Dissertations / Theses on the topic 'Wechsler Memory Scale. Memory Memory disorders'

The Wechsler Memory Scale –iii is the newest version of a six-decade old neuropsychological inventory. Since its conception, the Wechsler Memory Scale has been highly utilized by practitioners to accurately assess various memory functions in adult subjects. Revisions made within this inventory include the Faces I subtest, a facial recognition scale, which was added in order to strengthen the instrument’s accuracy at measuring episodic memory. Facial recognition, both cross-race and within-race, has been researched extensively and consistent biases have been found between race of test taker and cross-racial identification. Theories of exposure/contextual interaction (environment) and biological foundations have been the subject of study in the past in order to determine from where these racial identification deficits stem. The current study focuses on revealing bias in the Faces I subtest, regarding to an unequal distribution of racially representative faces in the testing materials. Eighty-eight college students were recruited to view forty-eight pictured faces from the Faces I subtest and determine the racial category to which the pictured face belonged. The subjects’ categorical responses were the basis for calculating a percent agreement score for racial category of each face. It was determined, using the results of subjects’ responses, that the Faces I subtest contained an unequal distribution of racially representative faces in both the Target and Interference testing material. This confirmed the presence of an inherent bias within the subscale. The implications of memory accuracy for the WMS-iii are discussed as it relates to different fields of study, but none more directly than the criminal justice system. Eyewitness testimony is a pivotal evidentiary tool in the criminal justice system, and ramifications of cross-racial identification deficits and biases in the tools to accurately assess memory are increasingly bringing this once heavily relied upon tool into question.

Instrumentos de avaliação da memória episódica não verbal são escassos. Além disto, consideramos a crescente necessidade de esforços para a adaptação transcultural de instrumentos de memória para nosso contexto. O subteste Visual Reproduction I e II (Reprodução Visual I e II) faz parte da Wechsler Memory Scale (WMS) e se trata de uma escala mundialmente utilizada e adaptada a diversas culturas, sendo considerada padrão ouro dentre as medidas de avaliação da memória. No presente estudo, utilizamos o subteste Reprodução Visual, da WMS na sua quarta edição (WMS-IV). O Reprodução Visual (RV) é subdividido em três domínios de investigação da memória visual (evocação imediata, evocação tardia e reconhecimento) e uma tarefa opcional para avaliação da percepção visual, habilidades construtivas e atenção aos detalhes (cópia). Além disto, o escore de cada um dos três domínios avaliados podem ser contrastados, de modo que se obtenham informações sobre a retenção, o quanto a memória é melhor ou pior do que as habilidades construtivas e, por último, o quão o sujeito evoca livremente ou precisa de pistas para evocar a informação aprendida. Esta versão da WMS-IV é uma revisão da WMS-III, cujos estudos resultaram em algumas alterações metodológicas e de conteúdo, no sentido de facilitar a análise dos resultados, diminuir os vieses de aplicação e correção. Desta forma, para atingir os propósitos desta pesquisa foram realizados dois estudos: o Estudo 1 teve como objetivo realizar a adaptação transcultural do subteste Visual Reproduction I and II - Wechsler Memory Scale IV (WMS-IV) e apresentar uma versão para uso preliminar no Brasil. O estudo 2 consistiu na avaliação das suas propriedades psicométricas. Participaram do estudo 1 três tradutores com fluência no inglês, que realizaram traduções independentes, dois tradutores profissionais e dois juízes especialistas (um neurologista e uma neuropsicóloga). Os juízes especialistas e um tradutor profissional investigaram a equivalência conceitual, semântica e operacional dos itens. Uma amostra de 24 sujeitos saudáveis responderam ao pré-teste, que consistiu na investigação da compreensão e dificuldade da versão adaptada do Reprodução Visual I e II. No estudo dois, participaram 62 adultos saudáveis e 29 adultos com Acidente vascular cerebral em hemisfério direito, no território da Artéria cerebral média (AVC-ACMHD). Os sujeitos tinham idade entre 20 e 59 anos e as respostas foram consideradas para análises de confiabilidade e validade baseadas em análises estatísticas da teoria clássica (ANOVA, ANCOVA, coeficiente alfa de Cronbach, e correlação