Task decomposition analysis of intertrial free recall performance on the Rey Auditory Verbal Learning Test in normal aging and Alzheimer's disease

Differentiation of memory processing stages and effect of demographic variables with alternative scoring approaches to the Rey auditory verbal learning test

BACKGROUND

The Rey Auditory Verbal Learning Test (RAVLT) is the third most popular verbal memory test and the tenth most frequently used neuropsychological test. The original scoring system of RAVLT does not differentiate stages of memory processing, but a recently developed composite scoring system has this potential. The objectives were to compare the two systems in terms of their capacity to differentiate the stages of memory processing and to study the effect of demographic variables on the learning trials (T) of the Turkish form of RAVLT (T-RAVLT).

METHOD

The sample consisted of 600 Caucasian Turkic adults, who were categorized into three levels of age, three levels of education, and two levels of gender. Individual administration of T-RAVLT was performed using the standard procedures of RAVLT.

RESULTS

The components in the exploratory factor analysis (EFA) and latent variables in the confirmatory factor analysis (CFA) of the original scores were consistent with sequentially ordered T-RAVLT stages. Demographic variables (age, education, and gender) affected performances in all of the learning trials. The composite scores revealed retrieval and retention as separate components, but these scores could not be predicted from the relevant T-RAVLT scores.

CONCLUSIONS

Findings recommend a combined utilization of the two scoring systems: The original system to provide scores on the performance at each stage of T-RAVLT and the combined system to provide separate scores on learning, retention, and retrieval, the three stages of memory processing. A selective effect of demographic variables on T1 was not observed, indicating a need for cross-cultural studies that are meticulously controlled for age and education.

Examining the factor structure of the Rey auditory verbal learning test in individuals across the life span

Objective: Previous studies analyzing the factor structure of the Rey Auditory Verbal Learning Test (RAVLT) have been limited in the number of scores included in the analysis. Often, they lacked inclusion of process scores that have been shown to add predictive value in identifying future cognitive decline. Therefore, the goal of the current study was to determine the factor structure of the RAVLT utilizing factor scores including serial position effects, repetitions, and intrusion errors, and to examine if the factor structure for older adults is similar to that found in the entire lifespan sample.Method: Exploratory factor analysis (EFA) was conducted on 718 participants (age 16-85 years) from the Nathan Kline Institute (NKI)-Rockland project. Confirmatory factor analyses (CFA) of a reduced model of the EFA was conducted on the entire sample and an older (ages 55-85 years; n = 265) and a younger (less than 55 years of age; n = 453) subsample.Results: EFA indicated three factors: Memory, Attention/Learning, and Inaccurate Memory (i.e., repetitions and intrusions). CFA of a reduced model indicated adequate fit in the entire sample and older subsample, and good fit in the younger subsample.Conclusion: The present study examined the factor structure of the RAVLT in a large lifespan sample utilizing a larger set of RAVLT scores than have been examined in prior studies, including total scores and process scores. The same factors were identified in the entire lifespan sample and the younger and older adult subsamples, although similar to previous studies, measures of model fit were less robust in the older adult subsample. These results provide additional support for the error scores (e.g., intrusions and repetitions) as separable from other aspects of learning and memory.

Objective subtle cognitive difficulties predict future amyloid accumulation and neurodegeneration

OBJECTIVE

To determine the temporal sequence of objectively defined subtle cognitive difficulties (Obj-SCD) in relation to amyloidosis and neurodegeneration, the current study examined the trajectories of amyloid PET and medial temporal neurodegeneration in participants with Obj-SCD relative to cognitively normal (CN) and mild cognitive impairment (MCI) groups.

METHOD

A total of 747 Alzheimer's Disease Neuroimaging Initiative participants (305 CN, 153 Obj-SCD, 289 MCI) underwent neuropsychological testing and serial amyloid PET and structural MRI examinations. Linear mixed effects models examined 4-year rate of change in cortical 18F-florbetapir PET, entorhinal cortex thickness, and hippocampal volume in those classified as Obj-SCD and MCI relative to CN.

