Conducting Geriatric Evaluations: Using Data from WAIS-IV, WMS-IV, and ACSW4W4 Gloria Maccow, Ph.D., Assessment Training Consultant Conducting Geriatric Evaluations: Using Data from WAIS-IV, WMS-IV, and ACSW4W4 Gloria Maccow, Ph.D. Assessment Training Consultant Objectives • Select components of Advanced Clinical Solutions for WAIS-IV and WMS-IV to determine the presence of dementia; • Link assessment data to treatment based on the demands of the individual’s functional environment. 2 | Copyright © 2011. All rights reserved. Three Batteries • WAIS-IV, WMS-IV, and ACS were developed to be used together. • Decisions made in the development of one instrument affected the development of other components. • Each instrument provides unique information about the examinee. 3 | Copyright © 2011. All rights reserved. Copyright © 2011. Pearson, Inc. All rights reserved. 1 Conducting Geriatric Evaluations: Using Data from WAIS-IV, WMS-IV, and ACSW4W4 Gloria Maccow, Ph.D., Assessment Training Consultant Factors to Consider • The tests were built together to allow users to better identify the nature of the underlying cognitive difficulty. • One of the strengths of the tests is their co-norming. • Use regression based approach to partial out overlapping variance (contrast scores). 4 | Copyright © 2011. All rights reserved. Three Batteries • WAIS‐IV, WMS‐IV, and ACS were developed to be used together. • Decisions made in the development of one instrument affected the development of other components. • Each instrument provides unique information about the examinee. 5 | Copyright © 2011. All rights reserved. Applications of Batteries WAIS‐IV and WMS‐IV used for – School based evaluations – Disability evaluations – Psychiatric evaluations – Neuropsychological evaluations – Forensic evaluations – Medical/legal evaluations – Competency evaluations – Vocational Rehabilitation evaluations, etc. 6 | Copyright © 2011. All rights reserved. Copyright © 2011. Pearson, Inc. All rights reserved. 2 Conducting Geriatric Evaluations: Using Data from WAIS-IV, WMS-IV, and ACSW4W4 Gloria Maccow, Ph.D., Assessment Training Consultant Factors to Consider • Difficult to build one instrument to answer all possible questions. • Not all clinicians will need all pieces of information. • Expectation is that clinicians will select those measures that best fit their practice and workflow. 7 | Copyright © 2011. All rights reserved. Factors to Consider • The tests were built together to allow users to better identify the nature of the underlying cognitive difficulty. • One of the strengths of the tests is their co‐norming. • Use regression based approach to partial out overlapping variance (contrast scores). 8 | Copyright © 2011. All rights reserved. Wechsler Adult Intelligence Scale Fourth Edition Copyright © 2011. Pearson, Inc. All rights reserved. 3 Conducting Geriatric Evaluations: Using Data from WAIS-IV, WMS-IV, and ACSW4W4 Gloria Maccow, Ph.D., Assessment Training Consultant WAIS-IV Content and Structure Ages 16–90 Perceptual Reasoning Scale Verbal Comprehension Scale GAI Core Subtests Core Subtests Block Design Similarities Matrix Reasoning Vocabulary Visual Puzzles New! Information Supplemental Subtests Supplemental Subtests Picture Completion Comprehension Figure Weights (16-69) New! Full Scale Working Memory Scale Processing Speed Scale Core Subtests Core Subtests Digit Span Symbol Search Arithmetic Coding Supplemental Subtests Supplemental Subtests Letter-Number Sequencing (16-69) Cancellation (16-69) New! 10 | Copyright © 2011. All rights reserved. What is the GAI? • The WAIS–IV GAI provides the practitioner with a summary score that is less sensitive than the FSIQ to the influence of working memory and processing speed. • GAI = sum of scaled scores for VCI subtests and PRI subtests 11 | Copyright © 2011. All rights reserved. What is the GAI? • WAIS–IV GAI should be used for discrepancy comparisons – Ability and Memory – Ability and achievement • GAI is NOT a replacement for FSIQ 12 | Copyright © 2011. All rights reserved. Copyright © 2011. Pearson, Inc. All rights reserved. 4 Conducting Geriatric Evaluations: Using Data from WAIS-IV, WMS-IV, and ACSW4W4 Gloria Maccow, Ph.D., Assessment Training Consultant General Ability Index Consider* using the GAI if a significant and unusual discrepancy exists between VCI and WMI; or PRI and PSI; or WMI and PSI, or between subtests within WMI and/or PSI. Note: The FSIQ is the most valid measure of overall cognitive ability and WM and PS are vital to comprehensive evaluation of cognitive ability. 