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Validity convergent and reliability test-retest of the rey auditory verbal learning test


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Objective: This study provides evidence for the validity and reliability of the Rey Auditory Verbal Learning Test (RAVLT). Method: The reliability was measured by internal consistency and the test-retest method with a mean interval of 35 days. To determine the convergent and divergent validity, it was compared the performance on the RAVLT with the Benton Visual Retention Test (BVRT) and the Trail Making Test (TMT), respectively. The test was been taken by 34 healthy participants of both genders, ages 17 to 40 and 11.2±0.7 years of education. Results: All test-retest correlation coefficients achieved significance, ranging between 0.36 and 0.68. The A2 measure obtained the weakest correlation (r =0.28), and the sum of A1-A5 (r =0.68) was the strongest. The rest of the measures obtained moderate correlations. The value of the Cronbach's Alpha coefficient was 0.80. The two RAVLT measures, the sum of A1-A5 and A7, did not significantly correlate with the TMT measures. In contrast, these measures did exhibit significant but modest correlations with the measures of BVRT (ranging from 0.37 to 0.44). Conclusions: The results had adequate divergent and convergent validity and good reliability in terms of internal consistency. The evidence collected in this study indicates that RAVLT is a valid and reliable psychometric instrument in neuropsychological assessment.
Content may be subject to copyright.
Clinical Neuropsychiatry (2012) 9, 3,
© 2012 Giovanni Fioriti Editore s.r.l.
Sabrina de Sousa Magalhães, Leandro Fernandes Malloy-Diniz, Amer Cavalheiro Hamdan
Objective: This study provides evidence for the validity and reliability of the Rey Auditory Verbal Learning Test
Method: The reliability was measured by internal consistency and the test-retest method with a mean interval of
35 days. To determine the convergent and divergent validity, it was compared the performance on the RAVLT with the
Benton Visual Retention Test (BVRT) and the Trail Making Test (TMT), respectively. The test was been taken by 34
healthy participants of both genders, ages 17 to 40 and 11.2±0.7 years of education.
Results: All test-retest correlation coefficients achieved significance, ranging between 0.36 and 0.68. The A2
measure obtained the weakest correlation (r =0.28), and the sum of A1-A5 (r =0.68) was the strongest. The rest of the
measures obtained moderate correlations. The value of the Cronbach’s Alpha coefficient was 0.80. The two RAVLT
measures, the sum of A1-A5 and A7, did not significantly correlate with the TMT measures. In contrast, these measures
did exhibit significant but modest correlations with the measures of BVRT (ranging from 0.37 to 0.44).
Conclusions: The results had adequate divergent and convergent validity and good reliability in terms of internal
consistency. The evidence collected in this study indicates that RAVLT is a valid and reliable psychometric instrument
in neuropsychological assessment.
Key words: neuropsychological tests, psychometrics, reliability, validity of tests
Declaration of interest: none
Sabrina de Sousa Magalhães – Department of Psychology, Federal University of Paraná, Paraná, Brazil
Leandro Fernandes Malloy-Diniz – Laboratory of Neuropsychological Investigations – National Institute of Science and
Technology of Molecular Medicine, Federal University of Minas Gerais, Minas Gerais, Brazil and Department of
Psychology, Federal University of Minas Gerais, Minas Gerais, Brazil
Amer Cavalheiro Hamdan – Department of Psychology, Federal University of Paraná, Paraná, Brazil
Corresponding author:
Amer Cavalheiro Hamdan, UFPR – Department of Psychology
Praça Santos Andrade, 50, Mestrado em Psicologia CEP: 80020-240, Curitiba, Paraná, Brazil
E-mail address:
The Rey Auditory Verbal Learning Test (RAVLT)
is an instrument used to evaluate episodic declarative
memory, immediate memory span, verbal learning,
susceptibility to proactive and retroactive interferences,
retention of information, recall and memory recognition
(Lezak et al. 2004, Strauss et al. 2006). In Brazil,
Malloy-Diniz et al. (2007) developed an RAVLT v e rs io n
composed of a list of high frequency, one or two-syllable
Portuguese substantives, which served as stimuli to
assess the performance of Brazilian adults and senior
citizens. The demographic variables that commonly
influence the performance on the RAVLT are gender,
educational level and age (Magalhães and Hamdan
2010). Normative data are available (Malloy-Diniz et
al. 2007, Magalhães and Hamdan 2010), however
evidence regarding its psychometric properties is still
There is evidence that the RAVLT has construct
validity when compared with other measures of verbal
learning and memory, such as the California Verbal
In the context of neuropsychological assessment,
there are two fundamental psychometric properties to
legitimate the efficiency of an instrument: validity and
reliability. Validity refers to what the test measures,
specifically the degree to which it actually measures
what it allegedly measures, according to empirical
verifications. Reliability is not about what is being
measured but whether the measure given by the
instrument is consistent. In other words, if the test shows
constancy in the scores for the same individual, the test
corresponds to an estimative of measurement error
(Mitrushina et al. 2005). The factors of reliability are
listed as follows: consistency (the test provides equal
or similar scores for the same individual); the ability to
replicate (within a certain margin of error, the test can
be refused and repeated); and confidence (the test
presents the same results to the same individual) (Hogan
Sabrina de Sousa Magalhães et al.
Clinical Neuropsychiatry (2012) 9, 3
Learning Test (Stallings et al. 1995). Several studies
conducted in Brazil also presented evidence of RAVTL
construct validity. For example, Fichman et al. (2010)
showed that some of the RAVLT indices present
significant and positive correlations with a test of visual
learning. De Paula et al. (2012) demonstrated that the
RAVLT has a bifactorial structure, which is related to
the processes of verbal learning and retrieval.
Nonetheless, despite the existence of a few studies on
RAVLT construct validity in the elderly Brazilian
population, we found no studies that evaluated the
reliability properties or construct validity of this test in
other age groups.
The main objective of this study was to assess the
psychometric properties of the reliability and validity
of the RAVLT. The additional objectives are listed as
follows: (a) to evaluate the confidence of the RAVLT
scores by comparing the performance in two distinct
experimental situations (test-retest); (b) to analyze the
internal consistency reliability of the instrument; (c) to
appraise the criterion validity of the RAVLT by
comparing it with other neuropsychological tests to
confirm that the test evaluates memory and not another
cognitive function. This study aims to contribute
evidence for the applicability of RAVLT by determining
whether the Brazilian adaptation is a valid psychometric
instrument in neuropsychological assessment.
1. Participants
The participants were 34 male and female
undergraduates between 17 to 40 years in age and were
recruited by requests for volunteer participation during
visits to undergraduate psychology classes. All
participants signed two copies of the Volunteer
Participation Consent and Confidentiality Terms. The
research was conducted according to the Helsinki
Declaration of ethical principles.
The research used the following exclusion criteria
to select only healthy individuals: a) a history or
presence of psychiatric disturbances, b) diabetes, c)
heart problems or any related pathologies, d) past or
current use of psychoactive drugs, especially those with
already related side effects that disturb mnemonic
functions, and e) abuse of illicit substances according
to the Brazilian law. These criteria were investigated
through the “Questionnaire of demographic data, health
and cultural conditions” and the Mini Mental State Exam
(MMSE). The inclusion criterion for participation in
the MMSE sample was a score of at least 24 points.
