Relation of cognitive functioning to daily living skills in a geriatric population

A modified version of the Community Competence Scale was administered along with the Wechsler Adult Intelligence Scale--Revised (WAIS--R) to 40 geriatric patients with suspected dementia. Scores on the Competence Scale, a measure of functional daily living skills, were correlated .72 with Full Scale IQs and .77 with Verbal IQs and moderately correlated (.55) with Performance IQs. A number of significant correlations were found between WAIS--R subtests and subscales of the competence instrument. Means and standard deviations for the 10 Competence subscale and total scores are presented.     

Influence of IQ in interpreting MMSE scores in patients with multiple sclerosis

The Mini-Mental State Examination (MMSE) and Wechsler Adult Intelligence Scale-Fourth Edition (WAIS-IV) were administered to 46 outpatients diagnosed with multiple sclerosis (MS). MMSE total raw score was significantly and positively correlated with all WAIS-IV indexes, even when controlling for the effects of participant educational level, with the strongest relationship being with Full Scale IQ. These results suggest that clinicians consider patient intellectual functioning, in particular Full Scale IQ, when diagnosing neurocognitive impairment based on screening with the MMSE in individuals with MS.     

Improving sensitivity of the recognition task in the Alzheimer's Disease Assessment Scale

This paper presents an alternative measure for scoring the recognition memory task in the Alzheimer's Disease Assessment Scale (ADAS), which is one of the most common screening tests. Memory studies routinely take into account not only correct responses to old items (Hits) but also incorrect responses to new items (False Alarms). Here, a bias-corrected measure of recognition memory, Hits minus False Alarms (called Pr), is computed and its significance evaluated against the original measure, Hits. 28 male and 40 female healthy elderly people (M age= 68.5 yr., SD=3.5) recruited from the neighborhood community participated in this study. Multiple stepwise regression analyses first with Hit Rate then False Alarm Rate showed that False Alarm Rate significantly improved R(2) in the two subscale scores of the Wechsler Memory Scale-Revised and scores of the Mini-Mental State Exam. Thus, this new measure taking into account false responses may be more sensitive and useful to detect early stages of cognitive dysfunction.     

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.     

The Wechsler Memory Scale—Revised: Psychometric characteristics and clinical application

The psychometric characteristics of the Wechsler Memory Scale—Revised (WMS-R) are evaluated and related to dits clinical utility. The accuracy of the scale scores is shown to be limited by their high standard error, low reliabilities, and consequent large standard errors of measurement. Specific procedures are discussed for establishing confidence intervals and for testing the significance of differences between scores. It is concluded that the WMS-R, like the original Wechsler Memory Scale, provides only a rough estimate of overall memory functioning. The multidimensional index scores have not been shown effective in describing the nature or the pattern of memory deficits. Recommendations for the clinical use of the WMS-R are provided.     

Neuropsychological correlates of Greek alcoholic patients who report memory disturbances

We studied 40 male and 37 female (M age=63 yr.) Greek alcoholic patients and an equal number of control subjects. Both groups were evaluated with the Mini-Mental State Examination, the Syndrome Short Test, the Verbal Fluency Test (Category & Letter), the Clock Test, and the Digit Span (Forward and Backward from the Wechsler Adult Intelligence Scale-Revised). Alcoholic patients had statistically significant lower scores on MMSE, Verbal Fluency Test, and Digit Span, and higher scores on the Syndrome Short Test, while positive correlations were found among MMSE, Verbal Fluency Test, Clock Test, Digit Span-Backward, and age. These findings point to frontal lobe dysfunction in Greek alcoholic patients which is not different from that shown in patients from diverse ethnic and cultural backgrounds.     

