impairment". There was no language restriction.

RESULTS:

25 articles fulfilled all the inclusion criteria. The seven neuropsychological tests most frequently used to evaluate executive functions in aging were: [1] Trail Making Test (TMT) Form B; [2] Verbal Fluency Test (VFT) - F, A and S; [3] VFT Animals category; [4] Clock Drawing Test (CDT); [5] Digits Forward and Backward subtests (WAIS-R or WAIS-III); [6] Stroop Test; and [7] Wisconsin Card Sorting Test (WCST) and its variants. The domains of executive functions most frequently assessed were: mental flexibility, verbal fluency, planning, working memory, and inhibitory control.

CONCLUSION:

The study identified the tests and domains of executive functions most frequently used in the last five years by research groups worldwide to evaluate older adults. These results can direct future research and help build evaluation protocols for assessing executive functions, taking into account the different educational levels and socio-demographic profiles of older adults in Brazil.

review; mild cognitive impairment; dementia; older adults; executive functions; neuropsychological tests

Names of EF tests	Predominant domain	Task description
Trail Making Test (TMT) Form B	Mental flexibility	Connect 13 numbers and 12 letters alternately and as quickly as possible.^9-10
Verbal Fluency Test (VFT) F, A and S	Verbal fluency	The test entails saying as many words a possible beginning with F, A and S in 1 minute. Participants cannot use proper nouns or use a stem word with different endings.^11-12
Verbal Fluency Test (VFT) Animals category	Verbal fluency	The entails saying as many animal names, as quickly as possible, in 1 minute, with no restrictions on first letter or any other characteristics.^{11, 13-14}
Clock Drawing Test (CDT)	Planning	Draw a clock with all the numbers and pointers marking a particular time. ^{13, 15-}¹⁹
Digits Forward and Backward subtests (WAIS-R or WAIS-III)	Working memory	In the Digits Forward subtest, the participant must repeat the numbers dictated by the examiner in the same order. In the Digits Backward subtest, the patient must repeat the same numbers in reverse order.^{13, 20}
Stroop Test	Inhibitory control	The test consists of three conditions: in the first condition, the subject must say, as quickly as possible, the names of the colors that are arranged on a card. In the second condition, the subject must say the names of the colors that the words “all”, “today”, etc. are printed in. In the third condition, the participant has to name the colors that the words “yellow”, “red”, etc. are printed in.^21-22
Wisconsin Card Sorting Test (WCST) and its variants	Mental flexibility	The test consists of cards that need to be classified according to color, shape or number categories. The categorization rules change every time 10 (out of a maximum of 128) response cards have been sorted correctly. WCST variants are versions with fewer cards.²³

Executive function tests	Frequency of test use	Percentage use, considering the 25 articles (%)	EF Domain	Study references (some studies used more than one test for the same domain)	Total studies evaluating the domain
Trail Making Test (TMT) Form B	9	36	mental flexibility	1, 29-42, 47	15
Wisconsin Card Sorting Test (WCST) and its variants	6	24
Rule Shift Cards Test (BADS)	2	8
Trail Making Test (TMT) Oral	1	4
Intra-Extra Dimensional Set Shifting (IED) of the CANTAB	1	4
VFT - F, A and S	7	28	verbal fluency	21-23, 32-33, 36, 38, 40, 42-46	13
VFT Animals category	6	24
VFT Fruits category	3	12
VFT semantics without specifying category	2	8
VFT “S”	1	4
VFT Vegetables category	1	4
VFT Supermarket category	1	4
VFT “A” of the EXIT-25	1	4
Clock Drawing Test (CDT)	6	24	Planning	1, 21-23, 31, 33, 40, 43, 45-49	13
Rey Complex Figure Copy	3	12
Action Program Test (BADS)	3	12
Key Search Test (BADS)	3	12
Zoo Map Test (BADS)	3	12
Tower of London	2	8
Setting Clock Test	1	4
Verbal Clock Test	1	4
Block Design subtest (WAIS-R)	1	4
Raven’s Colored Progressive Matrices	1	4
Digits Forward and Backward subtests (WAIS-R or WAIS-III)	6	24	working memory	21-22, 29-31, 33, 35-39, 42, 49	13
Codes subtest (WAIS-R or WAIS-III)	5	20
Arithmetic subtest (WAIS-R)	1	4
Number-Letter Sequencing subtest (WAIS-III)	1	4
Mind Control (WMS-R)	2	8
Clock Reading Test	1	4
Updating Test	1	4
SWM Strategy (CANTAB)	1	4
Cognitive Estimation Test	1	4
PaSMO	1	4
Stroop test	6	24	inhibitory control	1, 22, 29-30, 38-41, 43-45, 47, 49	13
Rule Shift Cards Test (BADS)	2	8
Inhibitory control subtest (FAB)	2	8
D-KEFS Interference Inhibition Test	1	4
Inhibitory control subtest (EXIT-25)	1	4
Hayling test	1	4
Codes subtest (WAIS-R or WAIS-III)	5	20	processing speed	30, 33, 35-37, 49	6
Simple reaction time (SRT) test (CANTAB)	1	4	processing speed	30, 33, 35-37, 49	6

Number of EF domains evaluated in study	Domain (number of studies)	Study references
1	planning (3) or mental flexibility (1)	1, 34, 47-48
2	verbal fluency (4), mental flexibility (2), planning (2) and inhibitory control (2)	23, 32, 41, 44, 46
3	working memory (7), mental flexibility (6), verbal fluency (4), planning (4), inhibitory control (4) and processing speed (2)	21, 29, 31, 35, 37, 39, 42-43, 45
4	working memory (5), mental flexibility (4), inhibitory control (4), verbal fluency (4), processing speed (3) and planning (3)	22, 30, 36, 38, 40, 49
5	mental flexibility, verbal fluency, planning, working memory, processing speed	33

Academia Brasileira de Neurologia, Departamento de Neurologia Cognitiva e Envelhecimento R. Vergueiro, 1353 sl.1404 - Ed. Top Towers Offices, Torre Norte, São Paulo, SP, Brazil, CEP 04101-000, Tel.: +55 11 5084-9463 | +55 11 5083-3876 - São Paulo - SP - Brazil
E-mail: revistadementia@abneuro.org.br | demneuropsy@uol.com.br

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[1] Camila de Assis Faria. Pontifícia Universidade Católica do Rio de Janeiro - Rua Marquês de São Vicente, 225, Gávea - 22451-900 Rio de Janeiro RJ - Brasil. E-mail : camila_psic@yahoo.com.br