Rey's verbal learning test: normative data for 1855 healthy participants aged 24-81 years and the influence of age, sex, education, and mode of presentation.

The Verbal Learning Test (VLT; Rey, 1958) evaluates the declarative memory. Despite its extensive use, it has been difficult to establish normative data because test administration has not been uniform. The purpose of the present study was to gather normative data for the VLT for a large number (N = 1855) of healthy participants aged 24-81 years, using a procedure in which the words to be learned were presented either verbally or visually. The results showed that VLT performance decreased in an age-dependent manner from an early age. The learning capacity of younger versus older adults differed quantitatively rather than qualitatively. Females and higher educated participants outperformed males and lower educated participants over the entire age range tested. Presentation mode affected VLT performance differently: auditory presentation resulted in a better recall on Trial 1 (a short-term or working memory measure), whereas visual presentation yielded a better performance on Trial 3, Trial 4, and Delta (a learning measure).     

The Letter Digit Substitution Test: normative data for 1,858 healthy participants aged 24-81 from the Maastricht Aging Study (MAAS): influence of age, education, and sex

The Letter Digit Substitution Test (LDST) is based on earlier developed substitution tests (e.g., Digit Symbol Substitution Test) but uses over-learned signs instead of the symbols used in other substitution tests. The written and oral versions of the LDST were administered to a large, cognitively screened sample (N = 1,858) of adults aged 24 to 81 years. Age was the most important predictor of LDST performance, and females outperformed males. A low level of education profoundly influenced LDST performance: the effect of a low versus high level of education on LDST performance was comparable to about 20 years of aging. Regression-based normative data were prepared for both the written and oral versions of the LDST.     

Development,Validity, and Normative Data Study for the 12-Word Philadelphia Verbal Learning Test [czP(r)VLT-12] Among Older and Very Old Czech Adults

The aim of the present study was to assess the validity of a 12-word Czech version of the Philadelphia (repeatable) Verbal Learning Test [czP(r)VLT-12]. The construction of the czP(r)VLT-12 was modeled after the California Verbal Learning Test (CVLT) and the nine-word Philadelphia (repeatable) Verbal Learning Test [P(r)VLT]. The czP(r)VLT-12 was constructed from a large corpus of old (60–74) and very old (75–96) Czech adults (n = 540). Participants met strict inclusion criteria for the absence of any active or past neurodegenerative disorders and performed within normal limits on other neuropsychological measures. Principal component analysis (PCA) and correlations between czP(r)VLT-12 factor structure and other memory tests were conducted. The czP(r)VLT-12 produced a four-factor solution, accounting for 70.90% of variance, with factors related to: (1) recall, (2) extra-list intrusion errors/recognition foils, (3) interference, and (4) acquisition rate; a solution similar to the CVLT and P(r)VLT. Increasing age resulted in a decline in most czP(r)VLT-12 indices, women outperformed men, and higher education led to higher scores. Memory performance in normal aging did not correlate with instrumental activities of daily living. Low, but significant, correlations were seen with other tests of cognitive performance (divergent validity). Appendices are available that provide normed percentile estimates of individual czP(r)VLT-12 performance stratified by age, education, and gender. In accordance with previous studies, these results demonstrate the usefulness of czP(r)VLT-12 in assessing declarative memory in older adults.     

Effects of Age and Dementia on the Trail Making Test

Trail Making Test (TMT) performance was investigated in 765 elderly volunteers (age range 60 to 96 years), 58 of whom met DSM-III-R criteria for dementia and 40 dementia “suspects,” who showed mild changes in one or two cognitive domains. Cross-sectional analyses of the 667 nondemented participants, revealed significant age effects in completion times for both Parts A and B. Prevalence of errors increased with age on Part B, but not on Part A. Two-year longitudinal changes were examined in a subset of the nondemented sample (n = 385). Significant slowing was found for Part B, but not for Part A, with older age groups showing the greatest change. Error rates did not increase. Dementia status accounted for a significant proportion of the variance in completion times after accounting for age, education, and gender. Receiver operating characteristic analyses suggest that the TMT may be useful in screening for cognitive dysfunction.     

