Relationships between measures of auditory verbal learning and executive functioning

Abstract

Relationships between performance on the California Verbal Learning Test (CVLT) and executive abilities were examined. In a sample of 115 neurological cases principal components factor analysis produced five theoretically and clinically meaningful CVLT factors. The five CVLT factors reflected general verbal learning (CVLT1), response discrimination (CVLT2), a proactive interference effect or “working memory” (CVLT3), serial learning strategy (CVLT4), and a retroactive interference effect (CVLT5). Canonical correlation between executive function measures and the five CVLT factor scores yielded one significant canonical variable accounting for 29 percent of the variance in the data. Two CVLT factors (CVLT1 and CVLT3), the Trail Making Test Part B, and Digit Span were significantly correlated with the canonical variate. Higher levels of memory performance were associated with better attention and mental tracking. Based on the present findings, attentional aspects of executive abilities appear to play a role in learning and working memory. Other aspects of executive abilities (abstraction, problem-solving, planning) appear to have minimal relationships with memory processes.     

Postdicting verbal iq of elderly individuals

abstract

we undertook a longitudinal crossvalidation of the Ryan and Paolo (1992) equation's ability to postdict Wechsler Adult Intelligence Scale-Revised (WAIS-R) Verbal IQ (VIQ) from National Adult Reading Test (NART) performance measured 5 years after VIQ scores were obtained, for a sample of 49 elderly normal individuals (mean age 71 years). Five-year interval postdiction accuracy agreed very well with the results of the original, concurrent study. Clinical utility is still limited, however, as VIQ must decline by 16.3 points for 95%-detection sensitivity. A new regression equation that utilizes a combination of NART errors and WAIS-R Vocabulary age-scaled scores (measured 3 years earlier) provided slightly better expected clinical sensitivity and accounted for 49% of the variance in VIQ scores.     

Verbal learning patterns in moderate and severe traumatic. brain injury

Abstract

Previous studies that have examined performances on the California Verbal Learning Test (CVLT) among individuals with traumatic brain injury (TBI) have found differing levels of performance. Differential patterns of performance, however, have only been inferred. The present investigation sought to determine empirically if differential patterns of performance could be discerned in a TBI sample of 65 subjects with CVLT variables. The CVLT variables were selected based on the instrument's factor structure. Cluster analysis yielded four distinct subtypes of brain-injured individuals. The Active subtype demonstrated impaired unassisted retrieval, but used active encoding strategies and showed relatively intact ability to store novel information. The Disorganized subtype demonstrated an inconsistent, haphazard learning style along with deficits in encoding. The Passive subtype was marked by an overreliance on a serial clustering strategy as well as impaired encoding and/or consolidation. The Deficient subtype was the most impaired of all groups, exhibiting a slowed rate of acquisition, passive learning style, and significant impairment in encoding. Implications for rehabilitation are discussed.     

A new assessment tool for patients with multiple sclerosis from Spanish-speaking countries: validation of the Brief International Cognitive Assessment for MS (BICAMS) in Argentina

Background: The Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) is an international assessment tool for monitoring cognitive function in multiple sclerosis (MS) patients. BICAMS comprises the Symbol Digit Modalities Test (SDMT), the California Verbal Learning Test – Second Edition (CVLT II) and the Brief Visuospatial Memory Test – Revised (BVMT-R). Our objective was to validate and assess the reliability of BICAMS as applied in Argentina and to obtain normative data in Spanish for this population. Method: The sample composed of 50 MS patients and 100 healthy controls (HC). In order to test its reliability, BICAMS was re-administered in a subset of 25 patients. Results: The sample’s average age was 43.42 ± 10.17 years old, and average years of schooling were 14.86 ± 2.78. About 74% of the participants were women. The groups did not differ in age, years of schooling, or gender. The MS group performed significantly worse than the HC group across the three neuropsychological tests, yielding the following Cohen’s d values: SDMT: .85; CVLT I: .87; and BVMT-R: .40. The mean raw scores for Argentina normative data were as follows: SDMT: 56.71 ± 10.85; CVLT I: 60.88 ± 10.46; and BVMT-R: 23.44 ± 5.84. Finally, test–retest reliability coefficients for each test were as follows: SDMT: r = .95; CVLT I: r = .87; and BVMT-R: r = .82. Conclusion: This BICAMS version is reliable and useful as a monitoring tool for identifying MS patients with cognitive impairment.     

