TEST

Token Test

Verbal comprehension and complex syntax across 36 commands

Detects subtle auditory comprehension deficits that other language tests miss. 36 commands of increasing complexity, from a single attribute to structures with logical operators and spatial relations.

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WHAT THE TEST IS

The classic of verbal comprehension, now digital

The Token Test was developed by De Renzi and Vignolo (1962) to detect subtle language comprehension deficits in patients with aphasia. Its insight was to assess auditory comprehension while minimising expressive demands: the patient does not have to speak, only carry out commands on a set of tokens varying in colour, shape and size.

The shortened version by De Renzi and Faglioni (1978) streamlined clinical administration without losing diagnostic sensitivity, and the test has since been incorporated into reference batteries such as the Multilingual Aphasia Examination.

Its sensitivity extends well beyond aphasia: it identifies impairment in acquired brain injury, TBI and neurodegenerative conditions, where it detects early deficits in complex comprehension.

HOW IT IS ADMINISTERED

Carrying out verbal commands of increasing complexity

The person sees a set of tokens differing in colour (red, green, yellow, black and white), shape (circle and square) and size (large and small), and carries out the commands they hear. Early items call for a single attribute (“touch the red circle”); later ones chain several elements and add subordination, spatial relations and logical operators (“above”, “next to”, “between”, “except”, “if”, “not”). This hierarchical progression is what makes the deficit surface even when performance on simpler tasks is normal.

WHAT THE TEST MEASURES

Indicators and their interpretation

Total score

Global index of correct responses across the 36 items, weighting performance at every level of linguistic complexity.

High: an intact verbal comprehension system, handling syntactic, semantic and executive load appropriately.
Low: impaired complex auditory comprehension, either primary (aphasia) or secondary to working memory, attention or executive deficits.

Block scores

Performance across each of the 6 blocks, from single-attribute commands (block 1) to structures involving logic, conditionality and inhibition (block 6). Pinpoints exactly where comprehension breaks down.

High: sound sequencing and intact executive control in the blocks with the highest combinatorial load.
Low: depending on the block affected, semantic impairment (1-2), working memory overload (3-5) or a deficit in complex syntax and executive function (6).

Colour hits

Correct responses identifying the colour attribute. Measures lexical-semantic access to basic categories and selective attention to relevant features.

High: an intact lexical-semantic system; errors in other domains cannot be put down to a basic semantic deficit.
Low: impaired semantic access, an attentional deficit or cognitive interference, especially where failures are systematic.

Shape hits

Correct responses discriminating circle from square. Assesses conceptual representation of basic geometric categories and auditory-visual integration.

High: preserved basic perceptual-semantic processing.
Low: conceptual or visuoperceptual impairment, or difficulty with multimodal integration.

Size hits

Correct responses discriminating “large” from “small”. This is the secondary attribute: it demands comparative processing and multiple encoding.

High: good handling of multiple attributes and efficient working memory.
Low: cognitive overload or difficulty prioritising relevant information.

Spatial relation hits

Correct responses on commands involving spatial relations (“above”, “next to”, “between”, “far from”). The most demanding indicator for relational syntax.

High: preserved complex syntactic processing and spatial representation.
Low: a deficit in relational syntax or in visuospatial processing.

REFERENCES

Bibliography

De Renzi, E., & Vignolo, L. A. (1962). The Token Test: A sensitive test to detect receptive disturbances in aphasia. Brain, 85, 665–678.
De Renzi, E., & Faglioni, P. (1978). Normative data and screening power of a shortened version of the Token Test. Cortex, 14(1), 41–49.
Aranciva, F., Casals-Coll, M., Sánchez-Benavides, G., et al. (2012). Estudios normativos españoles en población adulta joven (Proyecto NEURONORMA jóvenes): normas para el Boston Naming Test y el Token Test. Neurología, 27(7), 394–399.
Caplan, D., & Waters, G. S. (1999). Verbal working memory and sentence comprehension. The Behavioral and Brain Sciences, 22(1), 77–126.
Basagni, B., Pancani, S., Pellicciari, L., et al. (2022). Extra-Linguistic Cognitive Functions Involved in the Token Test: Results from a Cohort of Non-Aphasic Stroke Patients with Right Hemisphere Lesion. Behavioral Sciences, 12(12), 494.
Darshini, J. K., Afsar, M., Vandana, V. P., et al. (2021). The Triad of Cognition, Language, and Communication in Traumatic Brain Injury: A Correlational Study. Journal of Neurosciences in Rural Practice, 12(4), 666–672.