Structure of the Mini-Mental State Examination: a comparison between normal and clinical subjects

The Mini-Mental State Examination was administered to a sample of 133 Italians ranging from 60 to 80 years of age. From a Principal Components Analysis three factors were retained, being results of both varimax and oblimin rotations. These were labeled (1) Memory, (2) Verbal Comprehension, and (3) Attention. These factors are similar to those obtained with normal elderly Americans, but they are different from the factors based on clinical samples. No age differences in the factor scores were found among the normal elderly subjects when education was considered. In contrast, significant differences were found between a group of 25 demented patients and a matched group randomly extracted from the normal sample.     

Comparative relationships of the Wechsler Adult Intelligence Scale—Revised (WAIS-R) and the Wechsler Adult Intelligence Scale (WAIS) to the Wechsler Memory Scale (WMS)

This study investigated whether the Wechsler Adult Intelligence Scale — Revised (WAIS-R) and Wechsler Adult Intelligence Scale (WAIS) demonstrate similar patterns of relationship with the Wechsler Memory Scale (WMS). Sixty VA patients were administered the WAIS-R and WMS and 60 completed the WAIS and WMS. The groups were comparable in terms of demographic variables. Pearson correlations were computed between the subtest and IQ scores from the intelligence scales and the scores from the WMS for each group. Comparison of the resulting correlations for the WAIS-R group with those of the WAIS subjects demonstrated only four significant differences, indicating that the WAIS-R and WAIS variables covary in a similar manner with the WMS scores. Following factor analysis of the test data for both groups, coefficients of congruence indicated a high degree of similarity between the two factor solutions. Essentially the same relationships emerged between intelligence variables and the WMS regardless of which scale was administered.     

Expanding the ecological validity of WAIS-IV and WMS-IV with the Texas functional living scale

Assessment of functional status is an important aspect of clinical evaluation. As part of the standardization of the Wechsler Adult Intelligence Scale-Fourth Edition (WAIS-IV) and Wechsler Memory Scale-Fourth Edition (WMS-IV), participants completed the Texas Functional Living Scale (TFLS), a measure of Instrumental Activities of Daily Living. The relationships between TFLS and WAIS-IV and WMS-IV were examined in both normally developing and clinical samples. In general, the highest correlations were between TFLS and measures of general cognitive ability (WAIS-IV FSIQ [Full Scale IQ] and GAI [General Ability Index]) and working memory (WAIS-IV WMI [Working Memory Index] and WMS-IV VWMI [Visual Working Memory Index]). Across the clinical populations, working memory subtests were generally strongly related to TFLS performance, although this relationship was more consistent with WAIS-IV than WMS-IV. Contrast scaled scores are presented for the TFLS based on WAIS-IV or WMS-IV performance. These scores allow the evaluation of functional abilities within the context of cognitive and memory ability, enhancing and expanding the utility of the WAIS-IV and WMS-IV.     

IQ and Scores on the Mini-Mental State Examination (MMSE): Controlling for Effort and Education Among Geriatric Inpatients

ABSTRACT

The Mini-Mental State Examination (MMSE) and the Peabody Picture Vocabulary Test, Third Edition (PPVT-III) were administered to 76 Extended Care Center inpatients of a Veterans Affairs Medical Center, 56 of whom did not carry a diagnosis associated with brain impairment, and 20 of whom had a diagnosis associated with degenerative or cerebrovascular conditions. MMSE and PPVT-III scores, the latter of which estimates verbal IQ, were significantly correlated in both groups, even when controlling for the effects of education. This correlation was attenuated, but remained significant, in the face of varying levels of patient effort. The findings of this study support earlier findings, which also suggest that interpretation of “impaired” performance on the MMSE for those with IQ scores below 90 should be interpreted with caution. Average MMSE scores for Wechsler IQ classifications are provided.     