RESULT

Amyloid accumulation was faster in the Obj-SCD group than in the CN group; the MCI and CN groups did not significantly differ from each other. The Obj-SCD and MCI groups both demonstrated faster entorhinal cortical thinning relative to the CN group; only the MCI group exhibited faster hippocampal atrophy than CN participants.

CONCLUSION

Relative to CN participants, Obj-SCD was associated with faster amyloid accumulation and selective vulnerability of entorhinal cortical thinning, whereas MCI was associated with faster entorhinal and hippocampal atrophy. Findings suggest that Obj-SCD, operationally defined using sensitive neuropsychological measures, can be identified prior to or during the preclinical stage of amyloid deposition. Further, consistent with the Braak neurofibrillary staging scheme, Obj-SCD status may track with early entorhinal pathologic changes, whereas MCI may track with more widespread medial temporal change. Thus, Obj-SCD may be a sensitive and noninvasive predictor of encroaching amyloidosis and neurodegeneration, prior to frank cognitive impairment associated with MCI.

Word-list intrusion errors predict progression to mild cognitive impairment

OBJECTIVE

Preclinical Alzheimer's disease (AD) defined by a positive AD biomarker in the presence of normal cognition is presumed to precede mild cognitive impairment (MCI). Subtle cognitive deficits and cognitive inefficiencies in preclinical AD may be detected through process and error scores on neuropsychological tests in those at risk for progression to MCI.

METHOD

Cognitively normal participants (n = 525) from the Alzheimer's Disease Neuroimaging Initiative were followed for up to 5 years and classified as either stable normal (n = 305) or progressed to MCI (n = 220). Cox regressions were used to determine whether baseline process scores on the Rey Auditory Verbal Learning Test (AVLT; intrusion errors, learning slope, proactive interference, retroactive interference) predicted progression to MCI and a Clinical Dementia Rating (CDR) score of 1 after considering demographic characteristics, apolipoprotein E ε4 status, cerebrospinal fluid AD biomarkers, ischemia risk, mood, functional difficulty, and standard neuropsychological total test scores for the model.

RESULTS

Baseline AVLT intrusion errors predicted progression to MCI (hazard ratio = 1.04, 95% confidence interval 1.01-1.07, p = .008) and improved model fit after the other valuable predictors were already in the model, χ2(df = 1) = 6.330, p = .012. AVLT intrusion errors also predicted progression to CDR = 1 (hazard ratio = 1.10, 95% confidence interval 1.02-1.18, p = .016) and again improved model fit, χ2(df = 1) = 4.682, p = .030.

CONCLUSIONS

Intrusion errors on the AVLT contribute unique value for predicting progression from normal cognition to MCI and normal cognition to mild dementia (CDR = 1). Intrusion errors appear to reflect subtle change and inefficiencies in cognition that precede impairment detected by neuropsychological total scores. (PsycINFO Database Record

Using Neuropsychological Process Scores to Identify Subtle Cognitive Decline and Predict Progression to Mild Cognitive Impairment

BACKGROUND

We previously operationally-defined subtle cognitive decline (SCD) in preclinical Alzheimer's disease (AD) using total scores on neuropsychological (NP) tests. NP process scores (i.e., provide information about how a total NP score was achieved) may be a useful tool for identifying early cognitive inefficiencies prior to objective impairment seen in mild cognitive impairment (MCI) and dementia.

OBJECTIVE

We aimed to integrate process scores into the SCD definition to identify stages of SCD and improve early detection of those at risk for decline.

METHODS

Cognitively "normal" participants from the Alzheimer's Disease Neuroimaging Initiative were classified as "early" SCD (E-SCD; >1 SD below norm-adjusted mean on 2 process scores or on 1 process score plus 1 NP total score), "late" SCD (L-SCD; existing SCD criteria of >1 SD below norm-adjusted mean on 2 NP total scores in different domains), or "no SCD" (NC). Process scores considered in the SCD criteria were word-list intrusion errors, retroactive interference, and learning slope. Cerebrospinal fluid AD biomarkers were used to examine pathologic burden across groups.