Normative data on tests for frontal lobe functions: Trail Making Test, Verbal fluency, Wisconsin Card Sorting Test (Keio version)]

Trail Making Test (TMT Part A, B), Verbal fluency test (phonemic, semantic) and Wisconsin Card Sorting Test (Keio version : KWCST) are useful to evaluate frontal lobe functions and are commonly used in clinical settings. However, few normative data for aged Japanese have been reported. We collected normative data on these tests in elderly population, and examined the effects of age and education on the performance of these tests. Seventy-six healthy adults, aged 45 to 74 years, participated in this study. Subjects were classified into three groups by age (45-54, 55-64, 65-74). Fifty-five subjects repeated the same tests after 6 months to examine the test-retest reliability. Performance of the TMT Part A was correlated with age (r= 0.530) and that of Part B was correlated with age (r=0.500) and education (r=-0.340). Performance on both phonemic and semantic fluency was correlated with education (phonemic: r=0.357, semantic: r=0.279). Number of Categories Achieved (CA) of KWCST was correlated with education (r=0.376). The test-retest reliability of all these tests except for semantic verbal fluency and difficulty maintaining set (DMS) of KWCST was good enough for longitudinal studies.     

The Misplaced Objects Test: a measure of everyday visual memory

The Misplaced Objects Test is a computerized test of object location recall. The test is structurally similar to tasks used in the evaluation of age and drug effects in preclinical animal research. Delayed recall of 20 common objects which the subject has placed using a touch sensitive screen in a computer-simulated 12-room house is evaluated with three measures. Scores include the number of objects found on the first attempt (Found 1), the number of objects found on the second attempt (Found 2), and the total number of objects found on both attempts (Found T). Performance was evaluated in relation to age, gender, education, and affective status, as well as in relation to several traditional neuropsychological measures. Misplaced Objects Test performance was most strongly associated with age and Wechsler Memory Scale Paired Associate Learning. Additional significant relationships were found with gender, education, and the WAIS Digit Symbol subtest. Potential future applications of the test were discussed.     

Longitudinal evaluation of cognitive disorder in Huntington's disease.

The study investigated longitudinal change in cognitive function in 87 patients with Huntington's disease (HD), using a range of neuropsychological tests, which tap mental manipulative abilities, memory, and frontal executive skills. Over a 1-year period the largest changes were noted in letter fluency, object recall, and Stroop Test performance, whereas no changes were noted over more than 3 years on the modified Wisconsin Card Sorting Test. Contrary to expectation, greater change was evident over 1 year for tasks with low compared to high cognitive demands. The differential sensitivity of tasks was attributed in part to inherent characteristics of the tests themselves: their capacity to detect minor gradations of change and their vulnerability to practice effects. However, the greater change for relatively automatic, speed-based tasks with low cognitive demands was interpreted as reflecting the evolution of HD, with a greater magnitude of change occurring in basal ganglia than cortical function. One purpose of the study was to identify tasks sensitive to the progression of HD and hence most suitable for the evaluation of therapies. Despite reaching statistical significance by virtue of the large group size, numerical differences in test scores over 1 year were very small, suggesting that the use of such tests to evaluate change in individuals or small groups of subjects would be problematic. The data highlight the slow progression of HD, the limitations of standard cognitive tests in detecting change over short periods, and the need for therapeutic studies that encompass a relatively prolonged time frame.     

