WAIS-R Block Design Research Articles

Neuropsychological Functioning in Depressed Versus Nondepressed Participants with Alzheimer's Disease

Differences in cognitive functioning between participants with Alzheimer's Disease (AD) reporting depressive symptomatology (AD-Dep; n = 37) and a control group of nondepressed participants with AD (AD-Con; n = 98) were investigated based on hypothesized impairments of attention/concentration, psychomotor speed, and simple motor speed. Groups did not differ in age, education, overall severity of dementia, auditory comprehension, or use of psychotropic medications. AD-Dep participants performed significantly more poorly than AD-Con participants on 3 of the 13 measures on which they were hypothesized to exhibit greater impairment (WAIS-R Block Design, WAIS-R Digit Symbol, and speeded motor programming); and there were trends toward poorer performance on four additional measures (WAIS-R Object Assembly, WAIS-R Picture Arrangement, WAIS-R Digit Span-backward, and letter fluency). There was only one significant effect for the 13 measures on which no group differences were hypothesized; the AD-Dep participants unexpectedly obtained better WMS-R Logical Memory delayed recall scores than the AD-Con participants. Finally, AD-Dep participants exhibited an unexpected pattern of greater right hand advantage on the Finger Tapping Test.

Questionable Dementia: Clinical Course and Predictors of Outcome

To evaluate the clinical course and predictors of outcome in outpatients with cognitive impairment who do not meet criteria for dementia at initial evaluation. Naturalistic longitudinal study. Cognitively impaired patients in a memory disorders clinic who fell between the "normal" and "dementia" categories were defined broadly as "questionable dementia" (QD). Of 127 consecutive QD patients, 75 were followed for a minimum of 1 year (mean 2.5 years, SD 1.7). Baseline neuropsychological testing was conducted in 62 of these 75 QD patients. At the final follow-up time-point, 41.3% met diagnostic criteria for dementia (27 of 31 patients with dementia had possible or probable Alzheimer's Disease, AD), 44% were rated as not demented, and 14.7% remained as "uncertain" dementia. Increased age was associated with the final diagnosis of dementia, but duration of follow-up, Clinical Dementia Rating, and modified Mini Mental State (mMMS) scores were not predictive. Low scores on the mMMS delayed recall subtest, consistent long-term retrieval on the Selective Reminding Test, category naming for animals, and the WAIS-R digit symbol, picture arrangement, and block design subtests were predictive of the final diagnosis of dementia (all P < or = .01). mMMS delayed recall showed 66.7% sensitivity and 71.4% specificity, the other five neuropsychological subtests together showed 66.7% sensitivity and 66.7% specificity, and the six tests together showed 81% sensitivity and 76.9% specificity. Similar predictive accuracy was obtained for the final diagnosis of AD. In QD patients, poor performance on the mMMS delayed recall item may be a useful predictor of the diagnosis of dementia (and AD) on follow-up. Combining a screening instrument like the mMMS with specific neuropsychological tests may provide good predictive accuracy. In QD patients, the observed heterogeneity in diagnostic outcome, with most patients in the "dementia" and "no dementia" categories at follow-up, enhances the feasibility of evaluating early markers with predictive accuracy for dementia and AD.

The Ray-Osterrieth complex figure test as a neuropsychological measure in criminal offenders

What does the Rey-Osterrieth Complex Figure Test (CFT) measure in criminal offenders? This study examined neuropsychological and personality test correlates of performance on the Complex Figure Test in a sample of 110 incarcenated criminal offenders. Three standard CFT scores-copy accuracy, memory recall accuracy, and organizational quality-did not discriminate between violent and nonviolent offenders, and were not correlated with either Psychopathy Checklist scores or self-reported anger using the Novaco Anger Scales. CFT performance was significantly correlated with two other standard neuropsychological measures, a short form of the Category Test and the Trail Making Test. As might be expected, CFT scores were positively correlated with WAIS-R Block Design, and to a lesser extent Vocabulary. Organizational quality scores were significantly correlated with the Barratt Impulsiveness Scale. Approximately 27 to 36% of the variance in CFT scores could be explained by the combination of minority status, measures of nonverbal cognitive performance, and self-reported impulsivity.

