Beruflich Dokumente
Kultur Dokumente
Department of Psychology, University of Victoria, P.O. Box 3050 STN CSC, Victoria, BC, Canada V8W 3P5
b University of Alberta, Canada
Accepted 11 August 2005
Abstract
The individualized nature of the aging process underlines the need to have neuropsychological tests that are sensitive enough
to distinguish normal changes associated with aging from those that are pathological. However, these measures are only useful
if adequate normative data are available. Normative data are presented for two new executive functioning tasks, the Hayling and
Brixton tests, which were administered as part of a neuropsychological battery to 457 typically aging older adults (5390 years).
Advancing age was associated with poorer performance on both the Hayling and Brixton tests. Results showed that fluid intelligence
accounts for some but not all of the age-related variance on these tasks.
2005 National Academy of Neuropsychology. Published by Elsevier Ltd. All rights reserved.
Keywords: Normative data; Older adults; Executive function
The number of individuals surviving into old age is increasing dramatically as a result of factors such as better
nutrition, medical services, and efforts to adhere to a healthy lifestyle (Backman, Small, Wahlin, & Larsson, 2000;
Wahlin, 2004). However, complex interactions of these factors with other influences, such as genetics and education
have resulted in increasingly individualized trajectories of change during the aging process. Regarding cognitive
changes with aging, older adults show greater interindividual variability (between-person differences) across time
(Hultsch, Hertzog, Dixon, & Small, 1998) and in comparison to younger adults (Morse, 1993). Perhaps the most
studied and intriguing question related to variability and diversity is why some older adults develop neurodegenerative
diseases (e.g., Alzheimers disease) while others do not. The changing demographic structure of the population and
the possibility of detecting early indications of age-related diseases highlights the importance of focusing research
attention on distinguishing normal changes associated with aging from those that are prodromal or pathological. In
order to accomplish this goal, however, it is necessary to have a broad base of normative data on typically aging older
adults.
One notable area of cognitive functioning that seems to decline with age is executive functioning (e.g., Brennan,
Welsh, & Fisher; West, 1996). Executive functioning refers to higher-order processes that organize, plan, and monitor
behavior related to the context and goals of the individual. Thus, executive functioning has been characterized as potentially playing a central role in understanding a broad range of cognitive decrements occurring in aging. Two relatively
Corresponding author. Tel.: +1 250 721 8595; fax: +1 250 721 8929.
E-mail address: abielak@uvic.ca (A.A.M. Bielak).
0887-6177/$ see front matter 2005 National Academy of Neuropsychology. Published by Elsevier Ltd. All rights reserved.
doi:10.1016/j.acn.2005.08.006
142
new measures designed to assess important aspects of executive functioning are the Hayling Sentence Completion test
and the Brixton Spatial Anticipation test (Burgess & Shallice, 1997). To date, only preliminary normative data are
available for the Hayling and Brixton tests. The first comes from a relatively small sample (ns = 118121) of healthy
individuals aged 1880 years (Burgess & Shallice, 1997). Given the wide age range, relatively few participants were
over age 66 (Hayling: n = 19; Brixton: n = 18). In the second study, Andres and Van der Linden (2000) use an older
adult group (from 60 to 70 years old) to show significant age effects on both tasks in favor of younger adults (from 20
to 30 years old). Although this older group is somewhat larger (n = 48), the restricted age range offers data for only a
small window of the aged population. Clearly, more extensive normative information on older adults is required for
these two novel executive functioning tasks.
Recent research has also addressed the extent to which measures of executive functioning share variance with
indicators of fluid or crystallized intelligence. For example, Duncan, Burgess, and Emslie (1995) showed that performance on executive function tests are well predicted by measures of fluid intelligence, leading to the proposal
that indicators of fluid intelligence may really be more general measures of executive function. Consistent with this
interpretation, Rabbitt and Lowe (2000) found that following removal of variance associated with fluid intelligence,
executive functioning performance [i.e., Tower of London (TOL) and spatial working memory] no longer correlated
with age. However, executive function tasks may be designed more to measure specific components of executive functioning (e.g., planning, inhibition) than to represent the entire general construct. For example, the TOL test is purported
to assess planning, the Hayling task is believed to measure inhibition, and the Brixton task focuses on abstraction of
logical rules (Andres & Van der Linden, 2000). The distinction between the Hayling and Brixton tasks is supported by
data from patients with focal lesions, as individual cases with frontal lobe lesions that have shown double dissociations
on the Hayling and Brixton tests (Burgess & Shallice, 1994). Furthermore, data with healthy adults has found that
after controlling for age, the correlations between the two tasks disappear (Andres & Van der Linden, 2000), and in
a recent structural analysis for a sample of older adults, the Hayling and Brixton tasks loaded on a larger executive
functioning factor but shared a limited amount of variance (de Frias, Dixon, & Strauss, in press). Consequently, the
different aspects of executive functioning assessed by the Hayling and Brixton tasks may be differentially associated
with measures of intelligence.
