A Quick Test of Cognitive Speed: Preliminary Screening Criteria for Arabic-Speaking Adults, Ages 40 to 80 Years

Abstract

A Quick Test of Cognitive Speed (AQT) color, form, and color-form scales were administered to 90 educated (5-22 years of education) and 45 uneducated (0-2 years of education) healthy, Arabic-speaking adults. Lognormal (In) transformations of time measures (sec.) were used for statistical analyses. There were statistically significant mean differences for the color-form processing-speed measures between middle-aged (ages 40-50) and older (ages 51-80) educated adults and between educated and uneducated adults (ages 40-78). The study developed preliminary criterion cut-off times for color-form naming for screening educated and uneducated Arabic-speaking adults. The normal, slower-than-normal, and atypical/pathological performance ranges were characterized with frequency distributions and standard deviations. Age and education are factors that must be considered in stratifying samples in future studies to develop valid and reliable criteria for cognitive screening of Arabic speakers with the AQT.

Full text

ISSN 0031-5125DOI 10.2466/03.22.PMS.117x20z3
© Perceptual & Motor Skills 2013
Perceptual & Motor Skills: Physical Development & Measurement
A QUICK TEST OF COGNITIVE SPEED: PRELIMINARY SCREENING
CRITERIA FOR ARABIC-SPEAKING ADULTS, AGES 40 TO 80 YEARS
1 , 2
ELISABETH H. WIIG
Communication Disorders, Boston University
Knowledge Research Institute, Inc., Arlington, Texas
YOUSEF AL-HALEES
Communication Disorders, University of Jordan, Amman
Summary .— A Quick Test of Cognitive Speed (AQT) color, form, color-form, num-
ber and color-number naming scales were administered to 90 educated (5–22 years
of education) and 45 uneducated (0–2 years of education) healthy, Arabic-speaking
adults. Lognormal ( ln) transformations of time measures (sec.) were used for sta-
tistical analyses. There were statistically signifi cant mean diff erences for the color-
form processing-speed measures between middle-aged (ages 40–50) and older (ages
51–80) educated adults and between educated and uneducated adults (ages 40–78).
The study developed preliminary criterion cut-off times for color-form naming for
screening educated and uneducated Arabic-speaking adults. The normal, slower-
than-normal, and atypical/pathological performance ranges were characterized
with frequency distributions and standard deviations. Age and education are fac-
tors that must be considered in stratifying samples in future studies to develop
valid and reliable criteria for cognitive screening of Arabic speakers with the AQT.
The Arabic-speaking Middle Eastern population over age 65 has
been estimated to increase from 16.7 to 44.1 million between 1997 and
2025 ( Cummings, 2003 ). At the same time, the number of Arabic-speaking
immigrants to, for example, Western European and Scandinavian coun-
tries with universal health care has increased ( Nørskov, 2010 ). The Arab
population in Europe is estimated at 5 million
3 and the number of Arabic
speakers in the USA at 700,000. Cognitive aging in healthy adults has been
the focus of extensive studies, notably in Western societies ( Sachdev, 2003 ;
Fleischman, Wilson, Gabrieli, Bienias, & Bennett, 2004 ; Jacobson, Nielsen,
Minthon, Warkentin, & Wiig, 2004 ; Salthouse, 2004 ), but not in Arabic-
speaking, Middle Eastern societies. Few, if any, processing speed tests
2013, 117, 2, 1-12.
1 Address correspondence to Elisabeth H. Wiig, 2131 Refl ection Bay Drive, Arlington, Texas
76013, USA or e-mail ( ehwiig@krii.com ).
2Professor Emeritus Yousef Al-Halees, Ph.D., Communication Disorders, Faculty of Arts and
Sciences, University of Jordan, Amman, Jordan collected the data for this study with insti-
tutional approval. The author, on behalf of Professor Al-Halees, expresses gratitude to the
University of Jordan and to the participants for supporting this preliminary investigation.
The study did not receive external funding.
3http://en.wikipedia.org/Arabs_in_Europe.