The Rey-Osterrieth complex figure test as a neuropsychological measure in criminal offenders

What does the Rey-Osterrieth Complex Figure Test (CFT) measure in criminal offenders? This study examined neuropsychological and personality test correlates of performance on the Complex Figure Test in a sample of 110 incarcerated criminal offenders. Three standard CFT scores-copy accuracy, memory recall accuracy, and organizational quality-did not discriminate between violent and nonviolent offenders, and were not correlated with either Psychopathy Checklist scores or self-reported anger using the Novaco Anger Scales. CFT performance was significantly correlated with two other standard neuropsychological measures, a short form of the Category Test and the Trail Making Test. As might be expected, CFT scores were positively correlated with WAIS-R Block Design, and to a lesser extent Vocabulary. Organizational quality scores were significantly correlated with the Barratt Impulsiveness Scale. Approximately 27 to 36% of the variance in CFT scores could be explained by the combination of minority status, measures of nonverbal cognitive performance, and self-reported impulsivity.

The differential sensitivity of the Rey-Osterrieth complex figure and WAIS-R block design subtest in the assessment of constructional apraxia

The differential sensitivity of the Rey-Osterrieth complex figure and WAIS-R block design subtest in the assessment of constructional apraxia

The differential sensitivity of the Rey-Osterrieth complex figure and WAIS-R block design subtest in the assessment of constructional apraxia : Klitzke, M. J.

The differential sensitivity of the Rey-Osterrieth complex figure and WAIS-R block design subtest in the assessment of constructional apraxia : Klitzke, M. J.

Predicting Rate of Cognitive Decline in Probable Alzheimer's Disease

Recent attempts to identify predictors of rate of decline in Alzheimer's disease (AD) have been extremely variable in choice of outcome variables, predictor variables tested, timing of assessments, and statistical approaches. In this study, a random effects regression model was applied to seek predictors of decline on the Mini-Mental State Exam in 132 patients with probable AD reassessed every 6 months for up to 7.5 years. Potential predictor variables at baseline were of three types: patient characteristics, clinical variables, and cognitive performances. The final multivariate analysis indicated that the following characteristics predicted more rapid cognitive decline: more education, history of dementia in a first degree relative, non-right handedness, better performances on Boston Naming Test, Gollin Incomplete Figures Test, and Benton Visual Retention Test-Delay, and worse performances on Responsive Naming Test, WAIS-R Block Design, and Benton Visual Retention Test-Copy.

551. - Questionable dementia: Clinical course and predictors of outcome

OBJECTIVE: To evaluate the clinical course and predictors of outcome in outpatients with cognitive impairment who do not meet criteria for dementia at initial evaluation. DESIGN: Naturalistic longitudinal study. METHODS: Cognitively impaired patients in a memory disorders clinic who fell between the “normal” and “dementia” categories were defined broadly as “questionable dementia” (QD). Of 127 consecutive QD patients, 75 were followed for a minimum of 1 year (mean 2.5 years, SD 1.7). Baseline neuropsychological testing was conducted in 62 of these 75 QD patients. RESULTS:: At the final follow-up time-point, 41.3% met diagnostic criteria for dementia (27 of 31 patients with dementia had possible or probable Alzheimer's Disease, AD), 44% were rated as not demented, and 14.7% remained as “uncertain” dementia. Increased age was associated with the final diagnosis of dementia, but duration of follow-up, Clinical Dementia Rating, and modified Mini Mental State (mMMS) scores were not predictive. Low scores on the mMMS delayed recall subtest, consistent long-term retrieval on the Selective Reminding Test, category naming for animals, and the WAIS-R digit symbol, picture arrangement, and block design subtests were predictive of the final diagnosis of dementia (all P ≤.01). mMMS delayed recall showed 66.7% sensitivity and 71.4% specificity, the other five neuropsychological subtests together showed 66.7% sensitivity and 66.7% specificity, and the six tests together showed 81% sensitivity and 76.9% specificity. Similar predictive accuracy was obtained for the final diagnosis of AD. CONCLUSIONS: In QD patients, poor performance on the mMMS delayed recall item may be a useful predictor of the diagnosis of dementia (and AD) on follow-up. Combining a screening instrument like the mMMS with specific neuropsychological tests may provide good predictive accuracy. In QD patients, the observed heterogeneity in diagnostic outcome, with most patients in the “dementia” and “no dementia” categories at follow-up, enhances the feasibility of evaluating early markers with predictive accuracy for dementia and AD.

