title: The effect of age and educational level on the cognitive processes used to comprehend the meaning of pictograms.
abstract: OBJECTIVE
  Pictograms, designed to be a universal communication system, are often created from several concrete and easily recognizable drawings. Does understanding depend on a logical approach? Or is it the ability to inhibit the concrete sense of each picture that allows access to a higher level of comprehension? (ability to abstract). These executive functions are sensitive to the effects of aging and educational level. The aim of our study was to evaluate the nature of the cognitive processes underlying the meaning of pictograms and to test the effect of aging and educational level.
  
  
  METHODS
  We enrolled 19 older adults (60-69 years old) and 63 young adults (20-29 years old). Of these 63 young adults, 43 had a high educational level (Young-High participants), and 20 had a lower educational level (Young-Low participants). Each participant was asked the meaning of 20 pictograms and underwent an assessment of abstraction and logical abilities with WAIS-III test.
  
  
  RESULTS
  Older adults had lower pictogram assessment scores and abstraction and logical abilities when compared with young adults. In both groups, abstraction and logical abilities were correlated with the interpretation of pictograms but only abstraction ability remains strongly correlated with pictogram comprehension in the older group after adjustment of sex, age and educational level. Consequently, the poorer performances of older adults to determine the meaning of pictograms could be explained by the decline of abstraction ability in elderly.
  
  
  CONCLUSIONS
  Pictograms are not the universal communication system as we formerly thought. Age and educational level may influence the performance in determining the meaning of pictograms.
authors.affiliation: Centre Mémoire de Ressources et de Recherche et Service de Médecine Interne Gériatrique, Hôpital Bretonneau, CHRU Tours, 37044, Tours, France, e.beaufils@chu-tours.fr.
authors.forename: Emilie
authors.initials: E
authors.lastname: Beaufils
authors.forename: Caroline
authors.initials: C
authors.lastname: Hommet
authors.forename: Florence
authors.initials: F
authors.lastname: Brault
authors.forename: Aurélie
authors.initials: A
authors.lastname: Marqué
authors.forename: Charlotte
authors.initials: C
authors.lastname: Eudo
authors.forename: Emilie
authors.initials: E
authors.lastname: Vierron
authors.forename: Bertrand
authors.initials: B
authors.lastname: De Toffol
authors.forename: Thierry
authors.initials: T
authors.lastname: Constans
authors.forename: Karl
authors.initials: K
authors.lastname: Mondon
mesh_terms: D000328:Adult; D000367:Age Factors; D003071:Cognition / Q000502:physiology*; D003142:Communication; D003430:Cross-Sectional Studies; D004522:Educational Status; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D055815:Young Adult