Table 1 presents the demographic data from the
sample. The study included 34 participants of bother
genders (35% men and 65% women) with an age range
between 17 and 40 (mean 20.7±4.5). The education
variable was computed using the number of years the
subject studied according to the Brazilian school system.
All participants had reached at least the high school
level, and the average education time varied from 11 to
15 years of formal study, including repetitions of the
same grade. The MMSE score varied from 25 to 30
points, with the mean score of 29.1±1.1 points.
2. Instruments
The purpose and procedures of the instruments are
listed as follows:
1) The “Questionnaire on demographic data, health
and cultural conditions” was used to gather general per-
sonal, cultural and health information about the
individual, thus gathering data for the sample
2) The Mini Mental State Exam (MMSE)
screened for cognitive impairment. The MMSE is a
useful screening instrument to estimate the level of
performance of individuals aged 18 to 85+ (Strauss et
al. 2006) because it is highly specific (Bertolucci et
al. 1994, Hancock and Larner 2011, Milian et al. 2011)
and allows for reliable detection of cognitive
impairment among healthy individuals within a modest
margin of error, although it does not provide a
differential diagnosis. A cut-off of 24 points was used
for our Brazilian sample.
Table 1. Demographic characterization of the sample (n = 34)
Mean (SD) CI 95%
Minimum Maximum
Age (years) 20.7 (4.5) 19.1 22.3
Gender (Male/Female) 12 / 22 - -
%35.3 / 64.7 - -
Education level (years) 11.2 (0.7) 10.9 11.4
MMSE score 29.1 (1.1) 28.7 29.5
Note: SD = standard deviation; CI = confidence interval; MMSE = Mini Mental State Exam.
Rey Auditory Verbal Learning Test
Clinical Neuropsychiatry (2012) 9, 3
3) A Portuguese language version of the Rey
Auditory Verbal Learning Test (RAVLT) was used
(Malloy Diniz et al. 2007). The test consists of five
consecutive oral presentations of 15 concrete nouns (List
A), followed by a free-recall after each presentation
(trials A1, A2, A3, A4 and A5). An interference list (List
B) with 15 different concrete nouns is presented,
followed by an immediate recall of this new list (trial
B1). Next, the recall of List A post-interference takes
place (trial A6). After a 20-minute interval, a delayed
recall of List A is required (trial A7). The last trial
consists of an oral presentation of a 50-noun list, which
is composed by List A and B and 20 phonologically or
semantically similar words to the previous lists, and then
recognition of the words in List A. The score for each
trial corresponds to the number of correctly recalled
words (Strauss et al. 2006). The rates of proactive
interference (B1/A1) and retroactive interference (A6/
A5) are also calculated; the rates represent the
susceptibility to previous and later activities,
respectively, involving the presentation of the content
about to be recalled. Proactive interference can be
observed when the subject’s recall of List B is affected
by previously learning List A. Retroactive interference
occurs when the retention or recall of the post-distractor
list is affected by learning the distractor list, which is
assumed to confuse one’s memory of the learned list. If
the interference ratio is equal to 1, no interference effect
is observed; however, if it is less than 1, interference is
demonstrated. Facilitation instead of interference can
be verified if the interference ratio is greater than 1
(Geffen and Geffen 2000).
4) The Trail Making Test (TMT) evaluates
executive function and is composed by two activities.
In part A (TMTA), the participant is asked to connect,
in ascending order, 25 numbered circles randomly
arranged on the page. In part B (TMTB), the participant
is required to alternate circles of numbers and letters
(numbers in crescent order, letters alphabetically). The
score of the test reflects the time (in seconds) taken to
complete the cycle (Hamdan and Hamdan 2009, Strauss
et al. 2006).
5) The Benton Visual Retention Test (BVRT)
evaluates immediate and delayed visual memory. Using
form C, the test was composed of 10 cards, each
featuring a complex figure. On the first two cards, the
figure is composed of simple geometric forms; the eight
other cards features two large geometric forms with a
small geometric figure located in the cards’ peripheries
(Strauss et al. 2006). In the immediate recall, the
participant must draw a replica, as exact as possible, of
the figure on the card after a period of 10 seconds of
studying the card with no opportunity to consult it
afterward. The procedure is repeated for all 10 cards.
After a time interval usually of 10 minutes, the
participant is requested to draw all the cards he or she
still remembers, in any order, with no opportunity to
consult the cards. Each drawing is scored with 0, 1 or 2
points. The maximum score is given to an identical
reproduction; the score of 1 to those with at least two
correct components; and a score of zero to drawings
that do not have sufficient components from the original
card (and do not attempt to earn the intermediate score)
or contain more mistakes than what is acceptable.
Afterward, these scores were added, and the immediate
(Be1) and delayed (Be2) recall scores were obtained
(maximum of 20 points).
3. Design
All participants completed all instruments. Each
test was administered to the same group of participants
twice to evaluate the score stability over time (test-retest
reliability). The present study contained a mean interval
of 35 days±8.9 between the two test sessions. The
interval length was 31 days at minimum and 38 days at
The equivalence of the test scores across two
administrations and between all tests was first evaluated
prior to the assessment of scale reliability. Dependent t
tests were performed for the RAVLT if the means
calculated from the same form from both testing sessions
were significantly different. Internal consistency
reliability was estimated by intraclass correlation
coefficients (ICC) and coefficient a. The k-sample
significance test for independent coefficients proposed
by Hakstian and Whalen (1976) was adopted to
statistically evaluate the effects of the number of items
on coefficient a. The probability of making a Type I
error on each test was constrained at .01.
To access criterion validity, the two most reliable
RAVLT measures were chosen a posteriori, which were
the Sum A1-A5 and A7. Convergent validity was
estimated comparing those RAVLT items with the scores
on the Benton Visual Retention Test (BVRT), which is
also an instrument for episodic memory assessment.
Although the BVRT was developed for visual memory
assessment, some authors have argued that this test
assesses both visual and verbal memory because its
items (geometrical forms) can be verbalized (Strauss et
al. 2006). For divergent validity, the same RAVLT items
were compared with two measures of the TMT,
specifically, the TMTA, which demands mainly
attentional resources and the TMTB, which includes
an executive function component.
The first data collection began after the
presentation, reading, and discussion of possible doubts
about the Volunteer Participation Consent and
Confidentiality Terms, which was followed by the
“Questionnaire on demographic data, health and cultural
conditions” and the MMSE. After these screening
instruments, the RAVLT was administered. During the
twenty-minute interval necessary to collect data for the
A7 trial and Recognition, two other neuropsychological
tests, the TMT and immediate recall of the BVRT, were
given. Both instruments are assumed to have no
influence on the RAVLT scores because they are
nonverbal tasks and do not demand semantic processing.
The main concern here was to provide distractor tasks
without confounding the stimulus and the processing
demand of each task, in particular.