E. WIIG & Y. AL-HALEES
2
have been norm-referenced for Arabic-speaking adults. It is important to
provide culture-free, objective, behavioral measures in Arabic to diff eren-
tiate normal cognitive aging from memory impairments caused by disease
processes. Because cognitive performance varies due to hereditary, devel-
opmental, educational, or environmental factors, it is necessary to develop
normative criteria for each culture and language for which a cognitive test
is intended ( Mejia, Gutierrez, Villa, & Ostrosky-Solis, 2003 ; Meija, Miguel,
Gutierrez, Villa, & Ostrosky-Solis, 2006 ; Nielsen & Wiig, 2006 ). The Quick
Test of Cognitive Speed (AQT) provides objective, timed measures of execu-
tive functioning and is proven to have broad cultural and linguistic appli-
cation ( Wiig, Nielsen, Minthon, & Warkentin, 2003 ; Nielsen & Wiig, 2006 ).
These factors prompted collection of normative data for healthy, educated,
Arabic-speaking adults and from uneducated adults for comparison.
The AQT uses a sustained rapid-naming format to assess process-
ing speed by measuring the time required to complete relatively simple
naming tasks with controlled input ( Wiig, Nielsen, Minthon, & Warken-
tin, 2002 , 2003 ). The subtests measure reaction, retrieval, and response
times, time to make choice decisions, and shifting cognitive set. The mea-
sures are sensitive to small changes in the time used for processing and
responding. Sustained naming causes specifi c redistribution of cerebral
blood fl ow for the particular stimuli and tasks. During AQT color-form
combination naming, blood fl ow in healthy adults consistently increases
in the posterior temporal-parietal brain regions bilaterally and in subcor-
tical regions, including the hippocampus, while fl ow to frontal regions is
suppressed ( Wiig, et al., 2002 , 2003 ; Wiig, Nielsen, Minthon, McPeek, Said,
& Warkentin, 2002 ; Wiig, Nielsen, Minthon, & Jacobson, 2008 ). The acti-
vated regions are involved in the cognitive control of executive attention,
cognitive shifting, visual working memory, and automaticity of retrieval
( Baddeley, Bressi, Della Sala, Logie, & Spinnler, 1991 ; Downing, 2000 ;
Turken, Gabriel, Bammer, Baldo, Dronkers, & Gabrieli, 2008 ; Esterman,
Chui, Tamber-Rosenau, & Yantis, 2009 ; Berryhill, Chein, & Olson, 2011 ).
The AQT color, form, and color-form measures have been used to com-
pare eff ects of Alzheimer's disease and dementia with Lewy bodies on
cognition and to identify individual responsiveness to specifi c medica-
tion for Alzheimer's disease ( Andersson, Wiig, Londos, & Minthon, 2007 ;
Palmqvist, Minthon, Wattmo, Londos, & Hansson, 2010 ; Wiig, Annas,
Basun, Andreasen, Lannfelt, Zetterberg, et al., 2010 ; Palmqvist, 2011 ).
Among the AQT's statistical characteristics are (a) high rest-retest reli-
ability ( r = .84 to .96), (b) statistically non-signifi cant diff erences in per-
formances of men and women, (c) statistically non-signifi cant eff ects of
education after achieving literacy (Grades 8 and above), and (d) absence
of habituation and learning ( Wiig, Nielsen, Minthon, & Warkentin, 2002 ;