Alternative to the Stroop Color-Word Test for illiterate individuals

An alternative to the Stroop Color-Word Test (SCWT), denominated the Colored Numbers Test (CNT), was developed to evaluate the selective attention of illiterate individuals. A total of 30 volunteers with basic education (control group) and 30 illiterate volunteers (experimental group) performed the SCWT and the CNT. Volunteers had to name the color of the rectangles in the CNT neutral condition, and in the critical condition they had to either name the color of the numbers or, when the numbers were black, read the numbers. An interference index (II) was calculated for both tests by subtracting the time taken to complete the task in the neutral condition from the time taken to complete the task in the critical condition. The control group showed an II of 14.9 s in the SCWT and of 19.1 s in the CNT, and the experimental group, which practically presented no interference in the SCWT (II = 0.2 s), showed an II of 18.7 s in the CNT. These findings suggest that the CNT can be used to evaluate selective attention. Further work should confirm its validity. Its advantage over the SCWT is that it does not depend on the ability to read words, being then suitable for illiterate individuals.     

Normative data on the Korean version of the Boston Naming Test.

The purpose of this study is to introduce the Korean version of the Boston Naming Test (K-BNT) and to present the normative data. The K-BNT contains the same number of test items and uses the identical general administration method as the original Boston Naming Test (BNT). However, most of the items had to be altered due to the linguistic and cultural differences between Korean and English speakers. We administered 60 line-drawing pictures to six hundred normal participants in eight age groups (15-19, 20-24, 25-34, 35-44, 45-54, 55-64, 65-74, and 75 years and older), five educational levels (0, 1-6, 7-9, 10-12, and 13 years and more), and gender. Since the K-BNT scores were not affected by gender and found not to be significantly different among some age groups, we finalized each cell based on four age groups (15-44, 45-54, 55-74, and 75 years and older) and five education levels (0, 1-6, 7-9, 10-12, and 13 years and more). The highest score was achieved by the 15-44 age group with 13 and more years of education (M = 53.93, SD = 3.06), and the lowest by those of 75 years and older with no education (M = 27.42, SD = 8.22).     

BRIEF REPORT Normative Data on the Korean Version of the Boston Naming Test

The purpose of this study is to introduce the Korean version of the Boston Naming Test (K-BNT) and to present the normative data. The K-BNT contains the same number of test items and uses the identical general administration method as the original Boston Naming Test (BNT). However, most of the items had to be altered due to the linguistic and cultural differences between Korean and English speakers. We administered 60 line-drawing pictures to six hundred normal participants in eight age groups (15-19, 20-24, 25-34, 35-44, 45-54, 55-64, 65-74, and 75 years and older), five educational levels (0, 1-6, 7-9, 10-12, and 13 years and more), and gender. Since the K-BNT scores were not affected by gender and found not to be significantly different among some age groups, we finalized each cell based on four age groups (15-44, 45-54, 55-74, and 75 years and older) and five education levels (0, 1-6, 7-9, 10-12, and 13 years and more). The highest score was achieved by the 15-44 age group with 13 and more years of education (M = 53.93, SD = 3.06), and the lowest by those of 75 years and older with no education (M = 27.42, SD = 8.22).     

Normative data stratified for age, education, and gender on the Boston Naming Test

Stratified normative data for age, education, and gender are provided for the 60-item Boston Naming Test (BNT) on 1026 older participants ages 50-95 years using overlapping age ranges. Tables are presented that convert BNT raw scores to scaled scores and percentiles. Mild dementia cases were eliminated using a comprehensive cognitive battery. In a companion paper we found significantly poorer mean BNT scores and increasing variability with successively older age groups and decreasing educational levels indicating the need for demographically stratified normative data when determining an individual's degree of impairment. These norms should be clinically useful when assessing suspected dementia cases.     

Attention and executive control predict Alzheimer disease in late life: results from the Berlin Aging Study (BASE).

