Norms For CERAD Constructional Praxis Recall

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Norms for CERAD constructional praxis recall
Article in The Clinical Neuropsychologist · November 2011

DOI: 10.1080/13854046.2011.614962 · Source: PubMed
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Clin Neuropsychol. 2011 November ; 25(8): 1345–1358. doi:10.1080/13854046.2011.614962.
Norms for CERAD Constructional Praxis Recall

Gerda G. Fillenbaum, PhD1,2, Bruce M. Burchett, PhD1, Frederick W. Unverzagt, PhD3,
Daniel F. Rexroth, PsyD3, and Kathleen Welsh-Bohmer, PhD4
1Center for the Study of Aging and Human Development, Duke University Medical Center,
Durham, NC 27710
2Geriatric Research, Education, and Clinical Center, VAMC, Durham, NC
3Department of Psychiatry, Indiana School of Medicine, Indianapolis, IN 46202
4BryanAlzheimer Disease Research Center, Division of Neurology, Department of Medicine,
Duke University Medical Center, Durham, NC 27710
Abstract
Recall of the 4-item constructional praxis measure was a later addition to the Consortium to
Establish a Registry for Alzheimer’s Disease (CERAD) neuropsychological battery. Norms for
this measure, based on cognitively intact African Americans age ≥70 (Indianapolis-Ibadan
Dementia Project, N=372), European American participants age ≥66 (Cache County Study of
Memory, Health and Aging, N=507), and European American CERAD clinic controls age ≥50
(N=182), are presented here. Performance varied by site; by sex, education and age (African
Americans in Indianapolis); education and age (Cache County European Americans; and only age
(CERAD European American controls). Performance declined with increased age, within age with
less education, and was poorer for women. Means, standard deviations, and percentiles are
presented separately for each sample.
Keywords
Consortium to Establish a Registry for Alzheimer’s Disease; elderly; neuropsychology measures;
constructional praxis; norms; African American
Introduction
The neuropsychological battery developed by the Consortium to Establish a Registry for
Alzheimer’s Disease (CERAD) to assess stage of Alzheimer’s disease (AD) includes five
measures: verbal fluency; abbreviated Boston Naming test (Kaplan, Goodglass, &
Weintraub, 1983); Mini-Mental State Examination (MMSE; Folstein, Folstein, & McHugh,
1975); 10-item Word List Learning, Recall, and Recognition test; and constructional praxis
(CP; Rosen, Mohs, & Davis, 1984). Several years after the initial battery was developed, a
CP recall measure was added in response to concern about disproportional focus on
assessment of verbal abilities. Clinicians and researchers requested praxis memory in
addition to verbal memory, to better describe the characteristics and course of AD. With
heightened interest in different forms of mild cognitive impairment (Petersen, 2004), and
Contact Information: Gerda G. Fillenbaum, PhD, Center for the Study of Aging and Human Development, Box 3003, Duke University
Medical Center, Durham, NC 27710, Phone: 919-660-7530; Fax: 919-668-0453; ggf@geri.duke.edu.
Potential conflicts. There are no potential conflicts.
Fillenbaum et al. Page 2
proposed DSM 5 categories of neurocognitive decline, information on praxis memory

becomes increasingly important.
Norms for the original CERAD measures have been published for different settings,
languages and cultures (e.g., Berres, Monsch, Bernasconi, Thalmann, & Stahelin, 2000;
Ganguli, Ratcliff, & DeKosky, 1997; Guruje et al., 1995; Karrasch & Laine, 2003; Lee et
al., 2004; McCurry et al., 2001; Stewart, Richards, Brayne, & Mann, 2001; Unverzagt et al.,
1999; Welsh et al., 1994), but have not always provided norms on the CP recall test.
Exceptions includeBerres et al. (2000), for speakers of German in Europe;Lee et al. (2004),
for Korea;McCurry et al. (2001) for Japanese Americans (speakers of Japanese or English);
and Welsh-Bohmer et al. (2009), for English speakers in the U.S. With the exception of the
study by Lee et al. (2004), focus has been on investigator-identified community residents
with normal cognition. The present paper complements these and adds to the Lee et al.
(2004), clinically-based study by providing CP recall norms for carefully evaluated,
cognitively normal epidemiologically identified African Americans and European
Americans, as well as for volunteer control subjects followed at tertiary medical center
memory disorders clinics. The information provided is intended to be useful in determining
the status of community residents who are being evaluated for epidemiological or clinical
purposes. Information on European American volunteer control subjects indicates the level
of performance that may be expected in Memory Disorders Clinic volunteers – a comparison
group frequently used in clinical studies. Information on Memory Disorders Clinic
volunteers comes from the original English-speaking CERAD sample (Heyman et al., 1997;
Morris et al., 1989), and completes information on norms for the CERAD neuropsychology
battery based on that sample.
Methods
Samples
The performance of cognitively normal older persons on the CP recall test was available
from two epidemiological surveys designed to assess the prevalence and incidence of
Alzheimer’s disease and other dementing disorders. These were the Indianapolis-Ibadan
Dementia Project (Hendrie et al., 1995; 2001), from which we selected the African
Americans in Indianapolis, and the Cache County Study of Memory, Health and Aging
(Welsh-Bohmer et al., 2009), carried out in Utah with an overwhelmingly (99.6%) European
American sample. In addition information was available from a small group of cognitively
normal European American control subjects entered into CERAD (Morris et al., 1989). Thus
we are able to compare older, cognitively intact, epidemiologically identified African
Americans with epidemiologically identified European Americans, and the latter with
European American clinic volunteers.
African Americans in Indianapolis—Data on African Americans comes from the

