Upload
others
View
4
Download
0
Embed Size (px)
Citation preview
Conducting Geriatric Evaluations: Using Data from WAIS-IV, WMS-IV, and ACSW4W4Gloria Maccow, Ph.D., Assessment Training Consultant
Copyright © 2011. Pearson, Inc. All rights reserved. 1
Conducting Geriatric Evaluations:Using Data from WAIS-IV, WMS-IV, and
ACSW4W4
Gloria Maccow, Ph.D.Assessment Training Consultant
2 | Copyright © 2011. All rights reserved.
Objectives
• Select components of Advanced Clinical Solutions for WAIS-IV and WMS-IV to determine the presence of dementia;
• Link assessment data to treatment based on the demands of the individual’s functional environment.
3 | Copyright © 2011. All rights reserved.
Three Batteries
• WAIS-IV, WMS-IV, and ACS were developed to be used together.
• Decisions made in the development of one instrument affected the development of other components.
• Each instrument provides unique information about the examinee.
Conducting Geriatric Evaluations: Using Data from WAIS-IV, WMS-IV, and ACSW4W4Gloria Maccow, Ph.D., Assessment Training Consultant
Copyright © 2011. Pearson, Inc. All rights reserved. 2
4 | Copyright © 2011. All rights reserved.
Factors to Consider
• The tests were built together to allow users to better identify the nature of the underlying cognitive difficulty.
• One of the strengths of the tests is their co-norming.
• Use regression based approach to partial out overlapping variance (contrast scores).
5 | Copyright © 2011. All rights reserved.
Three Batteries
• WAIS‐IV, WMS‐IV, and ACS were developed to be used together.
• Decisions made in the development of one instrument affected the development of other components.
• Each instrument provides unique information about the examinee.
6 | Copyright © 2011. All rights reserved.
Applications of Batteries
WAIS‐IV and WMS‐IV used for– School based evaluations
– Disability evaluations– Psychiatric evaluations– Neuropsychological evaluations– Forensic evaluations– Medical/legal evaluations– Competency evaluations– Vocational Rehabilitation evaluations, etc.
Conducting Geriatric Evaluations: Using Data from WAIS-IV, WMS-IV, and ACSW4W4Gloria Maccow, Ph.D., Assessment Training Consultant
Copyright © 2011. Pearson, Inc. All rights reserved. 3
7 | Copyright © 2011. All rights reserved.
Factors to Consider
• Difficult to build one instrument to answer all possible questions.
• Not all clinicians will need all pieces of information.
• Expectation is that clinicians will select those measures that best fit their practice and workflow.
8 | Copyright © 2011. All rights reserved.
Factors to Consider
• The tests were built together to allow users to better identify the nature of the underlying cognitive difficulty.
• One of the strengths of the tests is their co‐norming.
• Use regression based approach to partial out overlapping variance (contrast scores).
Wechsler Adult Intelligence ScaleFourth Edition
Conducting Geriatric Evaluations: Using Data from WAIS-IV, WMS-IV, and ACSW4W4Gloria Maccow, Ph.D., Assessment Training Consultant
Copyright © 2011. Pearson, Inc. All rights reserved. 4
Working Memory Scale
Core SubtestsDigit Span Arithmetic
Supplemental SubtestsLetter-Number Sequencing (16-69)
Verbal Comprehension Scale
Core SubtestsSimilarities VocabularyInformation
Supplemental SubtestsComprehension
Processing Speed Scale
Core SubtestsSymbol Search Coding
Supplemental SubtestsCancellation (16-69)
Perceptual Reasoning Scale
Core SubtestsBlock Design Matrix Reasoning Visual Puzzles
Supplemental SubtestsPicture Completion Figure Weights (16-69)
Full Scale
New!
New!
WAIS-IV Content and Structure Ages 16–90
New!
GAI
10 | Copyright © 2011. All rights reserved.
11 | Copyright © 2011. All rights reserved.
What is the GAI?
• The WAIS–IV GAI provides the practitioner with a summary score that is less sensitive than the FSIQ to the influence of working memory and processing speed.
• GAI = sum of scaled scores for VCI subtests and PRI subtests
12 | Copyright © 2011. All rights reserved.
What is the GAI?