COGNITIVE SCREENING: ARABIC NORMS 3
Jacobson, et al., 2004 ; Nielsen & Wiig, 2006 ). There are statistically signifi -
cant but small increases in AQT processing speed with age for color-form
combinations among American-English speaking adults; these are about 1
sec. per decade under age 60 and 1 sec. per seven years after age 60 ( Jacob-
son, et al., 2004 ). Criterion cut-off times (sec.) for processing speed do not
diff er for English- and Scandinavian-speaking adults ( Wiig, Nielsen, Mint-
hon, & Warkentin, 2002 , 2003 ). In this study, the primary objective was to
obtain normative data for the AQT color-form processing speed tests for
cognitive screening of educated, Arabic-speaking adults. The second goal
was to compare processing speed measures among healthy, middle-aged
and older, educated and uneducated Arabic-speaking adults.
M ETHOD
Participants
There were 90 typically aging, educated adults (66 men; 24 women)
and 45 uneducated adults (14 men; 31 women). Participants were recruited
from contacts within the University of Jordan, the local mosque and its
community, and all of them volunteered. A health-wellness questionnaire,
designed by the researchers, with 10 questions, was administered for
inclusion. Of these, six questions asked for recent changes in habitual pat-
terns of eating, sleeping, work habits, social activities, and mood. Four
questions asked for the presence of untreated heart disease, past neurolog-
ical and psychiatric disorders, and familial dementia. Volunteers were not
excluded based on obesity or treated diabetes. Nine potential participants
were excluded based on past medical conditions (e.g., heart surgery) or
present changes in wellness patterns (e.g., mood and sleep patterns). The
participants gave informed consent in accordance with the Declaration of
Helsinki. All lived within the larger community of Amman, were natives
of Jordan and led functionally independent lives, holding low-level voca-
tional or professional jobs, depending on their educational level, and per-
formed societal responsibilities in their families and homes. Therefore, all
were presumed to function within the typical cognitive range for their age
and to be free of major interfering cognitive impairments.
The participants were fi rst grouped by level of education. This was
indicated by 2011 estimates that 66.7% of Jordanians aged 55 years and
above were illiterate and literacy rates were higher for men than for
women ( Anonymous, Jordan Times , 2012 ). Five years of formal education,
equivalent to having completed primary education (ages 6–11 years) ( Al-
No'aimi, 2008 ), formed the lower limit for the educated groups and two
years, corresponding to preschool, formed the upper limit for the unedu-
cated group. Within the educated group, 24% completed primary school,
49% secondary school, and 27% post-secondary education. Based on an

E. WIIG & Y. AL-HALEES
4
average life expectancy of about 74 years and of 71 years for males
4 , age
50 was chosen a priori to divide the participants into younger and older
groups. Group I (educated) with 45 adults (ages 40–50 years; M = 46.3 yr.,
SD = 3.6) had from 5–18 years of education ( M = 12.26, SD = 3.54). Group
II (educated) with 45 adults, ages 51–80 years ( M = 61.7 yr., SD = 6.3) had
from 5–22 years of education ( M = 10.3 yr., SD = 4.8). Group III (unedu-
cated) with 45 adults, ages 41–78 years ( M = 53.9, SD = 9.2) had between
zero and two years of formal education ( M = 0.6 yr., SD = 1.0). Group III
was further divided into (a) 22 adults, ranging in age from 41–50 years,
and (b) 23 adults, ranging in age from 50–78 years.
Measures
Of the AQT subtests, two require rapid naming of 40 single-dimen-
sion visual stimuli (colors or forms), measuring reaction, retrieval, and
response times. One requires rapid naming of 40 dual-dimension stim-
uli (color-form combinations), measuring reaction, response, and retrieval
times, and ‘switch cost,’ caused by co-articulating two stimulus labels.
The dual-dimension test also measures cognitive demands on executive
functions such as attention, working memory, and set-shifting.
Procedure
The AQT color, form, and color-form processing-speed tests were
administered in Arabic to all participants by Professor Yousef Al-Halees,
Ph.D., University of Jordan, Amman, Jordan. Familiarization trials estab-
lished adequacy and consistency in naming the stimuli. The order of
administration was fi xed with color naming, followed by form and color-
form naming. Total naming, time for each set of 40 stimuli was recorded
digitally in seconds and fractions of seconds, beginning with voice onset.
Analysis
Naming times (sec.) and lognormal ( ln ) transformations for each test
provided the basis for data analyses (IBM SPSS Statistics Version 21). The
analyses produced descriptive statistics and tested distributions for nor-
mality (Shapiro-Wilks W ). Multivariate analysis of variance (MANOVA)
tested the statistical signifi cance of mean diff erences between-groups.
Pearson correlations ( r ) explored relations between AQT naming mea-
sures ( ln ) and age and education. Frequency distributions, means, and
standard deviations for Groups I and II (educated adults) and IIIa and b
(uneducated adults) were used to establish preliminary processing speed
criteria (sec.) for the typical, slower-than-typical and atypical/pathologi-
cal performance ranges.
4www.indexmundi.com.