Indianapolis component of the Indianapolis-Ibadan Dementia Project, a study of the
prevalence and incidence of Alzheimer’s disease and dementia (Hendrie et al., 1995; 2001).
A sample of African Americans 65 years of age and over was drawn from a random
sampling of 60% of the households in 29 contiguous census tracts in Indianapolis in which
80% of the residents were African American according to 1990 census data. Of the invited
participants, 85% agreed to enter the study. In addition, all African Americans in a sample
of representative nursing homes in the same area were included in the study. The cohort was
formed in 1992–1993 with a sample size of 2,212 and followed longitudinally at 2–3 year
intervals. A two-stage design was used, with screening via the Community Screening
Instrument for Dementia (Hall et al., 1993). All who fell below the screen’s cutpoint, a
randomly selected 50% in the intermediate range, and 5% in the good performance group

received clinical evaluations which consisted of an examination by a clinician (physician or

nurse), structured informant interview, and cognitive testing. The clinician examination
included physical, neurological, and mental status examinations. The informant interview
was a structured interview adapted from the CAMDEX (Hendrie, et al., 1988), and
conducted by a research nurse with a family member who knew the subject well, to probe
for cognitive symptoms and current performance in daily functioning. Cognitive testing
included the CERAD neuropsychology battery (Morris et al., 1989). Diagnoses (normal
cognition, mild cognitive impairment, and dementia) were made in a consensus conference
of geriatric psychiatrists, neurologists, and neuropsychologists using standard diagnostic
criteria. Stage of dementia was assessed by the Clinical Dementia Rating scale (Morris,
1993), on which a rating of 0 indicates cognitively normal; 0.5 indicates questionable
dementia, very mild dementia, or now mild cognitive impairment; and values of 1 and
greater indicate increasing levels of impairment in dementia.
Data for the current study on CP recall come from 1997–2004 when the delayed recall
portion of this measure was first introduced in the Indianapolis-Ibadan study. Sample
members were then 70 years of age and older; 79 had been administered CP copy at a prior
wave (19 of them at two prior waves). Of the 395 participants identified with normal
cognition, 372 had a CDR rating of 0. Of the remaining 23, one had no CDR score, one had
a CDR rating of 1, and 21 had a CDR rating of 0.5. Only persons with a CDR score of 0
were included in analysis to insure unquestionable normal cognition. Complete information
was available on all 372 participants, three of whom were excluded since their CP recall
scores were out of range. The analysis sample therefore consists of 369 participants, 11 of
whom had prior exposure to CP copy.
Cognitively intact Cache County Study participants—In 1994, all persons 65 years
of age and older, living in Cache County, Utah, were invited to participate in the study; 90%
(5092/5067), did so. In 1995, these participants received an initial screening based on an
adapted version of the modified Mini-Mental State Exam (3MS-R; Tschanz et al., 2002), or
a proxy interview using the Informant Questionnaire for Cognitive Decline (IQCODE; Jorm
& Jacomb, 1989). Those 90 years of age and over, all persons scoring below predetermined
cutoffs on the 3MS-R and IQCODE, and randomly selected individuals above the cutoff,
matched in terms of gender, 5-year age group and APOE ε4 status (in a ratio of
approximately 2 normals:1 anticipated AD case), were selected for clinical evaluation.
Clinical evaluations were done in the home by a nurse and psychometrist, who determined
blood pressure, performed physical and neurological examinations, administered an
extended CERAD neuropsychological battery, reviewed cognitive symptoms, took a
medical history, and determined medication use. Individuals suspected of having a
dementing disorder were further examined by a board certified geropsychiatrist, and