Immediately after the Recognition trial of the
RAVLT, the late recall of the BVRT was administered.
In the retest session, the demographic questionnaire and
MMSE were not applied, and the session began with
the participant’s permission and the administration of
the RAVLT. All experimental sessions lasted
approximately 50 minutes, and all activities were
completed in a single session.
Sabrina de Sousa Magalhães et al.
Clinical Neuropsychiatry (2012) 9, 3
Table 2 presents the performance on the RAVLT
(test and retest session), Intraclass Correlation
Coefficient (ICC) and standard error of the mean (SEM).
The correlations varied from 0.36 to 0.68. The weakest
correlation was found in the A2 measure, and the
strongest was found in the Sum A1-A5. The indexes
A1, A5, B1 and A7 obtained medium correlation,
varying between 0.30 and 0.49. The A3, A4, Sum A1-
A5, A6 and Recognition reached a high correlation rate.
The proactive and retroactive interference did not
present any significant correlation between the two
sessions of testing. The susceptibility to interference
was small, except for those related to the expressive
proactive interference in the retest.
The paired t-test was performed to compare the
differences between the mean scores in both situations
(test-retest) and verify the presence of any disparity
between them. The results are listed as follows: A1:
t(33)=-9.13, p<0.001, d=3.18; A2: t(33)=-6.16,
p<=0.001, d=2.15; A3: t(33)=-6.54, p=<0.001, d=2.28;
A4: t(33)=-3.01, p<0.001, d=1.05; A5: t(33)=-4.13,
p<0.001, d=1.43; Sum A1 to A5: t(33)=-10.48, p<0.001,
d=3.65; B1/A1: t(33)=6.83, p<0.001, d=2.38; A6/A1:
t(33)=-0.70, p=0.4875, d=0.24; B1: t(33)=0.58,
p=0.5641, d=0.20; A6: t(33)= -4.61, p<0.001, d= 1.60
and A7: t(33)= -3.14, p<0.001, d= 1.09. Measures B1
and Recognition were the only ones that did not differ
in both situations (p>0,01); all the others demonstrate
significant differences in their results from both
experimental situations. The d measures reached small
effect sizes (Cohen 1988).
The F test for ICC are listed as follows: A1: F(1,
33)=83.39, p<0.001; A2: F(1, 33)=37.99, p<0.001; A3:
F(1, 33)= 42.73, p<0.001; A4: F(1, 33)= 9.08,
p=0.0049; A5: F(1, 33)=17.03, p<0.001; Sum A1 to
A5: F(1, 33)= 109.76, p<0.001; B1/A1: 46.71, p<0.001;
A6/A1: F(1, 33)= 0.49, p=0.488; B1: F(1, 33)= 0.34,
p=0.564; A6: F(1, 33)= 21.21, p<0.001 and A7: F(1,
33)= 9.85, p=0.0035.
The RAVLT measures analyzed with the
Cronbach’s Alpha Coefficient Reliability, deleting each
item in turn, are indicated in table 3. The alpha reliability
of the RAVLT was 0.84, and the standardized alpha was
0.88. The test condition coefficients varied from 0.78
to 0.82, and the retests varied between 0.81 and 0.86.
Table 4 shows the Pearson’s correlation between the
Table 2. Performance on the RAVLT (test and retest session), Intraclass Correlation Coefficient (ICC) and SEM
Mean (SD)
Mean (SD)
A1 7,2 (1,5) 10,2 (2,1) 0.71 1.38
A2 10,2 (2,1) 12,5 (1,7) 0.52 1.56
A3 11,9 (1,5) 13,6 (1,4) 0.55 1
A4 12,9 (1,6) 13,5 (1,3) 0.19 0.89
A5 12,8 (1,5) 13,8 (1,2) 0.32 1.06
Sum 54,9 (6,2) 63,6 (5,9) 0.76 3.42
B1/A1 0,98 (0,3) 0,66 (0,2) 0.57 0.19
A6/A5 0,95 (0,1) 0,97 (0,1) -0.02 0.11
B1 6,8 (1,6) 6,6 (1,7) -0.02 1.25
A6 12,1 (1,8) 13,3 (1,5) 0.37 1.13
A7 12,2 (1,8) 13,1 (1,6) 0.21 1.20
Rec 14,6 (0,7) 14,6 (0,9) -0,01 0.52
Note: SD = standard deviation; ICC = Intraclass Correlation Coefficient; SEM = standard error of the mean; Sum =
sum of scores across the five acquisition trials (A1–A5); B1/A1 = proactive interference; A6/A5 = retroactive
interference; Rec = recognition trial.
Rey Auditory Verbal Learning Test
Clinical Neuropsychiatry (2012) 9, 3
Table 3. Cronbach’s Alpha Coefficient for the RAVLT measures in the two experimental conditions
Table 4. Validity coefficients between the RAVLT, Trail Making Test and Benton Visual Retention Test
Test Retest
Alpha Sd.Alpha r(item, total) Alpha Sd.Alpha r(item, total)
A1 0.79 0.83 0.67 0.82 0.88 0.61
A2 0.79 0.83 0.60 0.81 0.86 0.75
A3 0.78 0.81 0.78 0.81 0.85 0.85
A4 0.79 0.82 0.68 0.82 0.86 0.72
A5 0.79 0.83 0.66 0.82 0.87 0.66
Sum 0.82 0.80 0.94 0.86 0.85 0.96
B1/A1 0.82 0.88 -0.23 0.83 0.87 0.47
A6/A5 0.82 0.84 0.26 0.84 0.90 0.02
B1 0.81 0.83 0.32 0.85 0.89 0.15
A6 0.78 0.81 0.73 0.82 0.86 0.68
A7 0.79 0.82 0.62 0.81 0.86 0.76
Rec 0.81 0.84 0.35 0.83 0.87 0.61
Note: Sd.Alpha = Standard Alpha; Sum = sum of scores across the five acquisition trials (A1 – A5);; B1/A1 = proactive
interference; A6/A5 = retroactive interference; A7 = RAVLT delayed recall measure; Rec = recognition trial.
Sum A7 B1/A1 A6/A5 TTA TTB Be1
Sum - - - - -
A7 0,57** - - - -
B1/A1 -0,33 -0,18 - -
A6/A5 0,12 0,45** 0,24 - -
TTA -0,03 0,01 0,22 0,02 - - -
TTB -0,19 -0,15 0,22 0,01 0,68** - -
Be1 0,44** 0,27 -0,12 -0,04 -0,31 -0,58** -
Be2 0,37* 0,39* -0,23 0,02 0,01 -0,13 0,31
Note: Sum = sum of scores across the five acquisition trials (A1 – A5); A7 = RAVLT delayed recall measure; B1/A1 =
proactive interference; A6/A5 = retroactive interference; TTA = part A score from TMT; TTB = part B score from
TMT; Be1 = immediate recall score from BVRT; Be2 = delayed recall score from BVRT; * = p<0,05; ** = p<0,01.
Sabrina de Sousa Magalhães et al.