• WAIS–IV GAI should be used for discrepancy comparisons
– Ability and Memory
– Ability and achievement
• GAI is NOT a replacement for FSIQ
Conducting Geriatric Evaluations: Using Data from WAIS-IV, WMS-IV, and ACSW4W4Gloria Maccow, Ph.D., Assessment Training Consultant
Copyright © 2011. Pearson, Inc. All rights reserved. 5
13 | Copyright © 2011. All rights reserved.
General Ability Index
Consider*Consider* using the GAI if a significant and unusual discrepancy exists between
VCI and WMI; or PRI and PSI; or WMI and PSI, or between subtests within WMI and/or PSI.
Note: The FSIQ is the most valid measure of overall cognitive ability and WM and PS are vital to comprehensive evaluation of cognitive ability.
14 | Copyright © 2011. All rights reserved.
General Ability Index - Note!
• The GAI is used when neuropsychological deficits adversely impact performance on WM and PS.
• Impaired performance on WM and/or PS may mask actual differences between general cognitive ability (FSIQ) and other cognitive functions (e.g., memory).
• The GAI does not replace the FSIQ. Report and interpret GAI along with FSIQ.
[see WAIS-IV Technical Manual]
Wechsler Memory ScaleFourth Edition
Conducting Geriatric Evaluations: Using Data from WAIS-IV, WMS-IV, and ACSW4W4Gloria Maccow, Ph.D., Assessment Training Consultant
Copyright © 2011. Pearson, Inc. All rights reserved. 6
16 | Copyright © 2011. All rights reserved.
Memory and Learning
• Encoding: External information is transformed into mental representations or memories and stored in STM.
• Consolidation: Information from immediate memory is solidified into long-term memory stores.
• Retrieval: Information is brought into conscious awareness.
17 | Copyright © 2011. All rights reserved.
WMS-IV Test Battery
Seven subtests: – Logical Memory, Verbal Paired
Associates, and Visual Reproduction -retained from WMS-III.
– Brief Cognitive Status Exam, Designs, Spatial Addition, and Symbol Span - NEW.
18 | Copyright © 2011. All rights reserved.
WMS-IV Test Battery
Logical Memory, Verbal Paired Associates, Designs, and Visual Reproduction have two conditions:
– the immediate condition (I), and
– the delayed condition (II),
Condition I and II are administered about 20–30 minutes apart.
Conducting Geriatric Evaluations: Using Data from WAIS-IV, WMS-IV, and ACSW4W4Gloria Maccow, Ph.D., Assessment Training Consultant
Copyright © 2011. Pearson, Inc. All rights reserved. 7
19 | Copyright © 2011. All rights reserved.
WMS-IV Batteries
Adult Battery Ages 16-69
Older Adult Battery Ages 65-90
[Also, WMS-IV Flexible Approach]
20 | Copyright © 2011. All rights reserved.
Types of Scores
• Primary Subtest Scaled Scores (mean=10, sd = 3)
• Index Scores (mean=100, sd = 15)
• Process Scores (Scaled Score or Cumulative Percentage)
• Contrast Scaled Scores
Components of ACSComponents of ACS
Memory GridCardsWord Choice Stimulus BookRecord Forms/Booklets
Conducting Geriatric Evaluations: Using Data from WAIS-IV, WMS-IV, and ACSW4W4Gloria Maccow, Ph.D., Assessment Training Consultant
Copyright © 2011. Pearson, Inc. All rights reserved. 8
22 | Copyright © 2011. All rights reserved.
Applications of ACS . . .
additional assessments of: – premorbid functioning– effort– social cognition– executive function
A separate instrument, Texas Functional Living Scale, linked with the WAIS-IV and WMS-IV, can be used to assess instrumental activities of daily living.
23 | Copyright © 2011. All rights reserved.
Applications of ACS . . .
and software that delivers:– Demographically Adjusted Norms– Additional scores for WAIS-IV and WMS-IV– Reliable Change scores
24 | Copyright © 2011. All rights reserved.
Remember! Many Factors Can Influence Performance
– Acuity– Attention– Executive Functioning– Global Intellectual Functioning– Working Memory– Language Impairment (Auditory Memory subtests)– Visual-Spatial Processing (Visual Memory subtests)– Fatigue– Poor Effort– Impulsivity
Conducting Geriatric Evaluations: Using Data from WAIS-IV, WMS-IV, and ACSW4W4Gloria Maccow, Ph.D., Assessment Training Consultant
Copyright © 2011. Pearson, Inc. All rights reserved. 9
Sample Case Study
Clinical Applications: Assessing DementiaMabel Sample82
26 | Copyright © 2011. All rights reserved.