standard laboratory studies and neuroimaging were carried out where feasible. Diagnosis of
dementia and AD followed DSM-III-R and NINCDS-ADRDA criteria, with final
determination by a consensus panel of neurologists, geriatric psychiatrists,
neuropsychologists, and behavioral neuroscientists (Breitner et al., 1999). Of 993 persons
who were fully clinically evaluated, 507 were rated as clinically normal, i.e., dementia, and
other cognitive impairments including mild cognitive disorders were determined to be
absent. Using this sample of 507, norms have previously been published for the measures of
the CERAD neuropsychological battery used in the Cache County Memory Study (Welsh-
Bohmer et al., 2009); information on CP recall was available for 484 participants. The CP
recall data have been re-analyzed here, using age categories that permit direct comparison
across the three data sets represented in the present paper.

CERAD European American control cases—Cases and controls enrolled in CERAD

by the then extant Alzheimer’s Disease Research Centers and other major AD centers in the
U.S., had to meet strict inclusion/exclusion criteria (Morris et al., 1989). At entry, control
subjects had to be cognitively intact, and had to meet the same health criteria as AD cases
(be ambulatory, have no health condition that could affect cognitive performance). In
addition they could not be blood relatives of an AD case. Stage of disease was determined
by the Clinical Dementia Rating scale (CDR; Hughes, Berg, Danziger, Coben, & Martin,
1982). Between 1987 and 1995, 429 European American, English-speaking control subjects
were entered into CERAD. CP recall was not part of the original battery, but was added in
1993. Of those then enrolled in CERAD, 182 European American controls were eligible to
be administered the CP recall test, with response obtained from 177. (Data were only
available on 11 African American controls, a number too small for consideration here.) All
but 1 subject had been administered the CP copying test on one or more previous occasions.
Each study was approved by the IRB at each site.
CERAD Neuropsychology Battery

The order of administration of the CERAD neuropsychology measures is as follows: verbal
fluency (naming as many animals as possible in 60 seconds), abbreviated 15-item Boston
Naming test, Mini-Mental State Examination (MMSE), 10-item Word List Learning test
(administration of a 10-item word list on three consecutive occasions, each time using a
different randomized order with immediate recall after each administration), CP copy, Word
List Recall (unprompted recall of the 10-item word list), Word List Recognition
(identification of the 10 original word list items in a list of 20 words), and CP recall. The
time interval between CP copy and CP recall is 2 to 2.5 minutes.
Constructional Praxis tasks

The CP copying task consists of four figures (circle, diamond, overlapping rectangles,
Necker cube). Each figure is printed on the top half of a regular size sheet of paper, and
presented individually to the subject, who is asked to copy the figure in the space below.
The scoring range is 0–11 (criteria are given in Table 1). The subject is not informed about
the later recall task, which is thus an incidental learning task.
Uniform test administration

At all sites, testers were trained to administer and score CP recall according to procedures
developed by CERAD, and their competence to do so was evaluated.
Statistical Analysis
Descriptive statistics were used to characterize the sample. SAS Proc GLM was run
separately for each site to determine whether there were significant differences in
performance as a function of sex, education, or age. All three were significant for
Indianapolis, education and age were significant for Cache county, and only age was
significant for CERAD. SAS Proc GLM was also used to determine whether there were
differences in performance across the three sites after sex, age, and education were
controlled when (a) all data from each site was entered, (b) when data was restricted to that
in common across all sites (i.e., age range 70–94, education 9–15 years), and (c) comparing
the two European American sites (age range restricted to 70–94, education unrestricted since
they had a similar education distribution).
In calculating norms, age was categorized in overlapping decades starting at 5-year intervals
(e.g., 70–79, 75–84, 80–89, 85–94, but with the oldest age category adjusted, where