RESULTS

E-SCD and L-SCD progressed to MCI 2.5-3.4 times faster than the NC group. Survival curves for E-SCD and L-SCD converged at 7-8 years after baseline. The combined (E-SCD+L-SCD) group had improved sensitivity to detect progression to MCI relative to L-SCD only. AD biomarker positivity increased across NC, SCD, and MCI groups.

CONCLUSIONS

Process scores can be integrated into the SCD criteria to allow for increased sensitivity and earlier identification of cognitively normal older adults at risk for decline prior to frank impairment on NP total scores.

The Hopkins Verbal Learning Test: an in-depth analysis of recall patterns

One of the earliest signs of dementia is memory issues and verbal word lists, such as the Hopkins Verbal Learning Test (HVLT), are successfully used for screening. To gain insight in how memory is affected in dementia, and to further improve the efficacy of the HVLT, in-depth analysis of the recall patterns of dementia cases and controls was conducted. Dementia cases and controls were matched for factors that can affect performance, such as age, gender and education level. Word frequency, syllable length, and orthographic neighbourhood size did not differ in the Indonesian version of the HVLT, nor did these characteristics affect recall. However dementia cases showed consistent and poor recall across the three trials; with the worst recall for the "human shelter" category and best recall for the "animals" category. Dementia cases also showed impaired accessibility of all categories with reduced subsequent recall from accessed categories and reduced primacy and recency levels. Finally, dementia cases exhibited lower levels of re-remembering and recalling new words, and higher levels of immediate forgetting and never recalling words. It was concluded that utilising the extra information provided by the in-depth analyses of the recall patterns could be beneficial to improve dementia screening.

Verbal and non-verbal memory and hippocampal volumes in a memory clinic population

Introduction

Better characterization of the relationship between episodic memory and hippocampal volumes is crucial in early detection of neurodegenerative disease. We examined these relationships in a memory clinic population.

Methods

Participants (n = 226) underwent structural magnetic resonance imaging and tests of verbal (Hopkins Verbal Learning Test-Revised, HVLT-R) and non-verbal (Brief Visuospatial Memory Test-Revised, BVMT-R) memory. Correlational analyses were performed, and analyses on clinical subgroups (i.e., amnestic Mild Cognitive Impairment, non-amnestic Mild Cognitive Impairment, probable Alzheimer’s disease, intact memory) were conducted.

Results

Positive associations were identified between bilateral hippocampal volumes and both memory measures, and BVMT-R learning slope was more strongly positively associated with hippocampal volumes than HVLT-R learning slope. Amnestic Mild Cognitive Impairment (aMCI) participants showed specific positive associations between BVMT-R performance and hippocampal volumes bilaterally. Additionally, analyses of the aMCI group showed trend-level evidence of material-specific lateralization, such that retention of verbal information was positively associated with left hippocampal volume, whereas learning curve and retention of non-verbal information was positively associated with right hippocampal volume.

Conclusions

Findings support the link between episodic memory and hippocampal volumes in a memory clinic population. Non-verbal memory measures also may have higher diagnostic value, particularly in individuals at elevated risk for Alzheimer’s disease.

Verbal learning across the lifespan: an analysis of the components of the learning curve

Previous studies on the acquisition process of verbal material, conducted separately on child and adult populations, reveal that the lifespan is characterized by an inverted-U performance curve with similar achievements at its two poles. To clarify the acquisition mechanism across the entire lifespan, the learning curve for the Rey Auditory Verbal Learning Test was reproduced for participants aged 8-91. The study utilized typical trial summary scores and a more refined analysis of trial-by-trial single-word recalls, including omissions (missed words that were previously recalled), additions (recalled words previously missed), and touched words (a count for the first recall time only, for each word during the five learning trial). A clear age effect was shown for the number of words recalled - symmetrically increases during childhood and decreases in adulthood. Similarly, increased turnover of words omitted and added characterized both incremental and decremental age differences. Measurement patterns differed for the age segments on the two sides of the lifespan, despite the similar total number of words recalled by the two sides. Acquisition pattern in children was characterized by a higher number of touched words and higher turnover than for adult groups. In contrast, older adults achieved fewer touched words and lower turnover than the child groups. This study shows that it is possible to reach the same quantitative results via different cognitive processes. The results are interpreted in terms of specific mechanisms of maturational characteristics.