IQ and scores on the Mini-Mental State Examination (MMSE): controlling for effort and education among geriatric inpatients

The Mini-Mental State Examination (MMSE) and the Peabody Picture Vocabulary Test, Third Edition (PPVT-III) were administered to 76 Extended Care Center inpatients of a Veterans Affairs Medical Center, 56 of whom did not carry a diagnosis associated with brain impairment, and 20 of whom had a diagnosis associated with degenerative or cerebrovascular conditions. MMSE and PPVT-III scores, the latter of which estimates verbal IQ, were significantly correlated in both groups, even when controlling for the effects of education. This correlation was attenuated, but remained significant, in the face of varying levels of patient effort. The findings of this study support earlier findings, which also suggest that interpretation of "impaired" performance on the MMSE for those with IQ scores below 90 should be interpreted with caution. Average MMSE scores for Wechsler IQ classifications are provided.     

Comparison of Scoring Criteria for Clock Drawing Test

This study compared clock drawings by 42 medically hospitalized patients with a mean age of 51.9 (SD = 10.1) years, using four sets of published scoring criteria to determine comparability of classification and to assess validity by comparison to other measures of cognitive functioning. We found impairment in 20 of 42 cases using the criteria of Mendez et al. (1992); 11 of 42 cases by Sunderland et al. (1989); 9 of 42 cases with Freedman et al. (1994); and 8 of 42 cases according to Rouleau et al. (1992). Kappa coefficients of impairment status between sets of scoring criteria ranged from .41 to .86. Pearson correlations of raw scores between schemes ranged from .72 to .94. All except Sunderland et al. were significantly correlated with the Standardized Mini-Mental State Examination. All correlated significantly with the Wechsler Adult Intelligence Scale–Revised Block Design; however, only Mendez et al. correlated significantly with the Neurobehavioral Cognitive Status Examination. On the basis of these results and our experience, we recommend using the Freedman scoring scheme.     

Comparability of WAIS and WAIS--R scores among mentally retarded adults

This study compared the performance on the WAIS and WAIS--R of 21 mentally retarded adults residing in an Intermediate Care Facility. Tests were administered in one order, the WAIS initially and the WAIS--R second, with approximately two years between testings. Significant differences were found on the WAIS and WAIS--R for Verbal, Performance and Full Scale IQs. This finding contrasts with the differences between the measures as reported in the WAIS--R manual.     

Convergent and discriminant validity of Russell's revised Wechsler memory scale

The convergent and discriminant validity of Russell's Revised Wechsler Memory Scale (RWMS) was investigated in a sample of 228 males referred to a VA Medical Center Psychology Service for evaluation. Results of correlational and regression analyses involving background characteristics (race, age, ward assignment) and scores on other measures (WAIS, MMPI, Graham-Kendall Memory for Designs, Tapping, Trails, Aphasia Screening Test) suggested both strengths and weaknesses in the RWMS. Strenghts included minimal relationships between RWMS scores and personality disturbance, race, or age, and substantially lower correlations with IQ than reported for the original WMS. Weaknesses involved the measurement properties of the retention scores, and uncertain discriminant validity in relation to the various other ability measures.     

Development of a Brief Cognitive Screen for Mild Cognitive Impairment and Neurocognitive Disorder

Abstract

The purpose of this study was to develop and evaluate a brief cognitive screen for possible Mild Cognitive Impairment (MCI) and other neurocognitive impairment in a sample of general medical patients. Two hundred community-dwelling general medical patients aged 65 or older participated in this study. Age and education corrected scores from the Rey Auditory Verbal Learning Test and Mattis Dementia Rating Scale were used to classify participants into three groups: MCI, neurocognitive disorder, cognitively intact. Groups were then compared on an independent set of measures: the Consortium to Establish a Registry for Alzheimer’s Disease (CERAD) neuropsychological battery, Mini-Mental State Examination, and Clock Drawing Test. The MCI group constituted 9% of the sample, while 10.5% of the sample was classified into the neurocognitive disorder group. The CERAD Verbal Category Fluency and CERAD Word List Memory Test Delayed Recall measures were individually and collectively the most effective in differentiating cognitively intact elders from persons in both the MCI and neurocognitive disorder groups. We conclude that these two brief measures appear to be effective for detecting possible MCI or neurocognitive disorder, thereby facilitating identification of candidates who would benefit from more detailed neuropsychological assessment.     