Intake Information
• Mabel is an 82-year old female.• She attended college but did not
complete degree. • She was married for 50 years until
her husband died 10 years ago. • She was a homemaker and never
worked outside the home.
27 | Copyright © 2011. All rights reserved.
Referral Concerns
• Her children referred Mabel for evaluation.
• They are concerned about declines in her cognitive abilities and about her living alone.
Conducting Geriatric Evaluations: Using Data from WAIS-IV, WMS-IV, and ACSW4W4Gloria Maccow, Ph.D., Assessment Training Consultant
Copyright © 2011. Pearson, Inc. All rights reserved. 10
28 | Copyright © 2011. All rights reserved.
Referral Concerns
According to her children,
– Mabel evidences word retrieval difficulties, and difficulty sequencing complex information.
– She is forgetful and easily overwhelmed with instrumental daily activities.
29 | Copyright © 2011. All rights reserved.
Intake Information
• Mabel is in relatively good physical health.
• She was diagnosed with atrial fibrilation and osteoporosis – both are being treated with medication.
• She takes Namenda to treat cognitive decline.
30 | Copyright © 2011. All rights reserved.
Dementia or Mild Cognitive Impairment
Clinical concepts concerning this referral:
– Change in cognitive status from a previous level
– Mental Status
– Memory impairment
– Self-care
– Depression
Conducting Geriatric Evaluations: Using Data from WAIS-IV, WMS-IV, and ACSW4W4Gloria Maccow, Ph.D., Assessment Training Consultant
Copyright © 2011. Pearson, Inc. All rights reserved. 11
31 | Copyright © 2011. All rights reserved.
Clinical Questions
Is Mabel experiencing dementia?– Does she evidence deficits in two or
more areas of cognition?– Does she manifest a decline in memory
and other cognitive functions relative to premorbid cognitive ability?
If cognitive abilities are impaired, what is the impact on daily living?
32 | Copyright © 2011. All rights reserved.
Procedures Utilized
– WAIS-IV– WMS-IV + Brief Cognitive Status Exam– ACS: Additional Scores– ACS: Test of Premorbid Functioning– Reliable Change Scores (Serial
Assessment)– Texas Functional Living Scales
33 | Copyright © 2011. All rights reserved.
Evaluation Results
• Mini Mental Status Exam = 19 (middle stage/moderate Alzheimer’s disease).
• BDI-II=1 (no indication of depression).
Conducting Geriatric Evaluations: Using Data from WAIS-IV, WMS-IV, and ACSW4W4Gloria Maccow, Ph.D., Assessment Training Consultant
Copyright © 2011. Pearson, Inc. All rights reserved. 12
34 | Copyright © 2011. All rights reserved.
1.25<.0120.87102.081.2FSIQ
1.70<.0126.06102.676.6PSI
1.12<.0116.66100.984.3WMI
1.01<.0115.72101.585.8PRI
1.04<.0116.84103.086.2VCI
Effect Effect SizeSizepp valuevalue
MeanMean
Diff.Diff.Control Control MeanMean
Clinical Clinical MeanMeanCompositeComposite
WAIS-IV: Probable Dementia of Alzheimer’s Type-Mild
n = 44
35 | Copyright © 2011. All rights reserved.
.72<.0110.00104.894.8FSIQ
.53.057.33102.294.9PSI
.54<.018.13104.796.6WMI
.61<.018.43102.493.9PRI
.49<.017.13106.199.0VCI
Effect Effect SizeSizepp valuevalue
MeanMean
Diff.Diff.Control Control MeanMean
Clinical Clinical MeanMeanCompositeComposite
WAIS-IV: Mild Cognitive Impairment
n = 53
36 | Copyright © 2011. All rights reserved.
Full Scale IQ = 89 General Ability Index = 95
Symbol Search 4Arithmetic 9
Coding 6Digit Span 10
Processing Speed 74Working Memory 97
Visual Puzzles 8Information 8
Matrix Reasoning 9Vocabulary 10
Block Design 9Similarities 11
Perceptual Reasoning 92Verbal Comprehension 98
Index/Subtest Index Score/ Scaled Score
Index/Subtest Index Score/ Scaled Score
WAIS-IV Scores
Conducting Geriatric Evaluations: Using Data from WAIS-IV, WMS-IV, and ACSW4W4Gloria Maccow, Ph.D., Assessment Training Consultant
Copyright © 2011. Pearson, Inc. All rights reserved. 13
37 | Copyright © 2011. All rights reserved.