The present study aims to fill two gaps in the literature: providing normative data from a typical aging population for
the Hayling and Brixton tests, and assessing the contribution of intelligence measures to the two tasks. The normative
dataset we provide has three important advantages. First, because the incidence of chronic illnesses increases with aging,
typical older adults will have a few medical conditions rather than none at all. Therefore, we chose to provide normative
data based on a group of typical older adults rather than on a select sample of perfectly healthy older adults. Accordingly,
our sample is arguably more representative of the general population. Second, due to the difficulty of obtaining large
samples of older adults, and to optimize the usefulness of the present normative information, we used overlapping
midpoint age ranges, as suggested by Pauker (1988). Ivnik et al. (1992) claimed that in addition to maximizing
the number of participants available, this format ensures that the person being assessed has an approximately equal
number of individuals younger and older than them in their respective age range. Thus, the use of midpoints allows
for more accurate assessments of individuals, and also appears to be the preferred format in recent neuropsychological
research (e.g., Duff et al., 2003). Finally, our sample also included participants with a wide range of education (623
years). In line with previous work, we expect to find age-related declines on these tasks. Further, we expect to find
differences between the two executive functioning tasks in the amount of variance accounted for by fluid and crystallized
intelligence. Consistent with prior research, we expect fluid intelligence to account for more variance than crystallized
intelligence in each of the two tasks, but given that the tasks may assess different components of executive functioning,
the amount of overlap with fluid intelligence may differ.
1. Method
The Hayling and Brixton tasks were administered as part a larger neuropsychological battery in the Victoria Longitudinal Study (VLS; Dixon & de Frias, 2004). The VLS includes an extensive battery of cognitive, physical, health,
sensory, and psychological measures. The neuropsychology battery was first added for VLS Sample 3 (Wave 1; tested
20002002) and Sample 1 (Wave 6; tested in 2003). Accordingly, this paper includes participants from these two
samples.
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1.1. Participants
VLS participants are community-dwelling older adults (initially aged 5585 years) living in Victoria, British
Columbia, Canada, and surrounding areas. They were originally recruited through advertisements in the public media
and through appeals to specific community groups. Initially, the sample for the present study included 673 participants
[n = 96 from Sample 1 (Wave 6); n = 577 from Sample 3 (Wave 1)], but 8 participants failed to complete the testing
protocol for their sample and wave. For the purposes of this paper, exclusionary criteria included: Mini-Mental State
Examination (MMSE; Folstein, Folstein, & McHugh, 1975) total score of 24 or less, moderate or very serious visual
or auditory impairment even with corrective aids, history of major neurological or psychiatric disease (e.g., stroke,
meningitis, schizophrenia), history of severe depression, insulin-controlled diabetes, history of moderate or very serious head injury, or diagnosed substance abuse within the past 5 years. A total of 208 participants were excluded as a
result of these criteria.
Demographic information concerning the remaining 457 participants is presented in Table 1. The sample was
further characterized by the following descriptive data: nearly all participants were Caucasian (98.2%), considered English their native language (90.4%), and had at least 12 years of education (92.1%). In addition,
more than half were married (59.5%) and approximately one third were either widowed or divorced (35.0%).
As previously mentioned, we assembled a sample of relatively typical aging adults; consequently, individuals
with some chronic diseases were included in the present analyses (see Table 1 for types and frequencies of
conditions).
