Re-examination of a Rey auditory verbal learning test/Rey complex figure discriminant function to detect suspect effort

Bernard (1990), and Bernard, Houston, and Natoli (1993) identified a discriminant function, derived from Rey figure recall score and RAVLT trial 1 and recognition, which discriminated simulators and controls with 77--85% accuracy. However, in the current study, application of the discriminant function to patients with suspect effort, brain injured patients, and controls, revealed excellent sensitivity (95%) but low specificity (33% for patients, 61% for controls). A new discriminant function using the same Rey figure and RAVLT scores, derived from actual patients with documented suspect effort and patients with confirmed brain injury, resulted in an overall classification of 85% correct, with only 16% of suspect effort and 15% of brain injured patients misidentified. Use of a discriminant function score of /=91%.     

The Rey 15-item recognition trial: a technique to enhance sensitivity of the Rey 15-item memorization test

Numerous publications on the Rey 15-item Memorization Test have cited limitations primarily in test sensitivity, as well as to some extent in specificity. In the current study, 49 patients with suspect effort, 36 neuropsychology clinic patients not in litigation or attempting to secure disability, 33 learning disabled college students, and 60 normal controls were administered the Rey Test in standard format followed by a recognition trial. A free recall score <9 was found to have excellent specificity (97-100%), although sensitivity was modest (47%). However, use of a combined recall and recognition score (i.e., free recall + [recognition - false positives] <20) substantially increased sensitivity (71%) while maintaining high specificity (> or=92%).     

Effect of memory impairment on training outcomes in ACTIVE.

Cognitive training improves mental abilities in older adults, but the trainability of persons with memory impairment is unclear. We conducted a subgroup analysis of subjects in the Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) trial to examine this issue. ACTIVE enrolled 2802 non-demented, community-dwelling adults aged 65 years and older and randomly assigned them to one of four groups: Memory training, reasoning training, speed-of-processing training, or no-contact control. For this study, participants were defined as memory-impaired if baseline Rey Auditory Verbal Learning Test (AVLT) sum recall score was 1.5 SD or more below predicted AVLT sum recall score from a regression-derived formula using age, education, ethnicity, and vocabulary from all subjects at baseline. Assessments were taken at baseline (BL), post-test, first annual (A1), and second annual (A2) follow-up. One hundred and ninety-three subjects were defined as memory-impaired and 2580 were memory-normal. Training gain as a function memory status (impaired vs. normal) was compared in a mixed effects model. Results indicated that memory-impaired participants failed to benefit from Memory training but did show normal training gains after reasoning and speed training. Memory function appears to mediate response to structured cognitive interventions in older adults.     

Re-Examination of a Rey Auditory Verbal Learning Test/Rey Complex Figure Discriminant Function to Detect Suspect Effort

Bernard (1990), and Bernard, Houston, and Natoli (1993) identified a discriminant function, derived from Rey figure recall score and RAVLT trial 1 and recognition, which discriminated simulators and controls with 77–85% accuracy. However, in the current study, application of the discriminant function to patients with suspect effort, brain injured patients, and controls, revealed excellent sensitivity (95%) but low specificity (33% for patients, 61% for controls). A new discriminant function using the same Rey figure and RAVLT scores, derived from actual patients with documented suspect effort and patients with confirmed brain injury, resulted in an overall classification of 85% correct, with only 16% of suspect effort and 15% of brain injured patients misidentified. Use of a discriminant function score of = -.40 resulted in sensitivity of 71% while maintaining specificity of =91%.     

Evaluation of neuropsychological functions in patients with Friedreich ataxia before and after cognitive therapy