COGNITIVE SCREENING: ARABIC NORMS 5
R ESULTS
Descriptive statistics for color, form, and color-form naming times
(sec.) for Groups I and II (educated), and IIIa and b (uneducated) are
reported in Table 1 . Shapiro-Wilks W indicated that age in the total group
of educated ( n = 90) and uneducated adults ( n = 45) met normality criteria,
whereas naming time distributions (sec.) for the majority of the processing
speed measures did not. Therefore, all naming time measures were trans-
formed to lognormal ( ln ) measures for statistical comparisons of means
for Groups I, II, and IIIa and b. Adults in Groups I and II made a max-
imum of three naming errors for color-form combinations, and naming
errors were not further analyzed for criterion-referencing.
The correlations (Pearson r ) among age, education, and color-form
naming times ( Nielsen, Wiig, Warkentin, & Minthon, 2004 ; Warkentin,
Tsantali, Kiosseoglou, Minthon, Wiig, Nielsen, et al., 2005 ; Andersson, et
al., 2007 ; Palmqvist, 2011 ) were calculated in the educated adults ( n = 90).
In the total educated group, the correlations between age and color nam-
ing ( r = .54), form naming ( r = .52), and color-form naming ( r = .58) were
all statistically signifi cant ( p s < .01), and eff ect sizes were large. In Group I,
correlations between years of education and color naming ( r = –.37), form
naming ( r = –.53), and color-form naming ( r = –.35) met a priori criteria for
statistical signifi cance ( p s > .01). In Group II, correlations between years of
education and color naming ( r = –.37), form naming ( r = –.50), and color-
form naming ( r = –.34) also were statistically signifi cant ( p s < .01). Eff ect
sizes for education ranged from medium to large in both groups.
Multivariate analysis of variance (MANOVA) in an unbalanced design
compared means and evaluated the infl uence of age and education on
color, form, and color-form naming times (after ln transformation). The
TABLE 1
D ESCRIPTIVE STATISTICS FOR A QUICK TEST OF COGNITIVE SPEED (AQT) BY AGE AND
EDUCATION GROUPS ( N = 135)
AQT
Group I
( n = 45)
Group II
( n = 45)
Group IIIa & b
( n = 45)
M SD M SD M SD
Color (sec.) 24.64 4.69 30.76 7.59 (a) 56.86
(b) 74.91
26.34
28.27
Form (sec.) 27.73 5.27 35.47 11.41
(a) 71.05
(b) 87.61
30.99
25.83
Color-form (sec.) 50.96 12.88 66.64 17.67
(a) 123.45
(b) 138.91
47.43
42.10

E. WIIG & Y. AL-HALEES
6
corrected model indicated statistically signifi cant diff erences for color
( F 3, 131 = 77.27), form ( F 3, 131 = 99.42), and color-form ( F 3, 131 = 84.54) ( ps < .01),
and the observed power was high for all (1.00). The results indicated no
signifi cant interaction eff ects ( ps > .05) for age × education for color ( F 1, 131 =
0.75), form ( F 1, 131 = 0.05), and color-form ( F 1, 131 = 1.73), and the observed
power was low for all measures. Diff erences between age groups were sta-
tistically signifi cant ( ps < .01) for color ( F 1, 131 = 19.28; η
2 = 0.96), form ( F 1, 131 =
17.85; η
2 = 0.95), and color-form ( F 1, 131 = 14.25; η
2 = 0.88), and the observed
power was high for all measures. Pairwise comparisons for the dependent
variable age indicated that naming times ( ln ) were consistently longer for
the older than for the middle-aged groups for all AQT measures ( ps < .01).
Diff erences between levels of education also proved signifi cant ( ps < .01)
for color ( F 1, 131 = 210.36, η
2 = ), form ( F 1, 131 = 277.08, η
2 = ), and color-form
( F 1, 131 = 231.00, η
2 = ), and the observed power was high for all measures.
Pairwise comparisons for level of education indicated that naming times
( ln ) were signifi cantly longer for the uneducated than for the educated
groups for all AQT measures ( ps < .01).
Two methods were used to develop preliminary normative ranges for
typical, slower-than-typical, and atypical/pathological naming times for
color, form, and color-form naming and number and color-number nam-
ing subtest performances for Groups I, II, and III. The color-form mea-
sures have been used extensively in research and have proved sensitive in
identifying mild-to-moderate cognitive impairments ( Anderson, et al., 2007 ;
Palmqvist, et al., 2010 ; Wiig, et al., 2010 ; Palmqvist, 2011 ). The methods
used to specify performance time ranges in normative samples of Amer-
ican and Scandinavian speakers ( Wiig, Nielsen, Minthon, & Warkentin,
2002 , 2003 ) were duplicated. In the fi rst method, naming times (sec.) cor-
responding to +1 SD above the mean indicated the upper limits of typical
performance. Naming times corresponding to +2 SD above the mean indi-
cated the lower limits of atypical (potentially pathological) performance.
In the second method, naming times (sec.) corresponding to a cumula-
tive frequency of 84% indicated the upper limits of the typical perfor-
mance ranges. Naming times corresponding to a cumulative frequency
of 98.5% indicated the lower limits of atypical, potentially pathological
performance. The results of the two methods were compared to assess the
best fi t and approximate cut-off times (sec.) that would lend parsimony
and ease of reference for screening Arabic-speaking adults. The criterion
cut-off times for color-form naming along a performance continuum are
shown for the educated 40–50 and 51–80 year-olds (Groups I and II) and
for the 40–78 year-old uneducated adults (Group III) in Table 2 .
The cut-off naming times for the educated Arabic speakers proved
higher than previously observed for educated American-English speakers
AQ: 1 & 2
AQ: 3

