Relationship between WAIS-R subtests and language measures after blunt head injury

Abstract

The relationship between language performance (Multilingual Aphasia Exam: MAE) and WAIS-R subtests was examined in 79 head-injured patients using multiple stepwise regression analyses. As expected, WAIS-R Verbal subtests are more highly correlated with basic language skills than are WAIS-R Performance subtests. The Verbal subtests demonstrated significant relationships with the Visual Naming, Controlled Oral Word Association, and Sentence Repetition subtests of the MAE. Most Verbal subtests were more strongly correlated with MAE Visual Naming; however, Digit Span and Arithmetic were more strongly related to MAE Sentence Repetition. WAIS-R Performance subtests also correlated with MAE subtests, primarily the Token Test and Controlled Oral Word Association. In general, premorbid education was not a significant factor in these correlations. Although severity of injury did not impact correlations between language measures and Verbal subtests, it was a factor in the correlations with some Performance subtests. Results argue that WAIS-R profiles of head-injured persons can be interpreted most accurately when knowledge of more basic language skills is available.     

Construct validity of the Denman Memory for Human Faces test

Assessed the validity of the Denman Memory for Human Faces (MHF) subtest employing a clinical sample. Factor analysis with marker variables was employed to establish the nature of the extracted factors. The MHF subtest, WAIS-R Verbal (i.e., Information, Vocabulary, and Digit Span) and Performance (i.e., Block Design and Object Assembly) subtests, the Wechsler Memory Scale Mental Control, Paired Associate Learning, 30-min Logical Memory, and 30-min Visual Reproduction, and Benton's Facial Recognition Test were subjected to a maximum likelihood factoring procedure with Varimax rotation. Four factors were extracted which accounted for 72.7% of the variance. Factor I was perceptual-organization, Factor II was verbal comprehension, Factor III was general memory, and Factor IV was attention-concentration. The MHF subtest achieved a substantial loading (i.e., 0.56) on the general memory factor along with Logical Memory (0.54), Visual Reproduction (0.51), and Paired Associate Learning (0.71). Clinical applications of the MHF were discussed.     

Cognitive changes in children treated for acute lymphoblastic leukemia with chemotherapy only according to the Pediatric Oncology Group 9605 protocol

The purpose of this study was to examine cognitive functioning and neuroimaging in children with leukemia treated with the Pediatric Oncology Group 9605 protocol at the Children's Hospital of Eastern Ontario. Mean age at diagnosis was 4.88 +/- 2.54 years. The mean (n = 24) Wechsler Verbal and Performance IQ fell in the low-average range (87.33 +/- 15.69 and 84.83 +/- 19.11, respectively). Mean (n = 20) Verbal and Visual Memory Indexes of 82.95 +/- 15.46 and 88.30+/- 10.80, respectively, were obtained. The proportion of scores on measures of intelligence and memory falling > 1 SD below the normative mean was substantially higher than expected. Paired t-test suggested that Wechsler Verbal IQ and memory remained stable, whereas Wechsler Performance IQ declined significantly. The results of growth curve analyses replicated these findings and suggested a significant adverse effect of cumulative dosage of intrathecal methotrexate on estimated Wechsler Performance IQ. Although only two children experienced seizures, 78% of the group showed leukoencephalopathy on at least one magnetic resonance image. Reliance on seizures as a predictor of leukoencephalopathy might underestimate the incidence of neurotoxicity.     

Development of a new Delayed Memory Index for the WMS-III

This paper presents the Delayed Memory Index (DMI) as an alternative to the General Memory Index (GMI) of the Weschler Memory Scale-Third Edition (WMS-III). The WMS-III Immediate Memory Index (IMI) and the GMI are not parallel in structure, making a direct comparison between these index scores (i.e., immediate vs. delayed memory variables) difficult. The IMI is composed of the sum of scaled scores of four subtests (Logical Memory I, Verbal Paired Associates I, Faces I, and Family Pictures I) while the GMI is composed of the sum of scaled scores of five subtests (Logical Memory II, Verbal Paired Associates II, Faces II, Family Pictures II and Auditory Recognition Delayed). Inclusion of Auditory Recognition Delayed in the GMI is also problematic as it is highly skewed and limited by extreme ceiling effects (see Tulsky, Chiaravalloti, Palmer, & Chelune, 2003). To remedy these problems, we present a new index score that does not include auditory recognition, the Delayed Memory Index. Normative tables for the new Delayed Memory Index based on the inclusion of the Faces subtest, or alternatively the Visual Reproduction subtest, are presented, and initial estimates of their psychometric properties are described.     