Friedreich ataxia (FA) is a neurodegenerative disease characterized by progressive nervous system damage resulting in severe disability. Cognitive functions and mood disorders in FA have been studied little and with conflicting results. The aim of this study was to investigate cognitive functions and mood disorders in FA subjects and the role of cognitive rehabilitation therapy (sequential treatments) performed during a scheduled study period. The executive functions of 24 subjects with FA were evaluated over one year during three separate periods of in-hospital rehabilitation. The neuropsychological evaluations performed before and after cognitive therapy did not reveal differences in the mean test scores of the MMSE, the Rey 15-item Memorization Test for long-term memory, Raven's Colored Progressive Matrices, the Phonemic Verbal Fluency Test, the Symbol Digit Modalities Test, or the Zung scale. The mean scores of the Stroop color-word interference task and of the Rey 15-item Memorization Test for short-term memory were increased at the final evaluation. This finding of long-lasting stability of neuropsychological test scores is noteworthy, as it suggests that one-year cognitive rehabilitation therapy (sequential treatments) may at least contribute to reducing cognitive decline. A cognitive rehabilitation therapy in addition to the conventional neuromotor rehabilitation treatment may improve the management of subjects with FA.     

The Rey 15-Item Recognition Trial: A Technique to Enhance Sensitivity of the Rey 15-Item Memorization Test

Numerous publications on the Rey 15-item Memorization Test have cited limitations primarily in test sensitivity, as well as to some extent in specificity. In the current study, 49 patients with suspect effort, 36 neuropsychology clinic patients not in litigation or attempting to secure disability, 33 learning disabled college students, and 60 normal controls were administered the Rey Test in standard format followed by a recognition trial. A free recall score &lt;9 was found to have excellent specificity (97–100%), although sensitivity was modest (47%). However, use of a combined recall and recognition score (i.e., free recall+[recognition–false positives] &lt;20) substantially increased sensitivity (71%) while maintaining high specificity (=92%).     

Dementia and effort test performance

Research on the performance of patients with dementia on tests of effort is particularly limited. We examined archival data from 214 non-litigating patients with dementia on 18 effort indices derived from 12 tests (WAIS-III/WAIS-R Digit Span and Vocabulary, Dot Counting Test, Warrington Recognition Memory Test-Words, WMS-III Logical Memory, Rey Word Recognition Memory Test, Finger Tapping, b-Test, Rey 15-Item, Test of Memory Malingering, Rey Auditory Verbal Learning Test, and Rey Complex Figure Test). Results indicated that recommended cut-offs for Digit Span indicators (Vocabulary Minus Digit Span and four-digit forward span time score) provided > or =90% specificity across participants, while the majority of other effort tests displayed specificities in the 30-70% range. Analyses of test specificity as a function of Mini Mental Status Examination (MMSE) score and specific dementia diagnosis are provided, as well as adjustments to cut-offs to maintain specificity where feasible.     

Imagine that: Self-imagination improves prospective memory in memory-impaired individuals with neurological damage

Recent research has demonstrated that “self-imagination” – a mnemonic strategy developed by Grilli and Glisky (2010) Grilli, M. D. and Glisky, E. L. 2010. Self-imagination enhances recognition memory in memory impaired individuals with neurological damage. Neuropsychology, 24(6): 698–710.  [Google Scholar] – enhances episodic memory in memory-impaired individuals with neurological damage more than traditional cognitive strategies, including semantic elaboration and visual imagery. The present study investigated the effect of self-imagination on prospective memory in individuals with neurologically based memory deficits. In two separate sessions, 12 patients with memory impairment took part in a computerised general knowledge test that required them to answer multiple choice questions (i.e., ongoing task) and press the “1” key when a target word appeared in a question (i.e., prospective memory task). Prior to the start of the general knowledge test in each session, participants attempted to encode the prospective memory task with one of two strategies: self-imagination or rote-rehearsal. The findings revealed a “self-imagination effect (SIE)” in prospective memory as self-imagining resulted in better prospective memory performance than rote-rehearsal. These results demonstrate that the mnemonic advantage of self-imagination extends to prospective memory in memory-impaired individuals with neurological damage and suggest that self-imagination has potential in cognitive rehabilitation.     

