Abstract We investigated the similarity of the Wechsler Memory Scale-Fourth Edition (WMS-IV) Auditory Memory Index (AMI) scores when California Verbal Learning Test-Second Edition (CVLT-II) scores are substituted for WMS-IV Verbal Paired Associates (VPA) subtest scores. College students ( n = 103) were administered select WMS-IV subtests and the CVLT-II in a randomized order. Immediate and delayed VPA scaled scores were significantly greater than VPA substitute scaled scores derived from CVLT-II performance. At the Index level, AMI scores were significantly lower when CVLT-II scores were used in place of VPA scores. It is important that clinicians recognize the accepted substitution of CVLT-II scores can result in WMS-IV scores that are inconsistent with those derived from standard administration.

• Wms-iv Administration And Scoring Manual
• Wais-iv Administration And Scoring Manual

Psychometric issues that plausibly contribute to these differences and clinical implications are discussed. , Introduction Clinical neuropsychologists routinely evaluate and quantify memory functioning during clinical examinations. It is an essential cognitive construct to consider during the differential diagnosis process. For example, patients with Alzheimer's disease demonstrate more impaired episodic memory whereas patients with vascular dementia demonstrate more impaired semantic memory. The construct is also essential to consider when developing treatment plans. For example, verbal memory functioning is a strong predictor of post-surgical outcome for individuals with epilepsy (; ).

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A host of stand-alone memory tests and batteries have been developed to assist clinicians in quantifying auditory, visual, immediate, delayed, cued, free recall, and recognition memory (e.g., ). Survey findings suggest that the Wechsler Memory Scale (WMS) is one of the most frequently utilized measure to evaluate memory functioning. The WMS battery has undergone a number of revisions with each new edition. Despite its wide use, some researchers question if changes have meaningfully improved the clinical utility of the measure. While there is evidence that the most recent test edition has improved psychometric properties, the relative value of this is unknown. Found that the dimensional structure underlying the Wechsler Memory Scale-Fourth Edition (WMS-IV; ) was more differentiated than the Wechsler Memory Scale-Third Edition (WMS-III; ), but it is unknown how this difference may affect clinical decision making. Nevertheless, literature is emerging that supports the construct validity of the WMS-IV in individuals with traumatic brain injury and amnestic mild cognitive impairment.

The WMS-IV attempts to quantify five different types of memory functioning. This study focuses on auditory memory, which is primarily reflected in the Auditory Memory Index (AMI) score, and is evaluated with Logical Memory (LM) and Verbal Paired Associates (VPA) immediate and delayed subtests. LM entails the immediate and delayed recall of two short stories.

VPA involves four learning trials of 14 word pairs, and the subsequent immediate and delayed recall of these word pairs. A unique feature of the WMS-IV, relative to earlier versions of the WMS, is the option of replacing VPA scores with scores obtained from the California Verbal Learning Test—Second Edition (CVLT-II; ).

Wms-iv Administration And Scoring Manual

The CVLT-II is a commonly administered word-learning task in which an examinee is provided a list of 16 words and asked to recall as many words as possible across a number of immediate and delayed trials. The WMS-IV Technical and Interpretive Manual (, p. 166) acknowledges that the CVLT-II is inherently different from the VPA subtest, and has different normative bases and score metrics.

Only moderate correlations are observed between the two tests. Specifically, the correlation between VPA I scaled scores and CVLT-II Trials 1–5 Free-Recall T scores is 0.54 and the correlation between VPA II scaled scores and CVLT-II Long-Delay Free-Recall z scores is 0.51 in a large normative sample. Speculate that the moderate correlation between VPA and CVLT-II is explained by task discrepancies, such as the explicit associative learning and cued-recall format of the VPA as opposed to the implicit structure and generally free-recall format of the CVLT-II. VPA also allows for potentially richer learning opportunities as test takers are given immediate feedback after each cue, whereas the CVLT-II does not allow for any performance feedback. Further, there are meaningful differences in the range of possible CVLT-II and VPA scores (i.e., floor and ceiling effects) that may also impact the relationship between test scores.

