Brett A. Steinberg

Mayo's Older Americans Normative Studies: Age- and IQ-Adjusted Norms for the Trail-Making Test, the Stroop Test, and MAE Controlled Oral Word Association Test

ABSTRACT Although normative data sets for standardized neuropsychometric instruments often include adjustments for subject variables, there are reasons to believe that improvements in interpretive accuracy that result from such adjustments are less than optimal. In particular, years of formal education may be less closely related to test performances than is general intellectual functioning. In this second of four reanalyses of results from the Mayo Clinics Older Americans Normative Studies (MOANS) databases, age-adjusted scores for the Trail-Making Test, the Stroop Color-Word Test, and the MAE Controlled Oral Word Associations Test were found to be more strongly associated with Mayo age-adjusted WAIS-R Full Scale IQ scores (rs = .368 to .495) than with education (rs = .174 to .367) for healthy older examinees between 56 and 99 years of age. For the TMT and the COWAT, but not the Stroop, these associations became stronger as IQ increased (cf. Dodrill, 1997, 1999). Tables of age- and IQ-adjusted percentile equivalents of MOANS age-adjusted TMT, Stroop, and COWAT scores are presented for eleven age ranges and seven IQ ranges.

Mayo's Older Americans Normative Studies: Age- and IQ-Adjusted Norms for the Auditory Verbal Learning Test and the Visual Spatial Learning Test

ABSTRACT Although normative data sets for standardized neuropsychometric instruments frequently feature adjustments for subject variables, there are reasons to believe that improvements in interpretive accuracy that result from such adjustments are less than optimal. In particular, years of education may be less closely associated with test performances than is overall intellectual functioning. In this last of four reanalyses of results from the Mayo Clinics Older Americans Normative Studies (MOANS) databases, age-adjusted scores for the Rey Auditory Verbal Learning Test and the Visual Spatial Learning Test were found to be more strongly related to Mayo age-adjusted WAIS-R Full Scale IQ scores (rs = .150 to .395) than to education (rs = .060 to .236) for healthy older examinees between 56 and 99 years of age. Although AVLT-FSIQ correlations were greatest at moderate levels of intelligence, VSLT-FSIQ correlations consistently increased in strength as intelligence increased (cf. Dodrill, 1997 1999). Based on these results, we present tables of age- and IQ-adjusted percentile equivalents of Mayo age-adjusted AVLT index scores and MOANS age-adjusted AVLT and VSLT scaled scores for ten age ranges and either seven (AVLT) or five (VSLT) IQ ranges.

Mayo's Older Americans Normative Studies: Age- and IQ-Adjusted Norms for the Wechsler Memory Scale--Revised

ABSTRACT Normative data sets for standardized neuropsychometric instruments often include adjustments for subject variables. There are reasons to believe, however, that improvements in interpretive accuracy that result from such adjustments are less than optimal. In particular, “years of formal education” may be less closely related to test performances than is general intellectual functioning. In this third of four reanalyses of results from the Mayo Clinics Older Americans Normative Studies (MOANS) databases, age-adjusted index and scaled scores for the Wechsler Memory Scale-Revised were found to be more strongly associated with Mayo age-adjusted WAIS-R Full Scale IQ scores (rs = .271 to .631) than with education (rs = .089 to .310) for healthy older examinees between 56 and 99 years of age. These associations were strongest for Attention/Concentration and General Memory Index scores and, in general, for individuals with average intelligence (cf. Dodrill, 1997 1999). Tables of age- and IQ-adjusted percentile equivalents of Mayo age-adjusted WMS-R index scores and MOANS age-adjusted WMS-R subtest scaled scores are presented for eleven age ranges and seven IQ ranges.

Mayo's Older Americans Normative Studies: Age- and IQ-adjusted norms for the Boston Naming Test, the MAE Token Test, and the Judgment of Line Orientation Test

ABSTRACT Although many extant normative data sets for standardized neuropsychometric instruments feature adjustments for subject variables, there are reasons to believe that improvements in interpretive accuracy that result from such adjustments are less than optimal. In particular, several theoretical considerations suggest that years of formal education may be less closely related to test performances than is general intellectual functioning. In this first of four reanalyses of results from the Mayo Clinics Older Americans Normative Studies (MOANS) databases, age-adjusted scores on the Boston Naming Test, the MAE Token Test, and the Judgment of Line Orientation Test were indeed found to be more strongly associated with Mayo Age-adjusted WAIS-R Full Scale IQ scores (rs = .608, .473, and .502, respectively) than with education (rs = .310, .306, and .236, respectively) for healthy older examinees (56–99 years). Consistent with the remarks of Dodrill (1997 1999), these correlations generally decreased at higher levels of intelligence. The magnitude and pattern of such declines varied across the three tests, however, suggesting that IQ-test score associations must be empirically determined rather than assumed to be linear. Tables of Age- and IQ-Adjusted percentile equivalents of MOANS Age-adjusted BNT, Token Test, and JLO scaled scores are presented for eleven age ranges and seven IQ ranges. The article concludes with a discussion of factors that may underlie observed relations among age, intelligence, and neuropsychometric test performances.

