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Original article
Spanish normative studies in young adults (NEURONORMA young adults project): Norms for Stroop Color–Word Interference and Tower of London-Drexel University tests
Estudios normativos españoles en población adulta joven (proyecto NEURONORMA jóvenes): normas para las pruebas Stroop Color–Word Interference Test y Tower of London-Drexel University
T. Rognonia, M. Casals-Colla, G. Sánchez-Benavidesa, M. Quintanaa, R.M. Manerob, L. Calvoa, R. Palomoa, F. Arancivaa, F. Tamayoa, J. Peña-Casanovab,
Corresponding author
jpcasanova@hospitaldelmar.cat

Corresponding author.
a Grupo de Neurología de la Conducta y Demencias, Programa de Neurociencias, Instituto de Investigación Hospital del Mar (IMIM), Barcelona, Spain
b Sección de Neurología de la Conducta y Demencias, Servicio de Neurología, Hospital del Mar, Barcelona, Spain
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    "textoCompleto" => "<span class="elsevierStyleSections"><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Introduction</span><p id="par0005" class="elsevierStylePara elsevierViewall">Proper assessment of performances on any type of neuropsychological test requires access to normative data of reference&#46; For these data of reference to be considered valid&#44; they must be representative of the demographic and cultural context in which they are used&#46; The NEURONORMA project &#40;NN&#41; was designed in order to remedy the lack of such data in Spain&#46; Its aim is to obtain normative data from the Spanish population on some of the most common neuropsychological tests&#46; Normative data have already been published for subjects older than 49 years<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> and an extension of the same project &#40;NNy&#41; is also being completed using younger subjects&#46;</p><p id="par0010" class="elsevierStylePara elsevierViewall">Within the framework of the NN Project&#44; this article presents normative data for subjects aged between 18 and 49 years old&#46; It employs 2 neuropsychological testing tools which evaluate executive capacities&#58; Golden&#39;s version of the Stroop Color&#8211;Word Interference Test &#40;Stroop&#41;&#44;<a class="elsevierStyleCrossRefs" href="#bib0010"><span class="elsevierStyleSup">2&#44;3</span></a> and the Tower of London-Drexel University version test &#40;TOL<span class="elsevierStyleSup">DX</span>&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> The characteristics and methodology of the present study have already been described in detail in another article&#46;<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">The Stroop test measures cognitive flexibility&#44; selective attention&#44; cognitive inhibition&#44; and information processing speed&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#44;7</span></a> Different versions of the test have been developed &#40;exhaustive reviews of the test may be found in certain compilations of neuropsychological tests&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#8211;10</span></a> Golden&#39;s version<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> is divided into 3 sections&#46; In the first and second sections&#44; researchers evaluate word reading speed and colour identification&#46; The last section is a test of resistance to interference in which the subject is asked to name the ink colour of incongruously named colour words instead of reading the printed words&#46; This test measures the executive function of cognitive inhibition&#44; since it requires the controlled process of engaging in a new task while suppressing the automatic process of reading&#46;<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">9&#44;11</span></a> Factor analysis of test results suggests that the interference section has more in common with executive functions of time management such as verbal fluency and information processing speed&#44; than with functions involving mental flexibility&#44; divided attention&#44; and working memory&#46;<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a></p><p id="par0020" class="elsevierStylePara elsevierViewall">We examined the effect of sociodemographic factors&#44; particularly those affecting the interference section&#46; Most authors have detected a significant decrease in performance due to an age effect&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#44;13&#8211;21</span></a> This effect appears to be more acute in subjects with a lower educational level&#46;<a class="elsevierStyleCrossRef" href="#bib0100"><span class="elsevierStyleSup">20</span></a> Certain authors attribute this difference in interference to an overall slowing process as well as to a deficit in specific inhibitory control processes&#44;<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">20&#44;22&#44;23</span></a> since the number of errors increases with age&#46;<a class="elsevierStyleCrossRefs" href="#bib0100"><span class="elsevierStyleSup">20&#44;22</span></a> In addition to citing the slowing effect observed in