Laura Glass Umfleet

Development of Alternate Paragraphs for the Logical Memory Subtest of the Wechsler Memory Scale-IV

The purpose of the two studies included in this article was to validate an alternate form, the Morris Revision-Fourth Edition (MR-IV), to the Logical Memory paragraphs of the Wechsler Memory Scale-Fourth Edition (LM-IV) for use when retesting of individuals is desired. Study I demonstrated high correlation with the LM-IV paragraphs. Study II was a replication that again demonstrated high correlation between the original LM-IV and the new MR-IV paragraphs. High interrater reliability also was demonstrated. Consequently, the MR-IV paragraphs can be considered an alternate form to the LM-IV paragraphs. Although other attempts have been made to develop alternate stories, these new paragraphs are the only ones that are equivalent in structure, affective tone, and number of scorable units. They have considerable clinical utility and research potential.

Sensitivity and Specificity of Memory and Naming Tests for Identifying Left Temporal-Lobe Epilepsy

The sensitivity and specificity of the Selective Reminding Test (SRT) Delayed Recall, Wechsler Memory Scale (WMS) Logical Memory, the Boston Naming Test (BNT), and two nonverbal memory measures for detecting lateralized dysfunction in association with side of seizure focus was examined in a sample of 143 patients with left or right temporal-lobe epilepsy (TLE). Scores on the SRT and BNT were statistically significantly lower in the left TLE group compared with the right TLE group, whereas no group differences emerged on the Logical Memory subtest. No significant group differences were found with nonverbal memory measures. When the SRT and BNT were both entered as predictors in a logistic regression, the BNT, although significant, added minimal value to the model beyond the variance accounted for by the SRT Delayed Recall. Both variables emerged as significant predictors of side of seizure focus when entered into separate regressions. Sensitivity and specificity of the SRT and BNT ranged from 56% to 65%. The WMS Logical Memory and nonverbal memory measures were not significant predictors of the side of seizure focus.

Estimating WAIS-IV indexes: proration versus linear scaling in a clinical sample.

OBJECTIVES We compared the accuracy of proration and linear scaling for estimating Wechsler Adult Intelligence Scale-Fourth Edition (WAIS-IV), Verbal Comprehension Index (VCI), and Perceptual Reasoning Index (PRI) composites from all possible two subtest combinations. The purpose was to provide practice relevant psychometric results in a clinical sample. DESIGN The present investigation was an archival study that used mostly within-group comparisons. We analyzed WAIS-IV data of a clinical sample comprising 104 patients with brain damage and 37 with no known neurological impairment. RESULTS In both clinical samples, actual VCI and PRI scores were highly correlated with estimated index scores based on proration and linear scaling (all rs ≥.95). In the brain-impaired sample, significant mean score differences between the actual and estimated composites were found in two comparisons, but these differences were less than three points; no other significant differences emerged. CONCLUSIONS Overall, findings demonstrate that proration and linear scaling methods are feasible procedures when estimating actual Indexes. There was no advantage of one computational method over the other.

Use of the 21-Item Test with children and adolescents 5 to 16 years of age

ABSTRACT The goals of the present study were to: (a) collect preliminary normative data on the 21-Item Test in children and adolescents and to determine if cutoffs for biased responding in adults can be generalized to a younger population; (b) determine if Caucasian and Hispanic children perform differently on the test; and (c) ascertain the relationships of age and verbal intelligence with effort test performance. The 21-Item Test was administered to 153 children attending either a public (n = 96) or private (n = 57) school. The Wechsler Intelligence Scale for Children-Fourth Edition (WISC-IV) was also administered to the private school sample. The results indicated that the 21-Item Test has potential as a tool for identifying children who do not put forth maximal effort during formal assessment and that the adult cutoffs appear applicable to children 8 years and older. Caucasian and Hispanic participants performed similarly on the test. Forced-choice scores ≤12 were associated with age and lower levels of performance on the Verbal Comprehension Index of the WISC-IV.

Classification Accuracy of Sequentially Administered WAIS-IV Short Forms.

A Wechsler Adult Intelligence Scale-Fourth Edition (WAIS-IV) short form (SF) may be effective for ruling out subnormal intelligence. To create a useful SF, subtest administration should follow the order prescribed in the manual and, depending upon individual performance, be terminated after completion of 2, 3, 4, or 5 subtests. One hundred and twenty-two patients completed the WAIS-IV. In two analyses, Full-Scale IQs (FSIQs) ≤69 and ≤79 were classified as impairment. Classification accuracy statistics indicated that all SFs using both cutoff scores exceeded the base rate (i.e., 14% and 34%) of subnormal intelligence, with hit rates ranging from 84% to 95%. The FSIQ cutoff of ≤69 had poor sensitivity for detecting impaired intellectual functioning with the 2-, 3-, 4-, and 5-subtest SFs; specificity, positive predictive value (PPV), and negative predictive value (NPV) were excellent for each SF. With the FSIQ cutoff of ≤79, sensitivity was strong to excellent for the 3-, 4-, and 5-subtest SFs as were specificity, PPV, and NPV.