13 | Copyright © 2011. All rights reserved. General Ability Index - Note! • The GAI is used when neuropsychological deficits adversely impact performance on WM and PS. • Impaired performance on WM and/or PS may mask actual differences between general cognitive ability (FSIQ) and other cognitive functions (e.g., memory). • The GAI does not replace the FSIQ. Report and interpret GAI along with FSIQ. [see WAIS-IV Technical Manual] 14 | Copyright © 2011. All rights reserved. Wechsler Memory Scale Fourth Edition Copyright © 2011. Pearson, Inc. All rights reserved. 5 Conducting Geriatric Evaluations: Using Data from WAIS-IV, WMS-IV, and ACSW4W4 Gloria Maccow, Ph.D., Assessment Training Consultant Memory and Learning • Encoding: External information is transformed into mental representations or memories and stored in STM. • Consolidation: Information from immediate memory is solidified into long-term memory stores. • Retrieval: Information is brought into conscious awareness. 16 | Copyright © 2011. All rights reserved. WMS-IV Test Battery Seven subtests: – Logical Memory, Verbal Paired Associates, and Visual Reproduction - retained from WMS-III. – Brief Cognitive Status Exam, Designs, Spatial Addition, and Symbol Span - NEW. 17 | Copyright © 2011. All rights reserved. WMS-IV Test Battery Logical Memory, Verbal Paired Associates, Designs, and Visual Reproduction have two conditions: – the immediate condition (I), and – the delayed condition (II), Condition I and II are administered about 20–30 minutes apart. 18 | Copyright © 2011. All rights reserved. Copyright © 2011. Pearson, Inc. All rights reserved. 6 Conducting Geriatric Evaluations: Using Data from WAIS-IV, WMS-IV, and ACSW4W4 Gloria Maccow, Ph.D., Assessment Training Consultant WMS-IV Batteries Adult Battery Ages 16-69 Older Adult Battery Ages 65-90 [Also, WMS-IV Flexible Approach] 19 | Copyright © 2011. All rights reserved. Types of Scores • Primary Subtest Scaled Scores (mean=10, sd = 3) • Index Scores (mean=100, sd = 15) • Process Scores (Scaled Score or Cumulative Percentage) • Contrast Scaled Scores 20 | Copyright © 2011. All rights reserved. Components of ACS Memory Grid Cards Word Choice Stimulus Book Record Forms/Booklets Copyright © 2011. Pearson, Inc. All rights reserved. 7 Conducting Geriatric Evaluations: Using Data from WAIS-IV, WMS-IV, and ACSW4W4 Gloria Maccow, Ph.D., Assessment Training Consultant Applications of ACS . additional assessments of: – premorbid functioning – effort – social cognition – executive function A separate instrument, Texas Functional Living Scale, linked with the WAIS-IV and WMS-IV, can be used to assess instrumental activities of daily living. 22 | Copyright © 2011. All rights reserved. Applications of ACS . and software that delivers: – Demographically Adjusted Norms – Additional scores for WAIS-IV and WMS-IV – Reliable Change scores 23 | Copyright © 2011. All rights reserved. Remember! Many Factors Can Influence Performance – Acuity – Attention – Executive Functioning – Global Intellectual Functioning – Working Memory – Language Impairment (Auditory Memory subtests) – Visual-Spatial Processing (Visual Memory subtests) – Fatigue – Poor Effort – Impulsivity 24 | Copyright © 2011. All rights reserved. Copyright © 2011. Pearson, Inc. All rights reserved. 8 Conducting Geriatric Evaluations: Using Data from WAIS-IV, WMS-IV, and ACSW4W4 Gloria Maccow, Ph.D., Assessment Training Consultant Sample Case Study Clinical Applications: Assessing Dementia Mabel Sample82 Intake Information • Mabel is an 82-year old female. • She attended college but did not complete degree. • She was married for 50 years until her husband died 10 years ago. • She was a homemaker and never worked outside the home. 26 | Copyright © 2011. All rights reserved. Referral Concerns • Her children referred Mabel for evaluation. • They are concerned about declines in her cognitive abilities and about her living alone. 27 | Copyright © 2011. All rights reserved. Copyright © 2011. Pearson, Inc. All rights reserved. 9 Conducting Geriatric Evaluations: Using Data from WAIS-IV, WMS-IV, and ACSW4W4 Gloria Maccow, Ph.D., Assessment Training Consultant Referral Concerns According to her children, – Mabel evidences word retrieval difficulties, and difficulty sequencing complex information. – She is forgetful and easily overwhelmed with instrumental daily activities. 28 | Copyright © 2011. All rights reserved. Intake Information • Mabel is in relatively good physical health. • She was diagnosed with atrial fibrilation and osteoporosis – both are being treated with medication. • She takes Namenda to treat cognitive decline. 29 | Copyright © 2011. All rights reserved. Dementia or Mild Cognitive Impairment Clinical concepts concerning this referral: – Change in cognitive status from a previous level – Mental Status – Memory impairment – Self-care – Depression 30 | Copyright © 2011. All rights reserved. Copyright © 2011. Pearson, Inc. All rights reserved. 10 Conducting Geriatric Evaluations: