Recognition Discriminability Research Articles

Identifying the “source” of recognition memory deficits in patients with Huntington's disease or Alzheimer's disease: Evidence from the CVLT-II

The present study compared the performance of individuals with Huntington's disease (HD) and Alzheimer's disease (AD) on three types of California Verbal Learning Test–Second Edition (CVLT-II) recognition discriminability indices (RDI): Source, Novel, and Total. The HD and AD groups did not differ significantly on Source RDI (all 16 targets versus the 16 previously presented, List B, distractors). However, HD patients performed significantly better than AD patients on Total RDI (all 16 targets versus all 32 distractors) and Novel RDI (all 16 targets versus 16 new distractors). Implications of these findings on the differentiation of the memory disorders associated with HD and AD are discussed.

Criterion validity of the California Verbal Learning Test-Second Edition (CVLT-II) after traumatic brain injury

The California Verbal Learning Test-Second Edition (CVLT-II) was performed by 200 participants, divided into moderate–severe traumatic brain injury ( n = 43), mild traumatic brain injury ( n = 57) and demographically matched control ( n = 100) groups. Participants with complicating premorbid histories or who scored below 15/16 on the CVLT-II forced choice recognition trial were excluded. There were statistically significant ( p < .0001) effects of group status on the CVLT-II total recall discriminability and recognition discriminability indices. Logistic regression revealed that, in the classification of control versus moderate–severe traumatic brain injury, CVLT-II variables were accurate 66–71% overall, but false positive rates ranged from 49 to 54%. In conclusion, average scores on the CVLT-II differ meaningfully between patients with various degrees of severity of traumatic brain injury and controls, but this test should not be used in isolation to determine the presence or absence of acquired memory impairment.

Patterns of Verbal Memory Performance in Mild Cognitive Impairment, Alzheimer Disease, and Normal Aging

Individuals with mild cognitive impairment (MCI) typically demonstrate memory loss that falls between normal aging (NA) and Alzheimer disease (AD), but little is known about the pattern of memory dysfunction in MCI. To explore this issue, California Verbal Learning Test (CVLT) performance was examined across groups of MCI, AD, and NA. MCI subjects displayed a pattern of deficits closely resembling that of AD, characterized by reduced learning, rapid forgetting, increased recency recall, elevated intrusion errors, and poor recognition discriminability with increased false-positives. MCI performance was significantly worse than that of controls and better than that of AD patients across memory indices. Although qualitative analysis of CVLT profiles may be useful in individual cases, discriminant function analysis revealed that delayed recall and total learning were the best aspects of learning/memory on the CVLT in differentiating MCI, AD, and NA. These findings support the position that amnestic MCI represents an early point of decline on the continuum of AD that is different from normal aging.

The interfering effect of related events on recognition memory discriminability: a functional magnetic resonance imaging study

Retrieval of information from memory often involves the selection of an event among competing related events, a process that frequently gives rise to interference effects. The present study used a forced-choice recognition test to identify neural correlates of the interfering effect of related events on recognition memory discriminability. Participants encoded landscape pictures divided into three segments. One segment was presented during encoding, and a forced-choice recognition task contrasted a studied and a nonstudied segment for each landscape. For half of the landscapes, the third segment was presented between encoding and recognition tasks to induce associative interference by reducing recognition discriminability. A behavioral study with 40 subjects yielded a significant difference in the correct recognition rate between control and interference trials (76% and 64%, respectively, p<0.001). A subsequent event-related fMRI study with 16 subjects yielded significant activations for correct interference recognition trials relative to control trials in left superior parietal regions, which suggests that these regions play a role in the representation of stimuli and associated information. The opposite contrast yielded significant activations in inferior prefrontal regions bilaterally, right dorsolateral prefrontal cortex and right parahippocampal cortex. Since this contrast was conducted using only correctly recognized trials, these findings could reflect an index of memory discriminability or saliency which could influence conscious recollection.