Cognitive impairment or inadequate norms? A study of healthy,rural, older adults with limited education

Abstract

This study established preliminary norms for nine commonly administered neuropsychological tests for a biracial sample (N = 133; White = 64, African American = 69) of nondemented, rural community-dwelling elders (mean age = 76.48; SD = 7.87) with 10 or fewer years of formal education (mean education = 6.65 years; SD = 2.14). Hierarchical multiple regression analyses revealed that education was an important predictor of performance on the Mini-Mental State Examination (MMSE), Mattis Dementia Rating Scale (MDRS), Clock Drawing, Ravens' Colored Progressive Matrices, Wechsler Adult Intelligence Scale-Revised (WAIS-R) Vocabulary and Block Design, Verbal Fluency (Category) and Logical Memory and Visual Reproduction subtests from the Wechsler Memory Scale-Revised (WMS-R), but did not predict scores on the Fuld Object Memory Evaluation or memory savings scores from the WMS-R. Race was a predictor only for WAIS-R Vocabulary and Block Design, and WMS-R Logical Memory Delayed. Approximately half of the subjects scored below the published cut-offs for the MMSE and MDRS and would have been considered mildly to moderately impaired on many of the test measures.     

The violence prevention climate of mental health wards: a cross-sectional study of staff and patient views

Purpose

Ward climate can shape the behaviour of both staff and patients. A subset of the ward climate is the violence prevention climate, the unique characteristics that are perceived by the people within the environment as contributing towards the prevention of violence. The aim of this study was to explore differences between and within staff and patient groups in terms of their perceptions of the violence prevention climate.

Methods

A cross-sectional survey was conducted with staff (n = 326) and patients (n = 95) in mental health care pathways within one charitable trust. All participants completed the VPC-14 to measure perceptions of the violence prevention climate, a validated 14-item two-factor scale (staff actions and patient actions). Staff demographic information was collected on the VPC-14 front sheet; patient demographic, clinical and violence data were collected from electronic case records. Bivariate analyses were conducted to compare within- and between-group variables. Significant staff and patient variables were entered into multiple hierarchical regression analyses to assess their relationship with VPC-14 factors.

Results

Staff had a more positive view than patients of staff actions and patients had a more positive view of patient actions than did staff; staff- or patient-group membership was the best predictor of staff action scores. Individual staff characteristics accounted for a small amount of the variance in staff and patient action scores; individual patient characteristics explained more variance, but this was still below 20%.

Conclusions

Staff perceive their violence prevention-related contributions more positively than patients and vice versa. This has implications for staff; they may need to better articulate their role in violence prevention to patients, as well as recognise the role that patients play. However, within staff and patient groups, individual variables only make up a small amount of variance of perceptions of the violence prevention climate. This suggests that the violence prevention climate is a valid construct, i.e. that despite differences in individual variables, individuals within the patient group have similar perceptions of the VPC, as do those within the staff group.

     

Intrusions and provoked and spontaneous confabulations on memory tests in Korsakoff’s syndrome

Introduction: Intrusions on verbal memory tests have been used as an index for clinical confabulation. Severe memory impairments in combination with executive dysfunction have been suggested to be the underlying mechanism of confabulation, but to date, this relation is unclear. The aim of this study was (a) to examine the relation between (different types of) intrusions and confabulations in a large sample of confabulating patients with Korsakoff’s syndrome (KS) and (b) to investigate whether different measures of executive functioning and memory performance are related to provoked and spontaneous confabulation. Method: The Dutch version of the California Verbal Learning Test (CVLT) and various executive function and memory tests were administered to a group of 51 confabulating patients with KS. Professional caregivers rated the severity of provoked and spontaneous confabulation behavior of the patients using the Nijmegen–Venray Confabulation List–20 (NVCL–20). Results: The total number of intrusions on the CVLT was not related to either provoked or spontaneous confabulation scores. None of the CVLT intrusion scores correlated significantly with any of the confabulation scores, but we did find small-to-medium, positive correlations between unrelated intrusions and both provoked confabulations and spontaneous confabulation. Provoked confabulation behavior was associated with executive dysfunction and poorer memory performances. Spontaneous confabulation was not related to performance on measures of executive function and memory. Conclusions: The total number of intrusions on verbal memory tests and clinical confabulations appear to be different phenomena. Only unrelated intrusions produced on the CVLT might possibly be related to confabulations. The production of provoked, but not spontaneous, confabulation is associated with executive dysfunction and memory deficits.     