relevant, to reflect the highest age in the sample), maximizing the clinical usefulness of the
data (Pauker, 1988). Education was categorized as 0–8, 9–11, 12–15, and ≥16 years. While
this represented the educational range across all three samples, distribution was skewed; the
lowest educational category was most strongly represented by the Indianapolis sample, and
the highest by the Cache county sample. Means and standard deviations and percentiles
were determined for each cell using SAS Proc Means, and are presented only when at least
10 people are included in a given cell. While only whole scores are recorded for CP recall,
Proc Means provides percentile scores that sometimes end in .5. Such scores were rounded
down to the next integer, to give poor performers the benefit of the doubt. All analyses were
run in SAS version 8.2 (SAS Institute, Cary, NC).
Results
The three samples differed in terms of ethnicity (all but two Cache county sample members
were European American, they were retained to maintain comparison with the original study
(Welsh-Bohmer et al., 2009), gender distribution, education, and age (Table 2). Just over
two thirds of the Indianapolis and CERAD samples were female, compared to just over half
for Cache County. Indianapolis sample members reported fewer years of education. Age
reflected study entry criteria, and time during the study when CP recall was introduced.
Analyses unrestricted on age and education indicated that each site was significantly
different from each other site. Least squares means (adjusted for demographic
characteristics, reported since this is an unbalanced design) and (standard errors) for
Indianapolis, Cache county, and CERAD were 6.25 (0.14), 7.87 (0.12), and 6.80 (0.22)
respectively, the significance of the difference between the Indianapolis and CERAD scores
was P <.05, while that between the other comparisons was P <.0001. Analyses restricted to a
common age and education range gave slightly different results. The significance of the
difference between Indianapolis and Cache county remained (P < .0001), but the Cache
County/CERAD difference declined to P <.002, and there was no longer a significant
difference between Indianapolis and CERAD. The least squares means (Indianapolis, Cache
county, CERAD) were 5.98 (0.16), 7.69 (0.15), 6.22 (0.44). Finally, analysis comparing
Cache county with CERAD, where age range was restricted to be the same for both groups
but restriction was not needed for education, found a statistically significant difference (P < .
0001), with least squares means (standard errors) being 8.12 (0.11) and 7.09 (0.23)
respectively. Based on these findings, information is presented separately for each sample.
Simultaneous consideration of sex, education and age showed that their associations with CP
recall score varied by study. All three were statistically significant for the Indianapolis
sample (education, P<0.001; age, P=0.0003; sex, P=0.042). For the Cache county sample
only education (P<0.0001) and age (P<0.0001) were significantly associated. For CERAD
controls only age (P<0.0001) was significantly associated with CP recall scores.
For all three samples, age was categorized in overlapping decades, increasing by 5-year
intervals. Ages 50–59, 55–64, and 60–69 are present only for CERAD, and 66–69 only for
Cache County. The youngest and oldest age categories vary for each group, as indicated in
Tables 3 and 4, otherwise the age categories are comparable across the three sites. Only age
categorization was used for CERAD, since neither education nor sex was related to score in
this sample. The same education categories were used for the Indianapolis and Cache county
samples, capturing the lower educational experience of the former group, and the higher
educational experience of the latter. Education was not categorized for CERAD since it was
not associated with score in this sample. Means, standard deviations, and percentiles are
given separately for each group (Table 3 for Indianapolis, Table 4 for Cache county and
CERAD).

In all samples, level of performance decreased with increase in age, and within age declined
as education decreased (where education was relevant). For the Indianapolis sample only,
there was further difference by sex, with women typically performing more poorly than
men.
Finally, we examined the effect of prior exposure to the CP copy test using data from the 11
Indianapolis participants who had responded to the test previously. They did not differ
significantly from the nonexposed group on demographic characteristics or in CP Recall
performance. We were unable to confirm this in the CERAD sample since all but one person
had received prior exposure.
Discussion
To the extent that sex, education, and age were relevant, the pattern of scores was
comparable across the three samples (poorer performance with increased age, less education,
and by women). The samples differed in the extent to which these demographic
characteristics were associated with CP recall score, and in level of performance, with Cache
County European Americans being consistently better. Differences in performance between
European Americans and African Americans have generally been considered to reflect non-
equivalence of similarly labeled years of education (Manly, Jacobs, Touradji, Small, &
Stern, 2002). Other factors, such as geographic region may also be involved, since there is
evidence that older community residents in the south may perform more poorly than those
living elsewhere (Fillenbaum, Unverzagt, Ganguli, Welsh-Bohmer, & Heyman, 2002;
Wadley, Unverzagt, McGuire, et al., 2011). Why the performance of Cache County
European Americans was better than that of the CERAD clinic volunteers is unclear.
All the main comparison studies (Berres et al., 2000; Lee et al., 2004; McCurry et al., 2001),
also looked at the impact of age, education, and sex on CP recall performance. All found
that age, sex, and gender (and sometimes also two-way interactions among these) to be
important. Berres et al. (2000), based on information from 617 cognitively normal German
speaking participants from the chemical-pharmaceutical industry (53–92 years old; 432 men,
185 women; 8–20 years of education), found all three demographic characteristics to be
important determinants of score on the CERAD neuropsychology measures, but do not
specifically indicate whether this holds for CP recall. Lee et al. (2004), based on 618
volunteers in Korea (60–90 years old; 209 men, 409 women; 0–20 years education), found
age, sex and education, and also the two way interactions between these characteristics, to
be significant. The AddNeuroMed study (Paajanen et al., 2010), with information on 223
cognitively intact subjects from Finland, France, Greece, Italy, Poland and the United
Kingdom, found that score varied with demographic characteristics. Other studies on CP
recall tend to have smaller samples (Karrasch, Sinerva, Gronholm, Rinne, & Laine, 2005;
Spangenburg, Henderson, & Wagner, 1997; Yuspeh, Vanderploeg, & Kershaw, 1998), or re-
analyze a larger study already referenced above (Zehnder et al., 2009). However, we found
sex differences only for the Indianapolis (African American) sample. Differences between
studies may reflect unexamined cultural factors: Berres et al. (2000) used information from
German speakers in the chemical-pharmaceutical industry; the Lee et al. (2004) data come
from Korea; the McCurry et al. (2001) data come from a Japanese-American sample, in
which nearly half were tested in Japanese and the AddNeuroMed study reported
performance differences across countries..
To date, comparison of CP recall performance across studies is problematic. Depending on