Identifying Retrieval Problems Using the California Verbal Learning Test

Wilde, Boake, and Sherer (1995) examined the discrepancy between Long Delayed Free Recall (LDFR) and Recognition Discriminability (RD) - the California Verbal Learning Test (CVLT) index thought to indicate the presence of memory retrieval problems - and found little evidence to recommend its use in traumatic brain injury (TBI). The present investigation re-examined this index from the perspective of a continuum of retrieval deficit severity. CVLT performance was examined in 122 TBI patients, and 2 retrieval deficit indicators of varying severity were evaluated. Memory-impaired control groups were matched with retrieval deficit groups on initial acquisition and demographic characteristics. Individuals with a LDFR/RD discrepancy did not show predicted differences on other CVLT indices of retrieval problems, similar to the findings of Wilde et al. (1995). In contrast, individuals with a consistent discrepancy between free recall and semantic cued recall (Short and Long Delay) had greater improvement with recognition cueing and made fewer intrusive errors than controls. Individuals who benefited from semantic cues (where retrieval of the target word is still required) also benefited from recognition cues (where retrieval demands are minimal). Evidence supported the existence of a continuum of retrieval deficit severity. An LDFR/RD discrepancy without performance improvement from semantic cueing appears to indicate a more severe retrieval deficit, whereas performance improvement from both recognition and semantic cueing indicates less severe retrieval deficits.

Brain activation on fMRI and verbal memory ability: functional neuroanatomic correlates of CVLT performance.

We have recently reported (Saykin et al., 1999b) selective activation of left medial temporal lobe structures during processing of novel compared to familiar words using functional magnetic resonance imaging (fMRI). The current study describes the relationship between a widely used clinical test of verbal learning, the California Verbal Learning Test (CVLT), and the previously reported fMRI activations. Thirteen right-handed healthy adult participants were studied with whole brain echo-planar fMRI while listening to novel and recently learned (familiar) words intermixed pseudorandomly in an event-related design. These participants were also tested with the CVLT. Scores for CVLT Trial 1 (immediate encoding of novel words) and recognition discriminability (recognition of familiar vs. novel words) were correlated with fMRI signal change during processing of novel versus familiar words using a covariance model implemented in SPM96. For the novel words analysis, voxels in the right anterior hippocampus correlated significantly with Trial 1 (r = .76 at the maxima). For the recognition analysis, a significant cluster of voxels was found in the right dorsolateral prefrontal cortex (r = .88 at the maxima). Our prior results of separable left medial temporal activation to novel and familiar words, together with results of the covariance analyses reported here, suggest that in addition to the left medial temporal lobe (MTL) regions that are engaged during novel and familiar word processing, the right hippocampus and right frontal lobe are also involved, particularly in those participants with better memory ability. This positive relationship between fMRI activation and CVLT performance suggests a role for these right hemisphere regions in successful memory processing of verbal material, perhaps reflecting more efficient encoding and retrieval strategies that facilitate memory.

Neurocognitive Functioning of Adolescents: Effects of Protracted Alcohol Use

The present study examined associations between alcohol involvement in early to middle adolescence and neuropsychological (NP) functioning. Alcohol-dependent adolescents (n = 33) with over 100 lifetime alcohol episodes and without dependence on other substances were recruited from alcohol/drug abuse treatment facilities. Comparison (n = 24) adolescents had no histories of alcohol or drug problems and were matched to alcohol-dependent participants on age (15 to 16 years), gender, socioeconomic status, education, and family history of alcohol dependence. NP tests and psychosocial measures were administered to alcohol-dependent participants following 3 weeks of detoxification. Alcohol-dependent and comparison adolescents demonstrated significant differences on several NP scores. Protracted alcohol use was associated with poorer performance on verbal and nonverbal retention in the context of intact learning and recognition discriminability. Recent alcohol withdrawal among adolescents was associated with poor visuospatial functioning, whereas lifetime alcohol withdrawal was associated with poorer retrieval of verbal and nonverbal information. Deficits in retrieval of verbal and nonverbal information and in visuospatial functioning were evident in youths with histories of heavy drinking during early and middle adolescence.

