WAIS-R Block Design Research Articles

Demographically-adjusted norms for the WAIS-R Block Design and Arithmetic subtests: Results from the Neuropsychological Norms for the US-Mexico Border Region in Spanish (NP-NUMBRS) project

Objective Wechsler Adult Intelligence Scale (WAIS) Block Design and Arithmetic subtests are frequently used as measures of visuospatial construction and verbal working memory, respectively. As part of a larger test adaptation and norming effort for this population, we generated and investigated demographically-adjusted interpretive norms for WAIS-R Block Design and Arithmetic in Spanish-speaking adults living in the US-Mexico border region. Method Participants included 183 community-dwelling adults ages 20-55 (education range: 0–20 years; 58% women) from the NeuroPsychological-Norms for the US-Mexico Border Region in Spanish (NP-NUMBRS) Project. They completed the WAIS-R Block Design and Arithmetic subtests in Spanish. Demographically-adjusted T-scores were calculated for these subtests using fractional polynomial equations adjusting for linear and non-linear effects of age, education (continuous), and sex. We compared our rates of impairment (i.e. T < 40) against rates calculated using published English-speaking WAIS-R standardization sample norms adjusted for age, education, and sex. Results Education was positively associated with performance on Block Design and Arithmetic subtests, and men outperformed women on both subtests. The present Spanish-speaker norms for these subtests yielded expected rates of “impairment” (i.e. 15–16% impaired, a 1 SD cutoff), while existing norms for English-speakers underestimated impairment (i.e. 5–6% impaired) when applied to our Spanish-speaking sample. Conclusions Regional normative data will improve interpretation of test performance on Block Design and Arithmetic subtests for Spanish-speakers living in the US-Mexico border region and may aid in bolstering the overall analysis of neuropsychological profile patterns in this population. Cross-validation with Spanish-speakers in other regions and/or with other national origins is needed.

Tau aggregation influences cognition and hippocampal atrophy in the absence of beta-amyloid: a clinico-imaging-pathological study of primary age-related tauopathy (PART).

We investigate whether there is any association between the Braak neurofibrillary tangle (NFT) stage and clinical and MRI features in definite primary age-related tauopathy (PART). We analysed 52 cases with a Braak NFT tangle stage >0 and≤IV, and a Thal phase of 0 (no beta-amyloid present). Twenty-nine (56%) were female. Median age at death was 88years (IQR 82-92years). Fifteen (29%) were TDP-positive (75% TDP stage I), 16 (31%) had argyrophilic grain disease and three (6%) had alpha-synuclein-positive Lewy bodies. TDP-43 inclusion when present were rare and predominantly perivascular. Of the 15 with TDP-43, three showed a moderate number of inclusions and also had hippocampal sclerosis, neuronal intranuclear inclusions and fine neurites of the CA1 region of the hippocampus. Four cases (8%) had an apolipoprotein epsilon 4 (APOE4) allele. There was a significant correlation between age at death and Braak NFT stage (r=0.32, p=0.02). After accounting for age at clinical examination, there were significant associations between Braak NFT stage, and WAIS-R Block Design and Trail Making Tests A and B, with higher Braak stage associated with poorer performances. Thirty of the 52 cases had completed an antemortem volumetric head MRI. Two separate MRI analyses revealed an association between higher Braak NFT stage and grey matter atrophy in the head of the left hippocampus. There were no significant clinical or radiologic associations with TDP-43. Findings from this study demonstrate that aggregated tau distribution is associated with poorer cognitive performance, as well as atrophy, in the absence of beta-amyloid. These findings support the parcellation of definite PART as a useful construct. The relatively low frequencies of APOE4, TDP-43, Lewy bodies, and hippocampal sclerosis, and the rarity and morphology of TDP-43 lesions are noted contrasts to what is typically observed in Alzheimer's disease of the old.