The 5 Objects Test: a novel,minimal-language,memory screening test

Very brief screening tests are useful in primary care, but may show reduced sensitivity in detecting Alzheimer’s disease or other dementias in the early stages and may show an education or age bias. We examined the reliability, validity, sensitivity, specificity and relationship with demographic variables of a novel, very brief memory screening test that makes limited language demands. Participants were 452 neurological patients with different diagnoses and a community-dwelling sample of 119 middle-aged and older controls. The 5 Objects Test requires the recall of the locations of five everyday objects, immediately after placement and after a brief period of time. The test was unaffected by age and education and showed good reliability and discriminant validity. In receiver operating characteristic (ROC) analyses, specificity was high across a range of sensitivities in all four main comparisons (AD cases versus controls; all dementia cases versus controls; memory-impaired versus non memory-impaired patients; MCI cases versus controls), and sensitivity was lowest in differentiating MCI cases from controls. The test showed similar areas under the ROC curve to the much longer modified Mini Mental State Examination. The 5 Objects Test is a reliable and valid very brief screening test that is suitable for primary care. Because of its limited linguistic demands, the test is appropriate for persons with limited language use or from different linguistic backgrounds.     

Drawing from memory in focal epilepsy: a cognitive and neural perspective

This study provides evidence of non-verbal cognitive functioning in temporal (TLE) and frontal lobe epilepsy (FLE) patients by exploring the mechanisms and neural correlates of drawing abilities. Sixty-six patients with left (n=32) or right TLE (n=34), 30 patients with left (n=18) or right FLE (n=12), and 30 healthy subjects were compared. The Drawing from Memory (DfM) test required participants to design 16 living or non-living items; the total score was the sum of all scores blindly provided by three judges who had to identify the drawings. The verbal and visual Pyramid and Palm Trees Test (PPTT), Raven Colored Progressive Matrices (Raven CPM), Cube Analysis, Token Test, Word Fluency, Card Classification, and Rey Complex Figure Test Copy trial (Rey CFC) assessed different verbal and non-verbal functions. Non-parametric statistics indicated that, with respect to controls, both TLE groups and the left FLE patients had significantly lower DfM scores. In the TLE group, hierarchical regression analyses revealed that the DfM score was predicted by the Raven CPM and PPTT scores, while, in the FLE group, it was predicted by the Rey CFC. Thus, drawing abilities may be impaired by TLE or FLE owing to different mechanisms that involve semantic or executive abilities. Implying cooperation between temporal and frontal areas that support these functions, DfM may be a sensitive index of integrity of cortical areas or neural pathways damaged by focal epilepsy.     

The PRM test (memory profile). Results in a situation of posttraumatic examination (author's transl)

Study of caracteristics of 50 protocoles of the PRM test obtained in "old" cranial traumatism. A comparison with the standards of Rey and various groups of results obtained for patients with traumatism (Rey, 1966; Crochelet, 1970) permits to situate our cases on a real scale of severity of memory deficit.     

Test-retest reliability of the dot test of visuospatial working memory in patients with schizophrenia and controls

To determine the test-retest reliability of the Dot Test of Visuospatial Working Memory, this task was administered to 29 patients with schizophrenia and 19 normal controls on two consecutive days. The test involved "copying" trials followed by "delay" recall trials. For "copying" trials, subjects saw a dot and then drew it on a blank sheet of paper. For "delay" trials, subjects drew the dot following a 10-, 20-, or 30-s delay. The distance between the stimulus and the drawn dot was measured for each trial. The composite score, termed "working memory deficit," is calculated by subtracting the average of the copying trials from the average of the delay trials. Pearson correlations revealed that overall performance in each group was comparable for days 1 and 2. Intra-class correlations of "working memory deficit" on days 1 and 2 were moderate in patients and controls, suggesting that task performance for each subject was similar on the testing days. Test-retest reliability tended to be higher for 10-s delay performance in patients and controls than for longer delay periods. Further analyses suggested that there was no significant learning effect on the task from day 1 to day 2 for either group on any measure. The Dot Test of Visuospatial Working Memory, especially the composite score, has moderate test-retest reliability and is a valuable tool that can be used to assess working memory functions in studies using a repeated-measures design.     

Performance of older depressed patients on two cognitive malingering tests: false positive rates for the Rey 15-item memorization and dot counting tests

To our knowledge, no investigations have been undertaken to determine whether depression impacts performance on two commonly used tests to detect malingering of cognitive symptoms, the Rey 15-item Memorization Test and the Rey Dot Counting Test. This is a critical issue because of the high rate of depressive symptoms in patients with neurological conditions. It was hypothesized that depressed individuals, especially those with more severe depression, might be at risk for failing the tests, because these patients exhibit mild deficits in mental speed, visual perceptual/spatial skills, and visual memory, abilities required for successful completion of the malingering tests. However, examination of test performance in 64 older participants with major depression generally revealed very low false positive rates for most test scores, and severity of depression was unrelated to test scores. These results add to accumulating data supporting the validity of these cognitive malingering tests by documenting few false positive identifications.     