sample characteristics, data may be presented separately by age group (with age categories
inconsistent across studies); by sex and age; by age and education (with both categories
differing across studies); or by sex, education, and age. We have tried to maintain

consistency in both age and education categories, using conventional groupings of each.
Overall, however, older people (regardless of how grouped) perform more poorly than
younger persons, women perform more poorly than men, possibly reflecting gender-related
spatial abilities (see review by Herlitz, Lovén, Thilers, & Rehnman, 2010), and those with
more years of education perform better than those with fewer. Within these general
similarities, specific scores may differ notably. For instance (and assuming a rough
education matching where such is possible), the CERAD mean CP recall score for persons
age 80 and over is 4.3, but the score for the Japanese American sample is 4.9, that for the
Korean sample is 5.7 (women) and 7.1 (men); for Cache County it is 7.1; and for the
German-speaking sample it is 7.7 (women), and 8.3 (men). Differences are unlikely to be
attributable to small sample sizes. Sample sizes were 201 (Japanese-Americans; McCurry et
al., 2001); 372 (African Americans; Hendrie et al., 2001); 507 (European Americans;
Welsh-Bohmer et al., 2009), 617 (German-speaking; Berres et al., 2002), and 618 (Korean;
Lee et al., 2004). The reasons for score differences in older age are unclear, possibly
education, environmental characteristics, and survival issues are at play. Differences,
however, are unlikely to be due to the Flynn effect (Flynn 1987), since all studies were done
within a decade of each other, and all persons were quite elderly. The score differences
suggest caution in using norms developed in a setting other than that for which comparison
is desired.
The additional value of CP recall is not yet known. CP copy has been found to discriminate
particularly in the later stages of AD (Wang et al., 2004; Welsh, Butters, Hughes, Mohs, &
Heyman, 1992; Zec et al., 1992). There has been interest in using CP tasks to identify
pathology in specific areas of the brain (Nielsen et al., 1996), to distinguish late onset
depression from AD (Künig et al., 2006), and to examine the impact of vitamins and
homocysteine on cognitive function (Riggs, Spiro III, Tucker, & Rush, 1996). It remains to
be seen whether CP recall can further aid in these endeavors.
This study has certain limitations. While the participants in both epidemiology-based studies
can be expected to be more representative of persons their age than volunteers, the manner
of selection which ensured that they were cognitively intact may have favored inclusion of
persons with lower cognition. (Among others, all persons with a score below a cutpoint
indicative of cognitive impairment were selected for further evaluation; some were deemed
cognitively intact.) All but one CERAD subject and 11 in the Indianapolis group had been
administered the CP copy task previously. While the current data focus on performance at
the first administration of CP recall, these participants had seen the figures at least once a
year or two before, and several had seen them on multiple prior occasions. Although prior
exposure might be expected to improve performance, no improvement was observed in the
present case. Unfortunately, unlike the other CERAD measures, for which 1-month test-
retest data were obtained, we have no comparable information for CP recall. Volunteers at
tertiary care memory disorders clinics have been found to perform better on
neuropsychology measures than the general population their age (Fillenbaum, et al., 2002),
although that does not seem to hold here.
The norms presented here are based on data gathered by uniformly trained testers from
carefully evaluated cognitively normal epidemiologically-based and volunteer-based
subjects. The extent to which they apply to persons in other countries, with different
educational systems and gender expectations is unclear. Similarly, it is appropriate to be
cautious in generalizing to other geographic areas in the U.S., which may have different
emphases on education. These limitations notwithstanding, present data complete the norms
developed for the CERAD Neuropsychology Battery based on the original CERAD sample
of control subjects, and provide age-consistent information on a broad variety of older
persons, particularly persons 80 years of age and older. They also provide norms useful in