Clinical Neuropsychiatry (2012) 9, 3
RAVLT, the TMT and the BVRT; these indices represent
the measurement of divergent and convergent validity,
respectively. Once the BVRT provided the immediate
and delayed memory rates, they were compared with
equivalent measures on the RAVLT, specifically Sum
A1-A5 (the most reliable between the immediate recall
indices) and A7. The measures of susceptibility to
proactive and retroactive interferences usually correlate
with measures of executive function (Mitrushina et al.
2005) and attention; therefore, they were also included
in the analysis.
The validity coefficient between Sum A1-A5 and
A7 of the RAVLT and the two TMT measures
demonstrated very weak and non-significant
correlations, which is evidence that they do not evaluate
the same function. None of the interference measures
of the RAVLT reached significant correlation with the
TMT measures. In contrast, regarding the BVRT
measures, the RAVLT mostly exhibited validity
coefficients of medium magnitude. The immediate
memory measures of the tests (Sum A1-A5 and Be1)
achieved a 0.44 correlation; the delayed memory
measures of both tests (A7 and Be2) reached a
correlation of 0.39. The Sum A1-A5 also demonstrated
a positive correlation of 0.37 with the Be2 measure but
did not verify a significant correlation between the
delayed memory recall of RAVLT (A7) and the imme-
diate memory BVRT measure (Be1).
This study provides evidence for the validity and
reliability of the RAVLT. Some factors and conditions
are described (Hogan 2007) as non-reliable sources that
affect the measurements of the test and bring it below a
reliable level. Among the numerous sources that result
in non-systematic variations in test scores, three are
highlighted: (a) different criteria of test correction
adopted by the person that grades the test; (b) changes
in test application procedure; (c) the personal condition
of the examinees, i.e., the participant’s temporary self-
state (characteristics not related to the ones under
evaluation, such as health and mood conditions,
willingness and level of engagement), which might
influence the participant’s performance. This study aims
to contribute evidence for the applicability of the
RAVLT by determining whether this Brazilian
adaptation is a valid psychometric instrument in
neuropsychological assessment.
The RAVLT includes clear and specific
instructions, which minimize possible variations
between different researchers during the application and
correction process. Thus, this study aimed to neutralize
this non-reliable source. Procedures were standardized,
and all examiners were trained in the test application
policies related to physical environment preparation,
instructions and test administration. The objective was
to keep all these factors constant to prevent them from
interfering with both test situations. It has been reported
that the examiner has an important role in participant
performance, and his/her preparation for the
administration of the neuropsychological instruments
should not be neglected (Van den Burg and Kingma
1999). Finally, the third source of non-systematic error
was verified through test-retest methodology.
The weakest reliability correlation was observed
in the A2 measure (r = 0.36), and the strongest was
found in the Sum A1-A5 (r = 0.68). Researchers who
have studied the psychometric properties of the RAVLT
in different language versions all find the Sum A1-A5
as the most reliable measure of the instrument, although
with different coefficients: r = 0.77 (Geffen and Geffen
2000), r = 0.79 (Knight et al. 2007) e r = 0.70 (Van den
Burg and Kingma 1999). This finding was expected
because the reliability is proportional to the test
extension. Nevertheless, these data are not unanimous.
In another study, although the Sum A1-A5 demonstrated
a significant correlation of r = 0.55, between the test
and retest session, the higher correlation rate was found
in the A1 trial (r = 0.69) (Rezvanfard et al. 2011).
The second highest correlation rate obtained in the
present study was for the A4 measure (r
= 0.64), followed by the Recognition (r = 0.59) and the
A3 measure (r = 0.53). Evidence indicates that
subsequent trials of the RAVLT are usually more reliable
than the first ones (Van den Burg & Kingma, 1999).
The exception found in this study was the A5 measure,
which was expected to reach a high correlation rate but
obtained an average score of (r = 0.41). In contrast,
another study obtained a 0.61 rate with this same trial
(Van den Burg and Kingma 1999).
The proactive and retroactive interference rates
were quantified by the ratio between the two analyzed
scores instead of subtraction. This method (Geffen and
Geffen 2000) takes into account the different perfor-
mance levels of the participants. The results showed no
correlation between these rates in both experimental
situations. Even when alternate forms of the test were
used, a correlation between those interference measures
was not reported (Rezvanfard et al. 2011). Thereby, the
data suggest that the measures of higher reliability and
stability levels are Sum A1-A5, A3, A4, A6 and
Recognition because they obtained high correlation
rates. Other measures pointed to moderate reliability.
The RAVLT exhibited two measures, B1 and
Recognition, which showed no significant differences
between both test situations. It is possible to infer that
the learning process did not influence these two
measures; therefore, their original results were
maintained. After List B is shown one time in the first
session, we can assume that it retains its novelty. In the
case of Recognition, this measure may be influenced
by the ceiling effect because the mean of the scores is
lower than one standard deviation of the maximum score
(Uttl 2005). The Recognition task may not serve as a
good measure of mnemonic skills of healthy
participants. This task is proposed to assist in identifying
persons with suspected retrieval problems that might
benefit from mnemonic hints.
The results indicate that in all other RAVLT trials,
the effect of the practice can be credited to two different
main factors: (a) retention of specific test material (in
this case, words that compose the lists); (b) a
metamemoric factor, which considers how the exposure
to a similar task may improve performance strategies
(Mitrushina et al. 2005). If one considers implementing
a different interval between test-retest sessions, this data
could be distinct. Knight et al. (2007), when performing
an analysis of the mean scores of the test-retest sessions
Rey Auditory Verbal Learning Test
Clinical Neuropsychiatry (2012) 9, 3
(with a 1 year interval between applications), found
significant differences only for the measures A5, Sum
A1-A5 and A7. In addition, if the samples are also
different, another data configuration might be expected.
The Cronbach’s Alpha Coefficient represents the
equivalence degree regarding to realized measurement
(Hogan 2007), it is a homogeneity index of the items.
The high value to this coefficient (r = 0.80) indicates a
good internal consistency of the items that compose the
RAVLT. Therefore, all the trials are reliable measures
for learning processes and verbal memory. This measure
has a value close to the found for the same Portuguese
version of the test (r = 0.85) (Malloy-Diniz et al. 2007).
The RAVLT correlates moderately with other
learning measures (Strauss et al. 2006, Kessels et al.
2006, Helmstaedter et al. 2009), verbal memory (Strauss
et al. 2006, Helmstaedter et al. 2009) and spacial
memory (Strauss et al. 2006, Kessels et al. 2006),
therefore, have moderate convergent validity. Medium
magnitude evidence has been ascertained to the
convergent validity of the RAVLT with the BVRT, what
means that it, indeed, evaluates episodic memory. High
and moderate magnitude correlations (minimum r =
0.47 e maximum r = 0.54) were obtained by Duff et al.
(2005) when comparing the measures A6 and A7 of the
RAVLT with immediate and delayed visual memory
instruments. Probably, the correlations between RAVLT
and BVRT were not of a higher rate due to the different
structures of the tests, as they measure distinct aspects
of episodic memory. Whereas RAVLT assess mainly
verbal memory, BVRT assess visual memory and is
related to other cognitive skills as psychomotor abilities
(Strauss et al. 2006). Nonetheless, is important to note
that the mnemonic variables are together, regardless of
being verbal or nonverbal measures (Strauss et al. 2006),
which justifies the choice of BVRT in the present study.