Confrontation naming in Alzheimer's patients: relation to disease severity.

Reports of Alzheimer's disease patients in whom naming performance is disproportionate to other cognitive performances raise questions about the stage model, or dementia-severity level, for predicting naming performance. Thus, dementia severity as defined by Global Deterioration Scale ratings, Mini-Mental State Examination scores, and combinations of them was evaluated as a predictor of naming performance in 102 Alzheimer's patients and was found to account for approximately 1/3 of performance variability. Additional contributions from age at onset, duration, family history, and gender were negligible. Therefore, naming ability can be argued to have a subcomponent that is not subsumed by overall cognitive ability.     

Reliability of proxy response on mental health indices for aged, community-dwelling women

The correspondence between respondent and proxy response was evaluated on 4 mental health measures (Affect Balance Scale, Center for Epidemiological Studies Depression Scale, Mental Status Questionnaire, and Mini-Mental State Examination) with a sample of 538 respondent-proxy pairs. Results indicated that respondent and proxy responses were strongly associated, particularly for the cognitive measures. This association was found even for respondents classified as depressed or cognitively impaired. Although there was evidence of proxy bias, with proxies underrating affective status and overrating cognitive status, the magnitude of the bias proved small for all scales but the Mental Status Questionnaire. Examination of response comparability by proxy characteristics showed that choice of proxy affected agreement and bias. Implications of these findings for survey research are discussed.     

A Study of the Criterion Validity of the Mattis Dementia Rating Scale

Criterion validity of the Mattis Dementia Rating Scale (MDRS) was evaluated with a concurrent study to obtain a cut-off score for an Argentinean population. A battery of several neuropsychological tests, including MDRS and Mini-Mental State Examination (MMSE), was administered to 60 patients in a memory disorder clinic. The MDRS cut-off score was used as the criterion variable. A total score of 123 in MDRS was found to classify incorrectly only 8 of 60 patients. Sensitivity was 0.83, and specificity was 0.90. MDRS showed a high convergent validity with MMSE. Consistent with the cut-off scores suggested by Mattis in his manual, a total score of 123 was found to be the most appropriate for adoption in the local population.     

Parallel-form reliability of the Wechsler Memory Scale in a geriatric population with suspected dementia

The present study examined parallel-form reliability of the Wechsler Memory Scale (WMS) in a population where such forms are particularly useful, that is, among patients who are suspected of having some type of dementing illness. Comparative analyses were made for total raw scores. Memory Quotient (MQ) scores, and individual subtest scores. Thirty geriatric patients originally referred for neuropsychological testing because of suspected dementia were given both Forms 1 and 2 of the WMS. The results yielded high overall reliability coefficients for MQ and total raw scores. Individual subtest scores also yielded rather high coefficients, and only one subtest (Associate Learning) had a significant mean difference. Apparently, the two forms have sufficient parallel-form reliability to be considered clinically interchangeable. Thus, the WMS may be a useful tool for repeat evaluations of memory functioning in a demented population.     

Age-related invariance of abilities measured with the Wechsler Adult Intelligence Scale--III

Examination of measurement invariance tests the assumption that the model underlying a set of test scores is directly comparable across groups. The observation of measurement invariance provides fundamental evidence for the inference that scores on a test afford equivalent measurement of the same psychological traits among diverse groups. Groups may be derived from different psychosocial backgrounds or different clinical presentations. In the Wechsler Adult Intelligence Scale-III (WAIS-III)/Wechsler Memory Scale-III (WMS-III) Technical Manual (Psychological Corporation, 2002), there appears to be a breakdown in factor structure among the standardization cases in older adults. In this study, the authors evaluated the invariance of the measurement model of the WAIS-III across 5 age bands. All components of the measurement model were examined. Overall, the evidence pointed to invariance across age of a modified 4-factor model that included cross-loadings for the Similarities and Arithmetic subtests. These results support the utility of the WAIS-III as a measure of stable intelligence traits across a wide age range.