Alternate form of the california verbal learning test: Development and reliability

An alternate form of the California Verbal Learning Test (CVLT) was developed and compared with the original form. The two CVLT forms yielded equivalent mean scores for all 19 learning and memory variables analyzed. No significant practice effects were found regardless of the order of administration of the two forms. The two forms yielded almost identical relationships between overall memory performance and age and education. Sixteen of the CVLT variables resulted in significant alternate form reliability coefficients. The coefficients for the traditional recall measures of the CVLT were particularly robust and higher than those reported for other, commonly used clinical memory tests.     

Do recognition-free recall discrepancies detect retrieval deficits in closed-head injury? an exploratory analysis with the california verbal learning test

Abstract

The present study examined the validity of the Recognition Discriminability-Long Delay Free Recall discrepancy from the California Verbal Learning Test (CVLT) as a sign of retrieval deficits in closed-head injury (CHI). Discrepancy and nondiscrepancy groups who differed in their Recognition Discriminability performance but were equated on Long-Delay Free Recall were compared on indices hypothesized to reveal performance patterns consistent with retrieval deficits. Results showed that the discrepancy group produced fewer intrusions. The two groups did not differ in their consistency of recall or relative degree of benefit from semantic cuing. Additional analysis using a discrepancy group with normal Recognition Discriminability scores but abnormal Long-Delay Free Recall performance did not alter these results. The hypotheses were not supported when patients with language deficits were excluded. The findings did not support the use of this discrepancy from the CVLT as a marker for retrieval deficits in CHI.     

Predictors of WAIS–R vocabulary in late life: Differences by race

Background: Vocabulary scores tend to be significantly related to education in heterogeneous groups of older adults, even after controlling for confounding variables. However, there may be other factors that impinge on cognitive functioning for certain demographic groups, particularly those whose educational opportunities were limited, and who may have experienced considerable stress as a result of their minority status. Objectives: This study sought to explore possible predictors of vocabulary scores among African American and White older adults. Method: In this study, samples of African American (N = 165) and White (N = 146) community-dwelling older adults reported their level of education, perceived health status, and number of stressful life events, and were administered the Wechsler Adult Intelligence Scale–Revised (WAIS–R) Vocabulary subtest. Results: Among the White participants, level of education was the only significant predictor of vocabulary score after controlling for perceived health and exposure to stress. Among African American participants, education was also a significant predictor of vocabulary score. However perceived health and number of stressful life events were also significantly predictors of vocabulary score. Conclusions: Findings indicate that for certain cohorts of older adults, especially those who may have experienced stressful life circumstances and health disparities as a result of racial inequality, education may not be the only variable that predicts verbal intelligence. The importance of investigating cognitive functioning within a broader sociocultural context is discussed.     

Predictors of self-reported resilience in parents of autistic children

BackgroundThough an emerging evidence base has documented the elevated stress and unique challenges among parents of autistic children, less is known about resilience. Based on the resilience-stress model (Fletcher & Sarkar, 2013; Masten, 2011), resilience may be a promising area of investigation given its inverse relationship with stress.MethodFifty parents of autistic children (4:0–10:11 years) self-reported resilience on the Connor-Davidson Resilience Scale (CD-RISC) and completed additional questionnaires, which were categorized into three classes of predictors: psychological functioning, child factors and parenting stress, and positive mental health practices. Regression analyses were conducted to identify the amount of variance in CD-RISC scores explained by the overall model and each class of predictors. The relative strength of individual predictors was investigated.ResultsThe overall model accounted for 66% of the variance in self-reported resilience scores. Two classes of predictors were significant – psychological functioning and positive mental health practices – while child factors and parenting stress were not. Specifically, the class of psychological functioning variables accounted for 45% of the variance in resilience scores and positive mental health practices accounted for an additional 19%. The individual predictors of anxiety, stress, optimism, and self-compassion were the most robust.ConclusionsFindings indicate that certain factors – anxiety, stress, optimism, and self-compassion – are important in understanding self-reported resilience among some parents of autistic children. This may suggest treatment targets for resilience interventions. Continued investigations with larger, more representative samples are needed to expand the present findings.     