Index-Level Discrepancy Comparisons
12.4Y3.19-69589FSIQ - GAI
7.3Y10.99237497WMI - PSI
12.1Y11.75187492PRI - PSI
37.1N10.99-59792PRI - WMI
7Y9.75247498VCI - PSI
48.1N8.8219798VCI - WMI
32.5N9.7569298VCI - PRI
Base RateOverall Sample
SignificantDifference
Y / N
Critical Value
.05Diff. Score 2Score 1Comparison
38 | Copyright © 2011. All rights reserved.
PSI: Weakness
Mabel’s ability to mentally process routine information rapidly without making errors is a weakness relative
to her verbal reasoning and nonverbal reasoning abilities.
39 | Copyright © 2011. All rights reserved.
PSI: Functional Implication
A weakness in the speed of processing routine visual information may make the task of comprehending novel and/or non-routine information more time-consuming
and difficult for Mabel.
Conducting Geriatric Evaluations: Using Data from WAIS-IV, WMS-IV, and ACSW4W4Gloria Maccow, Ph.D., Assessment Training Consultant
Copyright © 2011. Pearson, Inc. All rights reserved. 14
40 | Copyright © 2011. All rights reserved.
PSI: Functional Implication
A weakness in simple visual scanning and tracking may leave her less time and mental energy
for the complex task of understanding new material.
41 | Copyright © 2011. All rights reserved.
WMS-IV: Probable Dementia of Alzheimer’s Type-Mild
n = 48 (ages 65-89)
1.64<.0123.57110.486.9GAI
2.39<.0140.98104.663.6DMI
2.16<.0135.71107.471.7IMI
2.00<.0132.85102.569.7VMI
2.24<.0138.60107.168.5AMI
Effect Sizep value
MeanDiff.
Control Mean
Clinical Mean
WMS-IV Index
42 | Copyright © 2011. All rights reserved.
0.78<.019.73106.997.2GAI
1.01<.0116.00103.587.5DMI
1.09<.0115.00105.890.8IMI
1.22<.0115.54107.291.6VWMI
0.89<.0112.84102.189.3VMI
1.05<.0115.65105.689.9AMI
Effect Size
p valueMeanDiff.
Control Mean
Clinical Mean
WMS-IV Index
WMS-IV: Mild Cognitive Impairment
n = 50 (ages 55-84)
Conducting Geriatric Evaluations: Using Data from WAIS-IV, WMS-IV, and ACSW4W4Gloria Maccow, Ph.D., Assessment Training Consultant
Copyright © 2011. Pearson, Inc. All rights reserved. 15
43 | Copyright © 2011. All rights reserved.
WMS-IV Scores: BCSE
• Mabel’s global cognitive functioning, as measured by the BCSE, was in the Lowrange, compared to others, ages 70 to 90, with a similar educational background.
• This classification level represents 2–4% of cases within her age and education group.
• Functioning in this range has a moderately high probability of being considered atypical, though not necessarily diagnostic.
44 | Copyright © 2011. All rights reserved.
Visual Reproduction II 5
Symbol Span 6Verbal Paired Associates II 7
Visual Reproduction I 3
Verbal Paired Associates II 7Verbal Paired Associates I 7
Logical Memory II 2Logical Memory I 9
Delayed Memory 67Immediate Memory 77
Verbal Paired Associates I 7
Visual Reproduction II 5Logical Memory II 2
Visual Reproduction I 3Logical Memory I 9
Visual Memory 66Auditory Memory 78
Index/Subtest Index Score/ Scaled Score
Index/Subtest Index Score/ Scaled Score
WMS-IV Scores
45 | Copyright © 2011. All rights reserved.
Ability–Memory Analysis
1%Y10.86306797Delayed Memory
4%Y10.41207797Immediate Memory
<1%Y7.72316697Visual Memory
5-10%Y9.33197897Auditory Memory
BaseBaseRateRate
Sign. Sign. Diff. Diff. Y / NY / N
Critical Critical ValueValueDiff.Diff.