Convergent and Discriminant Validity of the CVLT (Dementia Version)

This study investigated the convergent and discriminant validity of the 9-item “dementia version” of the California Verbal Learning Test (CVLT-9) in a sample of 130 geriatric patients evaluated for memory complaints. Moderate correlations were observed between the CVLT-9 sum of words recalled for trials 1–5 (Trial 1–5 Recall) and Long-Delay Free Recall (LDFR) measures and the immediate and delayed Logical Memory (LM I and LM II) and Visual Reproduction (VR I and VR II) subtests from the Wechsler Memory Scale-Revised (WMS-R). However, the CVLT-9 Trial 1–5 Recall and VR I measures demonstrated significant correlations with a number of additional measures of language and visuospatial ability. The CVLT-9 LDFR, and the WMS-R LM I, LM II, and VR II showed less overlap with non-episodic memory functioning. A principal components analysis yielded a three-component solution consisting of a general or “g” component, a specific memory component, and a mood component. The CVLT-9 Trial 1–5 Recall and VR I loaded on both the “g” and the memory components, whereas LM I, LM II, and VR II loaded on only the memory component. We conclude that the CVLT-9 Trial 1–5 Recall and VR I demonstrate low discriminant validity, suggesting diminished specificity as memory measures.     

Convergent and discriminant validity of the CVLT (dementia version). California Verbal Learning Test.

This study investigated the convergent and discriminant validity of the 9-item "dementia version' of the California Verbal Learning Test (CVLT-9) in a sample of 130 geriatric patients evaluated for memory complaints. Moderate correlations were observed between the CVLT-9 sum of words recalled for trials 1-5 (Trial 1-5 Recall) and Long-Delay Free Recall (LDFR) measures and the immediate and delayed Logical Memory (LM I and LM II) and Visual Reproduction (VR I and VR II) subtests from the Wechsler Memory Scale-Revised (WMS-R). However, the CVLT-9 Trial 1-5 Recall and VR I measures demonstrated significant correlations with a number of additional measures of language and visuospatial ability. The CVLT-9 LDFR, and the WMS-R LM I, LM II, and VR II showed less overlap with non-episodic memory functioning. A principal components analysis yielded a three-component solution consisting of a general or "g' component, a specific memory component, and a mood component. The CVLT-9 Trial 1-5 Recall and VR I loaded on both the "g' and the memory components, whereas LM I, LM II, and VR II loaded on only the memory component. We conclude that the CVLT-9 Trial 1-5 Recall and VR I demonstrate low discriminant validity, suggesting diminished specificity as memory measures.     

Factor structure of the wechsler memory scale-revised (WMS-R) in a clinical sample: A methodological reappraisal

Principal components and common factors of the Wechsler Memory Scale-Revised (WMS-R) were derived from a clinical sample (N = 168) of males referred for neuropsychological evaluation at a rural Veterans Administration Medical Center. One general memory component accounting for 54% of the variance was consistently identified, whether the analyses included the eight immediate subtests alone, all 12 immediate and delayed-recall subtests, or the WMS-R and VIQ/PIQ combined. Minimal support for a second factor which contributed 9.4% of the total variance was found only after Verbal and Performance IQ scores were included in the analysis. The failure of these data to support previous reports of multiple WMS-R components is attributed in part to different factor retention criteria. Principal-component loadings nominally exceeded those derived by common factor analysis. Clinical implications of these findings are discussed.     

Development of brief versions of the Wechsler Intelligence Scale for schizophrenia: Considerations of the structure and predictability of intelligence

Short forms (SF) of the Wechsler Intelligence Scale have been developed to enhance its practicality. However, only a few studies have addressed the Wechsler Intelligence Scale Revised (WAIS-R) SFs based on data from patients with schizophrenia. The current study was conducted to develop the WAIS-R SFs for these patients based on the intelligence structure and predictability of the Full IQ (FIQ). Relations to demographic and clinical variables were also examined on selecting plausible subtests. The WAIS-R was administered to 90 Japanese patients with schizophrenia. Exploratory factor analysis (EFA) and multiple regression analysis were conducted to find potential subtests. EFA extracted two dominant factors corresponding to Verbal IQ and Performance IQ measures. Subtests with higher factor loadings on those factors were initially nominated. Regression analysis was carried out to reach the model containing all the nominated subtests. The optimality of the potential subtests included in that model was evaluated from the perspectives of the representativeness of intelligence structure, FIQ predictability, and the relation with demographic and clinical variables. Taken together, the dyad of Vocabulary and Block Design was considered to be the most optimal WAIS-R SF for patients with schizophrenia, reflecting both intelligence structure and FIQ predictability.     