COGNITIVE SCREENING: ARABIC NORMS 7
( Wiig, et al., 2002 ). To explore potential cross-linguistic diff erences fur-
ther, 45 middle-aged American adults, ages 38–50 years ( M = 44.2, SD =
2.6), and 45 older adults, ages 51–80 years ( M = 62.6, SD = 3.9), were
selected from existing samples ( Wiig, et al., 2007 ; Nielsen & Wiig, 2011 )
and matched for sex and age within two years. Naming time means for
the 38- to 50-year-olds (Group I) were 21.78 sec. ( SD = 3.90) for color, 24.09
sec. ( SD = 3.44) for form, and 47.09 sec. ( SD = 7.43) for color-form. Nam-
ing time means for the 51- to 80-year-olds (Group II) were 23.31 sec. ( SD =
3.95) for color, 27.8 sec. ( SD = 5.83) for form, and 52.29 sec. ( SD = 8.94) for
color-form.
MANOVA with a balanced design tested for the signifi cance of dif-
ferences resulting from language and age-level. The corrected model indi-
cated signifi cant diff erences for color ( F 3,176 = 20.44, η
2 = 1.00), form ( F 3,176 =
19.39, η
2 = 1.00), and color-form ( F 3,176 = 19.38, η
2 = 1.00) ( p s < .01). Lan-
guage × age interactions for color ( F 1,176 = 4.11, η
2 = 0.28), form ( F 1,176 = 1.48,
η
2 = 0.09), and color-form ( F 1,176 = 5.18, η
2 = 0.37) did not meet a priori cri-
teria for signifi cance ( p s > .01). Diff erences between languages proved sig-
nifi cant ( p s < .01) for color ( F 1,176 = 39.93, η
2 =1.00), form ( F 1,176 = 28.23, η
2 =
0.99), and color-form ( F 1,176 = 16.93, η
2 = 0.93). Pairwise comparisons for
the dependent variable language indicated that naming times ( ln ) were
signifi cantly longer for Arabic than for English speakers ( p < .01). Diff er-
ences between age levels also proved signifi cant ( ps < .01) for color ( F 1,176 =
17.27, η
2 = 0.94), form ( F 1,176 = 28.45, η
2 = 0.99) and color-form ( F 1,176 = 36.04,
η
2 = 1.00). Pairwise comparisons for the dependent variable age indicated
TABLE 2
C RITERION-REFERENCES CUT-OFF TIMES FOR A QUICK TEST OF COGNITIVE SPEED
SUBTESTS BY
AGE AND EDUCATION GROUPS ( N = 135)
Groups Normal Range Slower-than-Normal Atypical Range
I. Ages 40–50 yr.
Color < 30 sec. 31–34 sec. > 35 sec.
Form < 30 sec. 31–39 sec. > 40 sec.
Color-form < 65 sec. 66–74 sec. > 75 sec.
II. Ages 51–80 yr.
Color < 35 sec. 36–44 sec. > 45 sec.
Form < 45 sec. 46–54 sec. > 55 sec.
Color-form < 85 sec. 66–99 sec. > 100 sec.
III. Ages 41–78 yr.
Color < 95 sec. 96–125 sec. > 125 sec.
Form < 110 sec. 111–139 sec. > 140 sec.
Color-form < 175 sec. 176–219 sec. > 220 sec.
AQ: 4
AQ:5

E. WIIG & Y. AL-HALEES
8
that naming times ( ln ) for all AQT measures were consistently longer for
the older than for the middle-aged groups ( ps < 0.01). Cut-off times were
subsequently developed for the American adults based on these data. A
comparison of cut-off times for the educated Arabic and American adults
is presented in Table 3 .
D ISCUSSION
This study resulted in preliminary naming-time criteria for the AQT
color-form naming tests for culturally and linguistically representative
groups of educated and uneducated Arabic-speaking adults. The gender
bias in the educated and uneducated groups is considered to refl ect cul-
turally dependent diff erences in education and concurs with estimates for
literacy rates in Jordan ( Anonymous, Jordan Times , 2012 ). Among educated
Arabic-speaking adults, age was correlated with naming times for color,
form, and color-form naming ( r = .54, .52, and .58, respectively), and eff ect
sizes were large. This concurs with prior fi ndings for American adults,
although correlations were lower ( r s = .37, .44, and .30, respectively) and
eff ect sizes were medium ( Wiig, et al., 2007 ). Age contributed about one-
third of the variance in color-form naming among educated Arabic speak-
ers. This and life expectancy estimates supported the development of
separate criterion-referenced cut-off times for the educated speakers of
Arabic below and above 50 years of age.
MANOVA indicated no statistically signifi cant interactions between
age and level of education for any of the AQT measures among Arabic
adults, and eff ect sizes were low. Age aff ected color, form, and color-
form naming speed between the middle-aged and older Arabic adults,
and eff ect sizes were high. Level of education also aff ected all naming
times, both within the educated groups and between the educated and
uneducated groups, and eff ect sizes were high. In both the educated and
uneducated groups, middle-aged adults exhibited lower naming times
(greater speed) than older adults. This supported a priori hypotheses
that processing speed would be faster for all measures among middle-
TABLE 3
D IFFERENCES IN NORMAL RANGE CUT-OFF TIMES BETWEEN ARABIC GROUPS I/II ( N = 90) AND
AMERICAN GROUPS I/II ( N = 90)
Normal range cut-off Eff ect size of diff erence
Arabic
(Group I)
Arabic
(Group II)
American
(Group I)
American
(Group II)
Arabic versus
American
Color < 30 sec < 35 sec < 25 sec < 30 sec η
2 = 1.00
Form < 30 sec < 45 sec < 30 sec < 35 sec η
2 = 0.99
Color-form < 65 sec < 85 sec < 55 sec < 60 sec η
2 = 0.93