Actual Actual WMSWMS––IV IV Index Index ScoreScore
Predicted Predicted WMSWMS––IV IV Index Index ScoreScoreIndexIndex
Ability Score Type: GAI (= 95)Ability Score Type: GAI (= 95)
Predicted Difference MethodPredicted Difference Method
Conducting Geriatric Evaluations: Using Data from WAIS-IV, WMS-IV, and ACSW4W4Gloria Maccow, Ph.D., Assessment Training Consultant
Copyright © 2011. Pearson, Inc. All rights reserved. 16
46 | Copyright © 2011. All rights reserved.
Retention of Information
56777Immediate Memory Index vs. Delayed Memory Index
Contrast Scaled ScoreScore 2Score 1Index
WMSWMS––IV IndexesIV Indexes
47 | Copyright © 2011. All rights reserved.
Auditory Memory Relative to WAIS-IV Abilities
67897Working Memory Index vs. Auditory Memory Index
57898Verbal Comprehension Index vs. Auditory Memory Index
57895General Ability Index vs. Auditory Memory Index
Contrast Scaled ScoreScore 2Score 1Score
Contrast Scaled ScoresContrast Scaled Scores
48 | Copyright © 2011. All rights reserved.
GAI vs. AMI
The clinical groups that significantly differ from the controls and have large effect sizes on the GAI vs. AMI are
– Probable Dementia of the Alzheimer’s Type-Mild Severity,
– Mild Cognitive Impairment, – Mild and Moderate Intellectual Disability, – Schizophrenia, and – Moderate-to-Severe TBI groups.
Conducting Geriatric Evaluations: Using Data from WAIS-IV, WMS-IV, and ACSW4W4Gloria Maccow, Ph.D., Assessment Training Consultant
Copyright © 2011. Pearson, Inc. All rights reserved. 17
49 | Copyright © 2011. All rights reserved.
Auditory Process Scores
-1675VPA II Word Recall
10-16%--22VPA II Recognition
17-25%--15LM II Recognition
Cumulative Percentage(Base Rate)
Percentile Rank
Scaled Score
Raw ScoreScore
Auditory Memory Process Score SummaryAuditory Memory Process Score Summary
50 | Copyright © 2011. All rights reserved.
Forgetting and Retrieval: Auditory Modality
129LM Immediate Recall vs. Delayed Recall
1217-25%LM II Recognition vs. Delayed Recall
Contrast Scaled ScoreScore 2Score 1Score
Logical MemoryLogical Memory
51 | Copyright © 2011. All rights reserved.
Forgetting and Retrieval: Auditory Modality
1077VPA Immediate Recall vs. Delayed Recall
9710-16%VPA II Recognition vs. Delayed Recall
Contrast Scaled ScoreScore 2Score 1Score
Verbal Paired AssociatesVerbal Paired Associates
Conducting Geriatric Evaluations: Using Data from WAIS-IV, WMS-IV, and ACSW4W4Gloria Maccow, Ph.D., Assessment Training Consultant
Copyright © 2011. Pearson, Inc. All rights reserved. 18
52 | Copyright © 2011. All rights reserved.
Visual Memory Relative to Other Abilities
26692Perceptual Reasoning Index vs. Visual Memory Index
26695General Ability Index vs. Visual Memory Index
Contrast Scaled ScoreScore 2Score 1Score
53 | Copyright © 2011. All rights reserved.
Visual Process Scores
>75%--43VR II Copy
17-25%--2VR II Recognition
Cumulative Percentage(Base Rate)
Percentile Rank
Scaled Score
Raw ScoreScore
Visual Memory Process Score SummaryVisual Memory Process Score Summary
54 | Copyright © 2011. All rights reserved.
Forgetting and Retrieval: Visual Modality
853VR Immediate Recall vs. Delayed Recall
23>75%VR Copy vs. Immediate Recall
6517-25%VR II Recognition vs. Delayed Recall
Contrast Scaled ScoreScore 2Score 1Score
Visual ReproductionVisual Reproduction
Conducting Geriatric Evaluations: Using Data from WAIS-IV, WMS-IV, and ACSW4W4Gloria Maccow, Ph.D., Assessment Training Consultant
Copyright © 2011. Pearson, Inc. All rights reserved. 19
55 | Copyright © 2011. All rights reserved.