de Pearson) e da teoria moderna de testagem (Teoria de Resposta ao Item (TRI) através do modelo de um parâmetro ou método de Rasch). O processo de análise das propriedades psicométricas utilizou a metodologia recomendada pelo American Educational Research Association [AERA], American Psychological Association [APA] e o National council on measure in education [NCME], 2008 indicada pela editora responsável pelos direitos autorais do WMS-IV. Na confiabilidade, foi investigada a consistência interna (coeficiente alfa de Cronbach) e a estabilidade temporal (correlação de Pearson). Na investigação da validade, foram investigados: os processos de resposta, a estrutura interna (correlação de Pearson, Teoria de resposta ao Item pelo método de Rash), a relação com outros instrumentos (Mini Exame do Estado Mental - MEEM e Figuras Complexas de Rey) e a relação com variáveis externas (AVC-ACMHD comparados a controles saudáveis). O índice de consistência interna do subteste foi de 0,92 e a estabilidade teste-reteste mostrou correlação significativa, exceto com a tarefa de evocação tardia. Esses resultados são similares aos do estudo original, sendo, portanto caracterizada a sua equivalência. Os resultados do estudo de validade mostraram que há equivalência em termos de conteúdo.A investigação da estrutura interna pelo coeficiente de correlação de Pearson evidenciou que todas as figuras obtiveram correlação significativa (p<0,001). Ainda mais: correlacionaram-se congruentemente durante toda a tarefa. Na investigação da estrutura interna pelo método de Rasch foi evidenciado que o teste é unidimensional, que a progressão de theta ao longo das categorias de resposta foram como o esperado pelo modelo. A TRI mostrou que a figura mais fácil é a figura 1 da tarefa de evocação imediata e a mais difícil é a figura 5 de evocação tardia. Os índices de correlação theta foram superiores a 0,5, mostrando correlação. No mapa de pessoas-itens as variáveis tenderam a avaliar o constructo em níveis inferiores ao de habilidade dos sujeitos, sugerindo a necessidade de itens avaliando níveis mais altos do constructo. Na análise de validade considerando outras medidas a tarefa de evocação imediata o escore total e evocação tardia apresentaram correlação com o total da tarefa de memória das figuras complexas de Rey. As tarefas de cópia correlacionaram-se com o total de cópia do teste das figuras complexas de Rey. A tarefa de evocação imediata o escore total e evocação tardia apresentaram correlação com o total do MEEM. A análise de covariância mostrou que a escolaridade exerce influência nos escores do RV. Assim, depois de controlada a escolaridade foi evidenciado que os controles tiveram melhor desempenho em todas as tarefas do RV, quando comparados aos pacientes com AVC-ACMHD. Na análise qualitativa, através do escalonamento e contraste dos escores, foi observado que o baixo desempenho dos pacientes com AVC se deve ao fato de que esses pacientes percebem muito mal o item, com pior controle motor, habilidade visuo-construtiva e capacidade de prestar atenção a detalhes. O resultado é uma menor aquisição da informações e as conseqüências são dificuldades na memória episódica não verbal . Os nossos resultados foram demonstrativos de que o RV da WMS- IV, além de culturalmente equivalente em termos de confiabilidade e validade, é adequado para a cultura dos sujeitos e pacientes avaliados em Ribeirão Preto, preciso e válido para o uso no Brasil. Saliente-se a necessidade de estudos normativos com esse subteste.<br>Tools for evaluation of non-verbal episodic memory are scarce. Furthermore, we consider the increasing need for efforts to cross-cultural adaptation of instruments of memory for our context. The subtest Visual Reproduction I and II is part of the Wechsler Memory Scale (WMS), and it is used worldwide scale and adapted to different cultures, and is considered the gold standard among assessment measures of memory. In the present study, we use the Visual Reproduction subtest of WMS in its fourth edition (WMS-IV). The Visual Reproduction (VR) is subdivided into three fields of research in visual memory (immediate recall, delayed recall and recognition) and an optional task to assess visual perception, constructive abilities and attention to detail (copy). Moreover, the score of each of the three domains can be contrasted evaluated in order to obtain information on retention, and the memory is better or worse than the constructive abilities, and finally, how the subject refers freely or need tracks to evoke the information learned. This version of the WMS-IV is a review of the WMS-III, whose studies have resulted in some changes in methodology and content, to facilitate the analysis of results, lower camest application and correction. Thus, to obtain the purposes of this research were carried out two studies: Study 1 was aimed at making cross-cultural adaptation of the subtest \"Visual Reproduction I and II - Wechsler Memory Scale - IV (WMS-IV)\" and present a version for use preliminary in Brazil and the second study consisted of an evaluation of its psychometric properties. The study included a three translators fluent in English, which made independent translations, translators two professional judges and two experts (a neurologist and a neuropsychologist) who performed the conceptual and item equivalence, semantic, and operational. 