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4.6 Validation of The PASAT in Argentina
4.6 Validation of The PASAT in Argentina
4.6 Validation of The PASAT in Argentina
To cite this article: Sandra Vanotti, Maria Barbara Eizaguirre, Evangelina Valeria Cores, Cecilia
Yastremis, Orlando Garcea, Pablo Salgado & Fernando Cáceres (2016): Validation of the PASAT
in Argentina, Applied Neuropsychology: Adult, DOI: 10.1080/23279095.2015.1092150
Article views: 24
Download by: [RMIT University Library] Date: 19 April 2016, At: 15:47
APPLIED NEUROPSYCHOLOGY: ADULT
http://dx.doi.org/10.1080/23279095.2015.1092150
ABSTRACT KEYWORDS
The Paced Auditory Serial Addition Test (PASAT) is one of the most used neuropsychological tests Normative data;
to assess information processing speed and working memory in brain injured patients. This study neuropsychological test;
was carried out with the purpose of obtaining normative data for the PASAT-3″ in a healthy PASAT-300 ; processing speed;
working memory
Argentinean population, which would result in a reference control population. The PASAT-3″ was
administered in a sample of 296 healthy voluntary subjects, born and living in Argentina. The age
range went from 20 to 70 years-old. The level of education was 0 to 13 or more years of schooling.
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The sample obtained a mean of 44.60 (SD ¼ 10.72) in the PASAT-3″. It was found that the score
obtained in the PASAT-3″ was related to the age and the level of instruction of the participants.
Their performance diminished as age increased and, conversely, it increased as the level of
instruction was higher. Normative data was obtained for a Latin American population from
Argentina. Percentile distributions obtained by decades of age and different levels of education
should be considered as useful reference values for clinicians and investigators when applying the
PASAT-3″ to assess cognitive function in different pathologies.
The Paced Auditory Serial Addition Test (PASAT) is one Rao (1990)—which is recommended for inclusion in a
of the neuropsychological tests most widely used for clinical assessment measure of MS such as the
assessing information-processing speed and working Multiple Sclerosis Functional Composite (Rudick et al.,
memory at an auditory/verbal level (Spreen & Strauss, 1997).
1998). Initially, the PASAT was designed to evaluate In the neuropsychological clinical practice, to classify
the decline in information-processing speed in patients the performance of a patient with cerebral damage as
with traumatic brain injury (TBI; Gronwall, 1977; normal or pathological, it is necessary to count on
Sampson, 1956), but then clinicians began to implement reliable normative data. Also, normative studies should
it in patients with other pathologies, such as systemic take into account several variables that may affect test
lupus erythematosus (Shucard et al., 2004). Clinicians performance. However, it is not adequate to use popu-
also started to administer the PASAT to college lation-based normative data from other countries, as
football players 24 hr after suffering a mild concussion specific cultural variables influence test performance
(Macciocchi, Barth, Alves, Rimel, & Jane, 1996). (Ardila, 2005). These variables affect not only verbal
Tombaugh (2006) conducted an extensive study on the tasks, but also nonverbal tests (Rosselli & Ardila,
scope of administering the PASAT to patients with 2003). It has been recognized that the subjective values
TBI and concluded that the test is highly sensitive for affected by culture—such as processing speed—play an
patients with severe TBI. The PASAT is also considered important part in performance during the assessment
to be one of the most sensitive tools for evaluating of cognitive function (Ardila, 2005). Because in
cognitive dysfunction in multiple sclerosis (MS; Forn, Argentina there is a lack of updated normative data
Belenguer, Parcet-Ibars, & Ávila, 2008). for the PASAT, the aim of the present study was to
There have been several adaptations of the test. One is obtain normative data for the PASAT-3″ in a healthy
the PASAT-2″—the version used by Levin, Benton, and population in Argentina and to analyze the impact of
Grossman (1982)—which was developed to reduce variables such as age and level of instruction. The second
patient fatigue and practice effects after trials. Another aim was to compare the performance of healthy parti-
adaptation is the PASAT-3″—a version developed by cipants in the first half and the second half of the test.
CONTACT Sandra Vanotti svanotti@ineba.net Clinic of Multiple Sclerosis, INEBA Neurosciences Institute of Buenos Aires, Guardia
Vieja 4435, Buenos Aires, C1192AAW, Argentina.
Color versions of one or more of the figures in the article can be found online at www.tandfonline.com/hapn.
© 2016 Taylor & Francis
2 S. VANOTTI ET AL.
Method and materials was employed for paired samples. For all analyses, the
established alpha level was .05.
A sample of 296 healthy participants was analyzed: 105
men and 191 women aged 20 to 70 years old. Parti-
cipants’ mean age was 43.95 years (SD ¼ 16.31), and Results
the mean instruction level was 11.69 years (SD ¼ 4.42).