the interference section&#44; some authors have stated that ageing also influences colour naming speed&#46;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#44;17&#44;20&#44;24&#44;25</span></a> However&#44; studies with wider age ranges present inconclusive results&#44; ranging from considerable<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a> to low<a class="elsevierStyleCrossRefs" href="#bib0075"><span class="elsevierStyleSup">15&#44;19&#44;26</span></a> or even insignificant levels of influence&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">Similarly&#44; research on the influence of education provides no clear or conclusive data&#46; Studies of older population segments show a relationship between education and the subject&#39;s score in the interference part of the test&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13&#44;16&#44;17&#44;20&#44;22&#44;24&#44;25&#44;28&#44;29</span></a> However&#44; researchers have also detected isolated effects of this variable on all 3 parts of the test&#46;<a class="elsevierStyleCrossRef" href="#bib0090"><span class="elsevierStyleSup">18</span></a> More recent studies&#44; using other Stroop versions and including younger population segments&#44; have described education as having a significant effect on scores&#44;<a class="elsevierStyleCrossRef" href="#bib0130"><span class="elsevierStyleSup">26</span></a> mainly on the colour and interference sections&#46;</p><p id="par0030" class="elsevierStylePara elsevierViewall">The effect of sex on Stroop test performance has received less study&#46; Researchers have observed that sex seems to have the least influence of any other factors on performance by subjects of all ages<a class="elsevierStyleCrossRef" href="#bib0150"><span class="elsevierStyleSup">30</span></a> and some even cite absence of influence due to sex&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13&#44;16&#44;17&#44;20&#44;31</span></a> Nevertheless&#44; some researchers have found better performance by women<a class="elsevierStyleCrossRefs" href="#bib0035"><span class="elsevierStyleSup">7&#44;25</span></a> or by men&#46;<a class="elsevierStyleCrossRef" href="#bib0160"><span class="elsevierStyleSup">32</span></a> In any case&#44; any differences between these groups are very small and not relevant to clinical practice&#46;</p><p id="par0035" class="elsevierStylePara elsevierViewall">Some studies provide normative data from the Stroop test in different languages&#46;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#8211;10</span></a> Torrealba et al&#46;<a class="elsevierStyleCrossRef" href="#bib0165"><span class="elsevierStyleSup">33</span></a> completed the first Spanish pilot study with a wide age range &#40;20&#8211;83 years&#41;&#46; They observed that both age and educational level had a significant effect on scores&#46; Artiola et al&#46;<a class="elsevierStyleCrossRef" href="#bib0170"><span class="elsevierStyleSup">34</span></a> gathered normative data from 205 subjects living in Madrid and 185 subjects from the border region between Mexico and the USA with an age range of 18&#8211;65 years&#46; They found both age and education effect on performance&#46; L&#243;pez et al&#46;<a class="elsevierStyleCrossRef" href="#bib0135"><span class="elsevierStyleSup">27</span></a> found significant differences in performance on the colour and interference parts of the test between groups with different educational levels&#46;</p><p id="par0040" class="elsevierStylePara elsevierViewall">Shallice<a class="elsevierStyleCrossRef" href="#bib0175"><span class="elsevierStyleSup">35</span></a> originally designed the Tower of London<span class="elsevierStyleSup">DX</span> test in order to assess problem-solving ability&#44; and executive planning ability in particular&#44; in subjects with frontal lobe lesions&#46; There are several versions of the TOL tasks and each version has its own scoring and test administration protocols&#46; Regardless of the version&#44; these tasks have been traditionally used to measure planning and problem solving abilities&#46;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">36</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Some of the studies examine the influence of sociodemographic factors on TOL<span class="elsevierStyleSup">DX</span> performance&#46; Research on the age effect provides ambiguous results&#46; Some studies found no differences between younger and older subjects&#44;<a class="elsevierStyleCrossRef" href="#bib0180"><span class="elsevierStyleSup">36</span></a> while others detected a small&#44; but significant&#44; negative correlation between age and performance&#46;<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">6</span></a> Nevertheless&#44; some of the studies suggest that age has a clear effect on performance&#46;<a class="elsevierStyleCrossRefs" href="#bib0025"><span class="elsevierStyleSup">5&#44;17&#44;37</span></a> For example&#44; Andres et al&#46;<a class="elsevierStyleCrossRef" href="#bib0190"><span class="elsevierStyleSup">38</span></a> found that subjects