24 healthy subjects responded to the pretest, which consisted in the investigation of understanding and difficulty of the adapted version of the Visual Reproduction I and II. In the second study, participated in 62 healthy adults and 29 adults with stroke in the right hemisphere in the territory of the middle cerebral artery. All subjects were aged between 20 and 59 years and the responses were considered for analysis of reliability and validity based on statistical analysis of the classical theory (ANOVA, ANCOVA, Cronbach\'s alpha, and Pearsons correlation) and the modern theory testing (Item Theory Response IRT, the model of one parameter or Rasch method). The process of analyzing the psychometric properties following the methodology recommended by the American Educational Research Association [AERA], American Psychological Association [APA] and the National council on education measure in [NCME], 2008 - indicated by the publisher responsible for the copyright of the WMS-IV. In the reliability analysis, we investigated the internal consistency (Cronbach\'s alpha) and temporal stability (Pearsons correlation). To investigate the validity, were considered: the processes of response, the internal structure (Pearsons correlation and IRT), the relationship with other tools (Mini Mental State Exam- MMSE and Rey-Osterrieth Complex Figure Test (ROCF).) and the relationship with external variables (stroke in the right hemisphere in the territory of the middle cerebral artery, compared to healthy controls). The index of internal consistency overall subtest was 0.92 and test-retest stability showed significant correlation, except with the task of delayed recall. These results are similar to the original study, showing thus their equivalence. The results of the validity study showed that there is equivalence in terms of investigating the internal structure and content. Pearson\'s correlation coefficient showed that all the figures obtained significant correlation (p <0.001) and further correlated with each moment congruently the task. In investigating the internal structure by the Rasch method has been shown that the test is one-dimensional that the progression of theta over the response categories was as expected by the model, and show that the figure is the easier task of Figure 1 - immediate recall, and is harder to figure 5- for delayed recall. The theta correlation coefficients were greater than 0.5, showing good correlation. On the map of people-items showed that the variables tended to evaluate the construct at levels below the skill of the subjects, suggesting the need for items assessing higher levels of the construct. In the analysis of validity considering other measures, the total score of immediate recall and delayed recall correlated with the total of memory task of the Rey complex figure copy. The copy of the Visual Reproduction correlated with copy of Rey-Osterrieth Complex Figure Test (ROCF). The task of ROCF immediate recall of the total score and delayed recall correlated with total MMSE. Covariance analysis showed that education exercises influences on scores of the RV. So, after controlled the variable schooling, was evident that the controls performed better than patients with stroke on all Visual Reproduction subtest. The qualitative analysis via scaling contrast scores, shown that low performance of patients with stroke is due the fact they recognize the item very badly, the motor control, visuo-constructive ability and ability to pay attention to details is lowered. Its can occur, may be due apraxia, resulting in lower acquisition of the information, resulting in difficulties in non-verbal episodic memory. Our results showing that the Visual Reproduction subtest of the WMS-IV was considered culturally equivalent in terms of reliability and validity and is appropriate for culture of the subjects and patients evaluated in Ribeirão Preto, valid and reliable for use in Brazil. We emphasize the need of studies regarding to normative data for this subtest.