Midlife level and 15-year changes in general cognitive ability in a sample of men: The role of education, early adult ability, BMI, and pulse pressure

The objective of the study was to examine determinants of midlife level and long-term changes in a general cognitive ability (g) factor. The data were from a Swedish sample of men (n=262; M=49.9years, SD=4.0) for which cognitive (conscript) test scores at age 18 were retrieved. In midlife the men completed a battery of cognitive tests that was re-administered at five-year intervals up to 15years after the baseline assessment. Second-order latent growth curve models were used to examine predictors of midlife level and longitudinal changes in a g factor reflecting four cognitive measures (WAIS-R Block Design, vocabulary, action recall, and word fluency). The results showed education (years of schooling) to be related to ability level (intercept) before (β=0.71), but not after (β=0.09), adjustment of an early adult (age 18) g factor (reflecting three different cognitive measures) that was highly predictive of midlife g level (adjusted β=0.89). Neither education nor g at age 18 (or midlife g level) was related to long-term changes in g, though. Conversely, baseline age, BMI, and pulse pressure were unrelated to midlife ability level, but higher baseline age, higher BMI and higher pulse pressure in midlife were predictive of cognitive decline. Thus, whereas higher levels of initial ability or educational attainment do not appear to buffer against onset of age-related decline in g in midlife and young-old age, maintenance of lower levels of pulse pressure and body weight could possibly have such an effect. However, further research is required to evaluate the mechanisms behind the observed relationships of the targeted variables and cognitive decline.

Hand Dominance and WAIS-R Block Design Performance

Hand Dominance and WAIS-R Block Design Performance

Visuospatial characteristics of an elderly Chinese population: results from the WAIS-R block design test.

Visuospatial deficits have long been recognized as a potential predictor of dementia, with visuospatial ability decline having been found to accelerate in later stages of dementia. We, therefore, believe that the visuospatial performance of patients with mild cognitive impairment (MCI) and dementia (Dem) might change with varying visuospatial task difficulties. This study administered the Wechsler Adult Intelligence Scale-Revised (WAIS-R) Block Design Test (BDT) to determine whether visuospatial ability can help discriminate between MCI patients from Dem patients and normal controls (NC). Results showed that the BDT could contribute to the discrimination between MCI and Dem. Specifically, simple BDT task scores could best distinguish MCI from Dem patients, while difficult BDT task scores could contribute to discriminating between MCI and NC. Given the potential clinical value of the BDT in the diagnosis of Dem and MCI, normative data stratified by age and education for the Chinese elderly population are presented for use in research and clinical settings.

855 – Cognitive deficits in patients with schizophrenia and comorbid obsessivecompulsive symptoms: a 12 month longitudinal study

Epidemiological studies estimated that amongst patients with schizophrenia a large subgroup of up to 25% also suffers from comorbid obsessive compulsive symptoms (OCS). The association between these comorbid OCS and neuropsychological impairment remains unclear and somewhat contradictory. Longitudinal approaches which investigate the stability of OCS related cognitive deficits are missing. 37 patients with schizophrenia and comorbid OCS and 43 schizophrenia patients without OCS were assessed with a comprehensive cognitive test-battery and compared at baseline and again 12 months later. Schizophrenia patients with comorbid OCS showed significant pronounced deficits with increasing effect sizes over the 12 month assessment period in specific cognitive areas such as visuo-spatial perception and visual memory (WAIS-R block design, Rey-Osterrieth Complex Figure Test), executive functioning (perseveration in the Wisconsin card sorting test) and cognitive flexibility (Trail making test B). These cognitive domains correlated with OCS severity and are known to be candidate domains in obsessive compulsive disorder (OCD). OCS in schizophrenia is associated longitudinally stable specific cognitive deficits. Prospective studies involving patients with at risk mental states for psychosis are necessary to decipher the interaction of cognitive impairment and the clinical manifestation of schizophrenia and OCS. This might facilitate the definition of patients at high risk for OCS, an early detection of subclinical levels, therapeutic interventions and clinical monitoring.

Stable Cognitive Deficits in Schizophrenia Patients With Comorbid Obsessive-Compulsive Symptoms: A 12-Month Longitudinal Study

Amongst schizophrenia patients, a large subgroup of up to 25% also suffers from comorbid obsessive-compulsive symptoms (OCSs). The association between comorbid OCSs in these patients and neuropsychological impairment remains unclear and somewhat contradictory. Longitudinal approaches investigating the stability of OCS-associated cognitive deficits are missing. Thirty-seven patients with schizophrenia and comorbid OCSs and 43 schizophrenia patients without OCS were assessed with a comprehensive cognitive test battery and compared at baseline and, again, 12 months later. Schizophrenia patients with comorbid OCSs showed significant pronounced deficits, with increasing effect sizes over the 12-month assessment period in specific cognitive areas such as visuospatial perception and visual memory (WAIS-R block design, Rey-Osterrieth Complex Figure Test), executive functioning (perseveration in the Wisconsin Card Sorting test), and cognitive flexibility (Trail Making test B). These cognitive domains are correlated with OCS severity and are known to be candidate cognitive domains in obsessive-compulsive disorder (OCD). OCSs in schizophrenia is associated with specific and longitudinally stable cognitive deficits, strongly arguing for at least partially overlapping neurobiological mechanisms with OCD. Prospective studies involving patients with at-risk mental states for psychosis are necessary to decipher the interaction of cognitive impairment and the clinical manifestations of schizophrenia and OCSs. This might facilitate the definition of patients at high risk for OCSs, an early detection of subclinical levels, therapeutic interventions, and clinical monitoring.