The RAVLT demonstrated divergent validity
compared with the TMT, which supports the evidence
that both measure different cognitive functions.
However, other studies have presented contradictory
evidence regarding this correlation. Duff et al.
(2005) found a high and significant correlation of 0.51
between A7 and the performance on part B of the TMT.
This finding suggests a mutual relationship between
executive functions and verbal memory, which was not
verified in the present study. Although the proactive and
retroactive interference measures of the RAVLT were
expected to correlate with the TMT because they are
well-known executive measures, they did not exhibit
significant correlation. Additionally, for the German
version of the RAVLT, Helmstaedter et al. (2009) did
not find any significant correlation between A7 and the
tests that measure attention and fluency, both aspects
of executive function. It is important to highlight the
methodology differences regarding the sample
composition, chosen instrument and data analysis of the
mentioned studies. The range in which the measures of
the RAVLT correlate with executive functions still
requires additional empirical evidence.
Learning and memory difficulties are the most
common complaints in patients with neurological
impairment and significantly impact the daily life
activities and social functionality of these patients
(Messinis et al. 2007). The RAVLT is widely known to
offer objective methods to help identify these deficits.
Furthermore, repeated evaluations are often frequent
and necessary in the clinical context to closely follow
the progress of degenerative conditions, the effect of
prescribed drugs or recovery after intervention
(Uchiyama et al. 1995).
It is valid to note that all measurements obtained
by a neuropsychological test are subject to the influence
of non-reliable sources. Each investigation method seeks
to deal with one or more of the non-systematic variations
of the test scores. Therefore, one can assert that once
each reliability measures encompasses a part of each
possible source of variation, a single reliability measure
does not exist for a test (Hogan 2007).
Among the resultant limits of the test-retest
methodology choice for reliability measurement are: (a)
the difficulty of applying the test due to the fact that
participants need to cooperate to reestablish the same
application context in a second round; and, more
importantly, (b) decisions concerning the effects that
the first application might have on the second one. The
learning effect is a very important point to consider
because of its proclivity to inflate the reliability
coefficient and thus overestimate the measured attribute.
There are vast descriptions in the literature about
the RAVLT’s sensitivity to the effect of learning in a
second application of the same version of the test. After
successive applications, a small, but significant
enhancement in the number of recalled words (1 or two
words mean per trial) is expected (Mitrushina et al.
2005). The effect of the practice is diminished when
the participants are not exposed to the same list, which
is why the use of alternative lists is suggested to
minimize this effect (Uchiyama et al. 1995, Strauss et
al. 2006, Van den Burg and Kingma 1999, Beglinger et
al. 2005, Mitrushina et al. 2005, Knight et al. 2007).
Those studies that have applied the test-retest
methodology utilizing alternate forms of the RAVLT
found a lesser effect of practice (Strauss et al. 2006,
Va n d en B u r g a nd K i n gm a 1 9 9 9, Mi t r us h i na et a l . 2 0 05 ,
Rezvanfard et al. 2011). However, these data are not
unanimous; Uchiyama et al. (1995) demonstrated a
significant effect of practice on two distinct versions of
the RAVLT, using a 1-year interval between trials. Those
researchers therefore suggested the need for longitudinal
normative data for interpretation of the retest data
(Uchiyama et al. 1995).
Strauss et al. (2006) observed that with intervals
greater than 1 year, the RAVLT demonstrates moderate
test-retest reliability. In this study, the one-month interval
between applications was demonstrated to be
acceptable. However, this interval time is inferior when
observed in clinical practice, where the monitoring and
successive evaluations are performed with longer time
intervals, which varying from 3 months to 1 year, for
In the Portuguese language and Brazilian culture,
a second version that meets the RAVLT construction
criteria is unfortunately not yet available. This is a
problem for which Brazilian researchers will have to
find viable solutions. An alternative would be to use
the first list published by Malloy-Diniz et al. (2000).
Sabrina de Sousa Magalhães et al.
Clinical Neuropsychiatry (2012) 9, 3
However, this list is a direct translation of the English
version and demonstrates several limitations, such as
not taking into account the word frequency in the
Portuguese language and the number of syllables that
the newest version has presented (Malloy-Diniz et al.
The RAVLT evaluates the participant’s ability to
encode, consolidate, store and recall verbal information.
The most reliable measures in terms of stability and
low measurement error (greater reliability) were, in
regressive order, the Sum A1-A5, A4, Recognition, A6
and A3. The total score performance represented by Sum
A1-A5 is substantially more reliable than the items
considered individually.
Compared with other RAVLT psychometrical
property studies (Strauss et al. 2006, Van den Burg and
Kingma 1999, Geffen and Geffen 2000, Duff et al. 2005,
Kessels et al. 2006, Knight et al. 2007, Helmstaedter et
al. 2009), the current research achieves modest, although
relatively high, correlation values. The small sample
size might have been a contributing factor to the lower
reliability coefficient expression.
To establish validity, an integrated collection of
evidence is required for the appropriate interpretation
of the analyzed instrument’s score. The results indicate
that the verbal memory measured by the RAVLT
positively correlates with the visual memory evaluated
by BVRT but does not correspond to the executive
functions assessed by the TMT. Although a vast amount
of evidence suggests that memory and executive
functions correlate with each other (Tremont et al.
2000), this study did not aim to verify the magnitude of
their interaction. As such, the chosen methodology
effectively supported the proposed objectives and
verified that the RAVLT measures mnemonic attributes
rather than ones related to executive functions.
Reliability and validity are distinct but
complementary constructs and are important in the field
of psychometrics. A test can be valid without being
reliable; however, a test cannot be reliable if it is not
valid (Hogan 2007). Therefore, the relationship between
these two properties is a fundamental consideration
because the validity of the test depends considerably
on its degree of reliability.
We aimed to determine whether the RAVLT is a
safe source of information about the mnemonic
construct. The collected results suggest that the RAVLT
shows good reliability and validity, and therefore this
psychometric instrument can be considered to provide
valid measurement of episodic verbal memory in
neuropsychological evaluation. This study proposed to
contribute psychometrical evidence of the validity and
reliability of the RAVLT, but because of the relatively
small sample, the outcomes must be interpreted with
caution. New investigations are expected to supplement
these results and strengthen the data that has thus far
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... However, since some tests had to be omitted entirely, questionnaires were performed in lieu of those tests to maintain a similar delay for delayed recall. Although not extensively studied, the reported test-retest reliability of the RAVLT is variable, ranging from 0.12 to 0.86, and appears subject to minor practice effect [27,28]. In 2012, a Brazilian study assessed the test-retest validity for each component on the RAVLT and found only a weak agreement (ICC 0.21) between the baseline delayed recall component of the test and the repeated measure at 35 (± 8.9) days [28]. ...
... Although not extensively studied, the reported test-retest reliability of the RAVLT is variable, ranging from 0.12 to 0.86, and appears subject to minor practice effect [27,28]. In 2012, a Brazilian study assessed the test-retest validity for each component on the RAVLT and found only a weak agreement (ICC 0.21) between the baseline delayed recall component of the test and the repeated measure at 35 (± 8.9) days [28]. Certain limitations must be considered when interpreting our results. ...
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Background The COVID-19 pandemic poses challenges for timely outcome assessment in randomized clinical trials (RCT). Our aim was to describe our remote neurocognitive testing (NCT) protocol administered by telephone in patients with Parkinson’s disease (PD) and obstructive sleep apnea (OSA). Methods We studied PD patients with OSA and Montreal Cognitive Assessment (MoCA) score ≤ 27 participating in a RCT assessing OSA treatment impact on cognition. Trial outcomes included change in MoCA and specific cognitive domains from baseline to 3 and 6 months. With COVID19 pandemic-related restrictions, 3-month visits were converted from in-person to telephone administration with materials mailed to participants for compatible tests and retrieved by courier the same day. In exploratory analyses, we compared baseline vs. 3-month results in the control arm, which were not expected to change significantly (test-re-test), using a paired t -test and assessed agreement with the intraclass correlation coefficient (ICC). Results Seven participants were approached and agreed to remote NCT at 3-month follow-up. Compared to the in-person NCT control arm group, they were younger (60.6 versus 70.6 years) and had a shorter disease course (3.9 versus 9.2 years). Remote NCT data were complete. The mean test-retest difference in MoCA was similar for in-person and remote NCT control-arm groups (between group difference − 0.69; 95%CI − 3.67, 2.29). Agreement was good for MOCA and varied for specific neurocognitive tests. Conclusion Telephone administration of the MoCA and a modified neurocognitive battery is feasible in patients with PD and OSA. Further validation will require a larger sample size.
... 5 15 Standardised validated neuropsychological tests for objective assessment of cognitive function used in this study included: (1) the trail making test (TMT), a reliable (inter-rater: r=0.74-0.85) 21 measure of psychomotor speed (TMTA), working memory (TMTB) and executive function (TMTB-A); (2) the Rey Auditory Verbal Learning Test (RAVLT), a reliable test (ICC: 0.76) 22 for verbal memory and learning; (3) the digit span forwards (DSF) and backwards (DSB) test, a reliable (inter-rater: r=0.83) 23 The CogState Brief Battery was also included, which is a sensitive battery of five computerised cognitive tests, validated in patients with cancer. 26 27 These tests are considered reliable (ICC: 0.72-0.93) ...
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Objectives The aim of this preplanned secondary analysis of a 12-month randomised controlled trial was to investigate the effects of a multicomponent exercise programme combined with daily whey protein, calcium and vitamin D supplementation on cognition in men with prostate cancer treated with androgen deprivation therapy (ADT). Design 12-month, two-arm, randomised controlled trial. Setting University clinical exercise centre. Participants 70 ADT-treated men were randomised to exercise-training plus supplementation (Ex+ Suppl, n=34) or usual care (control, n=36). Intervention Men allocated to Ex + Suppl undertook thrice weekly resistance training with weight-bearing exercise training plus daily whey protein (25 g), calcium (1200 mg) and vitamin D (2000 IU) supplementation. Primary and secondary outcome measures Cognition was assessed at baseline, 6 and 12 months via a computerised battery (CogState), Trail-making test, Rey auditory-verbal learning test and Digit span. Data were analysed with linear mixed models and an intention-to-treat and prespecified per-protocol approach (exercise-training: ≥66%, nutritional supplement: ≥80%). Results Sixty (86%) men completed the trial (Ex + Suppl, n=31; control, n=29). Five (7.1%) men were classified as having mild cognitive impairment at baseline. Median (IQR) adherence to the exercise and supplement was 56% (37%–82%) and 91% (66%–97%), respectively. Ex + Suppl had no effect on cognition at any time. Conclusions A 12-month multicomponent exercise training and supplementation intervention had no significant effect on cognition in men treated with ADT for prostate cancer compared with usual care. Exercise training adherence below recommended guidelines does not support cognitive health in men treated with ADT for prostate cancer. Trial registration number Australian and New Zealand Clinical Trial Registry (ACTRN12614000317695, registered 25/03/2014) and acknowledged under the Therapeutic Goods Administration Clinical Trial Notification Scheme (CT-2015-CTN-03372-1 v1).
... After 20 min interval participants were asked again to recall the words from the List A Delayed Recall (DR). Finally, the final task was orally presenting to the participants a list of 50 nouns, including those from List A & B, and 20 phonologically (or) semantically similar words to List A & B. The participants needed to identify and recognize the words that were part of List A & B. For all trials total up each word recalled correctly and place the totals at the bottom of each column 16,17 . ...
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Exercise is recognized as a promising approach to counteract aging-associated declines in cognitive functions. Emerging literature suggests that exercise which involves with attention, concentration, memory, thinking have a positive effect on cognition. Objective: The aim of the current study is to compare Brain Gym and Dynamic Movement Skill on Verbal Memory in Middle-Aged Women.
... • RAVLT (Rey Auditory Verbal Learning Test) (Rey, 1964): assessment of verbal learning and memory, including proactive inhibition, retroactive inhibition, retention, encoding versus retrieval and subjective organization (Schmidt, 1996).It has adequate divergent and convergent validity and good reliability in terms of internal consistency (de Sousa Magalhães et al., 2012). Although internal consistency is not a comprehensive indicator of validity and reliability, in particular contexts it paves the way for proper interpretation (Alavi et al., 2021). ...
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Mindfulness has attracted considerable attention in educational settings as it can have positive effects on children. However, the role of mindfulness practice in schools has yet to be understood. The aim of the present study is to assess the impact of mindfulness on neuropsychological performance and psychological well-being of primary school children. It also aims to explore the teacher's mindfulness training effect on the intervention. The present study recruited 100 children (64% girls and 36% boys) aged 9-11 from a primary school in Tarragona (Spain). The research was conducted between 2016-2018 with three experimental groups: a mindfulness intervention group with a trained mindfulness teacher, a mindfulness intervention group with a non-trained mindfulness teacher, and a control group. All groups were evaluated before and after a 13-weeks intervention, consisting of 5-10 min mindfulness daily sessions before class. After the intervention, the two groups of children receiving mindfulness sessions performed better than controls in several neuropsychological tasks involving executive functions, such as short-term and working memory, learning, mental flexibility, visuospatial abilities and processing speed. No significant differences were found in the assessment of daily stress or emotional and behavioural problems. The findings of the present study can contribute to a better understanding of the role of mindfulness practice in primary children regarding neuropsychological performance, highlighting the importance of the teacher's mindfulness training in the teaching/ learning process.
... Subjective cognitive functioning was assessed with the Cognitive Failure Questionnaire (CFQ) (Broadbent et al., 1982) a self-rating questionnaire to evaluate the frequency of everyday cognitive errors made in the prior four weeks. The aforementioned scales have moderate to good psychometric properties, in general and as computerized versions in a schizophrenia population (Sousa-Magalhães et al., 2012;O'Halloran et al., 2008;Crawford et al., 1995;Merckelbach et al., 1996). ...