aged between 60 and 70 years did not perform as well as subjects aged between 20 and 30 years&#46; Researchers have observed that young adults present optimal performance on the task since they are able to solve 92&#37; of the problems correctly&#46;<a class="elsevierStyleCrossRef" href="#bib0195"><span class="elsevierStyleSup">39</span></a></p><p id="par0050" class="elsevierStylePara elsevierViewall">We find less data regarding education and sex effects on TOL<span class="elsevierStyleSup">DX</span> test results&#46; Some authors have concluded that neither education<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">40</span></a> nor sex<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> exert a significant influence on performing this task&#46; Nevertheless&#44; other authors have found significant effects of these variables on test performance&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">Most studies examining age and education effects on Stroop and TOL<span class="elsevierStyleSup">DX</span> test results were conducted in subjects older than 50&#46;<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> Considering the impact of sociodemographic variables on the scores&#44; we believe it is necessary to gather normative data from younger adults&#46;<a class="elsevierStyleCrossRef" href="#bib0120"><span class="elsevierStyleSup">24</span></a> Some Spanish normative studies include Stroop test data for this age group&#44;<a class="elsevierStyleCrossRefs" href="#bib0040"><span class="elsevierStyleSup">8&#44;34&#44;41</span></a> but level of education was not taken into account in all cases&#46;<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">42</span></a> Spanish literature contains no articles on the TOL<span class="elsevierStyleSup">DX</span> test&#46; The previous study in the framework of the NN Project&#44; which addressed subjects aged 50 and older&#44;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> was the first and only attempt at establishing normative data for the TOL<span class="elsevierStyleSup">DX</span> test in a Spanish population&#46; The aim of our current article is to describe performance on the Stroop and TOL<span class="elsevierStyleSup">DX</span> tests in younger Spanish adults&#46;</p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Materials and methods</span><span id="sec0015" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Subjects</span><p id="par0060" class="elsevierStylePara elsevierViewall">Recruitment methods and sample characteristics have already been thoroughly described in an earlier article<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> on NNy project methodology&#46; To summarise&#44; we recruited 179 subjects and stratified them by age and level of education&#46; None of the subjects presented cognitive decline&#46; All scores on the MMSE were equal to or higher than 24&#44;<a class="elsevierStyleCrossRefs" href="#bib0215"><span class="elsevierStyleSup">43&#44;44</span></a> and scores on the Memory Impairment Screen were equal to or higher than 4&#46;<a class="elsevierStyleCrossRefs" href="#bib0225"><span class="elsevierStyleSup">45&#44;46</span></a></p></span><span id="sec0020" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Neuropsychological measurements</span><p id="par0065" class="elsevierStylePara elsevierViewall">We followed the neuropsychological protocol established for the NN project&#44;<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> which included the Stroop and TOL<span class="elsevierStyleSup">DX17</span> tests&#46;</p></span><span id="sec0025" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Stroop Color&#8211;Word Interference Test</span><p id="par0070" class="elsevierStylePara elsevierViewall">We used Golden&#39;s version<a class="elsevierStyleCrossRef" href="#bib0210"><span class="elsevierStyleSup">42</span></a> consisting of 3 cards with 100 items arranged in 5 columns&#46; Subjects were allowed 45<span class="elsevierStyleHsp" style=""></span>seconds to complete each part and we recorded the last completed item on each of the 3 parts of the test&#46; We therefore obtained 3 scores&#58; Stroop-W &#40;word reading&#41;&#58; total number of completed items on card 1&#59; Stroop-C &#40;colour naming&#41;&#58; total number of completed items on card 2&#59; and Stroop-CW&#58; &#40;colour&#8211;word interference&#41;&#59; total number of completed items on card 3&#46; There was no penalty as such for errors&#44; but if the subject gave a wrong answer&#44; he had to rectify his answer while time was passing&#46; This resulted in having fewer completed items at the end of the test&#46;</p></span><span id="sec0030" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Tower of London</span><p id="par0075" class="elsevierStylePara elsevierViewall">Our study used the Drexel University version &#40;TOL<span class="elsevierStyleSup">DX</span>&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> The test includes 10 increasingly complex problems&#46; The subject had a maximum of 2<span