Distinguishing Alzheimer's Disease From Vascular Dementia: An Exploration of Five Cognitive Domains

ABSTRACTThe disease process of Alzheimer's disease (AD) and Vascular Dementia (VaD) are dissimilar; however, the cognitive presentations may be difficult to distinguish as they may present in tandem or result in similar deficits despite different pathogenesis. This study examined the efficacy of memory, confrontational naming, visuoconstructional ability, processing speed, and executive functioning in differentiating AD from VaD. Delayed verbal memory, visuoconstructional ability, and confrontational naming as measured by WMS-R Logical Memory II, WAIS-R Block Design (BD), and Boston Naming Test, respectively, were most effective in discriminating between these two disorders. Results indicated AD was best classified by BD, and BD was the most sensitive to AD-related pathogenesis. Delayed memory and confrontational naming were highly implicated in each subtype, suggesting they are sensitive to each disease process, thus reducing the reliability of utilizing them as sole differentiating agents.

Superior performance in WAIS-R block design among top-level rugby players

Objective and design:Following a report that a well-known soccer player achieved a perfect score on the Block Design subtest of WAIS-R, WAIS-R was conducted on 31 skilled rugby players.Participants:Twenty-seven of...

Adult life-span patterns in WAIS-R Block Design performance: Cross-sectional versus longitudinal age gradients and relations to demographic factors

Aging patterns in WAIS-R Block Design Test (BDT) were examined cross-sectionally and longitudinally. One sample (35–80 years, n = 1000) was assessed in 1988–1990 and five years later (836 returned). An independent cohort-matched sample ( n = 974) was assessed at Time 2 to control for practice effects. Relations between BDT, gender, and education were examined. The cross-sectional analyses indicated a gradual age-related deterioration from 35 to 85 years. By contrast, the longitudinal data indicated stable performance from age 35 to 55, even when minor practice effects were adjusted for, and decline past age 55. Education-adjusted cross-sectional differences revealed similar patterns. A minor, age- and time invariant, male advantage was observed. Education predicted time-related change in BDT, such that higher education was associated with lesser decline. Collectively, the results demonstrate the need to control for cohort and retest effects in cross-sectional and longitudinal studies, and reveal interesting relations between BDT performance and demographic variables.

Factor structure of the Hooper Visual Organization Test: a cross-cultural replication and extension

To investigate construct validity of the Hooper Visual Organization Test (VOT), a principal-axis analysis was performed on the neuropsychological test results of 200 German-speaking neurological patients who received a comprehensive battery, encompassing tests of visuospatial functions, memory, attention, executive functions, naming ability, and vocabulary. A four-factor solution was obtained with substantial loadings of the VOT only on the first factor, interpreted as a global dimension of non-verbal cognitive functions. This factor loaded significantly on numerous measures of visuospatial processing and attention (with particularly high loadings on WAIS-R Block Design, Trails A and B, and Raven’s Standard Progressive Matrices). The remaining three factors were interpreted as memory, verbal abilities (vocabulary), and a separate factor of naming abilities.

High incidence of mental disorders, reduced mental well-being and cognitive function in hypopituitary women with GH deficiency treated for pituitary disease.

