Convenient Auditory-Based Language and Executive Function Test (CABLET)

Abstract

The Convenient Auditory-Based Language and Executive Function Test (CABLET), introduced by Ohdake et al. in 2023, is a specialized, concise instrument designed for the rapid detection of cognitive impairment in patients diagnosed with Amyotrophic Lateral Sclerosis (ALS). Its core design principle is to minimize reliance on motor function, which is often severely compromised in ALS, by utilizing an entirely auditory-based, receptive task format employing spoken words.

The CABLET is structured into two primary components. Test 1 focuses on assessing basic language processing through tasks involving word repetition and lexical judgment. Test 2 shifts focus toward higher-order cognitive domains, specifically measuring verbal short-term memory and semantic knowledge. Initial validation studies, comparing ALS patients with healthy controls, established the preliminary reliability and validity of the instrument for use in this unique clinical population.

Keywords

Cognitive Test, Auditory-Based Language, Rapid Detection, Executive Function Test, Amyotrophic Lateral Sclerosis, Cognitive Dysfunction, Neuropsychological Tests, Auditory Perception, Word Repetition, Lexical Judgment, Verbal Short-Term Memory, Semantic Knowledge.

Authors

Ohdake, Reiko; Watanabe, Hirohisa; Kawabata, Kazuya; Ogura, Aya; Sato, Maki; Tanaka, Yasuhiro; Imai, Kazunori; Masuda, Michihito; Kato, Toshiyasu; Yokoi, Takamasa; Hara, Kazuhiro; Nakamura, Ryoichi; Atsuta, Naoki; Nakagawa, Masafumi; Katsuno, Masahisa; Sobue, Gen.

Purpose

The primary purpose of the CABLET is to serve as a specialized, rapid screening tool for the identification of cognitive impairment specifically associated with Amyotrophic Lateral Sclerosis (ALS). Given the motor difficulties inherent in ALS, the test structure ensures that cognitive assessment can be conducted efficiently and accurately without requiring significant motor responses from the patient, facilitating early clinical intervention.

Construct

The CABLET is designed to measure core aspects of Language and Executive Function that are frequently affected in ALS. The construct is divided operationally into two main cognitive domains addressed by the respective tests:

• Language and Basic Processing (Test 1): This component assesses fundamental language abilities, including the capacity for word repetition (phonological loop integrity) and lexical judgment (access and recognition of words).

• Verbal Executive Function (Test 2): This component evaluates higher-level cognitive control, specifically utilizing measures of verbal short-term memory and complex semantic knowledge retrieval, reflecting crucial aspects of executive function.

Validity

The validity of the CABLET was primarily established through analyses focusing on its diagnostic accuracy, as well as its convergent and discriminant properties relative to established ALS-related cognitive deficits.

Diagnostic Accuracy (Sensitivity and Specificity): Receiver operating characteristic (ROC) analyses demonstrated strong diagnostic capabilities. The Area Under the Curve (AUC) for the CABLET total score was 0.894, and for Test 2 alone, it was 0.893, indicating good overall diagnostic accuracy in distinguishing between cognitively impaired ALS patients and controls. Notably, Test 2 exhibited excellent sensitivity, achieving 100%, coupled with a specificity of 71.4%. The diagnostic utility remained robust even when controlling for covariates such as age, education, and disease severity.

Convergent and Discriminant Validity: Strong convergent validity was confirmed by significant correlations between the CABLET scores and a composite z-score specifically targeting ALS-specific functions (language and executive functions). The correlation coefficient (r) was 0.630 for the total CABLET score and 0.645 for Test 2 (p < 0.001 for both). Conversely, discriminant validity was established by the lack of significant correlation between CABLET scores and composite z-scores for ALS-nonspecific functions, such as memory and visuospatial abilities (total: r = 0.168, p = 0.208; Test 2: r = 0.166, p = 0.213).

Reliability

As of the initial pilot study (Ohdake et al., 2023), specific data regarding the internal consistency (e.g., Cronbach’s alpha) or test-retest reliability of the Convenient Auditory-Based Language and Executive Function Test (CABLET) was not available or reported.