Modality-Specific Memory Strengths and Weaknesses
56678Auditory Memory Index vs. Visual Memory Index
Contrast Scaled ScoreScore 2Score 1Index
WMSWMS––IV IndexesIV Indexes
56 | Copyright © 2011. All rights reserved.
Visual Working Memory
Mabel’s ability to keep in mind a mental image of a symbol and its relative spatial position on the
page is below average (Symbol Span scaled score = 6).
57 | Copyright © 2011. All rights reserved.
Immediate Memory Relative to WAIS-IV GAI
47795General Ability Index vs. Immediate Memory Index
Contrast Scaled ScoreScore 2Score 1Score
Conducting Geriatric Evaluations: Using Data from WAIS-IV, WMS-IV, and ACSW4W4Gloria Maccow, Ph.D., Assessment Training Consultant
Copyright © 2011. Pearson, Inc. All rights reserved. 20
58 | Copyright © 2011. All rights reserved.
GAI vs. IMI
The clinical groups that significantly differ from the controls and have large effect sizes on the GAI vs. IMI are
– Probable Dementia of the Alzheimer’s Type-Mild Severity,
– Mild Cognitive Impairment, – Mild and Moderate Intellectual Disability, – Right Temporal Lobectomy, – Moderate-to-Severe TBI groups, and– Autistic Disorder groups.
59 | Copyright © 2011. All rights reserved.
Delayed Memory Relative to WAIS-IV GAI
36795General Ability Index vs. Delayed Memory Index
Contrast Scaled ScoreScore 2Score 1Score
60 | Copyright © 2011. All rights reserved.
GAI vs. DMI
The clinical groups that significantly differ from the controls and have large effect sizes on the GAI vs. DMI are
– Probable Dementia of the Alzheimer’s Type-Mild Severity,
– Mild Cognitive Impairment, – Mild and Moderate Intellectual Disability, – Right Temporal Lobectomy, – Autistic Disorder, Schizophrenia, and – Moderate-to-Severe TBI groups.
Conducting Geriatric Evaluations: Using Data from WAIS-IV, WMS-IV, and ACSW4W4Gloria Maccow, Ph.D., Assessment Training Consultant
Copyright © 2011. Pearson, Inc. All rights reserved. 21
61 | Copyright © 2011. All rights reserved.
Additional Scores-AMI
Borderline576Auditory Recognition
Extremely Low167Auditory Delayed
Low Average2389Auditory Immediate
Qualitative Description
Percentile Rank
Index ScoreWMS-IV Index
62 | Copyright © 2011. All rights reserved.
Additional Scores-AMI
56776Auditory Recognition Index vs. Auditory Delayed Memory Index
16789Auditory Immediate Index vs. Auditory Delayed Memory Index
Contrast Scaled ScoreScore 2Score 1Score
63 | Copyright © 2011. All rights reserved.
Test of Premorbid Functioning
• Uses Atypical Grapheme-Phoneme translation to measure word knowledge through reading.
• Relatively resistant to brain injury and dementia.
Conducting Geriatric Evaluations: Using Data from WAIS-IV, WMS-IV, and ACSW4W4Gloria Maccow, Ph.D., Assessment Training Consultant
Copyright © 2011. Pearson, Inc. All rights reserved. 22
64 | Copyright © 2011. All rights reserved.
Test of Premorbid Functioning
• Premorbid Prediction Models– Demographics only (simple or complex)– TOPF only– Demographics with TOPF
• Predict WAIS-IV Indexes and WMS-IV IMI, DMI, and VWMI
65 | Copyright © 2011. All rights reserved.
Premorbid Functioning
High Average89.711961Test of Premorbid Functioning
Qualitative Description
Percentile Rank
Standard Score
Raw Score
Test of Premorbid Functioning Score Summary
66 | Copyright © 2011. All rights reserved.
Premorbid Functioning
5.7%Y11.04-4411874PSI
16.1%Y9.77-2111897WMI
17.9%Y11.12-2511792PRI
9.3%Y7.3-1911798VCI
3.4%Y6.11-2811789FSIQ
Base Rate
Significant Difference
Critical Value DifferenceEquatedActualComposite
WAISWAIS––IV Actual IV Actual –– Predicted ComparisonPredicted Comparison
Actual – Predicted Comparison based on Test of Premorbid Functioning Equated Model
Conducting Geriatric Evaluations: Using Data from WAIS-IV, WMS-IV, and ACSW4W4Gloria Maccow, Ph.D., Assessment Training Consultant
Copyright © 2011. Pearson, Inc. All rights reserved. 23
67 | Copyright © 2011. All rights reserved.