OBJECTIVE: Longitudinal studies of neuropsychological changes in the preclinical phase of Alzheimer disease (AD) have yielded mixed results. Although some studies report tests of episodic memory, others report tests of attention and executive functions as reliable predictors of subsequent AD. Following theoretical models of neuropsychological processes before AD onset, the authors examined the predictive value of attention and executive function in the preclinical phase of AD in old age. METHODS: Authors studied the cognitive performance of 187 initially normal participants of the Berlin Aging Study, a community-based representative sample of Berlin citizens age 70 to 103, over a period of 4 years. Tests of attention and executive function (Digit Letter Test, Trailmaking Part B Test, Digit Symbol Substitution Test, and Identical Pictures Test) and of learning and recall functions (Activity Recall, Memory for Text, and Paired-Associate Learning) were administered at baseline. Diagnosis of AD was made according to NINCDS-ADRDA criteria (probable AD). Receiver operating characteristics curve analyses and Cox regression analyses were used to assess the diagnostic accuracy and predictive value of the neuropsychological tests at baseline for incident AD after 4 years. RESULTS: After 4 years, 15 participants had developed AD. Tests of attention and executive function discriminated best between nonconverters and incident AD cases. A similar pattern was found in survival analyses; attention and executive function tests, together with tests of learning and recall, significantly predicted incident AD over and above age, gender, and education. CONCLUSION: These results support theoretical models of attention and executive function in the preclinical phase of AD in old age.     

SYSTEMS: School-Years Screening Test for the Evaluation of Mental Status

This paper introduces the School-Years Screening Test for Evaluation of Mental Status (SYSTEMS). It was designed to be used by neurologists, pediatricians, and other health professionals assessing children with suspected cognitive problems or changes. SYSTEMS was initially based on the adult Mini-Mental State Examination developed by Folstein, Folstein, and McHugh in 1975. SYSTEMS is a 7- to 12-minute, one-on-one interview test containing 46 items for use in children between 5 and 12 years of age. Although a full diagnosis cannot be made, the results do provide an indication of whether to send a child for further detailed cognitive assessment. The development of SYSTEMS comprised seven studies with a total of 1207 children involved from Sydney primary schools and neurology clinics of the New Children's Hospital, Westmead, New South Wales, Australia. All children were administered the SYSTEMS. Some of the children also were administered the Stanford-Binet Intelligence Test, 4th edition, or the Differential Ability Scales. Results showed that the SYSTEMS was internally consistent, unbiased by sex, socioeconomic indicators, or language groups; discriminated well by age; and strongly correlated (r = 0.88) with mental age. No significant differences in results obtained by two trained administrators were evident and no indication of apparent practice effect was found. The SYSTEMS was found to have desirable levels of sensitivity (83% and 92%), specificity (76% and 95%), and likelihood ratio for cognitive impairment (3.63 and 17.5) when compared with neurologic judgments and the Differential Ability Scales, respectively.     

Empirical Techniques for Determining the Reliability, Magnitude, and Pattern of Neuropsychological Change After Epilepsy Surgery

Summary: Purpose : We assessed test-retest neuropsychological performance in patients with complex partial seizures to derive reliable change indices (RCIs) and regression-based norms for change, indices that may be helpful in assessing cognitive outcome after anterior temporal lobectomy.
Methods : Forty patients with complex partial seizures (CPS) who did not undergo epilepsy surgery were administered a comprehensive neuropsychological battery on two. occasions. Their test-retest data were used to compute both RCIs and regression-based norms for change for each neuropsychological index. RCIs corrected for practice effects provide a confidence interval (CI) indicating the degree of performance change required to exceed the variability attributable to sources of error (e.g., practice, test-retest reliability). Regression-based norms for change also correct for several sources of measurement measurement error and examine observed versus expected test-retest changes on a common metric, thereby facilitating determination of the degree and relative magnitude of change across cognitive domains.
Results : Mean changes in test-retest performance were generally modest, but were evident across several test measures. Our data indicate a considerable degree of individual variability in test-retest Performance.
Conclusions : RCIs and regression-based norms are complementary indexes and can be particularly useful in examining the test-retest performance of individual patients who undergo epilepsy surgery as well as in the more general investigation of cognitive outcome after epilepsy surgery.     