To provide the broadest normative range and to maximize the clinical application of these data, we used overlapping
midpoint age ranges to constitute the groups, as suggested by Pauker (1988). Each midpoint age group included those
individuals 5 years younger and 5 years older than the midpoint of the age range. For example, the midpoint 60 age
group included those individuals aged 5565 years. However, it is important to note that the mean age of the midpoint
age groups was not always the same as the midpoint of the age range. For example, although the midpoint 85 age
group included individuals from 80 to 90 years of age, the mean age was approximately 83. Furthermore, because the
youngest participant was 53, the youngest midpoint age group included those participants who ranged from 53 to 60
years of age.
Table 1
Demographic and health variables of the final sample and age midpoints
Variable
Final
sample
Midpoint
age 57
Midpoint
age 60
Midpoint
age 65
Midpoint
age 70
Midpoint
age 75
Midpoint
age 80
Midpoint
age 85
Age range
M
(S.D.)
n
5390
68.59
(8.76)
457
5360
57.32
(1.65)
92
5565
60.19
(2.82)
180
6070
64.66
(2.90)
172
6575
69.95
(3.04)
145
7080
75.17
(2.96)
135
7585
79.41
(2.45)
112
8090
82.76
(2.38)
58
Gender (n)
Women
Men
319
138
71
21
138
42
121
51
93
52
88
47
74
38
39
19
Education
M
(S.D.)
15.23
(2.86)
15.72
(2.54)
15.68
(2.77)
15.5
(2.96)
15.13
(2.84)
14.95
(2.85)
14.66
(2.91)
14.34
(2.85)
38.0
6.5
28.2
5.4
9.8
18.5
38.3
7.8
25.0
5.0
10.6
22.8
40.7
9.9
21.5
5.8
13.4
15.6
42.1
11.0
18.6
6.9
19.3
33.1
40.0
15.6
16.3
8.2
19.3
37.8
42.9
23.2
17.0
10.7
24.1
41.1
44.8
24.1
19.0
8.6
34.5
48.3
Note: age is calculated to the exact date of the participants first testing session. Age and education are presented in years. Presence of medical
conditions is self-reported. Prevalence of depression refers to mild or moderately serious levels of depression.
144
145
Midpoint age 57
Midpoint age 60
Midpoint age 65
Midpoint age 70
Midpoint age 75
Midpoint age 80
Midpoint age 85
Age range
M
n
5360
57.34
88
5565
60.19
167
6070
64.80
161
6075
69.93
141
7080
75.11
128
7585
79.47
105
8090
82.69
55
Time to Section 1
M
4.49
(S.D.)
(5.21)
5.24
(6.65)
5.25
(6.30)
4.57
(4.34)
6.56
(7.77)
8.62
(8.64)
9.13
(6.41)
Time to Section 2
M
19.93
(S.D.)
(16.43)
20.83
(19.24)
24.80
(21.43)
34.38
(33.23)
40.41
(40.45)
43.65
(41.48)
51.38
(41.89)
Category A errors
M
0.83
(S.D.)
(1.04)
0.82
(0.98)
0.76
(0.91)
0.87
(0.01)
1.03
(1.18)
1.05
(1.28)
1.11
(1.41)
Category B errors
M
2.43
(S.D.)
(2.25)
2.23
(2.15)
2.52
(2.27)
3.33
(2.63)
3.36
(2.53)
3.30
(2.34)
3.64
(2.67)
Note: age is calculated to the exact date of the participants first testing session. Times are rounded down to nearest second and out of 15 trials.
146
Table 3
Brixton test: total number of errors by age midpoints
Variable
Midpoint age 57
Midpoint age 60
Midpoint age 65
Midpoint age 70
Midpoint age 75
Midpoint age 80
Midpoint age 85
Age range
M
n
5360
57.30
89
5565
60.19
172
6070
64.72
165
6575
69.98
143
7080
75.17
134
7585
79.36
107
8090
82.72
53
Errors score
M
16.1
(S.D.)
(5.32)
17.23
(6.86)
17.93
(7.37)
18.71
(6.93)
21.19
(8.08)
22.92
(8.53)
24.08
(7.37)
Note: age is calculated to the exact date of the participants first testing session.
section effect, F(1, 858) = 249.56, p < .001, 2 = .23. Gender did not contribute a significant effect, and there were
no significant interactions. As expected, increasing older age was associated with slower responding. This effect
was greater in Section 2 of the test, where age uniquely accounted for 10.23% of the variance in time, but only
accounted for 4.02% of the variance in time for Section 1. More years of education were associated with faster
responding, but this effect was only for significant for Section 1, where it uniquely contributed just under 1% of the total
variance.