Performance of Older Depressed Patients on Two Cognitive Malingering Tests: False Positive Rates for the Rey 15-item Memorization and Dot Counting Tests

To our knowledge, no investigations have been undertaken to determine whether depression impacts performance on two commonly used tests to detect malingering of cognitive symptoms, the Rey 15-item Memorization Test and the Rey Dot Counting Test. This is a critical issue because of the high rate of depressive symptoms in patients with neurological conditions. It was hypothesized that depressed individuals, especially those with more severe depression, might be at risk for failing the tests, because these patients exhibit mild deficits in mental speed, visual perceptual/spatial skills, and visual memory, abilities required for successful completion of the malingering tests. However, examination of test performance in 64 older participants with major depression generally revealed very low false positive rates for most test scores, and severity of depression was unrelated to test scores. These results add to accumulating data supporting the validity of these cognitive malingering tests by documenting few false positive identifications.     

Relationships between eight measures of suspect effort

Previous studies have recommended that multiple measures be employed concurrently to provide converging evidence regarding the presence of suspect effort during neuropsychological assessment. However, if the tests are highly correlated they do not represent independent sources of information. To date, no study has examined correspondence between effort tests. The present study assessed the relationships between eight measures which can be used to assess effort (Rey 15-item, Rey Dot Counting Test, Rey Word Recognition Test, RAVLT recognition trial, Rey-Osterrieth Complex Figure Test effort equation, Digit Span, Warrington Recognition Memory Test-Words, and "b" Test) in a sample of 105 patients in litigation or attempting to obtain/maintain disability compensation and who displayed noncredible symptoms based on psychometric performance and behavioral criteria. Modest to moderate correlations were observed between test summary scores with only two measures sharing more than 50% score variance (Digit Span and Dot Counting). Moderate correlations were also observed between individual test scores reflecting indices of response time, free recall, recognition, and false positive errors, providing possible evidence that patients may use specific strategies when producing noncredible performances. Overall the results suggest that the use of these various tests generally provides nonredundant data regarding patient credibility in neuropsychological evaluations.     

The Rey 15-item memory test and Spanish-speaking older adults

The Rey 15-Item Memory Test (Rey-15) is a standard instrument frequently employed to assess suspect effort/motivation in English-speaking populations. The objective of the current study was to examine the influence of socio-demographic variables on this measure and provide normative data for use with Spanish speakers. The performance of 130 primarily Spanish-speaking, cognitively intact, older adults (ages 50-69) on six Rey-15 scoring systems and six embedded measures of suboptimal performance was examined. Approximately 8% of the sample scored below the recommended cut-off of 9 on the Rey-15. The lowest recall score of 6 was also the minimum score obtained on the recognition trial. Additionally, scores on the alternative Rey-15 scoring methods and the embedded measures of suboptimal performance were lower in comparison to the normative data presently utilized with English speakers, yet comparable across the examined measures. Basic mental status and education level were significant predictors of Rey-15 performance; however, results indicate that these variables may share a close relationship with socio-demographic characteristics such as acculturation level and years of U.S. residency. Preliminary normative data on the Rey-15 for primarily Spanish-speaking older adults, stratified by education, is provided in conjunction with a recommendation for the use of the recognition trial when interpreting results.     