A comparison of the wais and wais-r using t-score conversions that correct for age,education, and sex

Abstract

A newly developed T score conversion system that corrects Wechsler Adult Intelligence Scale (WAIS) and Wechsler Adult Intelligence Scale-Revised (WAIS-R) subtest and IQ scores for appropriate demographic variables was used to compare subjects' performance on the two versions of the instrument. Using 428 pairs of subjects matched on age, education, and sex, with one person in each pair having taken the WAIS and the other the WAIS-R, we found no significant differences in level or pattern of performance when analyses were performed on the T scores. This was in contrast to highly significant differences when uncorrected scaled scores and IQ values were compared. Therefore, the T score system appears to provide a tool which may help clinicians make more direct comparisons between the results obtained on the WAIS and WAIS-R.     

Relationship between 18F-Flutemetamol uptake and RBANS performance in non-demented community-dwelling older adults

Objective: The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) has been used extensively for clinical care and in research for patients with mild cognitive impairment and Alzheimer’s disease (AD); however, relatively few studies have evaluated the relationship between RBANS performance and AD imaging biomarkers. The purpose of the current study was to evaluate the association between a relatively new amyloid positron emission tomography imaging biomarker and performance on the RBANS. Methods: Twenty-seven nondemented community-dwelling adults over the age of 65 underwent ¹⁸F-Flutemetamol amyloid– positron emission tomography imaging, along with cognitive testing using the RBANS and select behavioral measures. Partial correlation coefficients were used to identify relationships between the imaging and behavioral markers. Results: After controlling for age and education, amyloid deposition and RBANS Indexes of Immediate Memory, Delayed Memory, and Total Scale score were significantly correlated (p’s < .001, r’s = ?.73 to ?.77, d’s = 2.13–2.39), with greater amyloid burden being associated with lower RBANS scores. The Delayed Memory Index was particularly highly associated with ¹⁸F-Flutemetamol binding (r² = .59, p < .001, d = 2.39). Neither ¹⁸F-Flutemetamol binding nor RBANS performance was significantly correlated with levels of depression, subjective cognitive difficulties, or premorbid intellect. Conclusions: Because of the limited use of amyloid imaging in clinical settings due to high cost and lack of reimbursement, these findings suggest that in particular RBANS Delayed Memory Index may be a cost-efficient tool to identify early signs of AD pathology, and its use may enlighten clinical decision-making regarding potential progression to dementia due to AD.     

Estimation of K-WAIS-IV Premorbid Intelligence in South Korea: Development of the KPIE-IV

Objective: The accurate estimation of premorbid intellectual functioning in patients with known or suspected cognitive impairment is crucial for clinicians. However, there is no reliable method for estimating premorbid intelligence in South Korea. The purpose of this study was to develop the Korea Premorbid Intelligence Estimate (KPIE) as an estimate of the premorbid intellectual functioning. Method: Data from the Korean WAIS-IV standardization sample were used to generate several Full Scale Intelligence Quotient (FSIQ) estimation formulas using demographic variables and current WAIS-IV subtest performance. The standardization sample (N = 1216) was randomly divided into two groups: the first group was used to develop the formulas and the second group was used to validate the prediction equations. Age, education, gender, region of the country, and select subtest raw scores (Vocabulary, Information, Matrix Reasoning, and Visual Puzzle) were used as predictor variables. Results: Five KPIE-4 equations were generated. Estimated FSIQ derived from the KPIE-4 equation is highly correlated with K-WAIS-IV FSIQ. Conclusions: The resulting formulas for estimating premorbid FSIQ were highly significant and precise in predicting FSIQ scores of participants in the K-WAIS-IV normative sample. These equations provide a means for clinicians to estimate intellectual functioning in adults, and can be utilized as a method of estimating individuals premorbid functioning.     