Wais-iv Administration And Scoring Manual

For example, the WMS manual sets the maximum possible VPA II scaled score at 13 ( z-score of 1.0) for a 20-year-old, whereas the CVLT-II Long-Delay Free-Recall trial maximum z-score is 1.5. Psychometrically, variables with restricted ranges of scores have attenuated associations with other variables. Despite potentially meaningful differences between tasks, the WMS manual provides a method by which scores from the CVLT-II can be converted into scaled scores and substituted for VPA scores. Specifically, VPA I scaled score substitutes are derived from the CVLT-II Trials 1–5 Free-Recall T score and VPA II scaled score substitutes are derived from the CVLT-II Long-Delay Free-Recall z score. The rationale underlying these substitutions relate to the conceptual similarities between the VPA and CVLT-II in terms of verbal content, response processes, task demands, and semantic association.

The manual reports that the WMS-IV Index Scores derived when using the CVLT-II substitution are “very similar” (p. 167) to those obtained using the standard VPA scores. Only one published study to-date has investigated the degree to which WMS-IV VPA and substituted VPA scores are interchangeable.

Utilized archival data from a diverse clinical sample and reported that when the CVLT-II is substituted for VPA scores, index scores were significantly lower for Auditory Memory, but not Delayed Memory or Immediate Memory. They also found that substituted VPA scores were significantly lower than VPA scaled scores for the delayed recall condition, but not for the immediate recall condition. Clearly demonstrate discordance between VPA and substituted VPA scores derived from CVLT-II performance. Despite the moderate correlations between tasks, scores derived from VPA and CVLT-II can result in different performance categorization. This is not surprising and has been observed with other neuropsychological measures that evaluate similar constructs.

For example, demonstrated that despite strong correlations between the CVLT and the Rey Auditory Verbal Learning Test (RAVLT; ), a conceptually similar list learning task, different classification rates emerge. CVLT standard scores obtained from head injured patients were significantly lower than RAVLT standard scores, which presents an interpretive challenge in identifying neurocognitive issues. Even more relevant, found that CVLT-II delayed recall performance was more accurate than VPA delayed recall performance at distinguishing healthy older adults from patients with amnestic mild cognitive impairment. However, their study did not explicitly address whether there was a meaningful difference between VPA delayed recall performance and a substituted VPA delayed recall performance derived from the CVLT-II.

Clearly, it would be problematic if substituting CVLT-II scores produced inconsistent results with standard WMS-IV administration. Given the discordance found in recent studies among clinical populations, this study aims to investigate the concordance of VPA and CVLT-II scores, and the degree to which these scores are interchangeable in deriving the WMS-IV AMI score, among a relatively healthy sample of high functioning young adults. Young, healthy adults often participate in research (e.g., see,;; ) and undergo evaluations in academic or vocational contexts (e.g., see, ). It is expected that these healthy individuals will achieve average or above-average WMS-IV and CVLT-II scores which permits a unique investigation of the CVLT-II substitution. Given the differences between the CVLT-II and VPA subtests in terms of ceiling limits, it is possible that the nature and degree of concordance between the tasks might differ in this sample compared with the clinical sample reported.

The present study seeks to inform clinicians and researchers of psychometric implications of CVLT-II substitution for VPA in a young cognitively intact sample. Method Participants A total of 103 students were recruited from a Midwestern university. Four participants were excluded due to missing data and six were excluded due to questionably valid performance as evaluated by the Victoria Symptom Validity Test (; scoring. Auditory Memory Test/Index Mean SD Range Skewness Kurtosis VPA I Scaled Score 11.86 2.29 5–17 −0.33 0.26 VPA II Scaled Score 11.33 1.57 3–13 −2.14 8.02 LM I Scaled Score 10.78 2.53 3–16 −0.39 0.18 LM II Scaled Score 10.53 2.56 5–16 −0.04 −0.12 CVLT Trials 1–5 T Score 55.26 9.18 29–78 −0.28 0.01 VPA I Substitute Scaled Score 10.92 2.36 4–17 −0.33 0.26 CVLT Long-Delay Free-Recall z score 0.31 0.92 −2.50–1.50 −0.62 −0.25 VPA II Substitute Scaled Score 10.51 2.00 3–13 −0.71 2.37 AMI: LM and VPA 106.53 10.30 64–130 −0.71 2.37 AMI: LM and CVLT 103.83 10.51 70–123 −0.56 0.70.

