WAIS Performance Research Articles

Does psychological distress impact Wechsler Adult Intelligence Scale performance in adults with intellectual disabilities? A systematic review

BackgroundAvailable guidance states that psychological distress may impact on intellectual functioning assessment performance. Less clear is how clinicians should proceed when assessing an adult with a suspected intellectual disability (ID) presenting with psychological distress.MethodA systematic review was performed, that examined psychological distress and performance on the Weschler’s Adult Intelligence Scale (WAIS; all versions) in adults with ID.ResultsFrom 17,358 articles identified, one study was relevant. This study suggested psychological distress is associated with WAIS performance but had methodological issues.ConclusionThere is a dearth of evidence investigating this issue. Questions remain over the evidence base guiding clinical decision making.

P-442 - Educational level in the diagnostic of dementias: A research with eldery patients

A major problem in the early diagnosis of dementia is the absence, in most cases, the lack of previous objective information before the current expression of the symptoms. The analysis of the discrepancies is the only reference that can guide the diagnosis. Based on neuropsychological assessment of dementia in elderly patients, the present study analyzed the relationship between gender and educational level in the verbal and performance dimension results in dementia neuropsychological assessment among elderly patients. Twenty patients (10 males and 10 females), with more that 60 year old, participated in the study. The WAIS-III, the Rey auditory verbal learning, the Folstein and the Zulliger tests were employed. Results indicated that male subjects with higher education presented lower scores in the WAIS performance subtest when compared to verbal subtest. Although the educational status and the intellectual activity had a tendency to mask the lost of performance in the beginning of dementia disorder, the objective evaluation of the discrepancies indicated the presence of a reduction in efficiency. The female sample, with lower level of scholarship, although the results indicated a general tendency to cognitive impairment, no differences between verbal and performance subtests were detected. Without objective and reliable information regarding the antecedent performance, the mnemonic test resources were crucial to reach a diagnosis in this group. The male sample presented higher scores in the verbal subtest as compared to the female sample. A covariance analyses indicated that education level and not gender was the responsible variable for this difference.

P03-78 - No effects of polypharmacy and antipsychotic dose on spatial working memory in schizophrenia

ObjectivesAntipsychotic polypharmacy and high doses have been associated with poor outcome and increased adverse effects in schizophrenia. However, their relation to cognition has been poorly studied.Methods40 right-handed patients (mean age: 42.87 years; SD:10.57) with DSM-IV schizophrenia, were recruited in an acute psychiatric ward. They were assessed on the Spatial Working Memory test (SWM) of the Cambridge Neuropsychological Test Automated Battery (CANTAB) and the Wechsler Adult Intelligence Scale (WAIS-III) at a time when they were able to cooperate with neuropsychological testing. The pattern of their pharmacological treatment was also assessed. Statistical correlation and Mann-Whitney tests were performed using the SPSS, as appropriate.Results18 patients were receiving antipsychotic polypharmacy (≥2 antipsychotics) and 22 monotherapy. 13 patients received an excessive (≥1000 chloropromazine mEq(CmEq)/day), and 22 a normal antipsychotic dosage. No significant difference was detected on any of the SWM performance measures between the two groups of patients receiving either polypharmacy or monotherapy. These groups did not also differ in the WAIS full scale, performance or verbal IQ scores. When the patients were divided into two groups receiving either an excessive or a normal dose of antipsychotics, these two groups also showed a similar SWM and WAIS performance. The total antipsychotic dose showed negative but nonsignificant correlations with the SWM performance scores.ConclusionsWe did not detect any influence of antipsychotic polypharmacy or excessive dosing on spatial working memory in schizophrenia. This finding supports the independence of working memory deficits from the effects of treatment in schizophrenia.

Cognitive Dysfunctions Associated With PTSD: Evidence from World War II Prisoners of War

The authors aim to delineate cognitive dysfunction associated with posttraumatic stress disorder (PTSD) by evaluating a well-defined cohort of former World War II prisoners of war (POWs) with documented trauma and minimal comorbidities. The authors studied a cross-sectional assessment of neuropsychological performance in former POWs with PTSD, PTSD with other psychiatric comorbidities, and those with no PTSD or psychiatric diagnoses. Participants who developed PTSD had average IQ, while those who did not develop PTSD after similar traumatic experiences had higher IQs than average (approximately 116). Those with PTSD performed significantly less well in tests of selective frontal lobe functions and psychomotor speed. In addition, PTSD patients with co-occurring psychiatric conditions experienced impairment in recognition memory for faces. Higher IQ appears to protect individuals who undergo a traumatic experience from developing long-term PTSD, while cognitive dysfunctions appear to develop with or subsequent to PTSD. These distinctions were supported by the negative and positive correlations of these cognitive dysfunctions with quantitative markers of trauma, respectively. There is a suggestion that some cognitive decrements occur in PTSD patients only when they have comorbid psychiatric diagnoses.

Autism-related language, personality, and cognition in people with absolute pitch: results of a preliminary study.

Reports of a relatively high prevalence of absolute pitch (AP) in autistic disorder suggest that AP is associated with some of the distinctive cognitive and social characteristics seen in autism spectrum disorders. Accordingly we examined cognition, personality, social behavior, and language in 13 musicians with strictly defined AP (APS) and 33 musician controls (MC) without AP using standardized interviews and tests previously applied to identify the broad autism phenotype seen in the relatives of autistic probands. These included the Pragmatic Rating Scale (PRS) (social aspects of language) the Personality Assessment Schedule (PAS) (rigidity, aloofness, anxiety/worry, hypersensitivity), and WAIS performance subtests (PIQ). On the basis of their behavior in the interviews, subjects were classified as socially eccentric, somewhat eccentric, or not eccentric. Forty-six percent of the APS, but only 15% of the MC, were classified as socially eccentric (p < .03). APS but not MC showed higher scores on block design than on the other PIQ tests (p < .06), a PIQ pattern seen in autism spectrum disorders. Although APS and MC did not differ significantly on other measures it is of note that APS mean scores on the PRS and PAS (5.69, 4.92) were almost twice as high as those for the MC (3.03, 2.45). Thus, musicians with AP show some of the personality, language, and cognitive features associated with autism. Piecemeal information processing, of which AP is an extreme and rare example, is characteristic of autism and may be associated as well with subclinical variants in language and behavior. We speculate that the gene or genes that underlie AP may be among the genes that contribute to autism.

Thyroid hormones: positive relationships with cognition in healthy, euthyroid older men.

Although the association of clinical hypothyroidism with cognitive deficits is well known, the cognitive effects of thyroid hormones in euthyroid subjects are less studied and understood. The purpose of this study was to examine thyroid-cognition relationships in healthy, euthyroid older men. We examined healthy men (N = 44, mean age = 72), excluding clinically hypothyroid/hyperthyroid or diabetic/hyperglycemic subjects and those with dementia, depression, CNS medications, or recent illness. Plasma samples obtained across a 24-hour period were pooled, then assayed for total thyroxine (TT4), total triiodothyronine (TT3), and T3 resin uptake. Free thyroxine index (FT4I) was calculated. A broad cognitive battery (including the Wechsler Adult Intelligence Scale-Revised [WAIS-R], the Dementia Rating Scale [DRS], and the Rivermead Behavioral Profile [PROFILE]) was administered to all subjects. Regression analyses controlling age and education showed TT4 and FT4I to have significant positive relationships with measures of overall cognition; TT4 accounted for 8% to 12% of the variance in omnibus cognitive measures such as WAIS Performance, WAIS Verbal score, and GLOBAL cognitive scores. Our findings suggest that within "normal" range of variation in plasma thyroid hormones, TT4 but not T3 positively associates with general cognition in healthy elderly men.

Childhood inattention-overactivity, aggression, and stimulant medication history as predictors of young adult outcomes.

This study examined the contributions of childhood symptom dimensions and aspects of methylphenidate (MPH) treatment to the prediction of young adult outcomes in boys who were referred to a child psychiatry outpatient clinic. They were diagnosed with hyperkinetic reaction of childhood/minimal brain dysfunction, and given MPH for an average of 30 months. Including significant effects and statistical trends, childhood Inattention-Over-activity was uniquely associated with fewer than 10% of adult outcomes such as schizotypic features, impairment on the Global Assessment Scale (GAS), and unemployment. Childhood aggression was uniquely associated with 38% of adult outcomes such as lifetime diagnoses of major depression, drug abuse disorder, and antisocial personality disorder; MMPI PD, PA, and SC scores; and six additional measures of adult impairment and life circumstances-extending external validation of the two-factor model to young adulthood. For 20 young adult outcomes (63%), aspects of childhood treatment with MPH had no lasting effects. For one adult outcome (3%), a lasting negative effect of childhood drug treatment was found; better initial response to medication was associated with not graduating from high school. For 11 young adult outcomes (34%), however, aspects of childhood MPH treatment had positive effects that lasted long after treatment was discontinued. Higher dosage was associated with fewer diagnoses of alcoholism or suicide attempts. Better response to medication was associated with lower MMPI D scores and better social functioning. Longer medication duration was associated with fewer schizotypic features, lower MMPI MA scores, higher WAIS Performance and Full Scale IQs, and better WRAT Reading and Arithmetic performance.

WAIS performance during the acute recovery stage following closed-head injury.

WAIS profiles of 50 acute closed head-injured patients were examined and compared with those of 40 psychiatric inpatients. Patients with moderate and severe, but not with mild, head injury differed significantly from the control group on level of subtest performance. There was no significant interaction of group by subtest. The groups also differed significantly on a measure of between-subtest scatter. Discriminant function analysis incorporating measures of within-subtest scatter correctly classified 89% of all subjects. Within the head-injured group Similarities and Block Design scores were elevated, and the Digit Symbol score depressed. These results indicate that closed head-injured patients can be discriminated from psychiatric inpatients on the basis of WAIS performance, but that they do not necessarily show a characteristic WAIS profile. Within-subtest scatter may indicate information-processing deficits.

WAIS performance in epileptics with unilateral interictal EEG abnormalities

A predictable relationship between Verbal Comprehension deficits and EEG abnormalities in the left hemisphere of patients with focal and generalized seizures has been reported. A relationship has also been reported between Perceptual Organization deficits and right-hemisphere EEG abnormalities. To extend and verify these findings, the performance of the left- and right-hemisphere seizure groups were compared using multivariate analyses of variance on three factors of cognitive performance: Verbal Comprehension, Perceptual Organization, and Freedom from Distractibility. Twenty-eight right-handed male subjects with focal seizures lateralized to either the left or right hemisphere by EEG were studied using the Wechsler Adult Intelligence Scale. Our initial hypotheses that individuals with left-hemisphere seizure foci would perform significantly more poorly on Verbal Comprehension tasks and individuals with right-hemisphere seizure foci would perform significantly more poorly on Perceptual Organization tasks were not confirmed. The data suggest that theoretical bias may obscure the mechanism of cognitive dysfunction in epileptic populations.

Bromocriptine improves digit symbol substitution test scores in neuroleptic-treated chronic schizophrenic patients

SummaryThe cognitive effects of bromocriptine (10 mg/day) in chronic neuroleptic-treated schizophrenic patients were studied in a 4-month trial. Ten neuropsychological variables were used for the evaluations. Nine patients and seven controls completed the study. They were tested three times: before the beginning of the study, and after 2 and 4 months of treatment. The results showed that treated patients globally performed significantly better than the controls (P &lt; 0.05), and that the digit symbol substitution test was significantly improved (P &lt; 0.03). The WAIS performance score was also significantly improved (P &lt; 0.02). The picture arrangement test was improved, but did not reach significance (P &lt; 0.07). Verbal tests were not improved. It therefore appears that addition of a D2 dopamine agonist in neuroleptic-treated patients can improve some of their cognitive functions. Two explanations can be proposed: i) bromocriptine decreases neuroleptic-induced motor side effects or ii) has an effect on a putative hypodopaminergic function in schizophrenia.