California Verbal Learning Test indicators of suboptimal performance in a sample of head-injury litigants

Cutoff scores suggested by Millis, Putnam, Adams, and Ricker (1995) for detecting suboptimal performance on indices from the California Verbal Learning Test (CVLT) were evaluated using data from 193 compensation-seeking participants. All participants claimed to have suffered a blow to the head in an accident causing subsequent deterioration in cognitive function. The participants were divided into those with negligible or possible mild brain injuries and those with clear evidence of moderate to severe brain injuries. In addition to the CVLT, all participants were administered the Computerized Assessment of Response Bias (CARB), a two-alternative forced choice test of recognition memory that is used to detect feigned cognitive impairment. For all CVLT indices, the distributions of outcome (valid vs. suboptimal performance) was unrelated to age and brain injury severity, and only weakly associated with education. However, a significantly higher proportion of males than females obtained scores in the suboptimal performance range. The CVLT indices were not fully redundant with each other with respect to binary participant classifications; substantial disagreement between pairwise classifications was found among those participants who obtained at least one score in the suboptimal performance range. CVLT index classifications were also found to be non-redundant with classifications based on CARB scores. The CVLT may thus add useful data over and above that obtained from symptom validity testing. However, the data suggest that the use of the strategy where any one or more below-cutoff CVLT scores are considered a positive indicator of suboptimal performance may be associated with a higher than acceptable false-positive error rate.     

California Verbal Learning Test Indicators of Suboptimal Performance in a Sample of Head-Injury Litigants

Cutoff scores suggested by Millis, Putnam, Adams, and Ricker (1995) for detecting suboptimal performance on indices from the California Verbal Learning Test (CVLT) were evaluated using data from 193 compensation-seeking participants. All participants claimed to have suffered a blow to the head in an accident causing subsequent deterioration in cognitive function. The participants were divided into those with negligible or possible mild brain injuries and those with clear evidence of moderate to severe brain injuries. In addition to the CVLT, all participants were administered the Computerized Assessment of Response Bias (CARB), a two-alternative forced choice test of recognition memory that is used to detect feigned cognitive impairment. For all CVLT indices, the distributions of outcome (valid vs. suboptimal performance) was unrelated to age and brain injury severity, and only weakly associated with education. However, a significantly higher proportion of males than females obtained scores in the suboptimal performance range. The CVLT indices were not fully redundant with each other with respect to binary participant classifications; substantial disagreement between pairwise classifications was found among those participants who obtained at least one score in the suboptimal performance range. CVLT index classifications were also found to be non-redundant with classifications based on CARB scores. The CVLT may thus add useful data over and above that obtained from symptom validity testing. However, the data suggest that the use of the strategy where any one or more below-cutoff CVLT scores are considered a positive indicator of suboptimal performance may be associated with a higher than acceptable false-positive error rate.     

The role of insomnia,pre-sleep arousal and psychopathology symptoms in daytime impairment in adolescents with high-functioning autism spectrum disorder

ObjectivesSleep disturbance and psychopathology are common during adolescence and are highly prevalent in individuals diagnosed with autism spectrum disorder (ASD). The aim of this study was to investigate relationships between sleep disturbance, psychopathology symptoms, and daytime functioning in adolescents with high-functioning autism spectrum disorder (HFASD) compared to typically developing (TD) adolescents.MethodsTwenty-seven adolescents with HFASD and 27 age- and sex-matched TD adolescents completed questionnaires related to sleep, psychopathology and daytime functioning. Participants also completed a 7-day sleep/wake diary. A subsample of HFASD adolescents (55%) and all the TD adolescents wore an actigraphy monitor concurrently with the sleep diary.ResultsAdolescents with HFASD had significantly higher scores for depressed mood, anxiety and pre-sleep arousal compared with TD adolescents and poorer daytime functioning. There were more significant correlations between sleep variables and psychopathology variables, and sleep variables and daytime functioning, in the HFASD group than in the TD group. Standard regression found that sleep variables significantly accounted for 57% of the variance in daytime functioning symptoms of insufficient sleep in the HFASD group, while psychopathology variables accounted for 63% of the variance in daytime functioning.ConclusionsBoth sleep disturbance and psychopathology are more prevalent in adolescents with HFASD and are major contributors to poor daytime functioning in these individuals.     