The ceiling and basal rules of the Wechsler Adult Intelligence Scale – Fourth Edition (WAIS-IV; Wechsler, 2008) only function as intended if subtest items proceed in order of difficulty. While many aspects of the WAIS-IV have been researched, there is no literature about subtest item difficulty and precise item difficulty values are not available. The WAIS-IV was developed within the framework of Classical Test Theory (CTT) and item difficulty was most often determined using p-values. One limitation of this method is that item difficulty values are sample dependent. Both standard error of measurement, an important indicator of reliability, and p-values change when the sample changes. A different framework within which psychological tests can be created, analyzed and refined is called Item Response Theory (IRT). IRT places items and person ability onto the same scale using linear transformations and links item difficulty level to person ability. As a result, IRT is said to be produce sample-independent statistics. Rasch modeling, a form of IRT, is one parameter logistic model that is appropriate for items with only two response options and assumes that the only factors affecting test performance are characteristics of items, such as their difficulty level or their relationship to the construct being measured by the test, and characteristics of participants, such as their ability levels. The partial credit model is similar to the standard dichotomous Rasch model, except that it is appropriate for items with more than two response options. Proponents of standard dichotomous Rasch model argue that it has distinct advantages above both CTT-based methods as well as other IRT models (Bond & Fox, 2007; Embretson & Reise, 2000; Furr & Bacharach, 2013; Hambleton & Jones, 1993) because of the principle of monotonicity, also referred to as specific objectivity, the principle of additivity or double cancellation, which “establishes that two parameters are additively related to a third variable” (Embretson & Reise, 2000, p. 148). In other words, because of the principle of monotonicity, in Rasch modeling, probability of correctly answering an item is the additive function of individuals’ ability, or trait level, and the item’s degree of difficulty. As ability increases, so does an individual’s probability of answering that item. Because only item difficulty and person ability affect an individual’s chance of correctly answering an item, inter-individual comparisons can be made even if individuals did not receive identical items or items of the same difficulty level. This is why Rasch modeling is referred to as a test-free measurement. The purpose of this study was to apply a standard dichotomous Rasch model or partial credit model to the individual items of seven core perceptual, verbal and working memory subtests of the WAIS-IV: Block Design, Matrix Reasoning, Visual Puzzles, Similarities, Vocabulary, Information, Arithmetic Digits Forward, Digits Backward and Digit Sequencing. Results revealed that WAIS-IV subtests fall into one of three categories: optimally ordered, near optimally ordered and sub-optimally ordered. Optimally ordered subtests, Digits Forward and Digits Backward, had no disordered items. Near optimally ordered subtests were those with one to three disordered items and included Digit Sequencing, Arithmetic, Similarities and Block Design. Sub-optimally ordered subtests consisted of Matrix Reasoning, Visual Puzzles, Information and Vocabulary, with the number of disordered items ranging from six to 16. Two major implications of the result of this study were considered: the impact on individuals’ scores and the impact on overall test administration time. While the number of disordered items ranged from 0 to 16, the overall impact on raw scores was deemed minimal. Because of where the disordered items occur in the subtest, most individuals are administered all the items that they would be expected to answer correctly. A one-point reduction in any one subtest is unlikely to significantly affect overall index scores, which are the scores most commonly interpreted in the WAIS-IV. However, if an individual received a one-point reduction across all subtests, this may have a more noticeable impact on index scores. In cases where individuals discontinue before having a chance to answer items that were easier, clinicians may consider testing the limits. While this would have no impact on raw scores, it may provide clinicians with a better understanding of individuals’ true abilities. Based on the findings of this study, clinicians may consider administering only certain items in order to test the limits, based on the items’ difficulty value. This study found that the start point for most subtests is too easy for most individuals. For some subtests, most individuals may be administered more than 10 items that are too easy for them. Other than increasing overall administration time, it is not clear what impact, of any, this has. However, it does suggest the need to reevaluate current start items so that they are the true basal for most people. Future studies should break standard test administration by ignoring basal and ceiling rules to collect data on more items. In order to help clarify why some items are more or less difficult than would be expected given their ordinal rank, future studies should include a qualitative aspect, where, after each subtest, individuals are asked describe what they found easy and difficult about each item. Finally, future research should examine the effects of item ordering on participant performance. While this study revealed that only minimal reductions in index scores likely result from the prematurely stopping test administration, it is not known if disordering has other impacts on performance, perhaps by increasing or decreasing an individual’s confidence.

The Wechsler Memory Scale (WMS) is the most extensively used battery for memory assessment of adults. The third edition of the WMS (WMS-111) represents a substantial revision of previous versions. Accordingly, issues of validity of the revised instrument need to be addressed. The purpose of these studies was to contribute to the validation of the scale in the assessment of patients with temporal lobe epilepsy WE). An important role of the neuropsychological evaluation in TLE is to aid in the localization and lateralization of dysfunction. This is based on the premise that the temporal lobes are specialized for the acquisition of material-specific information, with dysfunction in the left and right mesial temporal regions being associated with verbal and nonverbal memory impairment, respectively. Since the WMS is utilized by the vast majority of epilepsy centres, evaluation of its meaning and utility in this population is essential. In Study 1, the utility of the WMS-I11 in detecting lateralized impairment was examined in a sample of patients with left (n = 55) or right (n = 47) TLE. Methods of analysis included evaluation of group means on the various indexes and subtest scores, the use of ROC curves, and an examination of Auditory-Visual Index discrepancy scores. The Auditory- Visual Delayed Index difference score appeared most sensitive to side of temporal dysfunction, although patient classification rates were not within an acceptable range to have clinical utility. The ability to predict laterality based on statistically significant index score differences was particularly weak for those with left temporal dysfunction. The use of unusually large discrepancies led to improved prediction; however, the rarity of such scores limits their usefulness. ill In Study 2, five competing models specifying the factor structure underlying the WMS- 111 primarysubtest scores were evaluated in a large sample of patients with TLE (N = 254). Models specifying separate immediate and delayed constructs resulted in inadmissible parameter estimates and model specification error. There were negligible goodness-of-fit differences between a 3-factor model of working memory, auditory memory, and visual memory, and a nested- more parsimonious- 2-factor model of working memory and general memory. The results suggested that specifying a separate visual memory factor provided little advantage for this sample- an unexpected finding in a population with lateralized dysfunction, for which one might have predicted separate auditory and visual memory dimensions. These findings add to a growing literature which suggests that the WMS-I11 has little utility in detecting lateralized dysfunction in TLE. This has important implications for the preoperative assessment of epilepsy patients.