class="elsevierStyleHsp" style=""></span>minutes to solve the problem and was permitted a maximum of 20 moves for each problem&#46; We took into account the 5 variables listed below&#46; &#40;a&#41; Total correct answers&#58; number of problems solved with the minimum number of moves&#46; The highest possible score on the test was 10&#46; &#40;b&#41; Total moves&#58; number of moves the subject needed to solve all the problems&#46; We considered a move to be the act of completely extracting the bead from the peg and placing it on another peg or the same peg &#40;on the base or the last bead on the peg&#41;&#46; The total score was the summation of excess moves for each item &#40;number of moves completed minus the minimum number of possible moves&#41;&#59; Scores ranged from 0 to 145&#46; &#40;c&#41; Latency time&#58; the time between displaying each problem and the onset of the first move for each problem&#46; &#40;d&#41; Completion time&#58; the time between beginning the first move and solving the problem&#46; &#40;e&#41; Resolution time&#58; the time between viewing the problem and solving it&#46; For additional information about test administration protocols&#44; see the manual&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0080" class="elsevierStylePara elsevierViewall">The variable of total latency time requires further comment due to its characteristics&#46; The authors propose this variable as a relatively stable and potentially inhibitory measurement&#46; In this sense&#44; the time lapse before the first move is made reflects the subject&#39;s inhibitory processes&#44; which may theoretically range from minimum response modulation &#40;low control&#41; to maximum response modulation &#40;high control&#41;&#46; Extremely low control is associated with rapid and impulsive response behaviour&#44; while the opposite situation would indicate excessively inhibited behaviour&#46; Both extremes may be accompanied by adaptation difficulties&#44; since rapid response time increases the probability of errors and excessive inhibition can be a handicap in situations requiring rapid decision-making&#46; As we will mention in a further section&#44; the analysis of this variable should therefore be presented in a context with the rest of the tasks&#46;</p></span><span id="sec0035" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Statistical analysis</span><p id="par0085" class="elsevierStylePara elsevierViewall">A standardised statistical analysis was carried out for all the neuropsychological tests included in the project&#46; The procedure was as follows&#58; &#40;a&#41; a normative data table was created for a single age group&#46; Raw scores were converted into Neuronorma scaled scores &#40;NSS&#41; so as to guarantee a normal distribution&#46; To do so&#44; we generated an array of cumulative frequencies of raw scores and created percentile ranges for raw scores according to their positions within the distribution&#46; Percentile ranges were then converted to scaled scores ranging from 2 to 18&#46; This transformation of raw scores to NSS produced a normal distribution &#40;mean<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>standard deviation&#58; 10<span class="elsevierStyleHsp" style=""></span>&#177;<span class="elsevierStyleHsp" style=""></span>3&#41; to which linear regressions could be applied&#46; &#40;b&#41; Next&#44; we defined the effects of age&#44; education and sex&#46; SS correlation coefficients &#40;<span class="elsevierStyleItalic">r</span>&#41; and coefficients of determination &#40;<span class="elsevierStyleItalic">R</span><span class="elsevierStyleSup">2</span>&#41; were determined for age&#44; years of education&#44; and sex for each of the variables on the Stroop and TOL<span class="elsevierStyleSup">DX</span> tests&#46; &#40;c&#41; The regression coefficient &#40;<span class="elsevierStyleItalic">&#946;</span>&#41; from this analysis was used as the basis for adjusting for age and education according to the following formula&#58; SS<span class="elsevierStyleInf">A&#38;E&#38;S</span><span class="elsevierStyleHsp" style=""></span>&#61;<span class="elsevierStyleHsp" style=""></span>SS<span class="elsevierStyleHsp" style=""></span>&#8722;<span class="elsevierStyleHsp" style=""></span>&#40;<span class="elsevierStyleItalic">&#946;</span><span class="elsevierStyleInf">1</span><span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>&#91;age<span class="elsevierStyleHsp" style=""></span>&#8722;<span class="elsevierStyleHsp" style=""></span>35&#93;<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#946;</span><span class="elsevierStyleInf">2</span><span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>&#91;education<span class="elsevierStyleHsp" style=""></span>&#8722;<span class="elsevierStyleHsp" style=""></span>13&#93;<span class="elsevierStyleHsp" style=""></span>&#43;<span class="elsevierStyleHsp" style=""></span><span class="elsevierStyleItalic">&#946;</span><span class="elsevierStyleInf">3</span><span class="elsevierStyleHsp" style=""></span>&#215;<span