Premorbid Functioning
3.9%Y10.36-5111867DMI
2.2%Y9.65-4011777IMI
Base Rate
Significant Difference
Critical Value DifferenceEquatedActualIndex
WMS–IV Actual – Predicted Comparison
Actual – Predicted Comparison based on Test of Premorbid Functioning Equated Model
68 | Copyright © 2011. All rights reserved.
Reliable Change Score
Used to determine if there has been a change in cognitive functioning between 2 time periods
– Decline associated with dementia or other progressive neurological condition.
– Improved function related to intervention such as rehabilitation or medication effects.
69 | Copyright © 2011. All rights reserved.
Reliable Change Score
Applies multivariate hierarchical regression method to control for practice effects and other factors associated with
change in performance.
Predictors: Time 1 performance, GAI (or VCI or PRI), Age, Education,
Sex, Test Interval.
Conducting Geriatric Evaluations: Using Data from WAIS-IV, WMS-IV, and ACSW4W4Gloria Maccow, Ph.D., Assessment Training Consultant
Copyright © 2011. Pearson, Inc. All rights reserved. 24
70 | Copyright © 2011. All rights reserved.
Reliable Change Score
• Compare actual time 2 performance to predicted time 2 performance– Statistically significant difference– Base rate
• If difference is significant and rare, may indicate a decline or improvement in functioning.
71 | Copyright © 2011. All rights reserved.
Reliable Change Score
Serial Assessment Report for WAIS-IV and WMS-IV Mabel Sample82
Test-Retest Interval 6 months 0 days
72 | Copyright © 2011. All rights reserved.
WAIS-IV Serial Assessment
Conducting Geriatric Evaluations: Using Data from WAIS-IV, WMS-IV, and ACSW4W4Gloria Maccow, Ph.D., Assessment Training Consultant
Copyright © 2011. Pearson, Inc. All rights reserved. 25
73 | Copyright © 2011. All rights reserved.
WMS-IV Serial Assessment
74 | Copyright © 2011. All rights reserved.
Clinical Questions
Is Mabel experiencing dementia?
– Progressive and long-term decline in cognitive function.
• Perceptual reasoning ability
• Speed of processing visual information
• Memory
75 | Copyright © 2011. All rights reserved.
Diagnosis and Treatment
• Evaluate all data to determine if Mabel’s current functioning is consistent with a diagnosis of Dementia.
• Establish the impact of cognitive impairment on Mabel’s performance of instrumental activities of daily living.
Conducting Geriatric Evaluations: Using Data from WAIS-IV, WMS-IV, and ACSW4W4Gloria Maccow, Ph.D., Assessment Training Consultant
Copyright © 2011. Pearson, Inc. All rights reserved. 26
76 | Copyright © 2011. All rights reserved.
Instrumental Activities of Daily Living
Texas Functional Living Scale
TFLS Total
Memory Total
Communication Total
Money and Calculation
TotalTime TotalScore
40TFLS T-Score
3-926-5017-2551-75Subscale Cumulative Percentage
4332668 Raw Score
77 | Copyright © 2011. All rights reserved.
Instrumental Activities of Daily Living
• Impairments in cognitive functions adversely impact Mabel’s ability to perform instrumental activities of daily living.
• T-score of 40 on the TFLS indicates mild impairment.
78 | Copyright © 2011. All rights reserved.
Diagnosis
• On initial assessment, Mabel’s performance indicated a possible decline in functioning from previous levels of performance with a clear memory impairment present.
• On re-evaluation, Mabel showed significant declines in general intellectual and memory functioning.
Conducting Geriatric Evaluations: Using Data from WAIS-IV, WMS-IV, and ACSW4W4Gloria Maccow, Ph.D., Assessment Training Consultant
Copyright © 2011. Pearson, Inc. All rights reserved. 27
79 | Copyright © 2011. All rights reserved.
Diagnosis
• The data indicate a progressive and long-term decline in cognitive function.
• The clinician diagnosed Mabel with Alzheimer’s Disease.
80 | Copyright © 2011. All rights reserved.