碩士<br>中原大學<br>心理學研究所<br>102<br>Wechsler Memory Scale-Third Edition Chinese version (WMS-IIIC) is a frequently used assessment tool in clinical practice. Even though there are plenty of accumulated malingering detection studies using WMS-III in Western society, it still extremely lacks related studies in Taiwan. According to the current studies, it’s because of the “word-length effect” that the cut-off points need to be raised when we use the Digit Span subtest in Wechsler Adult Intelligence Scale-Third Edition Chinese version (WAIS-IIIC) to detect malingering. As for WMS-IIIC, there is also included the Digit Span subtest. Besides, some of the test items were modified because of the culture and language difference. Therefore, it needs to examine whether the cut-off points that used in Western society for detecting malingering can be used with Chinese speakers. The aims of the present study were to explore the applicability of WMS-IIIC for detecting malingered neurocognitive dysfunction and the adequate cut-off points in Taiwan sample. The present study was based on a between-participant design. Eighty healthy participants were randomly assigned to two groups: dissimulated neurocognitive dysfunction group and control group. All of the participants were administered all the WMS-IIIC subtests. The result showed that the dissimulated neurocognitive dysfunction group performed significantly worse than the control group. Moreover, after using ROC analysis to calculate the sensitivity and the specificity of some malingering detection indexes that used in Western society, it showed that most of the cut-off points needed to be adjusted.

碩士<br>高雄醫學大學<br>行為科學研究所碩士班<br>95<br>The purposes of this project were twofold: first, to explore the memory pattern in patients with schizophrenia using the Wechsler Memory Scale-Third Edition (WMS-III); second, to compare five competing models of the underlying factor structure of the WMS-III. Convenience sampling was used to recruit 119 patients with schizophrenia from several sources, including psychiatric clinic, day care center and community rehabilitation center of the Kaohsiung Medical University Hospital. Patients who met all of the following criteria were eligible for this study: (1) diagnosis of schizophrenia or schizoaffective disorder (Diagnostic and Statistical Manual of Mental Disorders ; DSM-IV), (2) symptomatically stable outpatients, (3) age between 18 and 65, (4) Mini-Mental State Examination（MMSE）total score ≧24, (5) ability to follow test instructions, and (6) willingness to participate in the study. Patients were excluded if they had a past history of stroke, traumatic brain injury, Parkinson’s disease, or dementia, had underwent WMS-III testing within three months of the commencement of this study, had a history of substance abuse or alcoholism, and were unable to comply with the testing schedule. Demographic and clinical information of each patient were gathered from clinical interview and medical file. The WMS-III and MMSE were administered on an individual basis to the participants. To facilitate analyses, all raw scores of the WMS-III were first converted to standard scores using the publisher-provided norms. Next, a one-sample Z test was computed to assess whether patients performed differently from standardization samples on WMS-III measures. Since group mean may hide the distribution of test scores within a group, the proportion of patients whose score on an individual subtest fell more than 1.5 standard deviations below the normative mean was calculated. Finally, the factor structure of the WMS-III was investigated using the confirmatory factor analysis module of the Analysis of Moment Structures 5.0 for Windows（AMOS 5.0）. Several important findings emerged from our study. First, performance on seven out of the eight WMS-III index scores was classified as below the medium, whereas working memory index score fell within the medium category. Secondly, results of z tests revealed significant impairment on all test measures in patients with schizophrenia, with the worst performance on the general memory (delayed memory) index. Thirdly, significant difference was found between immediate and delayed auditory memory ( p < .0001 ). Fourthly, approximately 70% of the patients scored in the designated impaired range. In particular, 53 ( 44.2% ) of patients scored in the impaired rage on the family picture II recognition subtest, whereas only 10.8% of patients scored in the impaired range on the face memory II recognition subtest. Fifthly, the WMS-III was best represented by a three-dimensional model comprising auditory memory, visual memory, and working memory. Our results provided a reference for clinical assessment and explanation for patients with schizophrenia. Future research should aim at systematic replication of this three-factor model across different subgroups of patients with schizophrenia.