Auditory Memory Test/Index Mean SD Range Skewness Kurtosis VPA I Scaled Score 11.86 2.29 5–17 −0.33 0.26 VPA II Scaled Score 11.33 1.57 3–13 −2.14 8.02 LM I Scaled Score 10.78 2.53 3–16 −0.39 0.18 LM II Scaled Score 10.53 2.56 5–16 −0.04 −0.12 CVLT Trials 1–5 T Score 55.26 9.18 29–78 −0.28 0.01 VPA I Substitute Scaled Score 10.92 2.36 4–17 −0.33 0.26 CVLT Long-Delay Free-Recall z score 0.31 0.92 −2.50–1.50 −0.62 −0.25 VPA II Substitute Scaled Score 10.51 2.00 3–13 −0.71 2.37 AMI: LM and VPA 106.53 10.30 64–130 −0.71 2.37 AMI: LM and CVLT 103.83 10.51 70–123 −0.56 0.70. Auditory Memory Test/Index Mean SD Range Skewness Kurtosis VPA I Scaled Score 11.86 2.29 5–17 −0.33 0.26 VPA II Scaled Score 11.33 1.57 3–13 −2.14 8.02 LM I Scaled Score 10.78 2.53 3–16 −0.39 0.18 LM II Scaled Score 10.53 2.56 5–16 −0.04 −0.12 CVLT Trials 1–5 T Score 55.26 9.18 29–78 −0.28 0.01 VPA I Substitute Scaled Score 10.92 2.36 4–17 −0.33 0.26 CVLT Long-Delay Free-Recall z score 0.31 0.92 −2.50–1.50 −0.62 −0.25 VPA II Substitute Scaled Score 10.51 2.00 3–13 −0.71 2.37 AMI: LM and VPA 106.53 10.30 64–130 −0.71 2.37 AMI: LM and CVLT 103.83 10.51 70–123 −0.56 0.70. Auditory Memory Test/Index Mean SD Range Skewness Kurtosis VPA I Scaled Score 11.86 2.29 5–17 −0.33 0.26 VPA II Scaled Score 11.33 1.57 3–13 −2.14 8.02 LM I Scaled Score 10.78 2.53 3–16 −0.39 0.18 LM II Scaled Score 10.53 2.56 5–16 −0.04 −0.12 CVLT Trials 1–5 T Score 55.26 9.18 29–78 −0.28 0.01 VPA I Substitute Scaled Score 10.92 2.36 4–17 −0.33 0.26 CVLT Long-Delay Free-Recall z score 0.31 0.92 −2.50–1.50 −0.62 −0.25 VPA II Substitute Scaled Score 10.51 2.00 3–13 −0.71 2.37 AMI: LM and VPA 106.53 10.30 64–130 −0.71 2.37 AMI: LM and CVLT 103.83 10.51 70–123 −0.56 0.70. Distribution of Auditory Memory Index scores derived from Logical Memory and Verbal Paired Associates, and California Verbal Learning Test-Second Edition. Exploratory post hoc analyses were conducted to investigate whether test order might impact VPA and CVLT-II performances ( Post hoc analyses were based on 79 participants 85% of study sample, for whom test order were recorded.). The order of test administration impacted learning and recalling word lists. When the WMS-IV was administered prior to the CVLT-II, the average CVLT Trials 1–5 Free-Recall T score was significantly greater than if the CVLT-II had been administered first, t(77) = 4.47, p 15 points (1 SD) lower when substituting the CVLT-II for VPA performance.

Unlike Miller and colleagues's findings, none of the participants in this study had AMI scores that were 1 SD higher when using the CVLT-II to derive the AMI, than when using the VPA (see Table ). It is also important to recognize that 95th percentile confidence intervals expand as AMI scores become more extreme and regress towards a score of 100. In other words, it is possible that discrepancies further away from a score of 100 are smaller than they visually appear, though it is currently unclear if the same confidence intervals should be applied to alternatively derived AMI scores. As previously described, exploratory post hoc analyses revealed that the order of test administration clearly impacted learning and recalling word lists. When the WMS-IV was administered prior to the CVLT-II, CVLT-II performances increased by nearly an SD. While noteworthy, the significance of this finding is somewhat unclear because the order effect only resulted in different VPA equivalent scores and did not contribute to a difference between standard and alternatively generated AMI scores.