Living Arrangements
• It was determined that Mabel required an assisted living environment due to her significant difficulties with memory and daily functioning.
• Mabel was placed in an assisted living facility close to her children. She functioned relatively independently and did well with structured routines.
81 | Copyright © 2011. All rights reserved.
Interventions: Encoding
• Given her relative strength in higher-order conceptualization and reasoning, Mabel may benefit from using associative linkages when encoding information.
• By linking new information to what has been previously learned, she may be able to gain a more global understanding of the information and improve recall.
Conducting Geriatric Evaluations: Using Data from WAIS-IV, WMS-IV, and ACSW4W4Gloria Maccow, Ph.D., Assessment Training Consultant
Copyright © 2011. Pearson, Inc. All rights reserved. 28
82 | Copyright © 2011. All rights reserved.
Interventions: Encoding
• When she first encounters new information, she should link it in as many ways as possible to already known information.
• This strategy creates several avenues for remembering the information later.
83 | Copyright © 2011. All rights reserved.
Interventions: Encoding
• Encourage her to use external memory sources.
• For example, leaving verbal messages on her telephone answering machine, to remind herself to pay bills, take medication, schedule/keep appointments, etc.
84 | Copyright © 2011. All rights reserved.
Interventions: Retention of Information
To increase her ability to retain information, build on her relative strength in verbal comprehension.
– Encourage her to verbalize the steps she will use to complete a daily routine (e.g., dressing) or to complete an assigned task. This self-talk can reinforce the sequencing of all necessary steps for successful task completion.
Conducting Geriatric Evaluations: Using Data from WAIS-IV, WMS-IV, and ACSW4W4Gloria Maccow, Ph.D., Assessment Training Consultant
Copyright © 2011. Pearson, Inc. All rights reserved. 29
85 | Copyright © 2011. All rights reserved.
Interventions: Retention of Information
To increase her ability to retain information, build on her relative strength in verbal comprehension.
– To complete extensive or complex tasks, ask her to break down these larger tasks into shorter, simpler tasks with feasible deadlines.
86 | Copyright © 2011. All rights reserved.
Interventions to Improve Skills
• Her short-term memory and vocabulary skills could be improved at home while playing games that require memory, concentration, and recall of information.
87 | Copyright © 2011. All rights reserved.
Interventions to Improve Skills
• Computer-assisted educational programs may be of benefit to her.
• If she enjoys video games, learning can be integrated into this fun activity.
• Numerous commercial educational software packages exist to meet her needs.
Conducting Geriatric Evaluations: Using Data from WAIS-IV, WMS-IV, and ACSW4W4Gloria Maccow, Ph.D., Assessment Training Consultant
Copyright © 2011. Pearson, Inc. All rights reserved. 30
For more information contact your Pearson Assessment Consultant
DE, NJ (South), PA800.627.7271 x 262240James Whitaker
CT, MA, NY (Central/Upstate)800.627.7271 x 262279Michael Grau
FL800.627.7271 x 262267Diana Gintner
AK, CO, IN, ME, OK, VT800-627-7271 x 267056Dan Zwiers
DC, MD, VA800.627.7271 x 262295Susan Wallace
IL800.627.7271 x 262236Michael Suess
TX (North)800-627-7271 x 262237Tammy Stephens
NJ (Northern), NY (South)800.627.7271 x 262282Jim Simone
NC, SC800.627.7271 x 262138Gail Rodin
AL, MS, NH, RI, TN800-627-7271 x 267055Marissa Norman
KS, KY, IA, MT, NE, UT, WY800-627-7271 x 267054Cheryl Neithercott
CA (South), AZ800.627.7172 x 262235Ellen Murphy
CA (North), OR, WA800.627.7271 x 262134Patrick Moran
OH, LA, WV800-627-7271 x 267053Chris McMorris
MO, ID, ND, NM, SD 800-627-7271 x 267052Tiffany Laszlo
GA800.627.7172 x 262248Maggie Kjer
MI, MN, WI800.627.7271 x 262159John Hanson
AR, TX (South)800.627.7271 x 262308Anise Flowers
CA (Central), NV800.627.7271 x 262022Diane Donaldson
Geographic AreaTelephoneName
Questions and Comments
Gloria Maccow, [email protected]
www.psychcorp.comwww.wais-iv.comwww.wms-iv.com
www.acsw4w4.com