class="elsevierStyleHsp" style=""></span>sex&#41;&#46; The resulting value was truncated to the next lower integer&#46; We only adjusted for sociodemographic variables accounting for more than 5&#37; of the variance and presenting a significant regression coefficient&#46; For more detailed information about methodology&#44; see the NNy project&#39;s methodology article&#46;</p></span></span><span id="sec0040" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Results</span><p id="par0090" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a> displays the array of frequencies of raw scores with the corresponding NSS and percentile ranks&#46;</p><elsevierMultimedia ident="tbl0005"></elsevierMultimedia><p id="par0095" class="elsevierStylePara elsevierViewall">The correlation coefficient &#40;<span class="elsevierStyleItalic">r</span>&#41; and coefficient of determination &#40;<span class="elsevierStyleItalic">R</span><span class="elsevierStyleSup">2</span>&#41; are shown in <a class="elsevierStyleCrossRef" href="#tbl0010">Table 2</a>&#46; Education was the variable with the greatest effect on performance on both tests&#46; The effect on all variables was discrete&#46; In the Stroop test&#44; education accounted for a percentage of variance ranging from 4&#37; to 10&#37;&#46; The age and sex variables had no effect on any of the 3 variables&#46; In the TOL<span class="elsevierStyleSup">DX</span> test&#44; the variable &#8216;years of education&#8217; had a significant effect on all the variables&#44; except for the completion time variable&#46; The variables &#8216;total moves&#8217; &#40;8&#46;9&#37;&#41; and &#8216;latency time&#8217; &#40;7&#46;3&#37;&#41; were the only ones to have percentages of explained variance exceeding 5&#37;&#46; Therefore&#44; adjustments were applied to these measures only&#46; As on the Stroop test&#44; the age and sex effects were not significant for any of the variables&#46;</p><elsevierMultimedia ident="tbl0010"></elsevierMultimedia><p id="par0100" class="elsevierStylePara elsevierViewall"><a class="elsevierStyleCrossRef" href="#tbl0015">Table 3</a> shows education adjustments obtained from multiple regression coefficients&#46; The adjustment is applied by adding or subtracting scores corresponding to the variable &#8216;years of education&#8217; to or from the SS shown in <a class="elsevierStyleCrossRef" href="#tbl0005">Table 1</a>&#46;</p><elsevierMultimedia ident="tbl0015"></elsevierMultimedia></span><span id="sec0045" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discussion</span><p id="par0105" class="elsevierStylePara elsevierViewall">Within the context of the NN project in the group of subjects younger than 50&#44; the current article provides normative data from younger Spanish adults gathered from 2 executive function tests&#44; the Stroop Color&#8211;Word Interference Test and the Tower of London test&#46; We studied the effect of sociodemographic variables on the tests and created adjustment tables in order to correct the scores&#46;</p><span id="sec0050" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Stroop Color&#8211;Word Interference Test</span><p id="par0110" class="elsevierStylePara elsevierViewall">The current study revealed no significant age effects on any of the 3 study variables&#46; These results contrast with those published in prior studies in which researchers found a clear age effect on performance&#44;<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6&#44;7&#44;15&#44;17&#44;19&#44;24&#44;25&#44;34</span></a> especially in the interference section &#40;Stroop-CW&#41;&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13&#8211;21</span></a> This difference is attributable to the distinct characteristics of the samples&#46; The inclusion of elderly subjects in other studies&#44; whether in order to analyse changes longitudinally or to provide normative data for elderly subjects&#44; explains the appearance of the age effect&#46; Results suggest that age effect is only marked after a certain age threshold&#46; The absence of this effect in our sample leads us to think that it may appear in subjects older than 50&#46;</p><p id="par0115" class="elsevierStylePara elsevierViewall">Education effect was significant in the interference section &#40;Stroop-CW&#41;&#46; These results are similar to those from previous studies including younger population segments&#46;<a class="elsevierStyleCrossRefs" href="#bib0105"><span class="elsevierStyleSup">21&#44;26&#44;27&#44;33</span></a> In our study&#44; the education effect was slightly greater for the word reading section than for the colour naming section&#44; contrary to the effect observed in other studies&#46;<a class="elsevierStyleCrossRef" href="#bib0105"><span class="elsevierStyleSup">21</span></a></p><p id="par0120" class="elsevierStylePara elsevierViewall">The studied sample presented no significant sex effects on any of the 3 parts of the Stroop test&#44; which is true of studies of either younger or older populations&#46;<a class="elsevierStyleCrossRefs" href="#bib0065"><span