We read with interest the paper by Araujo et al.¹1.Araujo NB, Nielsen TR, Barca ML, Engedal K, Marinho V, Deslandes AC, et al. Brazilian version of the European Cross-Cultural Neuropsychological Test Battery (CNTB-BR): diagnostic accuracy across schooling levels. Braz J Psychiatry. 2020;42:286-94. on the translation and diagnostic accuracy of the Brazilian version of the European Cross-Cultural Neuropsychological Test Battery (CNTB). This battery consists of simple tests for diagnosing dementia in immigrants or low-educated individuals living in European countries.²2.Nielsen TR, Vogel A, Waldemar G. Comparison of performance on three neuropsychological tests in healthy Turkish immigrants and Danish elderly. Int Psychogeriatr. 2012;24:1515-21. The test that differentiated patients with Alzheimer’s disease from cognitively healthy controls with the highest accuracy was the Recall of Pictures Test (RPT), particularly the delayed recall task.¹1.Araujo NB, Nielsen TR, Barca ML, Engedal K, Marinho V, Deslandes AC, et al. Brazilian version of the European Cross-Cultural Neuropsychological Test Battery (CNTB-BR): diagnostic accuracy across schooling levels. Braz J Psychiatry. 2020;42:286-94.,²2.Nielsen TR, Vogel A, Waldemar G. Comparison of performance on three neuropsychological tests in healthy Turkish immigrants and Danish elderly. Int Psychogeriatr. 2012;24:1515-21. According to Araujo et al.,¹1.Araujo NB, Nielsen TR, Barca ML, Engedal K, Marinho V, Deslandes AC, et al. Brazilian version of the European Cross-Cultural Neuropsychological Test Battery (CNTB-BR): diagnostic accuracy across schooling levels. Braz J Psychiatry. 2020;42:286-94. this test is “similar to a test from the Brief Cognitive Screening Battery (BCSB),³3.Nitrini R, Caramelli P, Herrera Junior E, Porto CS, Charchat-Fichman H, Carthery MT, et al. Performance of illiterate and literate non-demented elderly subjects in two tests of long-term memory. J Int Neuropsychol Soc. 2004;10:634-8. except that color pictures are used.” The reason given for using color pictures instead of black and white line drawings was that color information “can improve the recognition of pictures in illiterate and less schooled individuals.”²2.Nielsen TR, Vogel A, Waldemar G. Comparison of performance on three neuropsychological tests in healthy Turkish immigrants and Danish elderly. Int Psychogeriatr. 2012;24:1515-21.

Since we first published the BCSB in 1994,⁴4.Nitrini R, Lefèvre BH, Mathias SC, Caramelli P, Carrilho PE, Sauaia N, et al. [Neuropsychological tests of simple application for diagnosing dementia]. Arq Neuropsiquiatr. 1994;52:457-65. our group conducted many studies involving this instrument. According to several studies by our and other groups in Brazil and abroad, identifying black and white line drawings is extremely easy for low-educated or even illiterate individuals. Of note, a study conducted on riverbanks in the Amazon basin found a median of 10 out of 10 drawings identified when evaluating 163 individuals with a mean of 0.83 years of education (±1.55), 110 of whom were illiterate.⁵5.Brucki SM, Nitrini R. Subjective memory impairment in a rural population with low education in the Amazon rainforest: an exploratory study. Int Psychogeriatr. 2009;21:164-71.

It is also remarkable that the figures in the BCSB and RPT are identical (except for the bucket, which was replaced with a trash can). In addition, the testing procedures of the RPT are exactly the same as those in the BCSB memory test: naming, incidental memory, immediate memory, learning, delayed recall and recognition. Therefore, in our view, the RPT is a color version of the BCSB memory test, and, as such, the original authors should be credited. Nevertheless, this test received a different name in the European battery, and the papers and names of the BCSB’s authors, who in fact designed this battery for use with low-educated individuals, are rarely mentioned. The first paper by Nitrini et al.,⁴4.Nitrini R, Lefèvre BH, Mathias SC, Caramelli P, Carrilho PE, Sauaia N, et al. [Neuropsychological tests of simple application for diagnosing dementia]. Arq Neuropsiquiatr. 1994;52:457-65. which describes the BCSB, was never cited by the authors of the CNTB.

We must also point out that we have never precluded the use of the BCSB by other researchers or clinicians, and the test has always been freely available. In fact, we have encouraged its use because we believe it is a powerful tool for dementia diagnosis in low-educated individuals. However, we never imagined that it would be used without due recognition that we designed and presented it to the clinical and scientific community.

As we close, we strongly suggest that the authors of the CNTB publicly recognize that the RPT is the color version of the BCSB memory test created by Nitrini et al. in 1994 and not a new or similar test.

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