Previous studies have shown possible neuroendocrine effects of GH. In the present study we investigated the incidence of mental disorders and the prevalence of mental distress and cognitive dysfunction in hypopituitary women with untreated GH deficiency compared to population-based controls. Thirty-three hypopituitary women with a median age of 64 years (range 39--77 years) were investigated cross-sectionally, without any change in hormone substitutions. Twenty-nine of the patients had been operated for a pituitary tumour, 25 had received radiotherapy and 15 had visual dysfunction. The patients were with a very high probability GH deficient, as 29 had subnormal IGF-I levels and the other four were GH deficient as assessed by an insulin tolerance test. The patients were compared with 33 controls matched for sex, age, smoking habits, educational level and residence. The incidence of mental disorders was calculated from the date of diagnosed hypopituitarism to the time of the present investigation. Mental well-being was assessed by three self-rating questionnaires: the Symptom Checklist-90 (SCL-90), the Interview Schedule for Social Interaction (ISSI) and the social network concept. The subjects were examined with neuropsychological tests of vocabulary (SRB:1 vocabulary test), perceptual speed (WAIS-R Digit Symbol), spatial ability (WAIS-R Block Design), verbal memory (Cronholm--Molander verbal memory test), spatial learning (Austin Maze Test) and reaction time (APT Two-way Reaction Time and APT Inhibition). The hypopituitary women had a higher incidence of mental disorders than the controls; Incidence Rate Ratio 4.5 (95% CI 1.0--21). The Global Severity Index, i.e. the average score of all 90 questions of the SCL-90, was higher in patients (P = 0.001), and the patients had significantly more symptoms of somatization, anxiety, depression, obsession--compulsion, hostility--irritability, phobic and psychotic symptoms (all P less-than-or-equal 0.04). Moreover, 14 patients compared to four controls were classified as possible cases of mental distress according to the SCL-90 (P = 0.006). The patients experienced lower availability of both social attachment (P = 0.02) and integration (P = 0.001), but there were no group differences in the adequacy of these dimensions or in emotional support. The patients had lower scores in four of seven neuropsychological tests (all P less-than-or-equal 0.04). The hypopituitary women had a higher incidence of mental disorders, more symptoms of mental distress and increased prevalence of cognitive dysfunction. The impaired results in the patients could possibly be explained by several factors, such as transfrontal surgery, radiotherapy, visual dysfunction and unphysiological hormone substitution. Moreover, it is probable that GH deficiency contributed, but placebo-controlled double-blind studies are warranted to investigate whether the psychological dysfunction is reversible on GH substitution.

The relationship between Benton Visual Form Discrimination and WAIS-R Block Design in inpatients with TBI

The relationship between Benton Visual Form Discrimination and WAIS-R Block Design in inpatients with TBI

Quantifying qualitative features of Block Design performance among healthy older adults

Block Design tasks are neuropsychologically valuable, but standard scoring sacrifices potentially useful information that could elucidate the cognitive processes underlying performance failures. Qualitative indices that were proposed in the WAIS-R-NI [Kaplan, E., Fein, D., Morris, R., & Delis, D. (1991). The WAIS-R as a neuropsychological instrument [Manual]. San Antonio, TX: Psychological Corporation] should help to remedy this situation but have received little research attention. We present WAIS-R Block Design data for 177 healthy older adults (aged 50-90) incorporating several qualitative measures, outlining normative ranges and examining age differences. Proportional scoring, counts of single-block placement and rotation errors, counts of parameter-violating errors such as breaking configuration, and availability of implicit grid information all offer potentially valuable supplementary data that can enrich clinical interpretation of Block Design protocols.

Quantifying qualitative features of Block Design performance among healthy older adults

Block Design tasks are neuropsychologically valuable, but standard scoring sacrifices potentially useful information that could elucidate the cognitive processes underlying performance failures. Qualitative indices that were proposed in the WAIS-R-NI [Kaplan, E., Fein, D., Morris, R., & Delis, D. (1991). The WAIS-R as a neuropsychological instrument [Manual]. San Antonio, TX: Psychological Corporation] should help to remedy this situation but have received little research attention. We present WAIS-R Block Design data for 177 healthy older adults (aged 50–90) incorporating several qualitative measures, outlining normative ranges and examining age differences. Proportional scoring, counts of single-block placement and rotation errors, counts of parameter-violating errors such as breaking configuration, and availability of implicit grid information all offer potentially valuable supplementary data that can enrich clinical interpretation of Block Design protocols.

The Salience of Visuospatial and Organizational Skills in Reproducing the Rey-Osterreith Complex Figure in Subjects with High and Low IQs

The salience of visuospatial and organizational skills in copying the Rey-Osterreith Complex Figure (ROCF) was examined in 44 adults diagnosed with Attention Deficit Hyperactivity Disorder (ADHD). Subjects were divided into a high average and above IQ group (n = 21) and an average and below IQ group (n = 23). Multiple regressions were conducted for both groups, with the ROCF copy as the dependent variable and WAIS-R Block Design and Stern Fragmentation scores as predictor variables. Results indicated that, for the high IQ group, visuospatial skills were more salient in predicting ROCF copy scores. By contrast, for the low IQ group, organizational skills were more salient for predicting ROCF copy score. Our findings are discussed in relation to the Boston Process Approach.