Participation was voluntary; all participants resided in The sample obtained a mean score of 44.60 (SD ¼ 10.72)
Buenos Aires, Argentina, and spoke Spanish. The on the PASAT-3”. Means and standard deviations for
inclusion criteria stated that the participants should each group of age and level of instruction are shown
possess a Mini Mental State Examination score greater in Table 1.
than 26 points (Folstein, Folstein, & McHugh, 1975), As shown in Figure 1, the probability density
whereas the exclusion criteria included substance abuse, distribution of the data observed in the PASAT-3”,
systemic pathologies that could cause cognitive degener- “smoothed” due to adjustments in the Kernell function,
ation, or a history of mental disorder. Variables such as does not obey any usual parametric function, but rather
age and level of instruction were taken into consider- appears to be right-censored. In fact, the construct to be
ation. The former was divided into five groups, each measured is, theoretically, a non-negative number that
one representing one decade: 20 to 30 years old, 31 to the tool produces by counting values with a maximum
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40 years old, 41 to 50 years old, 51 to 60 years old, and observed value (60) as reference, a limit beyond which
61 to 70 years old. The latter was classified into three the construct appears to be “censored.”
groups: participants who had 7 years of instruction or First, the simultaneous relationship between age and
less, those who had 8 to 12 years of instruction, and level of instruction (in years) and the PASAT-3” score
lastly, those with more than 12 years of instruction. was analyzed for exploratory purposes. A structured
Ten professionals specially trained in psychometric additive regression model was used to assess the
testing implemented the PASAT-3′’ in standard, independent effect of each variable and the way these
homogeneous conditions. The study was approved by variables interacted with one another.
the local Ethics Committee and all the participants Figures 2 and 3 show the results of the structured
signed an informed consent. additive regression model, where the relationship
Rao’s (1990) version was used in the administration between level of instruction (in years) and age can be
of the test. The required materials were an audio player observed as S(level of instruction) and S(age), respect-
and a recording with PASAT-3” stimuli. The test result ively, where S(level of instruction) ¼ centered additive
was the number of correct sums obtained by the partici-
pant (out of 60 possible); the total score of answers was Table 1. Paced Auditory Serial Addition Test score by level of
taken as the main outcome measure. The total correct education and age (in decades), number of participants, means,
responses for the first half and the second half of the test and standard deviations.
were calculated (Rao, 1990). 95% Confidence interval
Age Educational Lower Upper
For assessing the data obtained, Version 19.0 of the group level N M SD band band
Statistical Package for the Social Sciences (IBM SPSS) 20–30 0–7 15 44.000 8.90 39.339 48.661
was used, in addition to the Segmented and Tolerance 8–12 18 46.722 9.27 42.467 50.977
>13 41 50.439 6.90 47.620 53.258
packages in the R.3.0.15 programming environment. Total 74 48.23 8.26 46.32 50.14
The relationship between age, instruction level, and 31–40 0–7 17 42.294 9.47 37.916 46.672
PASAT score was explored with a structured additive 8–12 18 50.111 5.96 45.856 54.366
>13 27 50.519 8.85 47.044 53.993
regression model with the aim of evaluating the separate Total 62 48.15 8.94 45.87 50.42
effects of the variables and the interaction between them, 41–50 0–7 15 36.867 11.56 32.206 41.528
8–12 17 51.000 8.56 46.622 55.378
without imposing any restriction on the relationship. >13 20 49.600 11.66 45.563 53.637
Afterward, the effect of the level of instruction was Total 52 46.38 12.17 43.00 49.77
51–60 0–7 14 39.429 11.33 34.604 44.253
analyzed with a multiple regression model. To analyze 8–12 15 40.600 10.80 35.939 45.261
whether there were differences among the sample based >13 16 47.125 7.01 42.612 51.638
Total 45 42.56 10.19 39.49 45.62
on sex, a student’s t test was carried out for independent 61–70 0–7 27 34.148 7.46 30.674 37.622
samples. A univariate analysis of variance (ANOVA) was 8–12 19 36.211 8.66 32.069 40.352
used to analyze the influence of sex, age, and level of >13 17 41.824 12.80 37.445 46.202
Total 63 36.84 9.87 34.35 39.33
instruction variables and how they interacted with one Total 0–7 88 38.70 10.05 36.58 40.83
another in the PASAT. Lastly, to compare the first 8–12 87 44.91 10.30 42.71 47.10
>13 121 48.67 9.55 46.95 50.39
half and the second half of the test, a student’s t Total 296 44.60 10.72 43.37 45.83
APPLIED NEUROPSYCHOLOGY: ADULT 3
2005; Cores, Vanotti, Osorio, Politis, & Garcea, 2011; underlying the poor performance of multiple sclerosis
Fisk & Archibald, 2001), which could be more sensitive patients in the Paced Auditory Serial Addition Test
than the original scores (Fisk & Archibald, 2001). The (PASAT). Journal of Clinical and Experimental Neuropsy-
chology, 30, 789–796. doi:10.1080/13803390701779560
development of regulations for implementing these find- Gronwall, D. (1977). Paced Auditory Serial-Addition Task: A
ings in the clinic is still pending. measure of recovery from concussion. Perceptual and
Motor Skills, 44, 367–373. doi:10.2466/pms.1977.44.2.367
Kos, D., Kerckhofs, E., Nagels, G., & Geentjes, L. (2004).
Acknowledgements Cognitive fatigue in multiple sclerosis (Letter). Multiple
Sclerosis Journal, 10, 337.
We would like to thank Manuel Lago and Oscar Ianovsky, the
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Methodology Research and Biostatistics Department,
behavioral consequences of closed head injury. New York,
Committee for Teaching and Research from J. M. Ramos
NY: Oxford University Press.
Mejía Hospital, for supervising the statistical analysis.
Macciocchi, S. N., Barth, J. T., Alves, W., Rimel, R. W., & Jane,
J. A. (1996). Neuropsychological functioning and recovery
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