Performance variability during a multitrial list-learning task as a predictor of future cognitive decline in healthy elders

INTRODUCTION

In clinical settings, neuropsychological test performance is traditionally evaluated with total summary scores (TSS). However, recent studies demonstrated that indices of intraindividual variability (IIV) yielded unique information complementing TSS. This 18-month longitudinal study sought to determine whether IIV indices derived from a multitrial list-learning test (the Rey Auditory Verbal Learning Test) provided incremental utility in predicting cognitive decline in older adults compared to TSS.

METHOD

Ninety-nine cognitively intact older adults (aged 65 to 89 years) underwent neuropsychological testing (including the Rey Auditory Verbal Learning Test) at baseline and 18-month follow-up. Participants were classified as cognitively stable (n = 65) or declining (n = 34) based on changes in their neuropsychological test performance. Logistic regression modeling tested the ability of baseline TSS indices (sum of Trials 1-5, immediate recall, and delayed recall) and IIV indices (lost access and gained access) to discriminate between stable and declining individuals.

RESULTS

Higher values of both lost access and gained access at baseline were associated with an increased risk for decline at 18-month follow-up. Further, the IIV indices provided predictive utility above and beyond the TSS indices.

CONCLUSION

These results highlight the value of analyzing IIV in addition to TSS during neuropsychological evaluation in older adults. High levels of IIV may reflect impairment in anterograde memory systems and/or executive dysfunction that may serve as a prognostic indicator of cognitive decline.

Episodic intertrial learning of younger and older participants: effects of age of acquisition

There is clear evidence of a deficit in episodic memory for older adults compared to younger adults. Using an intertrial technique previous research has investigated whether this deficit can be attributed to a decline in encoding or consolidation. On standard memory tests, these two aspects of memory function can be measured by examining the items forgotten or acquired across multiple learning trials. The present study assessed whether age deficits in episodic memory were affected by stimulus characteristics, specifically age of acquisition (AoA). A standard intertrial design was implemented whereby participants studied word lists over several study-test trials. The stimulus characteristics of AoA were manipulated using a pure-list technique. Our findings showed that older adults demonstrate an overall recall deficit which appeared to be a consequence of both an encoding deficit and consolidation weakness. Earlier-acquired words were recalled significantly better than later-acquired words and this was apparently due to both enhanced encoding and consolidation of earlier- over later-acquired words. The key finding is that older adults show a recall advantage for earlier- compared to later-acquired words over the entire experiment to a greater degree than younger adults.

Differential effects of Parkinson's disease and dopamine replacement on memory encoding and retrieval

Increasingly memory deficits are recognized in Parkinson's disease (PD). In PD, the dopamine-producing cells of the substantia nigra (SN) are significantly degenerated whereas those in the ventral tegmental area (VTA) are relatively spared. Dopamine-replacement medication improves cognitive processes that implicate the SN-innervated dorsal striatum but is thought to impair those that depend upon the VTA-supplied ventral striatum, limbic and prefrontal cortices. Our aim was to examine memory encoding and retrieval in PD and how they are affected by dopamine replacement. Twenty-nine PD patients performed the Rey Auditory Verbal Learning Test (RAVLT) and a non-verbal analogue, the Aggie Figures Learning Test (AFLT), both on and off dopaminergic medications. Twenty-seven, age-matched controls also performed these memory tests twice and their data were analyzed to correspond to the ON-OFF order of the PD patients to whom they were matched. We contrasted measures that emphasized with those that accentuated retrieval and investigated the effect of PD and dopamine-replacement on these processes separately. For PD patients relative to controls, encoding performance was normal in the off state and was impaired on dopaminergic medication. Retrieval was impaired off medication and improved by dopamine repletion. This pattern of findings suggests that VTA-innervated brain regions such as ventral striatum, limbic and prefrontal cortices are implicated in encoding, whereas the SN-supplied dorsal striatum mediates retrieval. Understanding this pattern of spared functions and deficits in PD, and the effect of dopamine replacement on these distinct memory processes, should prompt closer scrutiny of patients' cognitive complaints to inform titration of dopamine replacement dosages along with motor symptoms.

