Executive function test norms in the Ecuadorian population: A generalized additive mixed model approach

Area of Science:

• Neuropsychology
• Cognitive Neuroscience
• Psychometrics

Background:

• Executive functions are crucial for daily activities.
• Existing normative data for executive function tests often lack demographic and regional diversity.
• Ecuador's population presents unique demographic characteristics requiring tailored normative data.

Purpose of the Study:

• To establish demographically adjusted normative data for executive function tests in Ecuador.
• To investigate the influence of age, education, sex, and region on executive function performance.
• To develop a practical tool for clinical neuropsychological assessment in Ecuador.

Main Methods:

• Recruited 1,084 healthy participants aged 6-82 years using stratified sampling.
• Administered Stroop Color-Word Test, Symbol Digit Modalities Test, Trail Making Tests A & B, and Modified Wisconsin Card Sorting Test.
• Employed generalized additive mixed models and derived normative percentiles, creating an interactive calculator.

Main Results:

• Significant nonlinear effects of age and education on executive function performance were observed.
• Education moderated age-related decline, particularly in tasks of cognitive flexibility and error correction.
• Women with higher education showed better performance on cognitive flexibility tasks compared to men.

Conclusions:

• The study presents the first large-scale, demographically diverse normative dataset for executive functions in Ecuador.
• Advanced statistical modeling captured complex demographic and regional influences on performance.
• The developed open-access calculator enhances diagnostic accuracy and cross-cultural validity in Latin American neuropsychological assessments.