class="elsevierStyleSup">13&#44;16&#44;17&#44;20&#44;31</span></a></p></span><span id="sec0055" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Tower of London</span><p id="par0125" class="elsevierStylePara elsevierViewall">Data from the present study showed no significant age effects on the scores obtained on the TOL<span class="elsevierStyleSup">DX</span> test&#46; These results coincide with those published in the original manual&#44; which only described an age effect in subjects older than 60&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> Central scores of subjects aged between 18 and 49 in the original data were similar to those of our sample&#46;</p><p id="par0130" class="elsevierStylePara elsevierViewall">Education had a clear effect on subjects&#8217; performance&#44; and mainly affected 2 of the variables on the TOL<span class="elsevierStyleSup">DX</span> test&#58; total moves and latency time&#46; The total number of moves&#44; that is&#44; the sum of excess moves for each problem&#44; is the main testing variable&#46; For this variable&#44; the percentage of variation explained by education was 9&#37;&#44; which is very similar to the percentage obtained in adults older than 49 &#40;10&#37;&#41;&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> We can therefore conclude that educational level may have a linear effect on the subject&#39;s test performance throughout his or her lifetime&#46; As stated previously&#44; the variable of latency time may be difficult to interpret and therefore deserves special mention&#46; Since requiring more time before starting the task may be indicative of loss of speed or a greater degree of cognitive control &#40;that is&#44; inhibition of excessively impulsive responses that may lead to errors&#41;&#44; we suggest that this measure should be always be analysed in the context of the other testing variables&#46; We should also be mindful of the fact that either extreme may be indicative of poor cognitive function&#46; The study sample showed a negative relationship between education and the scaled score corresponding to that variable&#46; As we mentioned before&#44; a higher educational level is related to a lower number of excess moves&#46; Therefore&#44; a longer time lapse before starting the task in more educated subjects may be indicative of greater inhibitory control and superior planning ability&#46; Such a relationship between education and latency time was not found in the NN project sample of older subjects&#46;<a class="elsevierStyleCrossRef" href="#bib0085"><span class="elsevierStyleSup">17</span></a> This could be due to the fact that elderly subjects are usually more reflective&#44; regardless of their educational level&#46; Other studies including subjects with a wide age range such as the one by Zook et al&#46;&#44;<a class="elsevierStyleCrossRef" href="#bib0200"><span class="elsevierStyleSup">40</span></a> do not report a different relationship between the TOL<span class="elsevierStyleSup">DX</span> score and education in young and older subjects&#46; The wide age range found in the study by Zook et al&#46; could be masking that difference&#44; although data interpretation is not conclusive since they only included subjects with 12 or more years of education&#46;</p><p id="par0135" class="elsevierStylePara elsevierViewall">As in the Stroop test&#44; our data showed no age effect on any of the TOL<span class="elsevierStyleSup">DX</span> test variables&#44; which concurs with findings from the original normative sample&#46;<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0140" class="elsevierStylePara elsevierViewall">The present study&#44; an extension of the NNy project&#44; provides normative data from the Stroop Color&#8211;Word Interference Test and the Tower of London test in a Spanish population segment aged between 18 and 49&#46; This study corroborates the effect of education on some of the variables in the Stroop and TOL<span class="elsevierStyleSup">DX</span> tests&#44; so we propose applying the appropriate adjustments&#46; In addition&#44; we show that age and sex had no effect on performance of these tasks&#46; It should be stated that these normative data for the TOL<span class="elsevierStyleSup">DX</span> test are the first that may be applied to a younger Spanish population&#46;</p><p id="par0145" class="elsevierStylePara elsevierViewall">In conclusion&#44; the normative data and the adjustments for education presented in this study are helpful for raising the quality of neuropsychological examinations of executive functions in younger Spanish subjects&#46; Likewise&#44; the NN project methodology allows us to directly compare performances between tests measuring different cognitive areas&#46;</p></span></span><span id="sec0060" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Conflicts of interest</span><p id="par0150" class="elsevierStylePara elsevierViewall">The authors have no conflicts of interest to declare&#46;</p></span></span>"
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            3 => "Material and methods"
            4 => "Results"