Differences in learning rates for item and associative memories between amnestic mild cognitive impairment and healthy controls

BACKGROUND

It has been established that the overall performance of associative memory was disproportionately impaired in contrast to item memory in aMCI (Amnestic mild cognitive impairment) patients, but little is known about the specific aspects of the memory process that show differences between aMCI and healthy controls. By comparing an item-item associative learning test with an individual item learning test, the present study investigated whether the rate of learning was slower in associative memory than in item memory in aMCI. Furthermore, we examined whether deficits in intertrial acquisition and consolidation contributed to the potential disproportionate impairments in the learning rate of associative memory for aMCI patients. In addition, we further explored whether the aMCI-discriminative power of the associative memory test increases more than that of the item memory test when the number of learning-test trials increases.

METHODS

A group of 40 aMCI patients and 40 matched control participants were administered a standardized item memory test (Auditory Verbal Learning Test, AVLT) and a standardized associative memory test (Paired Associative Learning Test, PALT), as well as other neuropsychological tests and clinical assessments.

RESULTS

The results indicated that the learning rate deficits in aMCI patients were more obvious for associative memory than for item memory and that the deficits resulted from impairments in both intertrial acquisition and consolidation. In addition, the receiver operating characteristic curve and logistical regression analysis revealed that the discriminative power of the associative memory test for aMCI was larger than that of the item memory test, especially with more than one learning-test trials.

CONCLUSIONS

Due to more deficits in learning rate of associative memory than that of item memory, the discriminative power for aMCI tended to be larger in associative memory than in item memory when the number of learning-test trials increased. It is suggested that associative memory tests with multiple trials may be particularly useful for early detection of aMCI.

Verbal learning in Alzheimer's disease and mild cognitive impairment: fine-grained acquisition and short-delay consolidation performance and neural correlates

The aim of this study was to examine correlations between acquisition and short-delay consolidation and brain metabolism at rest measured by fluorodeoxyglucose positron emission tomography (FDG-PET) in 44 Alzheimer's disease (AD) patients, 16 patients with mild cognitive impairment (MCI) who progressed to dementia (MCI-AD), 15 MCI patients who remained stable (MCI-S, 4-8 years of follow-up), and 20 healthy older participants. Acquisition and short-delay consolidation were calculated respectively as mean gained (MG) and lost (ML) access to items of the California Verbal Learning Task. MG performance suggests that acquisition is impaired in AD patients even at predementia stage (MCI-AD). ML performance suggests that short-delay consolidation is deficient only in confirmed AD patients. Variations in acquisition performance in control participants are related to metabolic activity in the anterior parietal cortex, an area supporting task-positive attentional processes. In contrast, the acquisition deficit is related to decreased activity in the lateral temporal cortex, an area supporting semantic processes, in patients at an early stage of AD and is related to metabolic activity in the hippocampus, an area supporting associative processes, in confirmed AD patients.

Episodic intertrial learning of younger and older adults: effects of word frequency

Older adults have a demonstrable episodic memory deficit. The present study aimed to investigate whether the age deficit in episodic memory was influenced by stimulus characteristics known to produce differences in memory performance in younger adults, specifically word frequency. An intertrial paradigm was used whereby participants studied high- or low-frequency lists over several study-test trials, and the loss and gain of individual items was measured across trials; putative measures of consolidation and encoding. The results show that high-frequency words are recalled significantly better than low-frequency words. Older adults acquired high-frequency words at a greater rate across trials than they did for low-frequency words, an effect not evident in the younger adults. Older adults were found to have deficits in both encoding and consolidation as measured by losses and gains of items across trials. The results support the inter-item association theory of the word frequency effect on recall, with the age differences suggesting that memory deficits are sensitive to stimuli characteristics - one interpretation being that the ease of processing of the stimuli at encoding facilitates later recall.

