Aims: The aim was to create a more challenging version of the Picture Naming and Immediate Recall test (PICNIR) to verify the difficulty of naming 20 strictly selected pictures by patients with cognitive impairments, to provide clear rules for the correct evaluation of their naming, and to specify the test administration rules. We refer to it as to the so-called door version according to the first picture.
Methods: Twenty more difficult pictures were named using a written or electronic form by 5,625 ordinary citizens from all over the Czech Republic with a wide age and educational range and by more than 100 patients with a diverse spectrum of cognitive impairment from our previous studies. Name agreement was determined by the correct naming of these pictures.
Then, name variants of each picture were categorized into two groups of correct and incorrect names. The categorization of the 15 remaining questionable names for the 12 pictures was assessed in an electronic questionnaire and voted on by 110 pharmacists, neurologists, speech therapists, psychologists, psychiatrists, and other people.
Results: First, we determined that the naming of the images matched the expected naming. High name agreement of the selected 20 pictures with the expected name was above 90% (97% on average) in ordinary citizens, and conversely, lower or no name agreement was desirable in patients with various cognitive disorders (76% on average) based on our several previous studies.
Names of the following categories will be considered as correct: synonyms (traffic lights - lights), diminutives (robot - small robot), multiword name containing the expected name (cake with candle), subordinate name (submarine - bathyscaphe), and other categories or names (cloverleaf - clover). Names of the following categories will be considered as incorrect: semantic paragraphia (door - window, fork - brush, pie - button, stamp - painting, cake - cemetery, waterfall - weir, chessboard - chess), graphemic changes (globe - globus), multiword name without the expected name (magnifier - magnifying glass, cake - Stalin's monument, waterfall - water stream), more general names (Eskimo - Northerner), approximate term (fence - planks), plurals (traffic light - traffic lights), and names of words without diacritics (jeřáb - jerab).
Conclusion: Correct and incorrect names of appropriately selected 20 more difficult pictures were defined and categorized into several subgroups to evaluate picture naming consistently and unambiguously in the more demanding door PICNIR test.