Future research is encouraged to more systematically explore whether this test order effect is uniquely associated with this specific sample of research participants. It is plausible that these bright participants developed effective memory strategies and confidence during the WMS-IV that meaningfully improved their CVLT-II performance. One might hypothesize that an impaired patient would benefit less from exposure to memory tasks than a healthy, young adult. Regardless, clinicians who routinely substitute CVLT-II performances when generating WMS-IV Index scores should recognize the potential meaningful impact of test order. Unfortunately, it is not clear whether the WMS-IV or CVLT-II was administered first when collecting normative data. While it is clear that substituting CVLT-II performances for VPA performances results in discrepant scores, it is plausible that each is a valid approximation of verbal memory functioning.

Factor analytic research is recommended to further explore whether the CVLT-II and VPA subtests are related to the same theoretical construct, verbal memory functioning. For example, VPA I and VPA II have been included in several factor analytic studies of the WMS-IV (e.g., see;; ). It would be worthwhile to evaluate the congruence of dimensions, loading strength, and amount of variance explained with VPA and VPA equivalent scaled scores. Alternatively, has identified a multidimensional structure underlying the CVLT-II that consists of Attention Span, Learning Efficiency, Delayed Memory, and Inaccurate Memory. Novel VPA scores could be generated (e.g., Intrusions, Learning Efficiency) and the fit between a similar factor structure (in terms of dimensionality, loading strength, common and unique variances) and VPA performance could be quantified through confirmatory factor analytic methods.

Additionally, novel empirical investigations are encouraged to explore whether the standard or alternatively generated AMI score is more predictive of verbal memory functioning, or another relevant outcome variable. The relatively brief assessment battery administered in this research significantly impacts the degree to which additional analyses could be conducted to explore these key issues. Also due to the limited nature of our assessment battery, we were unable to determine how substitution using the CVLT-II scores affected changes in the WMS-IV Immediate Memory Index (IMI) and Delayed Memory Index (DMI) scores in this sample.

One might anticipate that substituting CVLT-II for VPA performances would result in smaller changes for IMI and DMI scores, compared with AMI scores, since the substitution results in a relatively smaller percentage of change (one of four contributing subtest scores is changed in IMI and DMI, whereas two of four contributing subtest scores are changed in AMI). Nevertheless, given these observed differences in scores, we suggest that clinicians exercise caution in deriving the AMI using CVLT-II scores, due to the high likelihood of generating discrepant scores. If it is necessary to quantify verbal memory functioning, VPA subtests may not be sufficiently challenging for higher functioning young adults.

VPA administration, relative to CVLT-II administration, results in a more restricted range of scores, which could ultimately lead to differences in test sensitivity and specificity. Assuming VPA and the CVLT-II evaluate the same construct, our findings suggest that the higher ceiling of the CVLT-II is more sensitive to differences in memory performance among those with relatively strong memory functioning. As an additional advantage, the standard error of measurement (SEM) associated with CVLT-II scores is likely smaller than the SEM associated with VPA scores, given that the CVLT-II has greater test–retest reliability coefficients than the VPA.

In other words, there are several meaningful reasons to believe that the CVLT-II would be a more precise instrument to use during research and clinical activities. This belief is consistent with previously documented findings among clinical samples that suggest the CVLT-II is a particularly effective instrument. Specifically, the CVLT-II has been found to be more sensitive than the VPA subtest to memory deficits observed in a sample of patients who have amnestic mild cognitive impairment. Similarly, the original CVLT was found to be more sensitive than the Hopkins Verbal Learning Test due to the higher ceiling of the CVLT arising from more items on the word list. The quest to more precisely quantify memory functioning continues to challenge neuropsychologists. Future research could also investigate other methods of assessing memory, apart from total correct scores, as is the method used in VPA and CVLT-II. It may be helpful to emphasize and take into consideration learning curves instead of absolute correct or incorrect numbers.

In addition, utilizing an item response theory approach, and assigning different scoring weights to individual items based on item difficulty level could increase the precision at which different levels of memory functioning are distinguished (e.g., see,; ). Such procedures would likely overcome many difficulties associated with floor and ceiling effects commonly observed on memory tests such as the WMS-IV and CVLT-II. This would ultimately lead to more accurate assessment, which would be a positive development in an era of medicine that strives for cost-effective and empirically supported assessment and intervention.

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