COGNITIVE SCREENING: ARABIC NORMS 9
aged than among older educated and uneducated Arabic-speaking
adults. In turn, educated adults exhibited lower naming times (greater
speed) than uneducated adults for all measures. These diff erences are
best explained by educational levels and indirectly by socio-economic
factors.
This is the fi rst normative study using the AQT color-form naming
subtest that has shown years of education to infl uence naming times.
Among American English speakers, education has not been reported to
infl uence processing speed in adults after Grade 8. In those studies, no
adults were included who were not in Grade 8 or who had completed less
than 8 years of formal education. However, a study of processing speed
by educated (literate) and uneducated (illiterate) West-African speakers
of Krio also reported signifi cantly longer naming times for uneducated
adults, but color-form naming was not included and eff ect sizes for the
statistical comparisons were not reported ( Nielsen & Wiig, 2006 ). In that
study, naming time means for color-number and color-animal name com-
binations were signifi cantly ( ps < .01) longer for the 41 uneducated (73.10
and 82.98 sec., respectively) than for the 123 educated adults (55.30 and
76.13 sec., respectively). The reason that years of education resulted in
large group diff erences in this study may in part be explained by the fact
that a relatively large proportion of the educated Arabic adults (24%) com-
pleted only 5–6 years of formal education (primary school). These adults
would be expected to have attained less verbal automaticity for naming
basic colors and forms as a result of education, and therefore would have
required more time to complete the naming tasks.
It is remarkable that the group means for the Arabic speakers con-
form to the AQT additive model for color-form naming ( Nielsen & Wiig,
2011 ). According to this model, the sum of the means for color and form
naming times approximates the mean for color-form naming. This fi nd-
ing suggested that cross-cultural diff erences between American and Ara-
bic speakers may have resulted from linguistic factors such as syllable
length. An account of syllable length for the Arabic words indicates that
the color names /aħmr/, /azrq/, /asfr/, and /asu:d/, presented in the
International Phonetic Alphabet (IPA), contain two syllables each. The Ara-
bic form names /dæ:airæh/, /muθælæθ/, and /muræbæ/ contain three
syllables each and /xt/ (straight or not straight line) one syllable. In com-
parison, the English color words ‘red,’ ‘blue,’ and ‘black’ contain one syl-
lable each, and ‘yellow’ contains two syllables. The English form names
‘circle,’ ‘square,’ and ‘line’ contain one syllable each, and ‘triangle’ two syl-
lables. Thus, the possible Arabic color-form combinations would range
from a minimum of three syllables to a maximum of six syllables, while the
English equivalents would range from two to a maximum of four syllables.

E. WIIG & Y. AL-HALEES
10
To further explore the infl uence of linguistic factors, subsequent com-
parisons of color, form and color-form naming times were performed for
age- and sex-matched, educated Arabic and American English speakers.
MANOVA indicated no signifi cant interactions ( p > .01) between age and
language for color, form, or color-form naming, and eff ect sizes were
small. Age-level diff erences were signifi cant for both Arabic and American
speakers, and eff ect sizes were large. As expected, naming times were sig-
nifi cantly longer for the older for than the middle-aged Arabic and Ameri-
can adults. Diff erences between speakers of Arabic and American adults
also were signifi cant, and eff ect sizes were large. Naming times proved
signifi cantly longer for Arabic than for American adults, and eff ect sizes
were large. These diff erences resulted in the cut-off time criteria (sec.)
for color-form naming for educated Arabic adults that were 5 sec. longer
for color and 25 sec. longer for color-form naming than for the American
adults in the present sample.
The number of naming errors was low among the educated speakers
of Arabic, with a maximum of two errors for single-dimension and three
errors for dual-dimension naming. This fi nding agrees with observations
for healthy American and Scandinavian adults ( Wiig, Nielsen, Minthon, &
Warkentin, 2002 , 2003 ). A larger-than-expected number of naming errors,
more than two or three, would indicate self-monitoring problems. Clearly,
cross-cultural criterion referencing for the AQT color-form naming time
measures must account for diff erences in age as well as in years of education.
One of the limitations of this study is that the two age groups (Groups
I and II) contained only 45 adults each, when samples of 50–100 would
have been desirable. Moreover, the limited sample size ( n s = 22 and 23)
for the two age groups of uneducated adults places severe restrictions on
both interpretation and application of the fi ndings for these groups. A sec-
ond limitation relates to the lack of stratifi cation by age in the older edu-
cated group of Arabic speakers, a limitation that results from the restricted
sample size. Studies with larger samples of participants with better strat-
ifi cation based on both age and years of education should provide more
reliable and valid performance criteria. A third important limitation is that
the study did not assess the clinical utility of the preliminary norm-refer-
enced criteria for AQT single- and dual-dimension processing speed for
cognitive screening of Arabic-speaking adults.
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Accepted September 17 , 2013 .
AQ:6

AUTHOR QUERIES
AQ1: Please add eff ect size.
AQ2: Please add eff ect size.
AQ3: Please add eff ect size.
AQ4: Eta square is eff ect size, not power; please check the numbers.
AQ5: Which Wiig et al., 2002 reference is this? There are two.
AQ6: What was the date of this conference?