The number of Category A (plausible) and B (somewhat related) errors by midpoint age group are presented in
Table 2. Overall, there were fewer Category A (M = 0.90, S.D. = 1.10) than Category B (M = 2.89, S.D. = 2.44) errors.
ANOVAs using age and education as continuous variables showed that only the effect of age was significant for the
total number of Category A, F(1, 428) = 4.28, p < .05, 2 = .01, and Category B errors, F(1, 428) = 13.10, p < .001,
2 = .03. Gender and education were not significant, and there were no interactions. In each case, younger individuals
responded with fewer error responses than older individuals. Age uniquely accounted for just under 1% of the total
variance for the Category A errors, and 2.97% of the variance in Category B errors.
2.2. Brixton test
Due to partial missing data, five participants were dropped from the present analyses. Table 3 presents the total
numbers of errors (M = 19.29, S.D. = 7.66) made by the remaining 441 participants (304 women, 137 men) according to
each age midpoint. Each descriptive variable exerted a significant effect in the ANOVA: age: F(1, 437) = 53.23, p < .001,
2 = .11; education: F(1, 437) = 10.05, p < .01, 2 = .02; gender: F(1, 437) = 5.35, p < .05, 2 = .01. Therefore, older age,
less education, and being female (women: M = 19.81; men: M = 18.14) were associated with making significantly more
errors. Age accounted for 10.86% of the total variance in the total errors score over and above education and gender,
which uniquely contributed 2.25% and 1.21%, respectively.
Table 4
Correlations between age, Hayling and Brixton outcome variables, Letter Series, and Vocabulary
Measure
Brixton
L. Series
Age
.34**
.20***
.32***
15**
.17**
.51***
.01
.10*
.07
.02
.02
.34***
.08
.35**
.06
.23***
.18***
.54***
.37***
.18***
.29***
.18**
.17**
.15**
.20***
.07
.09
.42***
Brixton
Total errors
Hayling
Time to Section 1 (A)
Time to Section 2 (B)
Category A errors (C)
Category B errors (D)
Letter Series
*
**
***
p < .05.
p < .01.
p < .001.
Vocabulary
147
Table 5
Correlations with age (A) before and after controlling for (B) fluid intelligence and (C) crystallized intelligence
Measure
A
Age
B
Age (fluid)
C
Age (crystallized)
Brixton
Total errors
.34***
.17**
.34***
Hayling
Time to Section 1
Time to Section 2
Category A errors
Category B errors
.20***
.32***
.14**
.16**
.10*
.18***
.05
.07
.19***
.30***
.14**
.16**
*
**
***
p < .05.
p < .01.
p < .001.
148
(M = 18). As with the Hayling results, our normative data for the Brixton task appear to be generally consistent with
those reported previously.
Even within this older adult sample, several notable age effects were detected. As expected, older age was associated
with slower responses to both sections of the Hayling test. Moreover, the impact of age was greater in the second than
in the first section; this result is consistent with previous research (Burgess & Shallice, 1997) but extends it to an
older adult sample. Age seems to exert a small, but significant unique effect in responding with connected (0.99%)
or somewhat connected responses (2.97%) in Section 2 of the Hayling test when errors are considered. Age uniquely
accounted for about 10% of the variance in time scores for Section 2 and only 4% for Section 1 scores. The direction
of this effect was expected, as young-old participants were more likely to be able to inhibit a connected response.
Overall, the impact of increasing age on performance on the Hayling task is consistent with prior research (Andres
& Van der Linden, 2000) and the hypothesis that executive functioning ability declines in older age (e.g., Brennan,
Welsh, & Fisher, 1997). The Brixton test was also sensitive to age-related decline, as was to a lesser extent having
less education and being female. The contributions of age to performance on the different outcome measures of these
two executive functioning tasks were expected, given the evidence from neuro-imaging studies of age-related changes
disproportionately affecting the frontal lobes (e.g., Jernigan et al., 1991; Murphy et al., 1996) and of studies in normal
aging suggesting that frontal lobe/executive functions may deteriorate disproportionately with advancing age (e.g.,
Moscovitch & Winocur, 1992; Stuss, Craik, Sayer, Franchi, & Alexander, 1996; West, 1996).