Japanese version of the Test Your Memory as a screening test in a Japanese memory clinic

A self-administered cognitive test (Test Your Memory, TYM) is designed as a screening test for the detection of Alzheimer disease (AD). We compared the diagnostic utility of the Japanese version of the TYM (TYM-J) in AD and mild cognitive impairment (MCI) with that of the Mini-Mental State Examination (MMSE) and Alzheimer's Disease Assessment Scale—Cognitive Subscale Japanese version (ADAS-Jcog). We studied 79 patients with mild AD, 46 with MCI and 34 normal controls. The sensitivity and specificity of each test in the diagnosis of AD and MCI were compared. The average total TYM-J scores were 45.7 in controls, 41.7 in MCI, and 35.7 in AD. The TYM-J scores showed good correlations with other neuropsychological tests. The receiver operating characteristic analysis demonstrated that the TYM-J could better discriminate AD from controls and MCI from controls than the other tests. With each optimal cut-off score of the TYM-J, the sensitivity and specificity were 96% and 91% for diagnosing AD, and 76% and 74% for diagnosing MCI, respectively. The TYM-J is useful for the diagnosis of AD and MCI, and can be applied as a screening test in a Japanese memory clinic.     

A pilot study of a test for visual recognition memory in adults with moderate to severe intellectual disability

Objective assessment of memory functioning is an important part of evaluation for Dementia of Alzheimer Type (DAT). The revised Picture Recognition Memory Test (r-PRMT) is a test for visual recognition memory to assess memory functioning of persons with intellectual disabilities (ID), specifically targeting moderate to severe ID. A pilot study was performed to investigate whether the r-PRMT could differentiate DAT-related memory decline from pre-existing poor memory functioning of persons with moderate to severe ID. The r-PRMT scores were compared between 26 participants with DAT and moderate to severe ID and 33 controls with similar levels of ID. The results revealed that the controls with DS showed uniformly high scores in contrast to those with DAT on the r-PRMT and the score distributions of two groups were distinctly different with no overlap. On the other hand, the controls with non-DS etiologies scored much lower with a wider score spread, resulting in significant overlap with the score distribution of the participants with DAT. In conclusion, the r-PRMT may be effective in identifying persons with DAT among persons with moderate to severe ID from DS. However, the r-PRMT may result in a high false positive error rate in discriminating those with DAT among persons with moderate to severe ID from non-DS etiologies, if the judgment is based on a single point assessment.     

Parsing the recognition memory components of the WMS-III face memory subtest: normative data and clinical findings in dementia groups

The WMS-III face memory subtest was developed as a quick, reliable, measure of non-verbal recognition memory. While the face memory subtest has demonstrated clinical sensitivity, the test has been criticized for low correlation with other WMS-III visual memory subtests and for failing to differentiate performance between clinical groups. One possible reason for these findings may be due to the impact of response bias associated with recognition memory tests. Four studies were conducted to evaluate the utility of applying signal detection measures to the face memory subtests. The first two studies used the WMS-III standardization data set to determine age and education effects and to present normative and reliability data for hits, false positives, discriminability and response bias. The third study tested the hypothesis that using response components and signal detection measures would enhance the correlation between face memory and the other WMS-III visual memory subtests. The fourth study compared performance of patients with Alzheimer's disease, Huntington's disease, Korsakoff's syndrome and demographically matched controls on the new face memory scores. The new measures did not have higher correlation with other WMS-III visual memory measures than the standard scoring of the test. Analysis of the clinical samples indicated that the discriminability index best differentiated patients from controls. The response components, particularly delayed false positives, differentiated performance among the clinical groups. Normative and reliability data are presented.     

Imagine that: self-imagination improves prospective memory in memory-impaired individuals with neurological damage

Recent research has demonstrated that "self-imagination" - a mnemonic strategy developed by Grilli and Glisky (2010) - enhances episodic memory in memory-impaired individuals with neurological damage more than traditional cognitive strategies, including semantic elaboration and visual imagery. The present study investigated the effect of self-imagination on prospective memory in individuals with neurologically based memory deficits. In two separate sessions, 12 patients with memory impairment took part in a computerised general knowledge test that required them to answer multiple choice questions (i.e., ongoing task) and press the "1" key when a target word appeared in a question (i.e., prospective memory task). Prior to the start of the general knowledge test in each session, participants attempted to encode the prospective memory task with one of two strategies: self-imagination or rote-rehearsal. The findings revealed a "self-imagination effect (SIE)" in prospective memory as self-imagining resulted in better prospective memory performance than rote-rehearsal. These results demonstrate that the mnemonic advantage of self-imagination extends to prospective memory in memory-impaired individuals with neurological damage and suggest that self-imagination has potential in cognitive rehabilitation.