PSY 448 Clinical Neuropsychology	Last revised: Oct 22,2023
Testing Memory

What do we mean by "testing memory"? (based on Lezak et al. 2012)

"Memory is the capacity to retain information and utilize it for adaptive purposes" (Lezak et al, 2012, p. 466). This very general definition hides the fact that memory involves many different processes. So, what sorts of memory processes are important to evaluate in a neuropsychological assessment? These should include

• Orientation to time, place, and self (year, season, month, day; type of place, name of place; your name)
  
• Recall of prose from what one has heard (learning & retention of meaningful information)
• Rote learning: ability to learn and recall new materials across three or more trials.
• Visuo-spatial memory
• Remote memory, particularly one's overall fund of general information learned over a lifetime
• Personal-Autobiographical memory.

A. Verbal Memory

• Automatisms (alphabet, numbers)
• Supraspan (e.g., strings of numbers like telephone #s which are longer than average)
• Word memory
• Learning & recalling 3 or 4 words after 5 minutes
• Auditory verbal word lists, e.g., 15 words read at one word per second. How many can someone recall
• Story Recall: Remembering details from a story, i.e., how much information has person picked up and retained?
  

B. Visual Memory Often tests of visual memory use more abstract cues in order to minimize the use of verbal cues in recall.

• Visual Recognition, e.g., show a set of faces and, then, show a group of faces and ask if each has been seen before
• Visual Recall
• Verbal Response (show a picture and, then, ask what the individual saw)
• Design Reproduction (present a figure and, then, ask for the figure to be drawn)
  

• Visual Learning Measuring the rate, efficiency and retention of materials learned visually
  
• Hidden Objects Asking testees to recall where and what objects previously seen have been hidden
  

C. Tactile Memory

D. Incidental Learning: In performing a task does the person tend to pick up information along the way?

E. Prospective Memory: Do objects serve as cues for future work, e.g., alarm clocks or calendar dates?

F. Remote Memory

• Famous Persons and Events
• Autobiographical Memory
  

Some Important Neuropsychological Tests of Memory

WAIS-R/III/IV

• Digit Span: Forwards & Backwards
• Information
• Letter-Number Sequencing (WAIS-III/WMS-III [see below])

Mental Status

• Orientation x3 (Who are you? Where are you? What day is it?)
• Presidents since Kennedy (or Reagan)
• Recall of three items (e.g., "Orange, Book, Elephant") after a delay of 5 minutes

Wechsler Memory Scale-4th Edition (WMS-IV)

Published: 2009 by Pearson Assessment

Age Range: 16-90.11 years matched to 1995 US Census data with respect to gender, SES, ethnicity, educational attainment, and geographical location.

Components: Significant changes from earlier versions; validation data as of late 2015 seem to indicate that the WMS-IV seems to be as useful as previous versions of the WMS despite these changes; see Holdack et al. 2013)

• "WMS-IV is made up of seven subtests: Spatial Addition+, Symbol Span+, Design Memory+, General Cognitive Screener+, Logical Memory (I & II), Verbal Paired Associates (I & II), and Visual Reproduction (I & II). A person's performance is reported as five Index Scores: Auditory Memory, Visual Memory, Visual Working Memory, Immediate Memory, and Delayed Memory" {W} [+ indicates subtests added to the WMS-IV]
  

Earlier & Coordinate Versions

• 1945 Wechsler Memory Scale (WMS) Forms I and II
• 1987 Wechsler Memory Scale-Revised (WMS-R)
• 1997 Wechsler Memory Scale-3rd ed. (WMS-III)

Subtests on the WMS-III (* indicates subtests retained in WMS-IV; - indicates subtests dropped in WMS-IV)

   Immediate Memory

• Logical Memory I (Verbal)*
• Verbal Paired Associates I (Verbal)*: Examiner reads pairs of words. At end of list, examiner says one word and the testee must supply the associated word

• Faces I (Visual) -
• Family Pictures I (Visual) - 

   Delayed Memory

• Logical Memory II (Verbal)*
• Verbal Paired Associates II (Verbal)*

• Faces II (Visual) - 
• Family Pictures II (Visual) - 

   Working Memory

• Letter-Number Sequencing (Verbal) -  Testee listens to a intermixed set of letters and numbers orally presented. The task for the subject is to speak aloud the numbers and then the letters in their ascending sequential order.   Example "2 B 4 F 7 J

• Spatial Span (Visual) -  Testee watches examiner tap a sequence of blocks on the board (number side faces examiner) and then attempts to tap out the same sequence.