Cognitive Test Performance and Presence of Subclinical Cardiovascular Disease in the Cardiovascular Health Study

The purpose of the present study was to investigate the relationship between performance on a comprehensive battery of neuropsychological tests and the presence of clinical, subclinical or no cardiovascular disease in an elderly community-dwelling population. The results confirm previous reports of significant associations of age, education and gender with test performance. When performance was examined controlling for these variables, significant associations of disease group were seen with five measures emphasizing speed of performance; Parts A and B of the Trail Making Test, the WAIS-R Digit Symbol and Block Design subtests and category verbal fluency. These results add to the evidence that, in addition to other health implications, cardiovascular disease is related to cognitive functioning in the elderly even at subclinical levels.

Cognitive dysfunction in women withhypopituitarism

Patients with hypopituitarism and untreated growth hormone deficiency (GHD) have reported symptoms such as low energy levels, inability to concentrate and memory problems. It has been suggested that growth hormone (GH) and insulin-like growth factor I may have direct neuroendocrine effects on the CNS. We have previously reported that women with hypopituitarism have an almost five-fold increase in mortality due to cerebrovascular disease. The aim of the present study was to investigate whether or not women with hypopituitarism suffer from impaired cognitive function. Thirty women (median age, 62 years; age range, 39-77 years) with pituitary insufficiency (median duration, 18 years; duration range 6-43 years) were compared with a control group from the general population. Controls were matched with patients for age, sex, smoldng habits, educational level and place of residence. Patients had not previously been treated with GH; 27 had undergone surgery for a pituitary tumour, and 25 had received radiotherapy. Patients and controls were assessed using neuropsychological tests of perceptual speed (Wechsler Adult Intelligence Scale-Revised [WAIS-R] digit-symbol substitution), spatial ability (WAIS-R block design), verbal memory (CronholmMolander paired associates) and vocabulary (synonyms). The results shown in Table 1 indicate that the patients had significantly lower scores in the perceptual speed and vocabulary tests compared with the controls (P = 0.04 and P = 0.02, respectively). Statistically significant differences were not apparent, however, in the spatial ability and verbal memory tests. Thus, women with hypopituitarism had significantly poorer scores in two of the four neuropsychological tests, compared with demographically matched controls. Untreated GHD as well as neurosurgery and radiotherapy may have contributed to these findings.

Qualitative Block Design Performance in Epilepsy Patients

Broken configuration errors on the WAIS-R Block Design subtest have been associated with right hemisphere brain damage. This study examined whether pre-surgical epilepsy patients with seizure foci restricted to the right hemisphere would break configuration more frequently than those with left hemisphere foci. Subjects included 38 patients with unilateral right or left hemisphere epilepsy of frontal or temporal lobe origin. The left and right hemisphere groups did not differ significantly in demographic or disease variables, IQ, or Block Design standard scores. Right hemisphere patients made more broken configurations than did those with left hemisphere foci. In the right hemisphere group, more broken configurations were associated with a lower Block Design Scaled Score and Full Scale IQ. These results suggest that the observation of broken configurations in the Block Design can assist in corroborating the seizure focus and highlight the importance of qualitative Block Design analysis.

Qualitative Block Design Performance in Epilepsy Patients

Broken configuration errors on the WAIS-R Block Design subtest have been associated with right hemisphere brain damage. This study examined whether pre-surgical epilepsy patients with seizure foci restricted to the right hemisphere would break configuration more frequently than those with left hemisphere foci. Subjects included 38 patients with unilateral right or left hemisphere epilepsy of frontal or temporal lobe origin. The left and right hemisphere groups did not differ significantly in demographic or disease variables, IQ, or Block Design standard scores. Right hemisphere patients made more broken configurations than did those with left hemisphere foci. In the right hemisphere group, more broken configurations were associated with a lower Block Design Scaled Score and Full Scale IQ. These results suggest that the observation of broken configurations in the Block Design can assist in corroborating the seizure focus and highlight the importance of qualitative Block Design analysis.