The second goal of this paper was to explore the relationship between the two executive functioning tasks and
two aspects of intelligence. For this older adult sample, the correlations between the two tasks were uniformally low.
Others (e.g., Andres & Van der Linden, 2000; Burgess & Shallice, 1997) have found modest (r = .24.35) correlations
between the various measures of the two tasks. Ultimately, such task-relationship questions may be best answered at
the latent variable (factor) level (e.g., de Frias et al., in press).
Our analyses demonstrated that fluid intelligence, as indicated by the Letter Series test, overlaps partly with executive
functioning, whereas crystallized intelligence appears to contribute little to individual differences in the present tasks.
Following the removal of the fluid intelligence component, each outcome measures correlation to age was reduced, but
partialing the crystallized intelligence measure produced little change. Rabbitt and Lowe (2000) showed that another
executive function task (i.e., TOL test) which may measure a different component (i.e., planning ability), became
completely uncorrelated with age once the variance associated with fluid intelligence was controlled. However, in the
present study, three of the five measures maintained small significant correlations with age (i.e., errors on the Brixton
task; time for each of the two sections on the Hayling task) even after controlling for fluid intelligence. Furthermore,
despite the purported differences in the components of executive ability assessed by the Hayling and Brixton tests,
the measures of intelligence contributed similar effects. The divergent results across studies when age and executive
functioning relationships are explored in the context of more general variables (e.g., intelligence) underscore the
contention that executive functioning may be a diverse, if not multidimensional, construct. Differences in sample
composition (e.g., typically aging versus samples with more or less compromised older adults) may also contribute to
conflicting findings. Finally, the fact that partialing fluid intelligence did not remove all of the age-related variance in
the two tasks reveals that measures of fluid and executive ability tap similar but not identical constructs.
Several limitations of the present study may be noted. First, we targeted a typically aging sample rather than a
perfectly healthy one. Through our exclusion criteria we attempted to remove participants with diseases known to
have significant cognitive implications. However, numerous participants were managing at least one chronic illness.
Although it is possible that a unique constellation of illnesses could affect performance on these executive functioning
tasks, the presentation of data from a typically aging sample is an advantage from our perspective. Second, it should
also be noted that this sample is predominantly Caucasian, highly educated, and Canadian, and subsequently is a
sample that is possibly more homogeneous than may be expected in other elderly samples. Consequently, caution
should be used when applying these norms to more heterogeneous populations. Third, we used only one measure of
both crystallized and fluid intelligence in our analyses. The Letter Series tasks shares some method variance with the
Hayling (i.e., both are timed), so future research may benefit from examining other fluid intelligence tasks. Fourth,
we followed strict and published guidelines for scoring the Hayling task, but our large sample (over 400 individuals)
produced many responses that did not neatly fall into one of the given categories. As noted above, we compiled a
supplementary scoring list and developed high inter-rater reliability. However, other research groups or clinicians may
differ in how lenient, strict, and painstaking they score the Hayling protocols. For example, some words on either
the original or our supplemental lists may not be relevant across all geographic and cultural populations. Perhaps
149
some common repository of novel and difficult-to-classify responses should be developed and published in the test
manual.
The impact of age on each of the executive functioning tasks is consistent with prior studies showing declines
in executive ability with advancing age. Furthermore, the possibility that this decline may differentiate those with
preclinical dementia from healthy controls (Crowell, Luis, Vanderploeg, Schinka, & Mullan, 2002) underscores the
importance of providing normative data for this age group.
Acknowledgments
The Victoria Longitudinal Study is supported by a grant from the U.S. National Institutes of Health (National
Institute on Aging, R37 AG008235) to Roger A. Dixon. Further information about the VLS is available at
www.ualberta.ca/vlslab/. Allison Bielak was supported by a doctoral scholarship form the Michael Smith Foundation for Health Research and the BC Medical Services Foundation. We gratefully acknowledge Paul Burgess for his
guidance in scoring the Hayling task. We also thank the VLS staff and participants for contributions to all aspects of
the study.
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