Variations of the 2-line inspection time stimulus

Mackenzie and Bingham [(1985) Australian Journal of Psychology, 37, 257–268] used a variation of the 2-line Inspection Time (IT) task shifting the stimulus position between trials to prevent focussing of attention and obtained 71% thresholds which correlated -0.50 with WAIS Performance IQ. Nettelbeck [(1987) Speed of information-processing and intelligence. Norwood, NJ: Ablex] estimated the mean 97.5% threshold for Mackenzie and Bingham's subjects was 262 msec where other Inspection Time studies obtain estimated 97.5% thresholds of around 100 msec, and suggested the higher mean threshold estimate might be due to the changes in stimulus position. This experiment investigates whether the higher thresholds obtained by Mackenzie and his associates are due to the changes in stimuli used. Fifty non-retarded adults served as subjects for: M, stimuli which changed position as in Mackenzie and Bingham (1985); S, stimuli similar to M presented in fixed position; and N, stimuli more similar to the conventional 2-line stimuli in contrast and mask width. There were no significant differences between the 3 stimuli in their mean thresholds or in their correlations with progressive matrices (mean r = -0.61). The mean 79% threshold of 90 msec converts to an estimated 97.5% threshold of 216 msec. It follows that changing stimulus position (M vs S) or stimulus contrast or mask width (S vs N) are not responsible for the higher estimated 97.5% thresholds. The present study has obtained for the whole sample a correlation between mean IT and intelligence, -0.61, which is significantly higher than Hunt's [(1980) British Journal of Psychology, 71, 449–474] 0.3 barrier. Correcting possible skew in IT by log transform produces a correlation of -0.64, and there is no evidence that the correlation is substantially lower for subjects of above average IQ, after correcting for restriction of range r = -0.55.

Pattern of performance on the tactual performance test

Abstract This study explored the neuropsychological correlates of different performance patterns on the first two trials of the Tactual Performance Test (TPT) in normal subjects. Regression analysis showed a significant relationship between TPT pattern and neuropsychological summary scores, other TPT measures, and individual measures assessing visual-spatial skills and left-hand motor performance. A direct comparison of subjects who showed the expected pattern of improvement with reversal subjects, however, revealed differences only for other TPT measures and certain WAIS Performance subtests. These data are important because it appears that a reversal in the expected pattern of improvement on the TPT occurs fairly commonly in normals, especially those who are older and less well educated.

Predicting intellectual level from the Mini-Mental State Examination.

The Mini-Mental State Examination and the WAIS-R were administered to 105 patients in the early stages of Alzheimer's disease. MMSE scores correlated 0.83 with full scale IQ, which indicates that the MMSE may be a reasonable alternative measure of overall intellectual functioning in Alzheimer patients, for whom more extensive testing is impractical or clinically inappropriate. The prediction formula is presented, along with a prediction table. Folstein and McHugh report that, as the WAIS Performance IQ falls below 100 in demented patients, that there is a concomitant decline in the MMSE below 24 points. Data from our laboratory further support what some clinicians have long suggested, ie, that in those cases where only the mental status examination can be given, this short test can provide a reasonably valid and reliable prediction of the patient's IQ score.

MMPI correlates of performance intellectual deficits in patients with right hemisphere lesions.

This study investigated the emotional adjustment of 50 patients with focal brain damage in the right hemisphere (RHD). The impact of functional loss (as assessed by the WAIS Performance IQ) was assessed by a multivariate comparison of the composite MMPI profiles of these patients as classified into three groups: Below Average, Average, and Above Average Performance IQ. Regardless of the extent of decline in Performance-related abilities, right hemisphere impairment was associated with symptoms of mild depression, loss of initiative, anxiety, denial, and somatic preoccupations. MMPI scores were not correlated significantly with their WAIS Performance IQs. Implications for neuropsychological assessment are discussed.

Figure-object matching: Another frequent nonverbal impairement of aphasics

389 focal brain-damaged patients were examined by means of a nonverbal Figure-Object Matching Test (FOMT) and standardized aphasia battery. An LH lesion proved to be more relevant than an RH lesion to the outcome on FOMT. Both the presence and severity of aphasia play a significant role in the poor outcome on FOMT while type of aphasia, intelligence impairment (WAIS performance IQ) and presence of a visual field defect do not. It is concluded that this type of nonverbal defect of aphasics reflects a basic disorder, linked in some way to language impairment.

Assessment of quality of life in cardiovascular therapy.

Assessment of quality of life in cardiovascular therapy.

Relationship of anxiety and depression scores to WAIS performance of psychiatric patients.