Demographically Corrected Norms for the California Verbal Learning Test

The California Verbal Learning Test (CVLT) is designed to quantify components of verbal learning, retention and retrieval. The present study used multiple regression analyses to correct for demographic characteristics on CVLT performance measures. There were 906 subjects, of whom 549 were Caucasians (61%) and 357 were African Americans (39%). Age, education, ethnicity, and gender were found to be significant predictors of performance on several CVLT indices, including Total Words Recalled, Trial 1, Trial 5, List B, Short Delay Free Recall (SDFR), and Long Delay Free Recall (LDFR). Demographically corrected T-scores were calculated for a base sample of 672 subjects and cross-validated on 234 separate subjects. Tables and regression equations are offered to convert raw scores into T-scores corrected for age, gender, education, and ethnicity. Demographically corrected Recognition Discriminability cutoff scores were calculated for age and education levels. In order to provide some indices of important memory processes, we also computed indices of retrieval, Short-Delay forgetting and Long-Delay forgetting and present normative information for them.

Odor detection, learning, and memory in Huntington's disease.

We compared 7 mildly affected Huntington's disease (HD) patients to 7 age- and education-matched healthy controls (NC) on an odor detection test, the California Odor Learning Test, and the California Verbal Learning Test. Results demonstrated that odor detection sensitivity, but not group membership, accounted for significant variance in total olfactory learning. Both groups learned fewer items in the olfactory modality compared to the verbal modality, but retained a similar amount following a delay. No group differences were demonstrated for verbal recognition discriminability, but the HD group demonstrated significantly impaired odor recognition discriminability. Finally, odor detection provided excellent classification sensitivity and specificity between the patients and controls, suggesting that olfactory testing may provide a sensitive measure of the early disease process in HD.

The Hopkins Verbal Learning Test and CVLT: A Preliminary Comparison

A preliminary examination of the relationship between two clinical measures of verbal memory was conducted among healthy older subjects. Correlations between selected scores from the Hopkins Verbal Learning Test (HVLT) and the California Verbal Learning Test (CVLT) revealed that the total number of words learned across trials for both tests were significantly related (r = .74, p < .001), while there was no association between error rates (i.e., perseverations and intrusions). Recognition hits alone were not related, but recognition discriminability indices (accounting for false-positive errors) on the two measures were significantly correlated (r = .46, p = .02). While the HVLT appears to adequately assess basic verbal learning capacity, its utility in assessing some of the more complex and qualitative aspects of verbal learning and memory function may be limited, and interpretations of HVLT performances based on the CVLT literature must be made with caution. A clinical case example is presented to illustrate some of the issues in comparing performance on the HVLT and CVLT.

Effects of Coaching on Detection of Malingering on the California Verbal Learning Test

The diagnostic accuracy of California Verbal Learning Test (CVLT) indices to detect malingered head injury was examined using a simulation paradigm that included naive malingerers, malingerers provided with information about head injury, and normal controls (N = 90). The application of diagnostic cutoff scores for Recognition Discriminability and Recognition Hits derived from populations of individuals with bona fide head injury and individuals suspected of malingering (Millis et al., 1995) proved highly sensitive and modestly specific in detecting feigned head injury among both simulation groups. Results of analyses of variance and logistic regression support previous findings that malingerers overestimate memory impairment associated with mild head injury; however, they indicate that exposure to a simple instructional set may render insensitive many indices of malingering. In contrast, indices based on more subtle principles of learning theory hold promise in the detection of malingering, even in the presence of an instructional set.

Declarative and Procedural Learning, Quantitative Measures of the Hippocampus, and Subcortical White Alterations in Alzheimer's Disease and Ischaemic Vascular Dementia

This research investigated whether subjects with Alzheimer's disease (AD) and ischaemic vascular dementia (IVD) associated with periventricular and deep white matter alterations can be dissociated on tests of declarative and procedural memory, as well as on MRI indices of white matter alterations and the size of the hippocampal formation. The California Verbal Learning Test (CVLT) and the Pursuit Rotor Learning Tests (PRLT) were used to measure declarative and procedural memory, respectively. Subjects with IVD obtained a higher score on the CVLT recognition discriminability index; however, on the PRLT total time on target, carry-over between trial blocks, and slope calculated for all test trials was low. Subjects with AD exhibited the opposite profile. MRI studies indicated that subjects with IVD had considerably greater white matter alterations, but larger hippocampal formations than subjects with AD. Higher scores on the CVLT recognition discriminability index were correlated with increased size of the body of the hippocampus and parahippocampal gyrus. By contrast, as the severity of white matter alterations increased the slope on the PRLT declined. In sum, subjects with AD and IVD can be dissociated on the basis of differing patterns of impairment on tests of declarative and procedural memory, and MRI indices of white matter alteration and the integrity of the hippocampal formation.