The Visual Reproduction subtest of the Wechsler Memory Scale – Revised has been widely used in neuropsychological assessment as a measure of visual memory since its publication in 1987 by Wechsler. Mindful of practice effects in serial assessment, a potential limiting factor in assessing recovery or decline with this subtest is the absence of an alternative form. This study aimed to develop an alternative form and a scoring system for this form. The scoring system was modelled on a revised scoring system for the original version developed by Clark (2000). Additional procedures, namely a cued recall and recognition format, were included in the administration to improve the diagnostic utility of the subtest. Evaluation of the psychometric properties of the Alternative Form, based on the administration of both versions to an unselected adult non-clinical population (n = 44, aged 25-51) revealed high internal reliability, good convergent validity and satisfactory discriminant validity with other verbal and visual memory tests. Moreover, there was a good correlation between the Alternative Form and the Visual Reproduction subtest of the Wechsler Memory Scale – Revised, taking into account the test-retest reliability of the original version. Hence, this Alternative Form has the potential to be a useful addition to clinical practice with further refinement of the scoring criteria and development of normative data via administration to a larger sample that has a wider age range and intelligence.

Yim-chi Ho.<br>"Running head: Effects of music training on memory of children."<br>Thesis (M.Phil.)--Chinese University of Hong Kong, 2001.<br>Includes bibliographical references (leaves 51-65).<br>Abstracts in English and Chinese.<br>ABSTRACT (English Version) --- p.ii<br>ABSTRACT (Chinese Version) --- p.iii<br>ACKNOWLEDGEMENTS --- p.iv<br>TABLE OF CONTENTS --- p.v<br>LIST OF TABLES --- p.vi<br>LIST OF FIGURES --- p.vii<br>Chapter CHAPTER I - --- INTRODUCTION --- p.1<br>Chapter CHAPTER II - --- METHOD --- p.13<br>Chapter CHAPTER III - --- RESULTS --- p.19<br>Chapter CHAPTER IV - --- DISCUSSION --- p.42<br>REFERENCES --- p.51

碩士<br>中原大學<br>心理學研究所<br>94<br>The present study compared the performance of 20 patients (CDR=1) of Alzheimer’s Disease (AD) with 34 very mild dementia participants (CDR=0.5) and 30 normal control participants (CDR=0) on three verbal memory subtests in the Chinese Version of the Wechsler Memory Scale-III, including Logical Memory, Verbal Paired Associates, and Word List Learning. The researcher also used other cognitive tests that were commonly used in Taiwan in order to find out which non-memory tests have the most discriminative power for the diagnosis of dementia. Results revealed that in memory tests, the Auditory Delayed Index of the Weschler Memory Scale, which was calculated by the results of Logical Memory II and Verbal Paired Associates II, was the most predictive variable in differentiation between AD patients and normal participants. For early detection of dementia, Logical Memory subtest was found to be the best predictor for very mild dementia. In other cognitive functions, tests related to language and executive function had the most predictive value in differentiation between AD patient and normal control, such as Category Fluency, Proverbs, and Three-Dimensional Block Construction. The results of the present study provided clinical evidence for the application of the Weschler Memory Scale-III (Chinese Version) and recommendations for further study in Taiwan were also suggested.