Full-Information Models for Multiple Psychometric Tests: Annualized Rates of Change in Normal Aging and Dementia

The rates of change for five widely used psychometric tests were analyzed to compare how much more variance reduction can be achieved using full-information methods relative to the single-equation methods previously used in dementia research. Nondemented controls and subjects with Alzheimer disease (AD), probable/ possible vascular dementia (VD), or mixed dementia (MD) were evaluated. A cohort design was followed, with follow-up of three demented groups and one normal control group; data were analyzed in a multiple-equation regression model estimated with full-information methods. The study was conducted at Alzheimer's Disease Research Center sites at the University of California, Irvine, and at the University of Southern California. In all, 226 patients and controls who had completed initial assessment and at least one annual reassessment were included in the study. Dependent variables were annualized rates of change in the Mini-Mental State Examination (MMSE), the Short-Blessed Dementia Rating Scale (DRS), the Consortium to Establish a Registry for Alzheimer's Disease drawings test (CD), the WAIS-R Block Design test (WRB), and the Boston Naming Test (BNT). Independent variables were dementia severity, diagnosis (AD, VD, MD, or control), sex, age, marital status, education, and age at onset. Full-information methods reduced the variance in the change scores by > or = 25% compared with previous studies. The model's prediction of a test's rate of change was almost entirely due to dementia stage and diagnosis. The effects of other explanatory variables (sex, marital status, age, and education) were weak and statistically insignificant. When the effects of other independent variables were controlled, AD and MD patients were found to decline at significantly faster rates than VD patients. Full-information methods, relative to single-equation methods, substantially reduce the variance of rates of change for multiple psychometric tests. They do so by simultaneously considering the correlated error terms in the regression for each dependent psychometric change score variable. The robustness of these results to minor variations in follow-up time suggests that annualization is a reasonably valid procedure for making change scores comparable. This study's results suggest that change scores in psychometric tests provide information that can be used to aid differential diagnosis. However, the large variances of change scores preclude many other uses. Finally, since standardization of psychometric change scores translates all tests to the same scale (0-100%), standardized change scores are easier to interpret. The analysis of standardized change scores deserves further investigation.

The influence of mirror reversals on male and female performance in spatial tasks: A componential look

O'Boyle and Hoff ( Neuropsychologia, 25, 977–982, 1987) reported that females were faster and more accurate than males at mirror-tracing the outline of random shapes. To account for this differential performance, the authors advanced two alternative explanations. The first was a ‘Spatial Stroop’ effect which suggested that, because of their enhanced spatial ability, males are especially disadvantaged in escaping the misleading visual feedback provided by the mirror, resulting in slower and less accurate tracings. The second was a ‘manipulospatial’ hypothesis which suggested that the tracing advantage was related to female superiority in fine-detailed motor control, and perhaps, differential practice at performing skilled motor tasks in mirror-reversed contexts. In the present study, two experiments were conducted to assess the relative viability of these explanations. In Experiment 1, the WAIS-R Block Design task was performed within and outside the context of a mirror. This was done to determine if the observed female advantage was restricted to mirror-tracing per se, or generalizable to other manipulospatial tasks. In Experiment 2, a mental rotation task was performed within and outside the context of a mirror. The latter was designed to reveal if the removal of the motor component would affect the obtained sex difference. The present findings suggest that as long as some form of precision motor manipulation is required, females are superior to males at mirror-reversed spatial tasks. However, when the motor component is eliminated, a male performance advantage emerges in both normal and mirror-reversed contexts, suggesting that the manipulospatial hypothesis is the more viable explanation.