Memory Processes in Depressed Geriatric Patients With and Without Subcortical Hyperintensities on MRI

In this study, 12 patients over age 60 with depression with moderate to severe subcortical hyperintensities (SH) localized to the periventricular white matter were identified by quantitative MRI. Using the California Verbal Learning Test, they were compared with 12 age-, education-, and severity-matched patients with depression with minimal white matter changes on specific aspects of memory performance. Patients with cortical lesions, neurologic or systemic illness affecting cognition, and history of substance abuse were excluded. Patients in the group with high SH showed reduced use of semantic encoding strategies (p < 0.05), reduced learning efficiency (p < 0.05), and a greater discrepancy between free recall and recognition discriminability (p < 0.05) than their low SH counterparts. This pattern of performance on memory tasks is similar to that found in previous studies to be associated with subcortical degenerative disorders such as Huntington's and Parkinson's diseases. Geriatric patients with depression with SH may represent a subgroup with greater subcortical involvement, with associated cognitive and functional decline.

Neuropsychological functioning before and after unilateral thalamic stimulating electrode implantation in Parkinson's disease

One theoretical advantage of chronic thalamic stimulation compared with thalamotomy for the treatment of refractory Parkinson's disease (PD) entails the avoidance and reversibility of potential cognitive morbidity. Support for the cognitive safety of thalamic stimulation remains largely anecdotal; empirical data are limited to the neuropsychological findings published for one small series of patients. The purpose of this study was to supplement those published findings that pertain to the mean changes in neuropsychological test scores and to extend previous findings by evaluating cognitive changes in individual cases from preoperative baseline to 4 months after electrode implantation. Nine patients with tremor-dominant, refractory PD underwent unilateral implantation of a deep brain stimulating electrode in the ventralis intermedius thalamic nucleus (five patients on their left and four patients on their right sides). A neuropsychological test battery was administered to each patient to evaluate attention, language, memory, and visuoperceptual and executive functions during their best “on” state before surgery, while on a medication regimen, and with the stimulator turned on after surgery. As a group, the patients attained significantly higher scores on word list recognition (discriminability) and delayed recall of prose passages after surgery than before surgery. In addition, there was a trend toward higher scores on a visual confrontation naming test after surgery. Examination of individual patient data indicated gains and losses in test scores exceeding two standard deviations to be very rare. Changes of one standard deviation were also relatively rare, but gains were more likely to occur than losses. These observations provide preliminary support for the cognitive safety of thalamic stimulation for PD.

Dementia associated with periventricular and deep white matter alterations: A subtype of subcortical dementia

This research examined the neuropsychological functioning of demented patients with periventricular and deep white matter alterations. Thirty-three outpatients with NINCDS-ADRDA probable Alzheimer's disease (AD) and 27 outpatients with probable/ possible ischaemic vascular dementia (IVD, Chui et al., 1992) associated with periventricular and deep white matter alterations matched for age, education, level of dementia, and functional disability were studied. White matter alterations were measured using a 40-poin scale previously described by Junque et al. (1990). Subjects with cortical CVAs were excluded. On executive control tests, IVD subjects made more perseverations on tests of mental control and response set, and produced fewer responses on phonemic controlled oral word association tests (letters: F,A,S). IVD subjects also made more perseverations and graphomotor errors on clock drawings. On the California Verbal Learning Test the IVD group performed better than AD subjects on the short delay free recall test condition, the recognition discriminability index, and made fewer intrusion errors on both free and cued recall conditions. We conclude that neuropsychological assessment can differentiate AD from IVD associated with white matter alterations, and that the neuropsychological profile of demented subjects with significant periventricular and deep white matter alterations is similar to other subcortical dementing illnesses.