Test-retest reliability and practice effects of a rapid screen of mild traumatic brain injury

Test-retest reliabilities and practice effects of measures from the Rapid Screen of Concussion (RSC), in addition to the Digit Symbol Substitution Test (Digit Symbol), were examined. Twenty five male participants were tested three times; each testing session scheduled a week apart. The test-retest reliability estimates for most measures were reasonably good, ranging from .79 to .97. An exception was the delayed word recall test, which has had a reliability estimate of .66 for the first retest, and .59 for the second retest. Practice effects were evident from Times 1 to 2 on the sentence comprehension and delayed recall subtests of the RSC, Digit Symbol and a composite score. There was also a practice effect of the same magnitude found from Time 2 to Time 3 on Digit Symbol, delayed recall and the composite score. Statistics on measures for both the first and second retest intervals, with associated practice effects, are presented to enable the calculation of reliable change indices (RCI). The RCI may be used to assess any improvement in cognitive functioning after mild Traumatic Brain Injury.     

The Impact of American Content on California Verbal Learning Test Performance: A New Zealand Illustration

The assessment of verbal memory is a core component of neuropsychological assessment, and is often assessed through the use of list-learning tasks. As with other neuropsychological tests, list-learning tasks may be impacted by cultural relevance of test content. This study examined the extent to which the American content of the California Verbal Learning Test (CVLT) impacts upon the verbal memory performance of New Zealanders. Participants included 90 healthy New Zealand adults who ranged in age from 17 to 81 years. Each participant completed the CVLT and a new version of this test that was modified to reflect New Zealand content (NZ-VLT). Performance on the two measures was not significantly impacted by gender, cultural identity (European/Pakeha; Maori or Pacific Islander), or version of the test administered first. Poorer performances on all scores for both measures were significantly related to increased age, with larger correlation coefficients produced for the New Zealand version of the task. Within-subject comparisons revealed that participants performed significantly better on the New Zealand version of the task for short-delay free recall, long-delay free recall, and recognition trials. Implications of these findings are presented to aid clinicians in future applications of the CVLT in New Zealand.     

Volumetric and microstructural regional changes of the hippocampus underlying development of recall performance after extended retention intervals

Performance on recall tests improves through childhood and adolescence, in part due to structural maturation of the medial temporal cortex. Although partly different processes support successful recall over shorter vs. longer intervals, recall is usually tested after less than an hour. The aim of the present study was to test whether there are unique developmental changes in recall performance using extended retention intervals, and whether these are related to structural maturation of sub-regions of the hippocampus. 650 children and adolescents from 4.1 to 24.8 years were assessed in total 962 times (mean interval ≈ 1.8 years). The California Verbal Learning Test (CVLT) and the Rey Complex Figure Test (CFT) were used. Recall was tested 30 min and ≈ 10 days after encoding. We found unique developmental effects on recall in the extended retention interval condition independently of 30 min recall performance. For CVLT, major improvements happened between 10 and 15 years. For CFT, improvement was linear and was accounted for by visuo-constructive abilities. The relationships did not show anterior-posterior hippocampal axis differences. In conclusion, performance on recall tests using extended retention intervals shows unique development, likely due to changes in encoding depth or efficacy, or improvements of long-term consolidation processes.     

Predicting development of dementia in the elderly with the Selective Reminding Test

The ability to predict the development of dementia through the detection of memory impairment in nondemented individuals was assessed with the Selective Reminding Test (SR), a popular test of verbal memory functioning in the elderly. The SR was administered to 385 nondemented volunteer subjects (mean age = 80.4 years) enrolled in a longitudinal study of risk factors in the development of dementia. Of these, 36 subjects ultimately became demented. SR scores obtained from 1 to 2 years prior to the diagnosis of dementia were compared with a set of previously established cutoff scores derived from a cognitively normal elderly sample. The results demonstrated that sum of recall and delayed recall were the SR measures best able to predict dementia with sensitivities of 47% and 44%, respectively. The predictive values were 37% and 40%, respectively, or better than two-and-one-half times the base rate. The contributions of both the SR Test and the Fuld Object-Memory Test (OM) were discussed in terms of the further understanding of the characteristics of the preclinical phase of dementia.