Relationships between the D scale of the Minnesota Multiphasic Personality Inventory (MMPI) and the Taylor Scale of Manifest Anxiety and the Wechsler Adult Intelligence Scale were investigated in 464 acute psychiatric inpatients divided into four age-sex groups. Bivariate product-moment and multiple regression coefficients were obtained between Taylor's scale and D scale scores and both relative and absolute WAIS subtest scores, Verbal IQ, Performance IQ, and Full Scale IQ. 21 of 288 first-order and 7 of 144 multiple regression coefficients were significant. 18 of 21 significant first-order correlations occurred on timed subtests. IQ range had little effect on the magnitude or pattern of relationships obtained. With the exception of the Block Design there was little evidence of any systematic relationship between WAIS performance and either the anxiety or depression scale scores.

Left-Handed and Right-Handed Aphasics with Left Hemisphere Lesions Compared on Nonverbal Performance Measures

This study examined the performance of 21 left-handed (LH) and 57 righthanded (RH) aphasics with unilateral left hemisphere lesions on standardized measures of nonverbal ability, derived from the WAIS Performance Scale (Wechsler, 1958) and the Parietal Lobe Battery (Goodglass and Kaplan, 1972). The handedness groups were initially compared on a number of demographic, neurological, diagnostic, and language variables and found to be equivalent. When compared on measures of nonverbal ability. LHs were significantly more impaired than RHs particularly on tasks involving visuo-spatial organization and construction. This finding suggests that LH aphasics may have more left hemisphere representation than RH aphasics on some tasks for which the right hemisphere is typically dominant.Finally, this study provides some data to address the issue regarding the percentage of LHs relative to RHs who become aphasic from unilateral lesions. Out of 323 aphasics who were seen at the Aphasia Unit over a ten-year period, 43 (13%) were left-handed. Twenty-four percent of LHs, but only one percent of RHs, were aphasic due to lesions of the right hemisphere.

„Primitiveness” and „advancedness” of pleasures and aversions in relation to WAIS indices

Administered the Pleasure-Aversion Scale and all 11 subtests of the WAIS to 34 women and 28 men. On the PAS, Ss list pleasures and aversions, which fall into five categories: Reality Pleasure (RP), Fantasy Pleasure (FP), Reality Aversive (RA), Fantasy Aversive (FA), and Total Score. Each S response is rated by two trained raters, who use special rating scales. These scales provide ratings of cognitive „primitiveness” and „advancedness” for each listed pleasure or aversion. The five PAS measures essentially were uncorrelated with the WAIS indices for women, but a meaningful pattern of correlations emerged for men. Of most significance were tendencies for Reality Pleasure to correlate with WAIS Verbal indices (VIQ, FSIQ, I, V, and D) and Fantasy Pleasure to correlate negatively with WAIS Performance indices (DS, BD, PC, and OA). The strong correlation between RP and Digit Span was discussed from the standpoint of Bailey's primitive-advanced continuum (Bailey, 1982) and Gittinger's Externalizer-Internalizer dimension (Winne & Gittinger, 1973). Problems in generalizing from present findings also were discussed.

Effect of pairing scanning training with block design training in the remediation of perceptual problems in left hemiplegics.

Twenty-seven left hemiplegics were divided into three groups of nine, matched for age, education, degree of left neglect, and time since onset of stroke. Subjects were pretested and, following the training, posttested on the WAIS Performance subtests, the WRAT Reading subtest, a letter cancellation task, an address-copying task, and a face-counting task. Subjects received 1 hour of occupational therapy (OT) each day for 20 successive days as follows: Group I received 1 hour of routine OT; Group II received 20 minutes of routine OT, 20 minutes of cancellation training, and 20 minutes of visual scanning training; Group III received 20 minutes of block design training, 20 minutes of cancellation training, and 20 minutes of visual scanning training. Groups II and III improved on measures of visual scanning, reading, and writing to a significantly greater extent than did Group I, and Group III improved to a significantly greater extent than did Group II. Few differences among the groups were seen on measures of psychometric intelligence and face counting. The results, for the most part, supported previous findings and, furthermore, indicated that block design training enhances the effect of visual scanning training techniques in the remediation of perceptual problems in left hemiplegics.