Factor Analysis

Formal statistical analysis, such as Exploratory or Confirmatory Factor Analysis, has not been reported for the CABLET. Therefore, the underlying factor structure confirming the distinction between the language and executive function domains of the instrument remains to be fully elucidated in subsequent studies.

Instrument

Test Type: Original task.

Format: The test is administered using paper, requiring auditory input and receptive responses.

Language Available: Japanese.

Population Group: Human; Male; Female.

Age Group: Adulthood (18 yrs & older); Middle Age (40-64 yrs); Aged (65 yrs & older).

Population Details: Respondents were patients with Amyotrophic Lateral Sclerosis residing in Japan.

Test Methodology: Test Validity, Convergent Validity, Discriminant Validity, Test Sensitivity, Test Specificity.

Keywords

Neuropsychological Assessment, Receptive Task, ALS Cognitive Impairment, Diagnostic Accuracy, Auditory Processing, Semantic Knowledge, Lexical Judgment, ROC Analysis.

Authors

Author ORCID Identifier:

• Kawabata, Kazuya: http://orcid.org/0000-0002-8851-4377

Affiliation Details:

• Nagoya University Brain and Mind Research Center: Ohdake, Reiko; Watanabe, Hirohisa; Sobue, Gen.

• Nagoya University Department of Neurology: Kawabata, Kazuya; Ogura, Aya; Sato, Maki; Tanaka, Yasuhiro; Imai, Kazunori; Masuda, Michihito; Kato, Toshiyasu; Yokoi, Takamasa; Hara, Kazuhiro; Nakamura, Ryoichi; Katsuno, Masahisa.

• Aichi Medical University: Atsuta, Naoki.

• International University of Health and Welfare: Nakagawa, Masafumi.

Affiliation Email addresses:

• Watanabe, Hirohisa: [email protected]

Correspondence Address:

Watanabe, Hirohisa: Fujita Health University School of Medicine, Department of Neurology, 1-98, Dengakugakubo, Kutsukake-cho, Aichi, Toyoake, Japan, 470-1192, [email protected]

Permissions & Fee and Test Year

Permissions: Contact Corresponding Author.
Fee: No fee is reported for the use of the scale.
Test Year: 2023.

Reference’s

Ohdake, R., Watanabe, H., Kawabata, K., Ogura, A., Sato, M., Tanaka, Y., Imai, K., Masuda, M., Kato, T., Yokoi, T., Hara, K., Nakamura, R., Atsuta, N., Nakagawa, M., Katsuno, M., & Sobue, G. (2023). Convenient auditory-based language and executive function test for patients with amyotrophic lateral sclerosis: A pilot study. Archives of Clinical Neuropsychology, 38(1), 57–71. DOI: https://doi.org/10.1093/arclin/acac069

Items of the Convenient Auditory-Based Language and Executive Function Test (CABLET)

IMPORTANT: The following scale items must be preserved in their original language and must not be changed in any way.

While specific test content (the words or phrases used) is not available, the methodology and scoring rules for the two main tests are detailed below:

• Test 1 (Word Repetition and Lexical Judgment): The maximum score for Test 1 is 32 points. The administration time is approximately 1 minute. Participants who scored 4 points or less on the word repetition task were considered inappropriate to proceed to Test 2, suggesting a screening cutoff for basic auditory processing ability.

• Test 2 (Verbal Short-Term Memory and Semantic Knowledge): The maximum score for Test 2 is 40 points. This test employs a dynamic, adaptive span length methodology. The examiner begins with a 7-span task to facilitate rapid detection of ALS cognitive impairment. If the participant correctly answered either of the two trials for a specific sequence pattern, they advanced to a longer span task (8 spans); if the first trial was correct, the second trial was not required. If both trials were incorrect, the pattern shifted to a shorter span task (6 spans). Participants only progressed to the next span length after completing the 7-span task for each sequence pattern. The final span length successfully completed for each sequence pattern was used as the score. A score of 0 points was assigned if the participant failed the minimum 4-span task.