OBJECTIVES: The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) is a neuropsychological assessment consisting of twelve subtests, including the Picture Naming subtest. Examinees are shown a series of pictures and asked to name them. In a multinational study where the images cannot be adapted due to practical restrictions, a number of different methodological challenges arise. This comprehensive review suggests solutions to these challenges to ensure consistent and accurate scoring.

METHODS: Existing translations of the subtest were reviewed by the language services provider’s linguistic validation team and lead members from the CRO scientific team. The issues were defined and categorized. Solutions and further considerations were provided for each category, prior to revision of the existing translations and development of new language versions of the RBANS for a new clinical study.

RESULTS: The analysis resulted in the following distinctions of challenges:

1. Regionalisms: examinee responses to an image would be considered correct in one region of a country but incorrect in another
2. Target response variation: the picture presented to an examinee can elicit more than one correct response in the target language

1. Existing source alternative: multiple acceptable responses in English; only single acceptable response in target language

1. The picture presented is not culturally appropriate

CONCLUSIONS: When adapting the subtest for use in other countries, a thorough analysis of possible variations in examinee responses for each picture is necessary. Alternative responses must be included in target languages where regionalisms or common response target variations exist for an image. Alternative responses must be omitted when source response alternatives do not apply in the target language. Finally, translations of responses must deviate from the source when a culturally inappropriate image would otherwise elicit incorrect data.