Wechsler Memory Scale-IV Research Articles

Modality-Specific Working Memory Systems Verified by Clinical Working Memory Tests.

ObjectiveThis study was to identify whether working memory (WM) can be clearly subdivided according to auditory and visual modality. To do this, we administered the most recent and universal clinical WM measures in a mixed psychiatric sample.MethodsA total of 115 patients were diagnosed on the basis of DSM-IV diagnostic criteria and with MINI-Plus 5.0, a structured diagnostic interview. WM subtests of Korean version of Wechsler Adult Intelligence Scale-IV and Korean version of Wechsler Memory Scale-IV were administered to assess WM. Confirmatory factor analysis (CFA) was used to observe whether WM measures fit better to a one-factor or two-factor model.ResultsCFA results demonstrated that a two factor model fits the data better than one-factor model as expected.ConclusionOur study supports a modality model of WM, or the existence of modality-specific WM systems, and thus poses a clinical significance of assessing both auditory and visual WM tests.

Clarifying Discrepancies in Responsiveness Between Reliable Change Indices.

Several reliable change indices (RCIs) exist to evaluate statistically significant individual change with repeated neuropsychological assessment. Yet there is little guidance on model selection and subsequent implications. Using existing test-retest norms, key parameters were systematically evaluated for influence on different RCI models. Normative test-retest data for selected Wechsler Memory Scale-IV subtests were chosen based on the direction and magnitude of differential practice (inequality of test and retest variance). The influence of individual relative position compared to the normative mean was systematically manipulated to evaluate for predictable differences in responsiveness for three RCI models. With respect to negative change, RCI McSweeny was most responsive when individual baseline scores were below the normative mean, irrespective of differential practice. When an individual score was greater than the normative mean, RCI Chelune was most responsive with lower retest variance, and RCI Maassen most responsive with greater retest variance. This pattern of results can change when test-retest reliability is excellent and there is greater retest variability. Order of responsiveness is reversed if positive change is of interest. RCI models tend to agree when the individual approximates the normative mean at baseline and test-retest variability is equal. However, no RCI model will be universally more or less responsive across all conditions, and model selection may influence subsequent interpretation of change. Given the systematic and predictable differences between models, a more rationale choice can now be made. While a consensus on RCI model preference does not exist, we prefer the regression-based model for several reasons outlined.

Clinical validation of the WMS-IV-NL brief cognitive status exam (BCSE) in older adults with MCI or dementia.

ABSTRACT Background: The Brief Cognitive Status Exam (BCSE) is a new, optional subtest of the Wechsler Memory Scale-IV (WMS-IV) developed for rapid detection of cognitive deficits. We examined the clinical validation of the Dutch version of the BCSE in older adults with mild cognitive impairment (MCI) or dementia, comparing it to the Mini-Mental State Examination (MMSE). Method: BCSE and MMSE were administered in 39 older adults with MCI, 51 with dementia and 96 matched healthy controls. Results: Our results show that the BCSE is a valid screening instrument, with psychometric properties similar to the widely used MMSE. High correlations were found between the BCSE and MMSE (r = 0.79, n = 183, p < 0.001). Furthermore, a BCSE cut-off score ≤ 42 revealed a sensitivity of 96% a specificity of 92%, a positive predictive value of 86% and a negative predictive value of 97%, whereas the MMSE cut-off score of ≤ 24 showed values of 84%, 96%, 91%, and 92%, respectively. Sensitivity, specificity, positive and negative predictive values to detect MCI compared to controls was 81%, 80%, 61%, and 92%, respectively, on the BCSE, with a cut-off score of ≤ 46, and 84%, 76%, 57%, and 92%, respectively, on the MMSE, with a cut-off score of ≤ 27. Conclusions: The Dutch version of the BCSE is a clinically valid screening instrument for the detection of cognitive impairment in patients with dementia. Nevertheless, for distinguishing older adults with MCI from healthy controls both the BCSE and MMSE have limitations.

Evaluation of memory impairment in aging adult survivors of childhood acute lymphoblastic leukemia treated with cranial radiotherapy.

Cranial radiotherapy (CRT) is a known risk factor for neurocognitive impairment in survivors of childhood cancer and may increase risk for mild cognitive impairment and dementia in adulthood. We performed a cross-sectional evaluation of survivors of childhood acute lymphoblastic leukemia (ALL) treated with 18 Gy (n = 127) or 24 Gy (n = 138) CRT. Impairment (age-adjusted score >1 standard deviation below expected mean, two-sided exact binomial test) on the Wechsler Memory Scale IV (WMS-IV) was measured. A subset of survivors (n = 85) completed structural and functional neuroimaging. Survivors who received 24 Gy, but not 18 Gy, CRT had impairment in immediate (impairment rate = 33.8%, 95% confidence interval [CI] = 25.9% to 42.4%; P < .001) and delayed memory (impairment rate = 30.2%, 95% CI = 22.6% to 38.6%; P < .001). The mean score for long-term narrative memory among survivors who received 24 Gy CRT was equivalent to that for individuals older than 69 years. Impaired immediate memory was associated with smaller right (P = .02) and left (P = .008) temporal lobe volumes, and impaired delayed memory was associated with thinner parietal and frontal cortices. Lower hippocampal volumes and increased functional magnetic resonance imaging activation were observed with memory impairment. Reduced cognitive status (Brief Cognitive Status Exam from the WMS-IV) was identified after 24 Gy (18.5%, 95% CI = 12.4% to 26.1%; P < .001), but not 18 Gy (8.7%, 95% CI = 4.4% to 15.0%; P = .11), CRT, suggesting a dose-response effect. Employment rates were equivalent (63.8% for 24 Gy CRT and 63.0% for 18 Gy CRT). Adult survivors who received 24 Gy CRT had reduced cognitive status and memory, with reduced integrity in neuroanatomical regions essential in memory formation, consistent with early onset mild cognitive impairment.

Neuropsychological Assessment of Distractibility in Mild Traumatic Brain Injury and Depression

Traditional neuropsychological assessments are conducted exclusively in a quiet, distraction-free environment; clients’ abilities to operate under busy and distracting conditions remain untested. Environmental distractions, however, are typical for a multitude of real-life situations and present a challenge to clients with frontal-temporal brain injury. In an effort to improve ecological validity, an extension of the traditional neuropsychological assessment was developed, comprising a standardized distraction condition. This allowed cognitive functions to be tested both in the traditional setting and with exposure to a specified audio-visual distraction. The present study (n = 240) investigated how clients with mild Traumatic Brain Injury (mTBI) (n = 80), Major Depression (MDE) (n = 80), and a healthy control sample (n = 80) performed on sub-tests of the Wechsler Adult Intelligence Scale-IV and the Wechsler Memory Scale-IV both in the standard and the distraction conditions. Test effort was controlled. Significant deterioration of performance in the distraction setting was observed among clients with mTBI. In contrast the performance of a healthy control sample remained unchanged. Significant improvement of performance in the distraction setting was documented for clients with MDE. Contrary to their improved performance, depressed clients experienced the distraction setting as more distressing than the control and mTBI group.