The relationship between BDNF Val66Met polymorphism and functional mobility in chronic stroke survivors

Background A single nucleotide polymorphism, Val66Met, in the Brain Derived Neurotrophic Factor (BDNF) gene has been studied for its role in recovery following stroke. Despite this work, the role of BDNF genotype on long-term recovery is unclear. Additionally, no study has examined its impact on functional mobility. As a result, the purpose of this study was to examine the relationship between BDNF genotype and functional mobility in chronic stroke survivors by first accounting for factors related to the Val66Met polymorphism and post-stroke recovery.

Methods Participants 6 months post-stroke completed the Fugl-Meyer Lower Extremity Assessment (FMLE), Yesavage Geriatric Depression Scale (YGDS), 10 meter walk test (SSWS), and BDNF genotype testing. A regression model was used to determine if including genotype (Val or Met) and the genotype’s interactions with age, gender, and depression increased the model’s fit in predicting functional mobility, as measured by SSWS, after accounting for physical impairment (FMLE) and personal information (age, gender, and YGDS).

Results Sixty-three subjects, twenty-two percent of whom had at least one Met allele, were included. Impairment and personal information significantly predicted SSWS (R² = 0.268, p < 0.001 and ΔR² = 0.158, p = 0.002, respectively). The addition of genotype and genotype’s interactions did not significantly increase the variance accounted for in SSWS (ΔR² = 0.012, p = 0.27, and ΔR² = 0.006, p = 0.723, respectively).

Conclusions Our results suggest that the Val66Met polymorphism does not predict long-term, functional mobility following stroke. This difference may be due to differences in model variables or a reduced impact of the polymorphism as recovery progresses.     

Trajectories of Alzheimer disease-related cognitive measures in a longitudinal sample

BackgroundThe delineation of the relative temporal trajectories of specific cognitive measures associated with Alzheimer's disease (AD) is important for evaluating preclinical markers and monitoring disease progression.MethodsWe characterized the temporal trajectories of measures of verbal episodic memory, short-term visual memory, and mental status using data from 895 participants in the Baltimore Longitudinal Study of Aging.ResultsThe California Verbal Learning Test (CVLT) immediate recall was the first measure to decline, followed by CVLT delayed recall. However, further along the disease progression scale, CVLT delayed recall and visual memory changed more rapidly than CVLT immediate recall.ConclusionsOur findings reconcile reports of early changes in immediate recall with greater reliance on delayed recall performance in clinical settings. Moreover, the utility of cognitive markers in evaluating AD progression depends on the stage of cognitive decline, suggesting that optimal endpoints in therapeutic trials may vary across different stages of the disease process.     

Project Ice Storm: prenatal maternal stress affects cognitive and linguistic functioning in 5 1/2-year-old children

ObjectiveThis was a prospective study designed to determine the extent to which the degree of exposure to prenatal maternal stress due to a natural disaster explains variance in the intellectual and language performance of offspring at age 5½ while controlling for several potential confounding variables.MethodSubjects were eighty-nine 5½-year-old children whose mothers were pregnant during a natural disaster: the January 1998 ice storm crisis in the Canadian province of Québec that resulted in power losses for 3 million people for as long as 40 days. In June 1998, women completed several questionnaires including those about the extent of objective stress (Storm32) and subjective distress (Impact of Events Scale-Revised) experienced due to the storm. Their children were assessed with the Wechsler Preschool and Primary Scale of Intelligence-Revised (IQ) and Peabody Picture Vocabulary Test-Revised (language) at 5½ years of age, and mothers completed assessments of recent life events and psychological functioning.ResultsChildren exposed in utero to high levels of objective stress had lower Full Scale IQs, Verbal IQs, and language abilities compared to children exposed to low or moderate levels of objective prenatal maternal stress; there were no effects of subjective stress or objective stress on Performance IQs. Trend analyses show that for all outcome variables except Block Design, there was a significant curvilinear association between objective stress and functioning.ConclusionsPrenatal exposure to a moderately severe natural disaster is associated with lower cognitive and language abilities at 5½ years of age. J. Am. Acad. Child Adolesc. Psychiatry, 2008; 47:(9):1063–1072.