Sex differences among non-brain-damaged adults on the Wechsler Adult Intelligence Scales: a review of the literature

We reviewed studies of the performance of non-brain-damaged men and women on the Wechsler Adult Intelligence Scales (i.e., the Wechsler-Bellevue, Wechsler Adult Intelligence Scale, and Wechsler Adult Intelligence Scale-Revised) to determine if there were sex differences on specific test items, on specific subtests, or on Verbal IQ, Performance IQ, or the Verbal-Performance Discrepancy score. There were sex differences on some items of each of the three measures, but the number of such differences was small. A number of studies suggested differences on subtests of these scales. A meta-analysis indicated that females tended to outperform males by about a third of a standard deviation on the Digit Symbol subtest, while males tended to outperform females to the same extent or greater on the Arithmetic and Information subtests. Finally, in the few studies on IQ or discrepancy-score differences, there was no evidence of any consistent differences between the sexes in the Verbal-Performance Discrepancy, although there was some tendency for males to obtain higher Verbal IQs. This review, therefore, does not suggest that there are any major differences between non-brain-damaged males and females on the Wechsler adult intelligence scales.     

Intelligence or years of education: which is better correlated with memory function in normal elderly Japanese subjects?

Background: We compared differences in intelligence and memory function between normal elderly Japanese subjects with more years of education and those with fewer years of education. We also investigated clinical and neuropsychological factors that are strongly correlated with memory function. Methods: There were 118 normal elderly subjects who underwent the Mini‐Mental State Examination, Wechsler Adult Intelligence Scale, 3rd edition (WAIS‐III), and Wechsler Memory Scale Revised. Subjects with at least 13 years of education were categorized as the H group, and those with 12 years of education or less were categorized as the L group. Results: Age and Mini‐Mental State Examination scores were not significantly different between the two groups. On the WAIS‐III, there were significant differences between the two groups in Verbal IQ and Full Scale IQ. On the Wechsler Memory Scale Revised, there were significant differences between the two groups in Visual Memory, General Memory, and Delayed Recall. Correlation coefficients between memory function and the other factors demonstrated significant but weak correlations between years of education and General Memory (R = 0.22) and between years of education and Delayed Recall (R = 0.20). Strong correlations were found between Verbal IQ and Verbal Memory (R = 0.45), between Verbal IQ and General Memory (R = 0.49), between Full Scale IQ and General Memory (R = 0.50) and between Full Scale IQ and Delayed Recall (R = 0.48). Conclusions: In normal elderly Japanese subjects, years of education weakly correlated with memory function while Verbal IQ, Full Scale IQ and Verbal Comprehension on WAIS‐III had stronger correlations with memory function. Verbal IQ and Verbal Comprehension on WAIS‐III were found to be insusceptible to the cognitive decline characteristic of Alzheimer's disease or amnestic mild cognitive impairment. Therefore, verbal intelligence, as measured by Verbal IQ and Verbal Comprehension, may be the most useful factor for inferring premorbid memory function in Alzheimer's disease or amnestic mild cognitive impairment patients.     

Cognitive recovery after severe head injury. 1. Serial testing on the Wechsler Adult Intelligence Scale.

The Wechsler Adult Intelligence Scale was administered serially to 40 severely head-injured adults, and the results compared with a matched group of 40 non-injured men. The scores on the verbal subtests showed less initial impairment and were faster to recover to the level of the comparison group than were the non-verbal subtest scores. Verbal IQ of the head-injury group approached that of the comparison group within about one year of injury, while recovery of Performance IQ continued over about three years.     

Memory function decline over 18 months after selective amygdalohippocampectomy.

