Spanish validation and cultural adaptation of the Five-Word Test for the detection of the neurocognitive disorder in older adults

Sara Gloria Aguilar-Navarro, Alberto José Mimenza-Alvarado, Rafael Martínez-Sánchez, Silvia Mejía-Arango, Lidia Gutiérrez-Gutiérrez, José Alberto Ávila-Funes



Introduction. “Episodic” memory problems are common in people with cognitive impairment due to Alzheimer’s disease and related disorders. Dubois et al. developed the Five-Word Test (5WT) to evaluate episodic memory, which has proved to be an easy and valid test for identifying cognitive disorders. However, its validation and cultural adaptation from French to Spanish has not been undertaken and its usefulness in Mexican population is unknown.

Objective. Validation and cultural adaptation of the 5WT for screening minor and major neurocognitive disorder (ND) in Mexican older adults with probable Alzheimer’s disease.

Method. Two hundred and fifteen participants (70 cognitively healthy subjects, 73 with minor ND and 72 with major ND were included). The cognitive status (gold standard) was determined using current clinical criteria and neuropsychological evaluation. The Spearman coefficient, ROC curve, and multinomial logistic regression models were used to determine the concurrent validity of the 5WT.

Results. The correlation between the 5WT and the Mini-Mental State Exam (MMSE) was .58, whereas for the clock face test it was -.37 (p < .001). The area under the 5WT curve was .97 (95% CI [.94, .99]), with a cut-off point of ≤ 16/20 for the diagnosis of major ND (89% sensitivity, 98% specificity) and .77 (95% CI [.70, .85]) for minor ND with a cut-off point of ≤ 18/20 (66% sensitivity, 77% specificity).

Discussion and conclusion. Since the 5WT is a simple, valid instrument for the identification of neurocognitive disorders like Alzheimer’s disease, it could be a practical screening test.


Neurocognitive disorder; Alzheimer’s disease; Five-Word Test; screening; older adult

Full Text:

HTML Pdf ePub


Aguilar-Navarro, S. G., Mimenza-Alvarado, A. J., Samudio-Cruz, M. A., Hernández-Contreras, F. J., Gutiérrez-Gutiérrez, L. A., Ramírez-González, F., & Avila-Funes, J. A. (2018). Validation of the Clock Drawing Test Scoring Method in older adults with neurocognitive disorder. Salud Mental, 41(4), 179-186.

American Psychiatric Association. (2014). Guía de consulta de los criterios diagnósticos del DSM-5®: Spanish Edition of the Desk Reference to the Diagnostic Criteria From DSM-5®. American Psychiatric Pub.

Bolívar, J. C., & Saladie, D. G. (2016). Redefining amnestic mild cognitive impairment as an early form of Alzheimer’s disease based on assessment of memory systems. Journal of Alzheimer’s Disease, 53(2), 705-712. doi: 10.3233/JAD-160117

Bush, C., Kozak, J., & Elmslie, T. (1997). Screening for cognitive impairment in the elderly. Canadian Family Physician, 43, 1763-1768.

Carley, S., Dosman, S., Jones, S. R., & Harrison, M. (2005). Simple nomograms to calculate sample size in diagnostic studies. Emergency Medicine Journal, 22(3), 180-181. doi: 10.1136/emj.2003.011148

Consejo Nacional de Población. (2013). Proyecciones de la Población de México 2010-2050. Retrieved from

Croisile, B., Astier, J. L., & Beaumont, C. (2007). Étalonnage du test des cinq mots dans une population de sujets sains. Revue Neurologique, 163(3), 323-333. doi: 10.1016/S0035-3787(07)90404-X

Doraiswamy, P. M., Steffens, D. C., Pitchumoni, S., & Tabrizi, S. (1998). Early recognition of Alzheimer’s disease: what is consensual? What is controversial? What is practical?. The Journal of Clinical Psychiatry, 59(Suppl 13), 6-18.

Dubois, B., Feldman, H. H., Jacova, C., Cummings, J. L., DeKosky, S. T., Barberger-Gateau, P., ... Gauthier, S. (2010). Revising the definition of Alzheimer’s disease: a new lexicon. The Lancet Neurology, 9(11), 1118-1127. doi: 10.1016/S1474-4422(10)70223-4

Dubois, B., Touchon, J., Portet, F., Ousset, P. J., Vellas, B., & Michel, B. (2002). The 5 words: A simple and sensitive test for the diagnosis of Alzheimer’s disease. Presse Médicale, 31(36), 1696-1699.