determining the level of performance of older African Americans (by comparing with
Indianapolis data), and European Americans (by comparing with Cache county data) who
are evaluated for either epidemiological or clinical purposes, e.g., to ascertain whether
intervention is desirable to improve status or prevent decline, to determine eligibility for

clinical studies. In making such comparison, however, it is critical to bear in mind that these
data are not nationally representative, and may reflect unknown effects that are peculiar to
each site. The CERAD data indicate the levels of performance that may be expected of
European American volunteers to memory disorders clinics, a group frequently used as
control subjects in studies of patients at memory disorders clinics.
Acknowledgments
Support for this study was provided by National Institute on Aging grants R01 AG11380 (KW-B), P30 AG10133,
P30AG028716, R01 AG09956, R01 AG026096, and Alzheimer’s Association – IIRG-95-084 (FU, DR), U01
AG06790 and a consulting agreement with Bayer HealthCare Pharmaceuticals Inc. (GF).
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Table 1
Scoring criteria for Recall of CP
Item No. of points Criteria

Circle 2 Closed within 1/8”
Circular shape
Diamond 3 Draws 4 sides

Closes all angles, within 1/8”
Sides of approximately equal length
Overlapping rectangles 2 Both rectangles are 4-sided

Overlap resembles the original
Necker’s cube 4 Figure is 3-dimensional

Frontal face correctly oriented (may be right or left oriented)
Internal lines correctly drawn
Opposites sides are parallel (within 10°)

NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author Manuscript
Table 2
Demographic characteristics of the samples
Indianapolis Cache County CERAD controls

(African (European (European
Americans) Americans) Americans)
(N = 369) (N = 507) (N = 182)
Fillenbaum et al.
N % N % N %
Ethnicity 369 100.0 0 0 0 0
African American 0 0 505 99.6 182 100.0
White 0 0 1 0.2 0 0
Asian 0 0 1 0.2 0 0
Other
Sex 112 30.4 227 44.8 58 31.9

Male 257 69.6 280 55.2 124 68.1
Female
Education 107 29.0 22 4.4 12 6.6

0–8 years 104 28.2 65 12.8 7 3.8
9–11 years 144 38.0 286 56.4 116 47.3
12–15 years 14 3.8 134 26.4 77 42.3
≥16 years 10.23 (3.33) 13.41 (2.94) 14.30 (3.12)
Mean (standard deviation)
Age (years) 0 0.0 0 0.0 23 12.6

50–59 0 0.0 40 7.9 76 41.8
60–69 209 56.6 217 42.8 70 38.5
70–79 138 37.4 189 37.3 10 5.5
80–89 22 6.0 61 12.0 3 1.6
90+ 79.27 (5.64) 79.76 (7.54) 65.87 (7.98)
Mean (standard deviation)

Page 12
Table 3
Constructional Praxis 4-item recall – norms for Indianapolis sample (African American): means, standard deviations, and percentile scores by sex,
education and age categories (Indianapolis – epidemiological sample).
Percentile
Fillenbaum et al.
N Mean (SD) 95 90 75 50 25 10 5
Education: 0–8 years
Women
Age 70–79 35 4.71 (1.89) 8 8 6 4 4 2 2
Age 75–84 47 4.62 (2.44) 9 8 6 4 3 1 1
Age 80–89 31 4.35 (2.73) 9 8 6 4 2 1 1
Age 85–96 19 3.26 (2.47) 8 7 5 4 1 0 0
Men
Age 70–74 10 5.40 (2.91) 11 9* 8 5 3 2 0
Age 70–79 24 5.17 (2.76) 10 9 7 5 3 2 2
Age 75–84 20 5.40 (2.89) 10* 9* 7* 5 3 2 1