	WMS-III (1997)	WMS-IV (2009) !!! = Immediate Memory --- = Delayed Memory
Immediate Memory	Logical Memory I (Verbal) Verbal Paired Associates I (Verbal) Faces I (Visual) Family Pictures I (Visual)
Delayed Memory	Logical Memory II (Verbal) Verbal Paired Associates II (Verbal) Faces II (Visual) Family Pictures II (Visual)
Working Memory	Letter-Number Sequencing (Verbal) Spatial Span (Visual)
Auditory Memory		Logical Memory I !!! Verbal Paired Associates I !!! Logical Memory II --- Verbal Paired Associates II ---
Visual Memory		Designs I !!! Visual Reproduction I !!! Designs II --- Visual Reproduction II ---
Visual Working Memory		Symbol Span Spatial Addition

Tests on WMS-IV

• Logical Memory I: two short stories (1 for older adults) presented orally
• Logical Memory II: Retell both stories from LM I'; asked yes/no questions about stories
  
  
• Verbal Paired Associates I: Read 10 or 24 word pairs to examinee & then read 1st word and ask for corresponding word (4 trials)
• Verbal Paired Associates II: Later in test, re-do VPA I and ask examinee to recall corresponding word
  
  
• Visual Reproduction I: Show five designs, one at a time for 10 sec. each; examinee asked to draw design from memory after each
• Visual Reproduction II: Asked to recall and draw earlier designs; asked to recognize designs from among alternatives
  
  

         

• Designs I: Shown a grid with 4-8 designs on a page for 10 sec. (see above); examinee selects designs from set of cards and puts cards in a grid in same place as previously shown
• Designs II: Examinee asked to reproduce pages shown with cards and the grid; asked to select designs which are correct and in same place.
  

          

• Spatial Addition (Ages 16-69)" Examinee shown two grids with blue and red circles (see above); then examinee asked to add or subtract the location of the circles based on a set of rules.

         

• Symbol Span: Examinee briefly shown abstract symbols on a page (see above) and then asked to select them from an array of symbols in the same order as previously shown.
  

California Verbal Learning Test-3rd Edition (CVLT-3)

Published: 2019 by Pearson Assessment

• Full restandardization based on education, region, ethnicity, and age.
  

Age Range: 16-90 years

Administration Time: 30 minutes (+ 30 minutes delay; 15 minutes for Short Form + 15 minute delay)

• A Brief Form features lists of nine words in three categories and can be administered in 15 minutes.
  
• Test can be administered either digitally or by pen-and-pencil
  

Components: See description below of the CVLT-II administration. The CVLT-3 is a revision of the CVLT-II. However, the target words for List A and List B remain the same from the CVLT-II to the CVLT-3. These target words were carefully selected and they have proven successful in hundreds of studies. By maintaining the same target words, researchers using the CVLT-II in longitudinal studies can seamlessly employ the CVLT-3 while also benefiting from the new process measures in the new edition.

Earlier & Coordinate Versions

• 1987 California Verbal Learning Test (CVLT)
• 2000 California Verbal Learning Test - 2nd Edition (CVLT-II)

• Administration {Wikipedia}: The examiner reads a list of 16 nouns aloud, at one-second intervals, in fixed order, over five learning trials (list A). After each trial, the testee is asked to recall as many words as they can in any order (i.e., free recall). The words are drawn from four semantic categories (tools, fruits, clothing, spices and herbs), with no consecutive words from the same category. If a subject 'clusters' words from a category together, it is probable that they are using semantic organization.

An interference list (list B) is presented that shares two categories from List A (e.g., fruit and tools) and has two unshared categories (e.g., fish and kitchen utensils). However neither list uses common words for a specific category (e.g., apples used rather than bananas). Free and cued recall of list A are tested immediately (short-delay), and again after 20 minutes (long-delay). In cued recall, the examiner prompts the subjects with the word category.

The CVLT ends with a recognition task, where the examiner presents the testee with a 44-word list, and the testee must indicate whether it is a target word or a distractor. Some distractors share semantic categories with the target words while others sound alike. The 44-word list is presented like shopping list as it was argued that this is an activity that people face in their everyday activities. The words have an average of 2.37 syllables and there are 64% of distractor items on the recognition list.

References

Holdnack, J. A., Drozdick, L. W., Weiss, L. G., & Iverson, G. L. (Eds.). (2013). WAIS-IV, WMS-IV, and ACS: Advanced clinical interpretation. Waltham, MA: Academic Press.

Lezak, M. D., Howieson, D. B., Bigler, E. D., & Tramiel, D. (2012). Neuropsychological assessment (5th ed.). New York, NY: Oxford University Press.