Reexamination of executive functions in psychosis-prone college students

The verbal and nonverbal executive functions of 19 psychosis-prone and 19 normal controls were examined. Subjects completed the WAIS-R Block Design and Vocabulary subtests, the Wisconsin Card Sorting Test (WCST), the Controlled Word Association Test (COWAT), the Booklet Category Test (BCT), the Design Fluency Test (DFT), and the Trail Making Test (TMT) parts A and B. Analysis of the performance patterns on these measures revealed that psychosis-prone college students exhibit relative deficits on all of the above verbal and nonverbal measures of executive functions but not on measures of nonexecutive functions. These findings confirm previously reported studies that have correlated executive functions and pre-frontal structural deficits with schizotypal personality traits and provide additional support for the association between neuropsychological functions and certain personality traits.

The comparative efficacy and long-term effect of clozapine treatment on neuropsychological test performance

Previous studies have suggested that clozapine may improve neuropsychological test performance. The current study was designed to examine the comparative efficay and the long-term effect of clozapine (versus haloperidol), on neuropsychological test performance. Neuropsychological measures of executive/attention, visuospatial, and memory function were administered to schizophrenic patients at baseline, at the end of a 10-week double-blind study, and after 1 year of open clozapine treatment. Symptoms and funtcion ratings were obtained at the same time points. The 10-week double-blind study revealed significant group-by-time interactions for two measures: Categorical Fluency and WAIS-R Block Design. At the end of 1 year of open treatment there were significant improvements in Verbal Fluency, Mooney Faces Closure, and WAIS-R Block Design performance, and trend improvements in Stroop Color-Word Interference, Category Fluency, and WMS-R Logical Memory performance. Improvements in neuropsychological performance were unrelated to symptom changes. Change in selected neuropsychological measures were signigicantly correlated with improvement in quality of life. The results suggest that long-term clozapine treatment may have beneficial effects on a broad range of cognitive functions.

A meal preparation treatment protocol for adults with brain injury.

Adults with acquired brain injury often demonstrate dysfunction in meal preparation due to deficits in component cognitive-perceptual skills. Although occupational therapy for these clients routinely includes meal preparation training, there are no protocols in the occupational therapy literature to help structure that activity to address clients' cognitive-perceptual deficits. This paper describes a meal preparation treatment protocol based on cognitive-perceptual information processing theory that has been pilot tested in a treatment outcome study with adult men with traumatic or anoxic acquired brain injury. In that study, the group of 23 subjects treated with this meal preparation protocol showed significant improvement in their meal preparation skill, as measured by the Rabideau Kitchen Evaluation-Revised (RKE-R), a test of meal preparation skill, and in their cognitive-perceptual skill, as measured by the WAIS-R Block Design Test. The treatment protocol includes descriptions of the structure, grading, and cuing methods for light meal preparation activities.

The relationship between constructional and meal preparation skills.

The purpose of this descriptive, correlational study was to explore the relationship between constructional abilities and meal preparation skills--a previously unstudied relationship. Fifty-four men with head injury, aged 18 to 52, in long-term rehabilitation programs, were given a battery of constructional, functional, and coordination tests: (1) the WAIS-R Block Design test; (2) a Parquetry Block test; (3) the Rabideau Kitchen Evaluation-Revised (RKE-R); and (4) two subtests of the Jebsen Hand Function Test. Results showed significant associations between constructional abilities and meal preparation skill. Pearson correlations were -0.51 (p = 0.0001) between WAIS-R Block Design test and RKE-R scores, and 0.50 (p = 0.0001) between Parquetry Block test and RKE-R scores. Partial correlations controlling for the effects of coordination also yielded significant correlations between WAIS-R Block Design test and RKE-R scores (r = -0.36, p = 0.05) and between Parquetry Block test and RKE-R scores (r = 0.39, p = 0.03). Constructional abilities, then, may contribute to meal preparation performance.