Introduction to the Special Edition: IQ-Based MOANS Norms for Multiple Neuropsychological Instruments

The influence of age and education on performance on standard neuropsychological tests has been well documented. Heaton, Ryan, Grant, and Matthews (1996) argue convincingly that ‘‘adequate assessment of an individual’s cognitive functioning entails a knowledge of the demographic variables that have an effect on neuropsychological test performance’’ (p. 159). the authors show clearly how age and education affect commonly used tests from Finger Tapping to Block Design and Vocabulary subtests of the Wechsler Adult Intelligence Scale. Some authors have suggested that corrections on such demographic variables are not appropriate for brain-damaged individuals (Reitan & Wolfson, 1995) although Spreen and Strauss (1998) find their study and the arguments it makes unconvincing. There would appear to be no reason to suspect that demographic norms would not provide the most solid grounding for norms on cognitively based tests and their employment would provide a fairer comparison to an individual’s performance than nondemographically normed tests. This has recently been confirmed by Diaz-Asper, Schretlen, and Pearlson (2003), who show clearly that adults with above average IQs perform significantly better than adults with average IQs on a majority of neuropsychological test measures and that adults with average IQs perform significantly better than adults with below average IQs on most neuropsychological tests. The effect sizes these authors report are impressive. Heaton, Grant, and Matthews (1991) have provided comprehensive demographic norms for multiple neuropsychological tests, including those in the Halstead-Reitan battery. The normative data in this sample, however, was gathered from many varied population groups over many years. A more homogeneous sample was gathered by Robert Ivnik and colleagues from the Mayo Clinic, the ‘‘Mayo’s Older Americans Normative Studies’’ (MOANS; Ivnik et al., 1992a,b). The sample consisted of 500 English-speaking, White individuals, residing in the upper Midwest, and ranging in age from the mid-50s to late 90s. Clear relationships and appropriate corrections for neuropsychological test performance are provided with these norms as well. While demographic norms provide a reasonable context within which to view results of neuropsychological testing, norming by general intellectual ability would appear even more appropriate. Performance on tests of general intellectual ability (IQ) is normally distributed as is performance on most neuropsychological tests. A lively debate has recently surfaced regarding this notion. Dodrill (1997) suggested

IQ and Scores on the Mini-Mental State Examination (MMSE)

The Mini-Mental State Examination (MMSE) and the Peabody Picture Vocabulary Test-Revised (PPVT-R) were administered to 217 Veterans Affairs (VA) Nursing Home patients, 104 of whom did not carry a diagnosis associated with brain impairment, and 113 who had a diagnosis associated with degenerative or cerebrovascular conditions. MMSE and IQ scores were significantly correlated in both groups, even controlling for the effects of education. It is suggested that although previous normative studies of the MMSE may provide good general clinical guidance, interpretation of “impaired” performance on the MMSE for those with IQ scores below 90 should be approached with caution. Average MMSE scores for Wechsler IQ classifications are provided.

Cranial Nerve Clock

Abstract Rationale and Objectives The authors performed this study to compare a declarative memory paradigm developed to help teach medical students about the cranial nerves with a traditional text-based approach. Materials and Methods The authors designed a clock-based paradigm to help medical students learn about the cranial nerves. To enhance memorization and related brain activation, the paradigm uses visual, spatial, and word associations in the context of an analog clock face. Twenty-one undergraduate students were randomly divided into two groups. Group T viewed traditional text slides, and group C viewed text slides followed by the corresponding cranial clock slides. Subjects were tested before and after these sessions. Results Group C performed significantly better than group T in learning the names of the cranial nerves and their correct order ( P P = .005), V ( P = .04), and X ( P = .03). Conclusion Alternative teaching strategies may help improve declarative memory.

Cranial nerve clock: Part II: Functional MR imaging of brain activation during a declarative memory task

RATIONALE AND OBJECTIVES The authors performed this study to assess brain activation during encoding and successful recall with a declarative memory paradigm that has previously been demonstrated to be effective for teaching students about the cranial nerves. MATERIALS AND METHODS Twenty-four students underwent functional magnetic resonance (MR) imaging during encoding and recall of the name, number, and function of the 12 cranial nerves. The students viewed mnemonic graphic and text slides related to individual nerves, as well as their respective control slides. For the recall paradigm, students were prompted with the numbers 1-12 (test condition) intermixed with the number 14 (control condition). Subjects were tested about their knowledge of cranial nerves outside the MR unit before and after functional MR imaging. RESULTS Students learned about the cranial nerves while undergoing functional MR imaging (mean post- vs preparadigm score, 8.1 +/- 3.4 [of a possible 12] vs 0.75 +/- 0.94, bilateral prefrontal cortex, left greater than right; P < 2.0 x 10(-12)) and maintained this knowledge at I week. The encoding and recall paradigms elicited distributed networks of brain activation. Encoding revealed statistically significant activation in the bilateral prefrontal cortex, left greater than right [corrected]; bilateral occipital and parietal associative cortices, parahippocampus region, fusiform gyri, and cerebellum. Successful recall activated the left much more than the right prefrontal, parietal associative, and anterior cingulate cortices; bilateral precuneus and cerebellum; and right more than the left posterior cingulate. CONCLUSION A predictable pattern of brain activation at functional MR imaging accompanies the encoding and successful recall of the cranial nerves with this declarative memory paradigm.