Please cite as:Castro, S. L., Martins, L., & Cunha, L. (2003, August).

Neuropsychological screening with a Portuguese Stroop test. Poster session

presented at the 111th Annual Convention of the American Psychological
Association, Toronto.

Neuropsychological Screening with a Portuguese Stroop Test

São Luís Castro, Luísa Martins, and Luís Cunha
University of Porto, Portugal

ABSTRACT: A Portuguese Stroop Test was used to examine the accuracy and speed of
incongruous color naming in 145 healthy adults and 40 patients with unilateral
cerebrovascular accidents. Ages ranged from 18 to 87 years, and education from 3 to
12+ years of schooling. The number of correct responses and the ratio of time over
correct responses were analysed. Performance was significantly better in younger
healthy participants, as well as in those with at least 12 years of schooling. A
comparison between brain-damaged patients and healthy participants matched on age
and educational level revealed that brain-damaged patients performed worse on all
measures. The need to take into account not only age, but also schooling, in
determining cut-off scores is stressed.

INTRODUCTION: Stroop tasks involve the presentation of a stimulus that has conflicting
sources of information; in a typical situation, the participant is required to name the
color in which a word is printed when the word itself is a different color name. An
interference from the incongruous information is observed – the Stroop effect. Since it
was discovered, the Stroop effect has been investigated as a window to perceptual and
cognitive processes [1]. Because Stroop tasks offer a simple way to assess those aspects
of adaptive behavior, they have been developed into neuropsychological assessment
tests. Various Stroop tests are available in English [2]. The present study was conducted
in order to develop a Portuguese version of a Stroop test for neuropsychological
screening. A preliminary study included color naming in a neutral condition (XXXX
strings); however, results from patients and controls indicated that this task was not
informative [3], and it was discarded. Here, we present the SNP test, short for
Neuropsychological Stroop in Portuguese, as well as validation data from brain-
damaged and neurologically healthy participants. For the sake of potential cross-cultural
comparisons, the form of the test was chosen to be analogous to Trennery et al.'s
Stroop Neuropsychological Screening Test [4]. It comprises two tasks: naming the color
in which incongruous color words are printed, and reading those words. A time limit of
120s is imposed for each task.

See Table 1 (bottom of page 3)

METHOD
MATERIALS: Portuguese color names vary in length (AZUL vs. VERMELHO for blue and red).
Four color names that are 4-phoneme long (4 and 5-letter-long) were chosen;
corresponding hues were adjusted to be roughly equivalent in brightness and
saturation. Each word was printed in incongruous ink colors (see Tabel 1). A total of 112
stimuli evenly distributed by color name and ink color (28 x 4) was pseudorandomly
ordered and arranged into four columns.

PARTICIPANTS:
Comparison group
Adults (N = 145; ages from 18 to 87 years) with no known history of neurological, major
 PORTUGUESE STROOP TEST, p. 2

physical or psychiatric disorders

Clinical group
40 patients who had suffered unilateral cerebrovascular accidents (20 LCVA + 20 RCVA;
ages from 25 to 84 years)
Only patients with no major aphasic or disarthic impairments were included in the
clinical group.
Educational level in years of schooling:
from high (at least 12 years)
to low (3 or 4).
All of the patients had a low or intermediate (6 to 9 years) educational level.

PROCEDURE:
Pre-test (to ensure that the participant is able to name the colors)
Reading task
Color naming task.
The number of correct responses (total responses minus errors) and the time taken to
complete each task was recorded.

RESULTS: The number of correct responses in each task - the accuracy scores which are
typically used in Stroop neuropsychological tests -, as well as the ratio of time over
correct responses, calculated individually, were examined (ANOVAS).

Preliminary analyses on the comparison group data showed that both age and years of
schooling were correlated with performance on the color naming task [5].

Healthy participants were divided into subgroups according to educational level [5]:
higher (at least 12 years of schooling) vs. lower (4 to 9 years); and within each of these,
into age groups. Figures 1a and 1b depict the average accuracy and time rate of these
subgroups, in the color naming and in the reading tasks.

EFFECTS OF SCHOOLING AND OF AGE (NEUROLOGICALLY HEALTHY GROUP)

Highly schooled participants reached higher accuracy, and faster rate, than less
schooled age-matched ones - cf. front columns 3 and 4, vs. 5 and 6, in Figure 1a for
accuracy, and analogous back columns in Figure 1b [6] for time ratio (p < .008).
In the lower educational level, younger participants outperformed older ones - cf.
columns 5 vs. 6, front, in Figure 1a, and analogous ones, back, in Figure 1b (p < .02).
Reading accuracy attained the ceiling level in both educational groups, but less schooled
older participants had a slower reading rate than younger ones - cf. front columns 5 and
6 in Figure 1b (p < .001).