Dementia associated with periventricular and deep white matter alterations: A subtype of subcortical dementia

This research examined the neuropsychological functioning of demented patients with periventricular and deep white matter alterations. Thirty-three outpatients with NINCDS-ADRDA probable Alzheimer's disease (AD) and 27 outpatients with probable/ possible ischaemic vascular dementia (IVD, Chui et al., 1992) associated with periventricular and deep white matter alterations matched for age, education, level of dementia, and functional disability were studied. White matter alterations were measured using a 40-point scale previously described by Junque et al. (1990). Subjects with cortical CVAs were excluded. On executive control tests, IVD subjects made more preservations on tests of mental control and response set, and produced fewer responses on phonemic controlled oral word association tests (letters: F,A,S). IVD subjects also made more preservations and graphomotor errors on clock drawings. On the California Verbal Learning Test the IVD group performed better than AD subjects on the short delay free recall test condition, the recognition discriminability index, and made fewer intrusion errors on both free and cued recall conditions. We conclude that neuropsychological assessment can differentiate AD from IVD associated with white matter alterations, and that the neuropsychological profile of demented subjects with significant periventricular and deep white matter alterations is similar to other subcortical dementing illnesses.

Fluency and response speed in recognition judgments

Previous research has suggested that perceptual fluency can contribute to recognition judgments. In this study, we examined whether fluency in recognition is based upon the speed of preceding operations, as suggested by studies of perceptual fluency. Subjects studied items in both lexical decision and naming tasks, and were then tested on two blocks of lexical decision trials with probe recognition trials. Jacoby's process dissociation procedure was used, and results from this procedure suggested that recognition judgments in the task were based largely upon familiarity. However, the estimated discriminability available from response time distributions was significantly less than the observed recognition discriminability. Simulated memory operating characteristics confirmed this under determination of recognition by response times. The results demonstrate, contrary to previous suggestions, that fluency in recognition is not based upon speed.

The Spacing Effect in Aircraft Recognition

Two theories of the spacing effect are compared in the context of aircraft recognition: working memory reconstruction and encoding variability. Participants (130 men and 110 women) viewed enhanced silhouettes of aircraft in one of four presentation schedules: massed once, massed repeated, distributed fixed, and distributed random. The two distributed schedules were designed to differ only on structural components. Thus the encoding variability theory predicts that the distributed-random schedule will be superior to the distributed-fixed schedule, whereas the working memory reconstruction theory predicts no difference between the two. Measures of recognition discriminability on novel view stimuli indicated that men, but not women, showed a recognition with the distributed-random schedule superior to that with all other schedules. Thus the men's data were consistent with the encoding variability hypothesis. The gender difference suggests the importance of processing style, familiarity, and motivation in aircraft recognition. These results have implications for aircraft recognition training and instructional design.

The effects of perceptual interference at encoding on implicit memory, explicit memory, and memory for source.

Interfering with stimulus identification can enhance later explicit memory performance. This counterintuitive (and theoretically unexpected) phenomenon was investigated in 5 experiments. Perceptual interference enhanced category-cued recall (a conceptually driven explicit test) but had no effect on a comparable implicit memory test, category-exemplar production. This dissociation was obtained across higher levels of priming and with high-frequency as well as low-frequency exemplars. Furthermore, although perceptual interference enhanced old-new recognition memory, it did not enhance rhyme recognition (a data-driven explicit test) or source discriminability. Explanations based on enhanced semantic elaboration or enhanced encoding of spatio-temporal context do not account for the perceptual-interference effect. An account based on compensatory processing of higher level perceptual representations remains viable and is discussed in terms of the transfer-appropriate processing framework and the item-specific-relational distinction.

The effects of perceptual interference at encoding on implicit memory, explicit memory, and memory for source.

Interfering with stimulus identification can enhance later explicit memory performance. This counterintuitive (and theoretically unexpected) phenomenon was investigated in 5 experiments. Perceptual interference enhanced category-cued recall (a conceptually driven explicit test) but had no effect on a comparable implicit memory test, category-exemplar production. This dissociation was obtained across higher levels of priming and with high-frequency as well as low-frequency exemplars. Furthermore, although perceptual interference enhanced old-new recognition memory, it did not enhance rhyme recognition (a data-driven explicit test) or source discriminability. Explanations based on enhanced semantic elaboration or enhanced encoding of spatio-temporal context do not account for the perceptual-interference effect. An account based on compensatory processing of higher level perceptual representations remains viable and is discussed in terms of the transfer-appropriate processing framework and the item-specific-relational distinction.