Background After a first episode of psychosis, cognitive impairments present an important barrier to successful (re-)entry into work and education. We assessed whether cognitive remediation (CR) as an add-on to Individual Placement and Support (IPS) can improve participation in regular employment and education. Method Participants with early psychosis (N = 73) were randomly assigned to receive IPS supplemented with computerized CR, or IPS plus an active control intervention (computer games). The primary outcome was the number of hours spent in competitive employment or regular education, which was assessed every month during the 18-month study period. Secondary outcomes included employment rate, cognitive functioning, mental health (assessed at baseline, 6 and 18 months), and job duration (assessed after 18 months). Both patients and assessors were blind to treatment. Results Participants receiving IPS + CR showed greater improvement of competitive employment over time in terms of hours worked (during follow-up period: 38.5 vs. 19.6 h, B = 2.94; Wald χ² = 5.39; P = .02) and employment rate (at T2: 62.1% vs. 25.9%, χ ² = 7.39; df = 1; P = .008), compared with the IPS + control group, particularly in the longer term. The number of hours spent in regular education was lower in the IPS + CR group, with more participants having ended education for a positive reason. There was a significant beneficial effect of adjunctive CR for executive functioning, subjective cognitive functioning, and empowerment. Conclusions Augmenting IPS with CR has a significant impact on competitive employment in people with early psychosis, with beneficial effects being more pronounced after 18 months.
... The RAVLT was utilized to assess learning and verbal memory (Rey, 1964), with a version validated to normative standards for the Portuguese language (Malloy-Diniz et al., 2000). Evidence indicates that RAVLT had moderate convergent validity (r = 0.44) and presented good internal consistency (Cronbach's α = 0.83) in neuropsychological assessment in older adults (Magalhães et al., 2012). The test consisted of a 15 words-list 'List A', an interference list 'List B' and followed by a series of recall tests. ...
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In this randomized controlled pilot trial, the authors explored the feasibility, technology compliance, and preliminary efficacy of the Education for Action (EDU-ACT), a multimodal intervention combining evidence-based strategies of physical activity (PA) education and coaching in PA levels over 4 weeks between EDU-ACT and control groups. The authors also assessed pre–post changes in neurocognitive function, functional mobility and dual-task performance, sleep and quality of life. Thirty-two sedentary older adults with memory complaints (age = 66 ± 5.3) completed the study (EDU-ACT = 18 and control = 14). The EDU-ACT adherence rate was 95%, and compliance of daily PA reporting was, on average, 22.7 days (94.6%). The EDU-ACT group demonstrated a significantly greater number of steps, processing speed, and dual-task performance when compared with controls ( p < .05). In this study, a multimodal, evidence-based, low-cost intervention was feasible, well-accepted, with high adherence and compliance rates, and effective at promoting clinically meaningful increases in PA, for at least 1 month postintervention, in older adults with memory complaints.
Objective Using data from the National Longitudinal Study of Adolescent to Adult Health, we estimated the average causal effect of neighborhood disadvantage in adolescence on memory performance in young adulthood. We contrasted several different ways of operationalizing a continuous measure of neighborhood disadvantage including a continuous neighborhood disadvantage score and ordinal measures. Results Neighborhood disadvantage was measured in Wave I when participants were a mean age of 15.41 years (SE: 0.12) and memory performance was measured in Wave IV when participants were a mean age of 28.24 years (SE: 0.12). We found that adolescent neighborhood disadvantage was associated with decreased memory performance in young adulthood. Notably, we observed a linear decline in word recall score among those in the less disadvantaged tail of the distribution (neighborhood disadvantage <1), a finding not observed using traditional ordinal variable classifications of disadvantage. Conclusion Experiencing neighborhood disadvantage in adolescence may have lasting impacts on cognitive health throughout the life course.
Background: Preventing dementia warrants the pragmatic engagement of primary care. Objective: This study predicted conversion to dementia 12 months before diagnosis with indicators that primary care can utilize within the practical constraints of routine practice. Methods: The study analyzed data from the Alzheimer's Disease Neuroimaging Initiative (Total sample = 645, converting participants = 54). It predicted the conversion from biological (plasma neurofilament light chain), cognitive (Trails Making Test- B), and functional (Functional Activities Questionnaire) measures, in addition to demographic variables (age and education). Results: A Gradient Booster Trees classifier effectively predicted the conversion, based on a Synthetic Minority Oversampling Technique (n = 1,290, F1 Score = 92, AUC = 94, Recall = 87, Precision = 97, Accuracy = 92). Subsequent analysis indicated that the MCI False Positive group (i.e., non-converting participants with cognitive impairment flagged by the model for prospective conversion) scored significantly lower on multiple cognitive tests (Montreal Cognitive Assessment, p < 0.002; ADAS-13, p < 0.0004; Rey Auditory Verbal Learning Test, p < 0.002/0.003) than the MCI True Negative group (i.e., correctly classified non-converting participants with cognitive impairment). These groups also differed in CSF tau levels (p < 0.04), while consistent effect size differences emerged in the all-pairwise comparisons of hippocampal volume and CSF Aβ1 - 42. Conclusion: The model effectively predicted 12-month conversion to dementia and further identified non-converting participants with MCI, in the False Positive group, at relatively higher neurocognitive risk. Future studies may seek to extend these results to earlier prodromal phases. Detection of dementia before diagnosis may be feasible and practical in primary care settings, pending replication of these findings in diverse clinical samples.
This single-blinded RCT investigated cognitive effects of aerobic exercise in persons with TBI-related memory impairment. Five participants . were randomly assigned to 12-weeks of either supervised moderate intensity aerobic cycling or an active control. Outcome measures included neuropsychological assessments and structural neuroimaging (MRI,). The exercise group demonstrated greater improvements on auditory verbal learning (RAVLT; d=1.54) and processing speed (SDMT; d=1.58). The exercise group showed larger increases in volume of the left hippocampus (d=1.49) and right thalamus (d=1.44). These pilot data suggest that 12-weeks of moderate intensity aerobic cycling may improve memory and processing speed in those with TBI-related memory impairments.
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The Trail Making Test (TMT) has been a useful tool for neuropsychological assessment. The present study analyzed the influence of age and education level on TMT performance in healthy adult Portuguese speakers. The criteria for exclusion were a history of neurological disease, psychiatric illness, substance abuse, learning disabilities, or any other difficulty that may interfere with testing. The sample (n = 318) was divided into four age groups: (i) very young (n = 92; 18-34 years old), (ii) young (n = 66; 35-49 years old), (iii) middle-age (n = 117; 50-64 years old), and (iv) elderly (n = 43; 65-81 years old). The sample was also divided into three education levels: (i) low (2-8 years), (ii) middle (9-11 years), and (iii) high (> 12 years). Correlations among the demographic variables and scores on Trails A and B showed that age and education level were the two variables that most affected TMT scores (p < 0.001, analysis of covariance). Post hoc analyses of age did not reveal significant differences between the middle-age and elderly groups in TMT-A performance or between middle and high education level in TMT-A or TMT-B performance. These results are consistent with previous studies and demonstrate that age and education level affect the performance of Brazilian subjects on the TMT.