Differences in Acquisition, Not Retention, Largely Contribute to Sex Differences in Multitrial Word Recall Performance

Approximately 2,500 adults (ages 18-97) completed multiple study-test trials of a list of unrelated words. Consistent with past research, females outperformed males in the recall task. To assess whether sex differences in recall performance were attributable to differences in acquiring and/or retaining information, the data were analyzed at the individual item level to distinguish gains (i.e., items not recalled on Trial n that were recalled on Trial n+1) and losses (i.e., items recalled on Trial n that were not recalled on Trial n+1). Being a male, increased age, lower verbal episodic memory ability, and lower vocabulary ability were associated with smaller gains and greater losses. Even when controlling for the influence of other individual difference variables, being a male was still associated with fewer gains across the majority of trials. These results suggest that one factor contributing to sex differences in recall performance are differences in acquiring new items rather than differences in retaining information across trials.

Verbal learning in Alzheimer's disease: cumulative word knowledge gains across learning trials

Research regarding learning in Alzheimer's disease (AD) patients has been mixed. Learning capacity might be better indexed using a score that reflects the interaction between the learning slope and total recall, referred to as the Cumulative Word Learning (CWL) score. We compared a group of AD patients to normal participants using a traditional index of learning and the CWL score that were derived from the Hopkins Verbal Learning Test-Revised (HVLT-R). The HVLT-R is a supra-span, list-learning test containing 12 words from three semantic categories. The results indicated that the sample of AD patients performed within the average range, using the traditional learning z score. Although mild AD patients were not found to differ from controls in the traditional learning z score, a significant difference was noted for the CWL score. The moderate AD patients differed from the normal controls in both learning measures. Furthermore, unlike the traditional learning score, the CWL score was a significant predictor of overall cognitive functioning, as indexed using their Mini-Mental State Examination (MMSE) score. Thus, the CWL score might be a more sensitive indicator overall of total learning capacity and may be useful in staging Alzheimer's disease because of increased resilience to floor effects.

Physical activity and memory functions: an interventional study

Previous studies have suggested beneficial effects of physical activity on cognition. Here, we asked in an interventional approach if physical activity performed at different intensity levels would differentially affect episodic memory function. Additionally, we tried to identify mechanisms mediating these changes. Sixty-two healthy elderly individuals were assessed for level of physical activity, aerobic fitness, episodic memory score, neurotrophin and catecholamine levels, and received a magnetic resonance image of the brain at baseline and after a six months intervention of medium or low-intensity physical activity or control. Increase in total physical activity was positively associated with increase in memory score over the entire cohort, without significant differences between intensity groups. It was also positively associated with increases in local gray matter volume in prefrontal and cingulate cortex, and BDNF levels (trend). In conclusion, we showed that physical activity conveys the beneficial effects on memory function independently of its intensity, possibly mediated by local gray matter volume and neurotrophic factors. Our findings may carry significant implications for prevention of cognitive decline in the elderly.

Proactive and retroactive interference in young adults, healthy older adults, and older adults with amnestic mild cognitive impairment

This study investigated memory interference in amnestic mild cognitive impairment (aMCI) and normal aging. Participants were 27 young adults, 44 healthy older adults, and 15 older adults with aMCI. Memory interference was examined on the California Verbal Learning Test (CVLT) and on a modified AB-AC paradigm. Despite significant differences in memory performance on the CVLT, interference measures on this test did not distinguish individuals with aMCI and healthy older adults. The AB-AC task involved first learning a list (AB list) of 12 semantically related word pairs (e.g., knee-bone). Twenty minutes later, a second list (AC list) was learned in which the same stimulus words were paired with new response words (e.g., knee-bend). Both lists were repeated until 100% accurate recall was achieved. Finally, participants recalled the first (AB) list. Proactive interference (PI) was greater among older than younger adults, and greater still among individuals with aMCI, but the older and aMCI groups showed similar levels of retroactive interference. This study suggests that PI contributes to the memory deficits seen in aMCI and that tests sensitive to PI may assist in the early identification of aMCI. Memory interventions aimed at alleviating PI may improve memory functioning in individuals with aMCI. (JINS, 2009, 15, 83-93.).