EFFECT OF BRAIN LESION

The comparison with the neurologically healthy subjects was based on the subgroup
matched on educational level and age.
Brain-damaged patients performed significantly lower on all measures, including
reading accuracy (p < .01, cf. columns 7 and 8, front and back in Figures 1a and 1b).
There was a small, nonsignificant, advantage of the RCVA over the LCVA group.

DISCUSSION AND CONCLUSION:

As had been previously found by Trennery at al., this version of the Stroop Test is
sensitive to the effect of age in a normative sample. However, in the present study, we
also found an effect of educational level in neurologically healthy individuals. This fact
stresses the need to take educational level into account when using this test as a
neuropsychological screening tool.
 PORTUGUESE STROOP TEST, p. 3

[1] Stroop, J.R. (1935/1992). J. Exp. Psych.: General, 121, 15-23. MacLeod, C.M. (1991).
Psych. Bull., 109, 163-203. Brown, T.L., Gore, C.L., Carr, T.H. (2002). J. Exp. Psych.:
General, 131, 220-240.
[2] Lezak, M.D. (1995). Neuropsychological assessment (3rd ed). Oxford: Oxford
University Press. Spreen, O., Strauss, E. (1991). A compendium of neuropsychological
tests. New York: Oxford University Press. Dodrill, C.B. (1978). Epilepsia, 19, 611-623.
[3] Cunha, L., & Castro, S.L. (2000, January). A Portuguese test for neuropsychological
screening: Comparison between controls vs. TIA and stroke patients. Paper presented at
the Symposium: Brain Injury Rehabilitation. Europarque Congress Center, Santa Maria da
Feira, Portugal.
[4] Trenerry, M.R., Crosson, B., DeBoe, J., & Leber, W.R. (1995). Stroop
neuropsychological screening test (Manual). Tampa: Psychological Assessment
Resources.
[5] Accuracy in color naming was negatively correlated with age, r = -.77, and positively
correlated with years of schooling, r = .72, for both N = 145, p < .001; the correlations
with time ratios were of similar magnitude, r = .72 and r = -.67 (for age and schooling,
respectively; same N, p < .001), in the reverse direction (e.g., younger, more correct
responses, less time per item).
[6] An ANOVA computed on the number of correct responses with Age (Less-than-50
vs. 50-or-More) and Education (Higher vs. Lower) as between-participant factors
showed a main effect of Education, F(1,67) = 14.31, p = .0003 and of Age, F(1,67) =
5.54, p = .002, as well as an interaction, F(1,67) = 4.44, p = .03. A similar ANOVA
computed on the time ratio showed that only the effect of Education was significant,
F(1,67) = 7.35, p = .008 (Fs = 2.76 and 2.73 for Age and interaction, respectively, both
ns). Because the participants with a lower degree of schooling were generally older, the
younger groups with a higher schooling were not included in these analyses.
[7] Post-hoc Tukey tests, alpha at .05.
[8] There was a significant effect of Education, F(1,67) = 11.2, p = .0013 on an ANOVA
computed on the time ratios of the reading task (neither age nor the interaction reached
significance).
[9] Separate ANOVAS on the number of correct responses and on the time ratios in the
color naming and in the reading tasks, with Group (Clinical vs. Comparison) and Age
(Less-than-50 vs. 50-or-More) as factors, all showed significant effects of Group: F(1,
86) = 29.72, 6.21, 5.06, 5.66, all with p < .03.

Table 1.
STROOP TEST (PORTUGUESE): TARGET TASK
NAME THE COLOR OF THE WORD
VERDE
AZUL
CINZA
ROSA
 PORTUGUESE STROOP TEST, p. 4

CRColor
110
CRRead

100

90

80

70

60

50
Teens

20's

30&40's

50's&Up

Ed9<50 CRColor

Ed9>50

CVA<50

CVA>50
timeCRRead
2.9 timeCRColor

2.4

1.9

1.4

0.9

0.4
Teens

20's

30&40's

timeCRColor
50's&Up

Ed9<50

timeCRRead
Ed9>50

CVA<50

CVA>50

Figure 1. Average number of correct responses in the color naming and in the reading
tasks for the neurologically healthy and for the brain lesioned participants (CVAs), by
subgroup according to educational level (1 to 4: at least 12 years of schooling; 5 to 8: 9
years or less) and to age in years(1a). Maximum number of correct responses is 112.
Corresponding values for the ratio of time over correct responses (1b). Ns in each
subgroup: 43, 31, 9, 12; 8, 42; 9, and 31, respectively.

111th Annual Convention of the APA

Metro Toronto Convention Centre - Exhibit Hall
August 9, 2003, 10:00 - 11:50 AM