Diffuse axonal injury (DAI) is a microscopic injury caused by a rotational acceleration of the head, the result of a traumatic brain injury (TBI), and is associated with high levels of morbidity and mortality. Researchers have studied the origin of verbal memory deficits in this population. This study aims at analyzing the relation between the different measures of verbal memory performance (immediate memory, deferred memory, learning progress, and percentage of retention) of patients with DAI. To this end, 14 adult patients with CMRRC-RP DAIs were collected, who willingly performed one of the following tests: Logic Memory I and II (ML) of the Wechsler Memory Scale -III (WMS-III), or the Auditory Verbal Learning Test (AVLT). Pearson's and Ponto-Bisserial's correlation coefficients were performed, and the results showed significant correlations between sex and the immediate memory variable (rpb=-.63, p=.008) in addition to the correlations between the variables immediate memory and the evolution of learning (r=.73, p=.003), immediate memory and deferred memory (r=.91, p=.000), immediate memory and the percentage of retention (r=.81, p=.003), deferred memory and the evolution of learning (r=.88, p=.000), deferred memory and the percentage of retention (r=.95, p=.000), and finally evolution of learning and the percentage of retention (r=.78, p=.005). Contrary to expectations, the results showed no significant correlations between these variables and the clinical variables; GCS score and coma time. In general, it was possible to infer that the four dependent variables correlate with each other, which means that the performance of patients with DAI in one of these variables will influence their performance in the others, because the stages of the memory process are correlated. If primary phases of the memory process fail, subsequent ones will not be successful, resulting in poor verbal memory performance.<br>A lesão axonal difusa (LAD) é uma lesão microscópica provocada por uma aceleração rotacional da cabeça, resultado de um traumatismo crânioencefálico (TCE) e está associada a níveis elevados de morbilidade e mortalidade. Investigadores têm estudado a origem dos défices de memória verbal nesta população. A presente investigação objetiva analisar a relação entre as diferentes medidas de desempenho de memória verbal (memória imediata, memória diferida, evolução da aprendizagem e percentagem de retenção) de doentes com LAD. Para tal foram recolhidos 14 doentes adultos com LAD do CMRRC-RP, os quais realizaram uma das seguintes provas: Memória Lógica I e II (ML) da Escala de Memória de Wechsler-III (WMS-III) ou o teste de Aprendizagem Audio-Verbal de Rey (RAVLT). Foram realizados coeficientes de correlação de Pearson e de Ponto-Bisserial e os resultados mostraram correlações significativas entre o sexo e a variável memória imediata (rpb=-.63, p=.008), bem como correlações entre as variáveis memória imediata e a evolução da aprendizagem (r=.73, p=.003), memória imediata e a memória diferida (r=.91, p=.000), memória imediata e a percentagem de retenção (r=.81, p=.003), memória diferida e a evolução da aprendizagem (r=.88, p=.000), memória diferida e a percentagem de retenção (r=.95, p=.000) e por fim, evolução da aprendizagem e a percentagem de retenção (r=.78, p=.005). Ao contrário do esperado, os resultados não mostraram correlações significativas entre estas variáveis e as variáveis clínicas pontuação da GCS e tempo de coma. De uma forma geral, foi possível inferir que as quatros variáveis dependentes correlacionam-se entre si, o que significa que o desempenho dos doentes com LAD numa destas variáveis influenciará o seu desempenho nas restantes. Isto acontece uma vez que as fases do processo de memória estão relacionadas. Se fases mais primárias do processo de memória falharem, as posteriores não irão obter sucesso, refletindo-se em fracos desempenhos de memória verbal.<br>Mestrado em Psicologia da Saúde e Reabilitação Neuropsicológica

Tese de doutoramento em Psicologia, na especialidade de Neuropsicologia, apresentada à Faculdade de Psicologia e de Ciências da Educação da Universidade de Coimbra<br>Apesar de nos últimos anos ter havido em Portugal um grande desenvolvimento no campo da avaliação neuropsicológica de pessoas idosas, no sentido de providenciar instrumentos com normas específicas para diversas populações, alguns deles ainda carecem de estudos sistemáticos com determinados grupos clínicos, de forma a serem maximizadas as potencialidades da sua utilização em contexto clínico. Entre estes grupos encontram-se diferentes tipos de demências. Os neuropsicólogos são, frequentemente, solicitados para diferenciar a doença de Alzheimer (DA) e a demência vascular (DV), as duas causas de demência mais comuns na população idosa. O principal objetivo desta investigação foi o de averiguar se haveria um funcionamento mnésico diferencial na demência vascular subcortical (DVS), um subtipo de DV relativamente homogéneo com uma etiologia mais uniforme e um desfecho mais previsível, e na doença de Alzheimer (DA). Caso este fosse observado, pretendia-se detetar padrões de défice específicos que pudessem contribuir para o diagnóstico diferencial entre estas duas patologias. Administrou-se a Escala de Memória