Eknoyan, D., Hurley, R. A., & Taber, K. H. (2012). The clock drawing task: common errors and functional neuroanatomy. The Journal of Neuropsychiatry and Clinical Neurosciences, 24(3), 260-265. doi: 10.1176/appi.neuropsych.12070180

Folstein, M. F., Folstein, S. E., & McHugh, P. R. (1975). Mini-mental state: A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12(3), 189-198. doi: 10.1016/0022-3956(75)90026-6. Retrieved from

Grober, E., Buschke, H., Crystal, H., Bang, S., & Dresner, R. (1988). Screening for dementia by memory testing. Neurology, 38(6), 900-903. doi: 10.1212/WNL.38.6.900

Grober, E., Mowrey, W. B., Ehrlich, A. R., Mabie, P., Hahn, S., & Lipton, R. B. (2016). Two-stage screening for early dementia in primary care. Journal of Clinical and Experimental Neuropsychology, 38(9), 1038-1049. doi: 10.1080/13803395.2016.1187117

Katz, S., & Akpom, C. A. (1976). 12. Index of ADL. Medical Care, 14(Suppl 5), 116-118. doi: 10.1097/00005650-197605001-00018

Lawton, M. P., & Brody, E. M. (1969). Assessment of older people: self-maintaining and instrumental activities of daily living. The Gerontologist, 9(3), 179-186. doi: 10.1093/geront/9.3_Part_1.179. Retrieved from

McKhann, G., Drachman, D., Folstein, M., Katzman, R., Price, D., & Stadlan, E. M. (1984). Clinical diagnosis of Alzheimer’s disease: Report of the NINCDS‐ADRDA Work Group under the auspices of Department of Health and Human Services Task Force on Alzheimer’s Disease. Neurology, 34(7), 939-939. doi: 10.1212/WNL.34.7.939

Mejía-Arango, S., & Gutierrez-Robledo, L. M. (2011) Prevalence and incidence rates of dementia and cognitive impairment no dementia in the Mexican population: data from the Mexican Health and Aging Study. Journal of Aging and Health, 23(7), 1050-1074. doi: 10.1177/0898264311421199

Mejía-Arango, S., Miguel-Jaimes, A., Villa, A., Ruiz-Arregui, L., & Gutiérrez-Robledo, L. M. (2007). Cognitive impairment and associated factors in older adults in Mexico. Salud Pública de México, 49(4), 475-481.

Mormont, E., Jamart, J., & Robaye, L. (2012). Validity of the five-word test for the evaluation of verbal episodic memory and dementia in a memory clinic setting. Journal of Geriatric Psychiatry and Neurology, 25(2), 78-84. doi: 10.1177/0891988712445088

Morris, J. C. (1993). The Clinical Dementia Rating (CDR): current version and scoring rules. Neurology, 43(11), 2412-2414. doi: 10.1212/wnl.43.11.2412-a. Retrieved from

Navarrete, H., & Rodríguez-Leyva, I. (2003). La demencia ¿Subdiagnosticada o ignorada?. Revista Mexicana de Neurociencias, 4, 11-12. Retrieved from

Organización Panamericana de la Salud. (2001). Encuesta de Salud y Envejecimiento de Latinoamérica. Retrieved from

Prince M., Acosta D., Ferri C. P., Guerra M., Huang Y., Llibre Rodriguez J. J. L., ... Liu Z. (2012). Dementia incidence and mortality in middle income countries, and associations with indicators of cognitive reserve: a 10/66 Dementia Research Group population-based cohort study. Lancet, 380(9836), 50-58. doi: 10.1016/S0140-6736(12)60399-7

Rodriguez, J. J. L., Ferri, C. P., Acosta, D., Guerra, M., Huang, Y., Jacob, K. S., ... Prince, M. E. (2008). Prevalence of dementia in Latin America, India, and China: a population-based cross-sectional survey. The Lancet, 372(9637), 464-474. doi: 10.1016/S0140-6736(08)61002-8

Rozzini, L., Ceraso, A., Zanetti, M., Pelizzari, S., Tomasoni, E., Accardo, V., & Padovani, A. (2017). The Italian version of the five-word test: A simple diagnostic test for Dementia due to Alzheimer’s Disease in routine clinical practice. Behavioural Neurology, 9, 1-6. doi: 10.1155/2017/3781407

Sheikh, J. I., & Yesavage, J. A. (1986). Geriatric Depression Scale (GDS): recent evidence and development of a shorter version. Clinical Gerontologist: The Journal of Aging and Mental Health, 5(1-2), 165-173. doi: 10.1300/J018v05n01_09

Wong, R., Espinoza, M., & Palloni, A. (2007). Adultos mayores mexicanos en contexto socioeconómico amplio: salud y envejecimiento. Salud Pública de México, 49(S4), 436-447.

Wong, R., Michaels-Obregon, A., & Palloni, A. (2015). Cohort profile: the Mexican health and aging study (MHAS). International Journal of Epidemiology, 46(2), e2-e2. doi: 10.1093/ije/dyu263