            5 => "Conclusions"
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          "identificador" => "xpalclavsec164018"
          "titulo" => "Keywords"
        ]
        2 => array:2 [
          "identificador" => "xres175682"
          "titulo" => array:6 [
            0 => "Resumen"
            1 => "Introducci&#243;n"
            2 => "Objetivo"
            3 => "Material y m&#233;todos"
            4 => "Resultados"
            5 => "Conclusiones"
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          "identificador" => "xpalclavsec164019"
          "titulo" => "Palabras clave"
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        4 => array:2 [
          "identificador" => "sec0005"
          "titulo" => "Introduction"
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        5 => array:3 [
          "identificador" => "sec0010"
          "titulo" => "Materials and methods"
          "secciones" => array:5 [
            0 => array:2 [
              "identificador" => "sec0015"
              "titulo" => "Subjects"
            ]
            1 => array:2 [
              "identificador" => "sec0020"
              "titulo" => "Neuropsychological measurements"
            ]
            2 => array:2 [
              "identificador" => "sec0025"
              "titulo" => "Stroop Color&#8211;Word Interference Test"
            ]
            3 => array:2 [
              "identificador" => "sec0030"
              "titulo" => "Tower of London"
            ]
            4 => array:2 [
              "identificador" => "sec0035"
              "titulo" => "Statistical analysis"
            ]
          ]
        ]
        6 => array:2 [
          "identificador" => "sec0040"
          "titulo" => "Results"
        ]
        7 => array:3 [
          "identificador" => "sec0045"
          "titulo" => "Discussion"
          "secciones" => array:2 [
            0 => array:2 [
              "identificador" => "sec0050"
              "titulo" => "Stroop Color&#8211;Word Interference Test"
            ]
            1 => array:2 [
              "identificador" => "sec0055"
              "titulo" => "Tower of London"
            ]
          ]
        ]
        8 => array:2 [
          "identificador" => "sec0060"
          "titulo" => "Conflicts of interest"
        ]
        9 => array:1 [
          "titulo" => "References"
        ]
      ]
    ]
    "pdfFichero" => "main.pdf"
    "tienePdf" => true
    "fechaRecibido" => "2011-11-04"
    "fechaAceptado" => "2012-02-18"
    "PalabrasClave" => array:2 [
      "en" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Keywords"
          "identificador" => "xpalclavsec164018"
          "palabras" => array:5 [
            0 => "Normative data"
            1 => "Age"
            2 => "Educational level"
            3 => "Interference"
            4 => "Problem-solving"
          ]
        ]
      ]
      "es" => array:1 [
        0 => array:4 [
          "clase" => "keyword"
          "titulo" => "Palabras clave"
          "identificador" => "xpalclavsec164019"
          "palabras" => array:5 [
            0 => "Datos normativos"
            1 => "Edad"
            2 => "Escolaridad"
            3 => "Interferencia"
            4 => "Resoluci&#243;n de problemas"
          ]
        ]
      ]
    ]
    "tieneResumen" => true
    "resumen" => array:2 [
      "en" => array:2 [
        "titulo" => "Abstract"
        "resumen" => "<span class="elsevierStyleSectionTitle">Introduction</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">The Stroop Color&#8211;Word Interference Test &#40;Stroop&#41; measures cognitive flexibility&#44; selective attention&#44; cognitive inhibition and information processing speed&#46; The Tower of London-Drexel University version test &#40;TOL<span class="elsevierStyleSup">DX</span>&#41; assesses higher-order problem solving and executive planning abilities&#46;</p> <span class="elsevierStyleSectionTitle">Objective</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">In this study&#44; as part of the Spanish normative studies project in young adults &#40;<span class="elsevierStyleItalic">NEURONORMA</span> young adults&#41;&#44; we present normative data for the Stroop and TOL<span class="elsevierStyleSup">DX</span> tests&#46;</p> <span class="elsevierStyleSectionTitle">Material and methods</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">The sample consisted of 179 participants who are cognitively normal and range in age from 18 to 49 years&#46; Tables are provided to convert raw scores to scaled scores&#46; Scores adjusted for sociodemographic factors were obtained by applying linear regression techniques&#46;</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">No effects were found for age and sex in either test&#46; Educational level impacted most of the Stroop test variables and some of the TOL<span class="elsevierStyleSup">DX</span> scores &#40;total moves score and total initiation time score&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">The norms obtained will be extremely useful in the clinical evaluation of young Spanish adults&#46;</p>"