Modeling of context-dependent retrieval in hippocampal region CA1: implications for cognitive function in schizophrenia

The symptoms of schizophrenia may be associated with reductions in NMDA receptor (NMDAR) function. This is suggested by the psychotomimetic effects of NMDA antagonists, the ameliorative effects of NMDAR indirect agonists, elevated levels of the NMDA antagonist N-acetyl-aspartyl-glutamate (NAAG) in schizophrenic brain, and findings from recent genetic studies. However, the link between reduced NMDAR function and the behavioral features of schizophrenics has not been made explicit. Here we present a network simulation of hippocampal function, focused on retrieval of verbal stimuli in human memory tasks. Specifically, we trained a computational model of the hippocampal complex to perform a context-dependent paired associate task, a free recall task with category clustering, and the transitive inference (TI) task. In this network, direct perforant pathway input from entorhinal cortex to region CA1 provides the basis for semantic context cueing during initial encoding and retrieval, allowing selective retrieval on the basis of category cues. Alterations in the magnitude of this direct perforant pathway input to region CA1 causes impairments in use of organizational strategies for memory, accounting for specific features of memory dysfunction in schizophrenics and in normals treated with ketamine. This model provides a theoretical link between cellular physiological changes and specific cognitive symptoms. As such, it can shed light on the etiology of schizophrenia in a fundamental way, and also holds the promise of pointing the way to more effective treatments.

Are people with mild cognitive impairment aware of the benefits of errorless learning?

Mild cognitive impairment (MCI) has been described as a memory deficit in the absence of other cognitive dysfunction. It can be thought of as a pre-clinical dementia. Memory impairment in this group is not as severe as in early dementia and thus learning is still possible. We were interested to see if errorless learning, a widely used rehabilitation technique, was of benefit to people with MCI. Since it has been shown that successful rehabilitation is somewhat contingent on awareness of function, we were also interested to see if people with MCI were aware of the benefits of errorless learning. The present study employed an errorless learning procedure on 16 people with MCI and 16 older adult controls to learn two lists of 10 words in errorless and errorful learning conditions. We adopted a metacognitive approach measuring people's memory monitoring through judgements of learning (JOLs) a prediction of future memory performance. The results revealed errorless learning is an effective memory rehabilitation tool for people with MCI, with significant increases in recall performance for both groups relative to errorful learning. Most interestingly participants were aware of the benefits of errorless learning in their JOLs. MCI participants and controls both had significantly higher JOLs for words studied under errorless learning conditions. The learning performance in MCI and theories of metacognitive awareness are discussed.

Usefulness of repeated presentation of Mini-Mental State Examination as a diagnostic procedure--a population-based study

MATERIAL AND METHODS

The 280 subjects who achieved 24 points or less in the Mini-Mental State Examination (MMSE) in the first survey of 1449 subjects were invited for a comprehensive diagnostic examination for dementia including medical history, thorough neurological and cardiovascular examinations and detailed neuropsychological evaluation, magnetic resonance imaging (MRI)-study, cerebrospinal fluid (CSF)-analysis, electrocardiogram (ECG), chest radiograph and blood tests after the first assessment. The MMSE was presented again.

RESULTS

Out of 240 persons, 57 subjects were diagnosed as having dementia. When the cut-off point of 24 or less in the second MMSE was used, the sensitivity of the second MMSE was 82% and the specificity was 64%. The positive predictive value of the second MMSE was 42% and negative predictive value 92%. The non-demented subjects improved their MMSE score at the second examination. In contrast, the demented subjects maintained their low MMSE score at the second examination.