de Wechsler-3ª edição (WMS-III) por constituir uma bateria que avalia várias dimensões da memória em adultos e analisou-se a sua capacidade discriminativa para identificar e diferenciar a DVS da DA. Adicionalmente, aplicou-se a versão portuguesa do Addenbrooke’s Cognitive Examination-Revised (ACE-R), um instrumento de rastreio cognitivo, relativamente ao qual também foi investigada a capacidade de exatidão diagnóstica. A amostra foi constituída por dois grupos clínicos (DVS: n=18; DA: n=36) e um grupo controlo (n=40). Nenhum dos grupos diferia quanto à idade e sexo e os grupos clínicos estavam emparelhados entre si quanto às seguintes variáveis: severidade da doença, funcionamento cognitivo global, sintomatologia depressiva e inteligência pré-mórbida. Os participantes dos grupos clínicos foram recrutados em contexto hospitalar (quatro serviços de neurologia de centros hospitalares) e os participantes controlo saudáveis foram recrutados na comunidade, em instituições de cariz social e/ou recreativo. As comparações do desempenho dos participantes basearam-se em modelos estatísticos não paramétricos (Quade’s rank ANCOVA) devido ao número reduzido e características das distribuições dos resultados obtidos por cada grupo. A exatidão diagnóstica e a capacidade discriminativa dos instrumentos aplicados foram calculadas através de curvas ROC (receiver operating characteristic). Os resultados globais sugerem que os dois grupos clínicos têm um funcionamento mnésico distinto, apresentando dificuldades em diferentes tipos e fases da memória. Assim o grupo com DVS teve um desempenho significativamente superior ao do grupo com DA nos seguintes tipos de memória: auditiva imediata, visual e auditiva diferida, de reconhecimento e memória geral. Os participantes com DA manifestaram problemas ao nível da codificação e consolidação da informação e os participantes com DVS caracterizaram-se por dificuldades na recuperação da mesma. Apesar das limitações da amostra, os resultados obtidos podem fornecem orientações acerca da exatidão diagnóstica e capacidade de diagnóstico diferencial da WMS-III e do ACE-R nestes grupos clínicos.<br>Although in the recent years there has been a great development in the field of neuropsychological assessment of older people in Portugal, providing tools with specific norms for certain populations, a number of these instruments still lack systematic studies with certain clinical groups in order to maximize the potentialities of their use in clinical practice. Among these there are different types of dementia. Neuropsychologists are often asked to differentiate Alzheimer’s disease (AD) and vascular dementia (VD), the two most common causes of dementia in the elderly population. The main goal of this research was to understand if there is a differential memory functioning in subcortical vascular dementia (SVD), a more homogenous VD subtype with a more uniform aetiology and a predictable outcome, and in Alzheimer’s disease. If there was such differention, we would intend to detect patterns of specific deficits which can help in the differential diagnosis between these two pathologies. For that purpose we used the Wechsler Memory Scale – 3rd edition (WMS-III) because it is a battery for adults’ memory assessment, which evaluates several dimensions of this cognitive function, and we analysed its discriminative capacity in detecting and differentiating the SVD from AD. Additionally, we administered the Portuguese version of Addenbrooke’s Cognitive Examination – Revised (ACE-R), a cognitive screening tool. We also evaluated the diagnostic accuracy of this test. The sample was composed by two clinical groups (SVD: n=18; AD: n=36) and one control group (n=40). None of the groups differed in age and sex and the clinical groups were matched in the following variables: disease severity, overall cognitive functioning, depressive symptomatology, and pre-morbid intelligence. The participants of the clinical groups were recruited in the hospital setting (four neurological departments of hospital centres took part in this research) and the control participants were recruited from the community in senior social and/or recreational institutions. The performance comparisons of the subjects were based on nonparametric statistical models (Quade’s rank ANCOVA) due to the small number and specific distribution features of the data obtained from each group. The diagnostic accuracy and discriminative ability of the tools were examined via ROC (receiver operating characteristic) curves. General findings suggest that these two clinical groups have a different memory functioning, presenting difficulties in different memory types and stages. The SVD group had a significantly better performance than the AD group on the following types of memory: auditory immediate, visual and auditory delayed, auditory recognition delayed and general memory. The AD patients showed encoding and consolidation problems and the SVD patients were characterized by difficulties in retrieval. Despite sample limitations, the results obtained could provide some guidelines for the diagnostic accuracy and differential diagnosis ability of the WMS-III and the ACE-R in these clinical groups.<br>Fundação para a Ciência e Tecnologia - SFRH/68763/2010