We report on a 22 year-old woman with left temporal lobe epilepsy who had suffered complex partial seizures since childhood. At 19 years 10 months of age she underwent selective amygdalohippocampectomy, which resulted in a complete cessation of seizures. Preoperatively, the Logical Memory II section of the WMS-R revealed poor logical memory function. Postoperatively, the patient's scores on several neuropsychological tests had deteriorated, namely, the Miyake Paired-Associate Word Learning Test (related and unrelated pairs), several sections of the WMS-R (Figural Memory, Logical memory I, Visual Reproduction II, Visual Paired Associates I, and Verbal Paired Associates I and II), and the BVRT-R. In particular, her scores on the Visual Paired Associates I, Verbal Paired Associates I and II sections of the WMS-R, and the BVRT-R not only declined at one and three months post-surgery, but also showed progressive deterioration at 16 and 18 months post-surgery. It should be kept in mind that selective amygdalohippocampectomy can result in progressive postoperative, deterioration in some aspects of memory function.     

Factorial Invariance for Combined Wechsler Adult Intelligence Scale-Revised and Wechsler Memory Scale-Revised Scores in a Sample of Clients With Alcohol Dependency*

This study examined the joint factor structure of the WAIS-R and WMS-R in a sample of 289 participants (mostly males) with alcohol dependency. In a confirmatory phase we contrasted a range of factor models derived from previous analyses of the Wechsler scales. The best fitting model incorporated five factors representing Verbal Comprehension, Perceptual Organization, Attention-Concentration, Verbal Memory, and Visual Memory, with reassignment of factor loadings for two subtests. The invariance of the measurement model was then examined comparing data from a large sample of healthy participants (J. R. Carstairs E. A. Shores, 1999). The results indicated that the number of factors was invariant across samples, and four of the factors satisfied the criterion of partial measurement invariance.     

WAIS performances in antisocial personality (disorder)

In the present study, the WAIS performances of subjects with antisocial personality disorder were compared with the performances of controls who had other personality disorders and had usually only occasional criminality. It appeared that in all subtests the age-scaled scores of the controls were higher than those of the subjects. Statistically significant differences emerged in subtests Information, Comprehension and Arithmetic of the Verbal Scale, and in the Picture Completion subtest of the Performance Scale, as well as in the Verbal, Performance and Total IQ. In the light of these results, one fundamental feature in antisocial personality could be the lack of general interest and intellectual curiosity, which is probably associated with a poor ability to “feel” (inadequacy of feelings of pleasure) in those predisposed to antisocial personality.     

Clinical utility of the Wechsler Memory Scale — Fourth Edition (WMS-IV) in patients with intractable temporal lobe epilepsy

IntroductionThe Wechsler Memory Scale (WMS) is one of the most widely used test batteries to assess memory functions in patients with brain dysfunctions of different etiologies. This study examined the clinical validation of the Dutch Wechsler Memory Scale — Fourth Edition (WMS-IV-NL) in patients with temporal lobe epilepsy (TLE).MethodThe sample consisted of 75 patients with intractable TLE, who were eligible for epilepsy surgery, and 77 demographically matched healthy controls. All participants were examined with the WMS-IV-NL.ResultsPatients with TLE performed significantly worse than healthy controls on all WMS-IV-NL indices and subtests (p < .01), with the exception of the Visual Working Memory Index including its contributing subtests, as well as the subtests Logical Memory I, Verbal Paired Associates I, and Designs II. In addition, patients with mesiotemporal abnormalities performed significantly worse than patients with lateral temporal abnormalities on the subtests Logical Memory I and Designs II and all the indices (p < .05), with the exception of the Auditory Memory Index and Visual Working Memory Index. Patients with either a left or a right temporal focus performed equally on all WMS-IV-NL indices and subtests (F(15, 50) = .70, p = .78), as well as the Auditory–Visual discrepancy score (t(64) = − 1.40, p = .17).ConclusionThe WMS-IV-NL is capable of detecting memory problems in patients with TLE, indicating that it is a sufficiently valid memory battery. Furthermore, the findings support previous research showing that the WMS-IV has limited value in identifying material-specific memory deficits in presurgical patients with TLE.     

Factor structure of the wechsler memory scale-revised

Abstract

The factor structure of the Wechsler Memory Scale-Revised (WMS-R) was examined in a large (N = 434) sample of patients referred to the neuropsychology laboratories of two large medical centers. The subtests of the WMS-R were subjected to principal-components factor analysis. Some analyses included only the immediate-recall subtests, while other analyses included both immediate-and delayed-recall subtests. Additional analyses included VIQ and PIQ from the WAIS-R. Initial analyses of immediate-recall subtests indicated a two-factor solution similar to that reported in the standardization sample. Inclusion of IQ scores also revealed a two-factor solution with IQ scores and most memory subtests loading on separate factors. Inclusion in the analysis of delayed-recall subtests revealed three-factor solution with factors interpreted as representing verbal memory, nonverbal memory, and attention/IQ. These results are discussed in terms of factor-analytic studies of the earlier Wechsler Memory Scale, and the implications of the current data for research and clinical practice.     