Women
Age 70–74 20 5.75 (2.57) 9 8* 8 6 4 2 1
Age 70–79 40 5.93 (2.58) 9* 9 8 6 4 2 2
Age 75–84 40 5.95 (2.65) 10 9 8* 6 4 2* 1
Age 80–89 26 5.88 (2.50) 9 9 8 6 5 3 1
Men

Age 70–79 25 6.44 (2.62) 10 9 9 6 5 3 2
Age 75–84 22 5.68 (2.48) 9 9 8 6 4 2 2
Age 80–89 10 4.30 (2.16) 8 7* 5 4* 3 1* 1

Information on 16+ years of education is not provided because of sample size
Women
Age 70–74 21 5.95 (3.41) 10 10 9 7 2 2 1

Page 13
Percentile
N Mean (SD) 95 90 75 50 25 10 5
Age 70–79 56 6.16 (2.87) 10 9 8 7 4 2 1
Age 75–84 66 6.27 (2.71) 10 10 8 7 5 2 1
Age 80–89 44 5.34 (3.01) 10 10 8 5 3 2 0

Fillenbaum et al.
Age 85–96 19 3.21 (2.02) 8 6 4 3 2 0 0
Men
Age 70–74 10 7.90 (2.38) 11 10* 10 8 7 4* 3
Age 70–79 20 7.60 (2.59) 11 11 10 7 6 3* 3
Age 75–84 24 6.79 (3.01) 11 11 9 6* 5 3 3
Age 80–89 16 6.13 (3.07) 11 11 8* 6 4 3 0
N = number of respondents in group. In the Indianapolis sample there were no non-respondents.
(SD) = (Standard deviation)

*
indicates that score has been rounded down to the next whole number

Page 14
Table 4
Constructional Praxis 4-item recall -- norms for Cache County (epidemiological sample, European American) and controls at CERAD-participating
memory disorders clinics (European American): means, standard deviations and percentile scores by education and age categories (Cache County), and
age categories only (CERAD).
Percentile
Fillenbaum et al.
N (group Mean (SD) 95 90 75 50 25 10 5

size)
Cache county
Education: 0–8 years No information provided, sample too small (n = 22)
Age 66–74 13 (13) 8.08(2.60) 11 10 10 9 7 5 2
Age 70–79 19 (19) 7.79 (2.12) 10 10 9 8 7 5 2
Age 75–84 23 (24) 7.48 (2.29) 10 10 9 8 7 5 2
Age 80–89 24 (25) 6.67 (2.44) 9 9 9 7* 6 3 2
Age 85–94 22 (24) 5.77 (2.79) 9 9 8 6 4 2 1
Age 90–102 12 (16) 5.25 (3.33) 9 9 8* 5 2* 1 0

Age 66–69 23 (23) 8.83 (2.08) 11 11 11 9 8 6 5
Age 66–74 81 (81) 8.63 (1.87) 11 11 10 9 7 6 5
Age 70–79 129 (129) 8.40 (2.06) 11 11 10 9 7 6 5
Age 75–84 132 (135) 8.13 (2.07) 11 11 10 8 7 6 4
Age 80–89 97 (105) 7.38 (2.34) 11 10 9 7 6 4 3
Age 85–94 53 (62) 6.62 (2.61) 11 10 8 7 5 3 2
Age 90–102 23 (29) 6.30 (2.60) 11 9 8 6 4 4 3

Education: 16+ years
Age 66–69 12 (12) 9.33 (1.61) 11 11 11 9* 8 8 6
Age 66–74 47 (47) 9.11 (1.73) 11 11 11 9 8 6 6
Age 70–79 65 (65) 8.89 (1.74) 11 11 10 9 8 6 6
Age 75–84 61 (61) 8.57 (2.00) 11 11 10 9 7 6 5
Age 80–89 50 (50) 8.24 (2.21) 11 11 10 8 7 5 4
Age 85–94 23 (26) 7.61 (2.27) 11 11 9 8 6 4 4

Page 15
Percentile
N (group Mean (SD) 95 90 75 50 25 10 5
View publication stats

size)
Controls at CERAD Memory Disorders Clinics

(The values below apply to 6–21 years of education; education was not associated
with score in this group)
Fillenbaum et al.
Age 50–54 12 (12) 9.17 (3.24) 11 11 11 11 8 7 0
Age 50–59 23 (23) 9.30 (2.55) 11 11 11 10 8 7 6
Age 55–64 33 (33) 8.76 (3.15) 11 11 11 10 8 6 0
Age 60–69 70 (76) 8.74 (2.94) 11 11 11 10 8 5 0
Age 65–74 88 (99) 8.51 (2.55) 11 11 11 9 7 5 3
Age 70–79 60 (70) 7.85 (2.75) 11 11 10* 8 6 4 3
Age 75–84 29 (34) 6.62 (3.68) 11 11 11 7 4 1 1
Age 80–89 11 (11) 4.73 (4.15) 11 9 9 4 1 0 0
N = number responding; number in parentheses is total group size.
(SD) = (Standard deviation)