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Background: The Rey Auditory-Verbal Learning Test (RAVLT) is widely used for the assessment of episodic memory. However, there are few studies in Brazil assessing its psychometric properties. Objectives: To search for evidence of reliability and construct validity of the RAVLT, and to assess the influence of age, schooling, gender, and depressive symptoms on test performance. Methods: One hundred twenty-six healthy older adults (aged 60 and over) performed the RAVLT, Mini-Mental State Exam (MMSE), Clock Drawing Test (CDT) and the Geriatric Depression Scale. Reliability was assessed by analysis of internal consistency, and construct validity by factor analysis and correlations with the MMSE and CDT. The influence of age, schooling and depressive symptoms was estimated by conducting linear regression analysis, and the role of gender by comparing the performance of males and females. Results: The RAVLT showed a high internal consistency, weak correlations with the MMSE and CDT, and a bifactorial structure, which is related to the processes of learning and episodic memory retrieval. Only age and gender affected test performance. Discussion: Our results provide evidence of reliability and construct validity in the tested RAVLT version, attesting its potential for clinical and research purposes for the Brazilian elderly population.
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Increasing demand for memory assessment in clinical settings in Iran, as well as the absence of a comprehensive and standardized task based upon the Persian culture and language, requires an appropriate culture- and language-specific version of the commonly used neuropsychological measure of verbal learning and memory, the Rey Auditory Verbal Learning Test (RAVLT). The Persian adapted version of the original RAVLT and two other alternate word lists were generated based upon criteria previously set for developing new word lists. A total of 90 subjects (three groups of 30 persons), aged 29.75±7.10 years, volunteered to participate in our study and were tested using the original word list. The practice effect was assessed by retesting the first and second groups using the same word list after 30 and 60 days, respectively. The test-retest reliability was evaluated by retesting the third group of participants twice using two new alternate word lists with an interval of 30 days. The re-administration of the same list after one or even two months led to significant practice effects. However, the use of alternate forms after a one-month delay yielded no significant difference across the forms. The first and second trials, as well as the total, immediate, and delayed recall scores showed the best reliability in retesting by the alternate list. The difference between the generated forms was minor, and it seems that the Persian version of the RAVLT is a reliable instrument for repeated neuropsychological testing as long as alternate forms are used and scores are carefully chosen.
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The Rey Auditory Verbal Learning Test (RAVLT) is an efficient neuropsychological instrument for testing episodic declarative memory. Performance on this test can be influenced by demographic and cultural variables. The objective of the present study was to analyze the influence of demographics variables, such as age, gender, and education, on RAVLT performance in young and elderly adults. A Portuguese version of the RAVLT was administered to 302 healthy participants. Subjects were from both genders, ranging in age from 17 to 85 years (mean 50.6 ± 15.9 years) and in education from 1 to 20 years (mean 11.3 ± 3.7 years). Participants were grouped by age: 17-34 years old, 34-49 years old, 50-64 years old, and 65-85 years old. Pearson’s Correlation analysis showed a significant association between RAVLT performance and both age and education (p < 0.001), but not between RAVLT performance and gender. Two-way analysis of variance revealed significant effects of age on all RAVLT measurements and significant effects of years of education on all measurements, with the exception of recognition. The present data indicate that participant age and education significantly influence performance on the RAVLT.
The present investigation examines the alternate-form and longitudinal reliability of two versions of the Auditory-Verbal Learning Test (AVLT) on a large, multiregional, healthy male sample. Subjects included 2,059 bisexual and homosexual HIV-seronegative males recruited from the Multicenter AIDS Cohort Study from centers in Baltimore, Chicago, Los Angeles, and Pittsburgh. The findings revealed no significant differences between forms upon initial or 1-year longitudinal administration, supporting the equivalence of the two versions. However, significant practice effects were noted longitudinally, arguing for the need of appropriate retest normative data. Furthermore, as age, ethnicity, and education were found to significantly affect test performance, it is recommended that normative data be interpreted according to these variables. In addition to providing normative and longitudinal data, this investigation presents information concerning the use and limitations of the alternate forms of the AVLT.
The aim of this study was to compare the screening value of the Mini-Cog, Clock Drawing Test (CDT), Mini-Mental State Examination (MMSE) and the algorithm MMSE and/or CDT to separate elderly people with dementia from healthy depending on test time, type and severity of dementia, and demographic variables in a German Memory Clinic. Data from a heterogeneous patient sample and healthy participants (n = 502) were retrospectively analyzed. Of the 438 patients with dementia, 49.1% of the dementia diagnoses were Alzheimer's dementia and 50.9% were non-Alzheimer's dementia. Sixty-four participants were classified as cognitively unimpaired. The CDT and an extraction of the 3-item recall of the MMSE were used to constitute the Mini-Cog algorithm. Overall, the Mini-Cog showed significantly higher discriminatory power (86.8%) than the MMSE (72.6% at a cut-off ≤ 24 and 79.2% at ≤ 25, respectively) and CDT (78.1%) (each p < 0.01) and did not perform worse than the algorithm MMSE and/or CDT (each p > 0.05). The specificity of the Mini-Cog (100.0%) was similar to that of the MMSE (100.0% for both cut-offs) and CDT (96.9%) (p = 0.154). For all age and educational groups the Mini-Cog outmatched the CDT and MMSE, and was less affected by education than MMSE and less susceptible for the dementia stage than the CDT. The Mini-Cog proved to have superior discriminatory power than either CDT or MMSE and is demonstrated to be a valid "short" screening instrument taking 3 to 4 minutes to administer in the geriatric setting.
Test Your Memory (TYM) test is a recently described cognitive test instrument designed to be self-administered under medical supervision. The pragmatic role of such self-administered tests in cognitive clinics has not previously been examined. We investigated the diagnostic utility of the TYM as an independent test to differentiate patients with and without dementia at initial clinical diagnostic interview in dedicated memory clinics. TYM was administered to consecutive new patient referrals to two memory clinics independent of other tests [Mini-Mental State Examination (MMSE) and the Addenbrooke's Cognitive Examination-Revised] which were used to establish diagnoses according to standard diagnostic criteria (DSM-IV), and results were compared. In a cohort of 224 patients, 35% fulfilling clinical diagnostic criteria for dementia, TYM proved easy to use and acceptable to patients. Downward adjustment of the TYM test cutoff to ≤30/50, compared to ≤42/50 used in the index study, proved necessary to maximise test accuracy and specificity. Using this revised cutoff, TYM showed comparable diagnostic utility (sensitivity 0.73, specificity 0.88, positive predictive value 0.77, negative predictive value 0.86 and area under receiver operating characteristic curve 0.89) to the MMSE and the Addenbrooke's Cognitive Examination-Revised for the differentiation of cases of dementia from non-dementia. TYM is a useful screening test in the cognitive function clinic setting, with patients who fall below the designated cutoff requiring further investigation to ascertain a cause for their cognitive impairment. Self-administered tests such as TYM may be of particular value in situations where clinician time is limited.