NEUROCOGNITIVE IMPAIRMENT IS COMMON IN THE ADULT WITH CONGENITAL HEART DISEASE: IDENTIFICATION USING A NOVEL CLINICAL QUESTIONNAIRE

Methods: The Wisconsin Adult Congenital Heart Disease (WAtCH) Program recently began screening patients to identify those at high risk of having neurocognitive impairments. Patients without congenital heart disease, a known genetic syndrome, or a previously diagnosed neurocognitive disorder were excluded from the screening process. Screening consists of using a validated neuro-oncology screening instrument that has been modified for the ACHD population. It consists of 10 questions answered on a Likert scale that measure a subject’s self perceived competence in 8 neurocognitive domains (attention, memory, language, executive functioning, independence in activities of daily living, math, processing speed and reading). Those patients who answer this survey in a predetermined high risk fashion for a neurocognitive disorder are then referred for a formal neurocognitive evaluation. A database consisting of the patients that are screened, those that meet criteria to be referred and the answers to the questions has been developed. Demographic information, type of CHD, number of surgeries and medications at the time of the survey are obtained by chart review.

Stability of WISC-IV Process Scores

Forty-three students were administered on two occasions approximately 11 months apart the complete Wechsler Intelligence Scale for Children-Fourth Edition, including the seven process components of Block Design No Time Bonus, Digit Span Forward (DSF), Digit Span Backward (DSB), Cancellation Random (CAR), Cancellation Structured (CAS), Longest Digit Span Forward (LDSF), and Longest Digit Span Backward (LDSB). Mean ages at first and second testing were 7.77 years (SD = 1.91) and 8.74 years (SD = 1.93), respectively. Mean Full-Scale IQ at initial testing was 111.63 (SD = 10.71). Process score stability coefficients ranged from .75 on DSF to .32 on CAS. Discrepancy score stabilities ranged from .45 on DSF minus DSB to .05 on CAS minus CAR. Approximately 21% of participants increased their LDSF on retest, and 16.3% showed a gain on LDSB. Caution must be exercised when interpreting process scores, and interpretation of discrepancy scores should probably be avoided.

Neuropsychological Differences between Men and Women with Alzheimer's Disease

ABSTRACT Background: It has been suggested that men and women with Alzheimers disease (AD) at comparable levels of global cognitive impairment perform differently on neuropsychological measures. Such differences may have practical implications for designing cognitive interventions that address symptoms of dementia. Methods: We compared men (n = 86) and women (n = 96) with AD on tests of immediate and delayed prose memory, verbal fluency, semantic fluency, semantic memory and confrontation naming. Mean years for age, education and duration of illness were 70.81 (SD = 7.55), 13.37 (SD = 3.38) and 2.17 (SD = 1.72) for men and 73.11(SD = 8.53), 12.27 (SD = 2.86) and 2.42 (SD = 1.92) for women. The groups were comparable in global cognitive functioning as indicated by Dementia Rating Scale total scores for men of 89.27 (SD = 29.80) and women of 90.86 (SD = 30.20). Results: Men earned significantly better scores in immediate prose memory, semantic verbal fluency, semantic memory and response naming. Men and women performed similarly on the remaining tests. When the variables of age, education and duration of disease were controlled, the significant effect of gender was maintained only on tests of semantic fluency, semantic memory and confrontation naming. Conclusions: The hypothesis of the study was partially confirmed in that women with AD evidenced greater impairment than men with AD on three of six neuropsychological measures even after potentially confounding variables were controlled.

WAIS-IV GAI and CPI discrepancies in multiple sclerosis and traumatic brain injury.

ABSTRACT We examined relationships between the Wechsler Adult Intelligence Scale-Fourth Edition (WAIS-IV) General Ability Index (GAI) and Cognitive Proficiency Index (CPI) in two clinical samples. The mean pattern produced by 42 individuals with multiple sclerosis (MS) and 47 with traumatic brain injury (TBI) was the same, GAI > CPI. This pattern occurred in 61.9% and 78.7% of the protocols of patients with MS or TBI, respectively. The MS sample earned a significantly larger CPI mean than did patients with TBI. The group means did not differ on the GAI. Patients with TBI had significantly larger GAI-CPI discrepancy score means than those with MS. Receiver operating characteristics (ROC) analysis assessed the ability of GAI-CPI discrepancies to differentiate the samples. The area under curve (AUC) was 0.67, 95% [0.55, 0.78], which indicated low accuracy in terms of group classification.

Prorating WAIS – IV summary scores for patients with relapsing-remitting multiple sclerosis

We evaluated the utility of prorating appropriate combinations of two, six and eight Wechsler Adult Intelligence Scale – Fourth Edition (WAIS – IV) subtests for estimating the Verbal Comprehension Index (VCI), Perceptual Reasoning Index (PRI), Full Scale IQ (FSIQ) and General Ability Index (GAI) in a sample of individuals diagnosed with multiple sclerosis (MS). Forty-eight outpatients completed the WAIS – IV and Wechsler Memory Scale – Fourth Edition (WMS – IV) as part of a comprehensive neuropsychological battery. Means for age, education and duration of diagnosis were 42.35, 14.21 and 8.30 years, respectively. Paired t-tests showed no significant differences between prorated and standard means for VCI (93.46 vs. 93.73), PRI (90.19 vs. 89.44), FSIQ (88.53 vs. 88.47) or GAI (90.56 vs. 90.65). Correlations between prorated and standard composites were ≥0.89 in every instance. Correlations between the standard and prorated composites and education, disability status and WMS – IV indexes did not reveal a single contrast, where the correlations were significantly different. The present findings support the use of the two-subtest VCI and PRI composites and the eight-subtest FSIQ and four-subtest GAI in the assessment of patients with MS.