Language comprehension in schizophrenics and their brothers

Disturbances in language functioning may be associated with familial vulnerability to schizophrenia. Language comprehension, measured by the Luria-Nebraska Relational Concepts Factor Scale, was evaluated in 36 schizophrenic probands and their nonschizophrenic adult brothers ( n = 41), and in 18 normal controls. Language comprehension performance was a function of psychiatric diagnosis in the brothers. Brothers who met criteria for schizophrenia-spectrum disorders showed significantly reduced language performance compared with unaffected brothers and normal controls. Moreover, abnormal language performance was exhibited by significantly more probands and spectrum-disordered brothers than by the normal controls and the brothers without schizophrenia-spectrum disorders. Finally, language performance was not significantly different for 31 pairs of schizophrenic probands and their brothers. Impaired language comprehension appeared comparatively specific in this sample of relatives, as groups were not significantly different on measures of nonlinguistic concept formation (Wisconsin Card Sorting Test) and general intellectual functioning (WAIS-R Information and Block design). Results suggest that impaired language comprehension is associated with familial vulnerability to schizophrenia, and that this disturbance may be most severe in relatives diagnosed with schizophrenia-spectrum disorders.

Healthy adults' performance on the Austin Maze

Abstract This paper reports an analysis of performance on an electric pushbutton maze test, known as the Austin Maze. The subjects consisted of a sample of 536 healthy volunteers within the age range 16 to 70, pooled from two published and two unpublished studies and including 163 pairs of same sex twins. Selecting one twin at random from each pair, and using 299 cases, maze scores were regressed on a range of demographic and ability variables. The results showed that age (12% explained variance) and WAIS-R Block Design (23% explained variance) make substantial contributions to scores on the maze, while WAIS-R Vocabulary and the sex of the subject make statistically significant but minor contributions (3% and 1%, respectively). In addition, we found that the cumulative error score from ten trials is an excellent predictor of performance to criterion.

Wisconsin card sorting test performance over time in schizophrenia: Preliminary evidence from clinical follow-up and neuroleptic reduction studies

Two groups of schizophrenic patients took the Wisconsin Card Sorting Test (WCST) in separate follow-up studies; a naturalistic clinical follow-up ( n = 12, study 1) and a neuroleptic reduction study ( n = 10, study 2). 11 of 22 subjects (50%) performed well on the task at one or both time points. In each study no group differences were found between time 1 and time 2 performance on three WCST variables. However, correlational analyses revealed considerable within-subject variation on the WCST in the study 1 sample, which was composed of younger and more acute patients than those in study 2. This variation was present despite within-subject stability on the WAIS-R Vocabulary and Block Design subtests. For the sample combined, a trend was found ( p = 0.12) linking better WCST performance at either time period with higher WAIS-R Vocabulary scores. This intra-subject variability may reflect fluctuations in neuropsychological performance in schizophrenics who maintain the residual capacity to do the task. These findings highlight the importance of longitudinal studies of neuropsychological functioning in schizophrenia. Studies of larger samples are needed to confirm these initial results.

Visual hierarchical analysis of block design configural errors

Patients have been frequently observed to violate the overall configuration on the WAIS-R Block Design subtest. The significance of these configural errors was investigated with hierarchical patterns consisting of large "global" shapes made from smaller "local" shapes. Subjects were administered two similarity judgment tasks in which they were asked to decide which of two hierarchically structured comparison figures most resembled a standard figure. Results indicated that subjects who made configural errors on Block Design were less likely than a matched sample who did not make configural errors to select the comparison figure that resembled the standard figure at the global level. Furthermore, the present findings were obtained from subjects without known right-hemisphere lesions, suggesting that the correlation between Block Design errors and global/local performance is applicable to a broad range of patient and non-patient populations. The data are consistent with the view that errors on Block Design may reflect differences in the perceptual encoding of global/local features.

Effects of Chronic Alcoholism on Perception of Hierarchical Visual Stimuli

Visuospatial processing in chronic alcoholism was investigated by asking subjects to make similarity judgements of hierarchically constructed visual stimuli. Comparison figures were similar to a standard figure at the global or local level. Alcoholics were less influenced by the global patterns in their similarity judgements than were controls. On the WAIS-R Block Design subtest, alcoholics were also more likely than controls to distort the outer configuration of the design. Results indicate that alcoholism affects global processing on both experimental visuoperception tasks and on clinical measures of visuospatial ability. Implications for models of alcoholic dysfunction are discussed.