*
indicates that score has been rounded down to the next whole number

Page 16

Norms For CERAD Constructional Praxis Recall

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Norms for CERAD constructional praxis recall

Article in The Clinical Neuropsychologist · November 2011

Bruce M Burchett Daniel Rexroth

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Clin Neuropsychol. 2011 November ; 25(8): 1345–1358. doi:10.1080/13854046.2011.614962.

Norms for CERAD Constructional Praxis Recall

proposed DSM 5 categories of neurocognitive decline, information on praxis memory

African Americans in Indianapolis—Data on African Americans comes from the

Clin Neuropsychol. Author manuscript; available in PMC 2012 November 01.

received clinical evaluations which consisted of an examination by a clinician (physician or

dementing disorder were further examined by a board certified geropsychiatrist, and

Clin Neuropsychol. Author manuscript; available in PMC 2012 November 01.

CERAD European American control cases—Cases and controls enrolled in CERAD

Each study was approved by the IRB at each site.

CERAD Neuropsychology Battery

Constructional Praxis tasks

Uniform test administration

Clin Neuropsychol. Author manuscript; available in PMC 2012 November 01.

Clin Neuropsychol. Author manuscript; available in PMC 2012 November 01.

To date, comparison of CP recall performance across studies is problematic. Depending on

Clin Neuropsychol. Author manuscript; available in PMC 2012 November 01.

Clin Neuropsychol. Author manuscript; available in PMC 2012 November 01.

intervention is desirable to improve status or prevent decline, to determine eligibility for

Clin Neuropsychol. Author manuscript; available in PMC 2012 November 01.

dementia. British Journal of Psychiatry. 1982; 140:566–572. [PubMed: 7104545]

Clin Neuropsychol. Author manuscript; available in PMC 2012 November 01.

Neurology. 2002; 15:28–38.

CERAD experience. Neurology. Vol. 49. 1997. p. S11-S13.

Clin Neuropsychol. Author manuscript; available in PMC 2012 November 01.

Item No. of points Criteria

Diamond 3 Draws 4 sides

Overlapping rectangles 2 Both rectangles are 4-sided

Necker’s cube 4 Figure is 3-dimensional

Clin Neuropsychol. Author manuscript; available in PMC 2012 November 01.

Indianapolis Cache County CERAD controls

Sex 112 30.4 227 44.8 58 31.9

Education 107 29.0 22 4.4 12 6.6

Age (years) 0 0.0 0 0.0 23 12.6

Clin Neuropsychol. Author manuscript; available in PMC 2012 November 01.

Education: 0–8 years

Age 75–84 47 4.62 (2.44) 9 8 6 4 3 1 1

Age 80–89 31 4.35 (2.73) 9 8 6 4 2 1 1

Age 85–96 19 3.26 (2.47) 8 7 5 4 1 0 0

Age 70–74 10 5.40 (2.91) 11 9* 8 5 3 2 0

Age 70–79 24 5.17 (2.76) 10 9 7 5 3 2 2

Age 75–84 20 5.40 (2.89) 10* 9* 7* 5 3 2 1

Education: 9–11 years

Age 70–74 20 5.75 (2.57) 9 8* 8 6 4 2 1

Age 70–79 40 5.93 (2.58) 9* 9 8 6 4 2 2

Age 75–84 40 5.95 (2.65) 10 9 8* 6 4 2* 1

Age 80–89 26 5.88 (2.50) 9 9 8 6 5 3 1

Clin Neuropsychol. Author manuscript; available in PMC 2012 November 01.

Age 75–84 22 5.68 (2.48) 9 9 8 6 4 2 2

Age 80–89 10 4.30 (2.16) 8 7* 5 4* 3 1* 1

Education: 12–15 years

Age 70–74 21 5.95 (3.41) 10 10 9 7 2 2 1

Age 75–84 66 6.27 (2.71) 10 10 8 7 5 2 1

Age 80–89 44 5.34 (3.01) 10 10 8 5 3 2 0

Age 85–96 19 3.21 (2.02) 8 6 4 3 2 0 0

Age 70–74 10 7.90 (2.38) 11 10* 10 8 7 4* 3