      ]
      "es" => array:2 [
        "titulo" => "Resumen"
        "resumen" => "<span class="elsevierStyleSectionTitle">Introducci&#243;n</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">El <span class="elsevierStyleItalic">Stroop Color-Word Interference Test</span> &#40;Stroop&#41; se utiliza para explorar la flexibilidad mental&#44; la atenci&#243;n selectiva&#44; la inhibici&#243;n cognitiva y la velocidad de procesamiento de la informaci&#243;n&#46; El test <span class="elsevierStyleItalic">Tower of London-Drexel University version</span> &#40;TOL<span class="elsevierStyleSup">DX</span>&#41; es &#250;til para explorar la habilidad para resolver problemas y la planificaci&#243;n&#46;</p> <span class="elsevierStyleSectionTitle">Objetivo</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">En el presente estudio&#44; como parte de los estudios normativos espa&#241;oles del proyecto NEURONORMA j&#243;venes&#44; se presentan datos normativos para el Stroop y la TOL<span class="elsevierStyleSup">DX</span>&#46;</p> <span class="elsevierStyleSectionTitle">Material y m&#233;todos</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">La muestra est&#225; formada por 179 participantes&#44; cognitivamente normales&#44; de entre 18 y 49 a&#241;os de edad&#46; Se aportan tablas para convertir las puntuaciones brutas en escalares&#46; Se aplican regresiones lineales para calcular los ajustes por factores sociodemogr&#225;ficos&#46;</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0045" class="elsevierStyleSimplePara elsevierViewall">Se observ&#243; un efecto nulo de la edad y el g&#233;nero en ambas pruebas&#46; La escolaridad influy&#243; en la mayor&#237;a de variables del Stroop y en algunas medidas de la TOL<span class="elsevierStyleSup">DX</span> &#40;movimientos totales y tiempo de latencia&#41;&#46;</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0050" class="elsevierStyleSimplePara elsevierViewall">Los datos normativos obtenidos son de gran utilidad cl&#237;nica para la evaluaci&#243;n de poblaci&#243;n adulta joven espa&#241;ola&#46;</p>"
      ]
    ]
    "NotaPie" => array:1 [
      0 => array:2 [
        "etiqueta" => "&#9734;"
        "nota" => "<p class="elsevierStyleNotepara">Please cite this article as&#58; Rognoni T&#44; et al&#46; Estudios normativos espa&#241;oles en poblaci&#243;n adulta joven &#40;proyecto NEURO-NORMA j&#243;venes&#41;&#58; normas para las pruebas Stroop Color&#8211;Word Interference Test y Tower of London-Drexel University&#46; Neurolog&#237;a&#46; 2013&#59;28&#58;73&#8211;80&#46;</p>"
      ]
    ]
    "multimedia" => array:3 [
      0 => array:7 [
        "identificador" => "tbl0005"
        "etiqueta" => "Table 1"
        "tipo" => "MULTIMEDIATABLA"
        "mostrarFloat" => true
        "mostrarDisplay" => false
        "tabla" => array:2 [
          "leyenda" => "<p id="spar0060" class="elsevierStyleSimplePara elsevierViewall">SS&#58; scaled scores&#59; TOL<span class="elsevierStyleSup">DX</span>&#58; Tower of London Drexel University version&#46;</p>"
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            0 => array:2 [
              "tabla" => array:1 [
                0 => """
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                  \t\t\t\t  " align="left" valign="\n
                  \t\t\t\t\ttop\n
                  \t\t\t\t">SS&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t">Percentile ranges&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " colspan="3" align="center" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Stroop</td><td class="td" title="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">TOL<span class="elsevierStyleSup">DX</span></td></tr><tr title="table-row"><td class="td" title="\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">&nbsp;\t\t\t\t\t\t\n
                  \t\t\t\t</td><td class="td" title="\n
                  \t\t\t\t\ttable-head\n
                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">W&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">C&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">CW&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Total correct&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t  " align="left" valign="\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Total moves&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Latency time&nbsp;\t\t\t\t\t\t\n
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                  \t\t\t\t" style="border-bottom: 2px solid black">Resolution time&nbsp;\t\t\t\t\t\t\n
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                  """
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                0 => "xTab268006.png"
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        "descripcion" => array:1 [
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Article information
ISSN: 21735808
Original language: English
DOI:10.1016/j.nrleng.2012.02.004
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