Neuropsychological patterns of presenile and senile dementia of the Alzheimer type

Thirty-seven patients with a presumptive diagnosis of dementia of the Alzheimer type were divided into presenile and senile groups according to the age at which they first received a clinical diagnosis. Although there were no differences in mental status, dementia rating, or chronicity of disease, multivariate analyses of WAIS subtests revealed the presenile subjects to be relatively impaired on Performance subtests. Univariate tests of Verbal, Performance, and Full Scale IQ measures were significantly lower in the presenile group. There was no group effect detected for Digits forward, adjusted for age differences based upon performance of 40 age-matched controls, while the presenile group performed significantly more poorly on backward span. Further, significant differences were detected for an embedded figure task, as well as graphomotor speed. These data suggest that patients who develop a degenerative dementia during the presenile period are more impaired than their senile counterparts on age-adjusted measures of sustained concentration and mental tracking.     

Emotional discomfort and impairments in verbal memory in schizophrenia

Research has demonstrated that impairments in verbal memory in schizophrenia are linked with psychosocial deficits. Less is known, however, about their relationship to clinical features of illness. This study explores the hypothesis that impairments in verbal memory, particularly forms of memory requiring deeper levels of encoding, are uniquely linked to symptoms of dysphoria or emotional discomfort. Accordingly, we examined the association between concurrent measures of symptoms and verbal memory for 84 subjects with schizophrenia. Measures of positive, negative, cognitive, excitement and emotional discomfort symptoms were derived from factor scores of the Positive and Negative Syndrome Scale. Verbal memory was assessed using two tests requiring relatively superficial levels of encoding: The Hopkins Verbal Memory Test and the Digit Span subtest; and one test requiring deeper levels of encoding: the Logical Memory subtests I and II. As predicted, multiple regressions controlling for age, education and attention revealed that poorer performance on Logical Memory was strongly associated with greater levels of emotional discomfort (R(2)=0.22 and 0.25, respectively) while performance on the Hopkins test was related to cognitive symptoms scores (R(2)=0.08 and 0.09, respectively). Implications for the conceptualization of verbal memory deficits in schizophrenia are discussed.     

Construct validity of the Continuous Recognition Memory test

A principal factor analysis was performed on variables derived from a neuropsychological battery administered to 100 healthy young adults in order to investigate the construct validity of the Continuous Recognition Memory test (CRM). It was hypothesized that CRM "hits" and "false alarms" would load on different factors. The factors that emerged in the analysis were labeled "Verbal Ability", "Divided Attention", "Attention to Visual Detail", "Visuomotor Integration and Planning", and "Learning and Memory". As expected, CRM hits had a significant loading on the Learning and Memory factor. However, CRM false alarms did not have a significant loading on the Divided Attention factor as expected and, instead, loaded significantly on the Attention to Visual Detail factor. A second analysis was performed using variables from the delayed condition of the memory measures. In this analysis, the CRM delayed recognition variable had significant loadings on both a "Nonverbal Memory" factor and a "Verbal Memory" factor. These analyses support the construct validity of CRM hits as a measure of learning and memory and suggest that false alarms provide a measure of attention to visual detail.     

The Memory Assessment Scales in the detection of incomplete effort in mild head injury

Despite differences in the constructs measured, the Memory Assessment Scales (MAS) remain an alternative to the Wechsler Memory Scales (WMS) as a broad-band instrument for assessing multiple aspects of attention and memory. Although a number of studies have examined indices of the WMS as indicators of malingering, few studies have similarly investigated the MAS. In this study, we examined the degree to which the MAS was effective in detecting incomplete effort in a clinical sample of patients referred for neuropsychological evaluation after mild head injury. Included in the sample were 21 financially compensable (FC) participants with alleged mild head injury and 21 participants who were not involved in litigation and suffered more serious head injuries. Examination of the four MAS domain indices indicated that Short-Term Memory was most useful at identifying incomplete effort. We also examined subscales of the MAS. Consistent with previous findings, brief tests such as Verbal and Visual Span had high rates of diagnostic sensitivity and specificity. Although tests based on a forced-choice recognition paradigm (e.g., Immediate and Delayed Visual Recognition) predicted group membership above chance levels, they failed to significantly add to prediction above Verbal and Visual Span subtests.