Biomedical subjects

David S Tulsky

Publications and source records attributed to David S Tulsky.

14 recordsLinked to original sources

PubMed2006

Development of WAIS-III General Ability Index Minus WMS-III memory discrepancy scores.

Analysis of the discrepancy between intellectual functioning and memory ability has received some support as a useful means for evaluating memory impairment. In recent additions to Wechlser scale interpretation, the WAIS-III General Ability Index (GAI) and the WMS-III Delayed Memory Index (DMI) were developed. The purpose of this investigation is to develop base rate data for GAI-IMI, GAI-GMI, and GAI-DMI discrepancy scores using data from the WAIS-III/WMS-III standardization sample (weighted N = 1250). Base rate tables were developed using the predicted-difference method and two simple-difference methods (i.e., stratified and non-stratified). These tables provide valuable data for clinical reference purposes to determine the frequency of GAI-IMI, GAI-GMI, and GAI-DMI discrepancy scores in the WAIS-III/WMS-III standardization sample.

Abstracting and Indexing↗

PubMed2004

A new look at the WMS-III: new research to guide clinical practice.

The Wechsler Memory Scale, Third Edition (WMS-III) was published in 1997 and marked an ambitious and substantial revision of the traditional memory scale. Since publication, however, clinical experience has led many practitioners to raise questions about the validity and clinical utility of the new subtests and new index scores. The impetus of this special issue was to address some of the questions with which clinicians have been struggling. The articles contained in this special issue present new empirical research on the WMS-III, and several include new methods and scoring techniques that go beyond what has been published in the WAIS-III-WMS-III Technical Manual (The Psychological Corporation, 1997, 2002). It is hoped that the new scores and techniques will prove useful in clinical practice and that this research will benefit future revisions of the Wechsler Memory Scale.

Biomedical Research↗

PubMed2004

Development of a new Delayed Memory Index for the WMS-III.

This paper presents the Delayed Memory Index (DMI) as an alternative to the General Memory Index (GMI) of the Weschler Memory Scale-Third Edition (WMS-III). The WMS-III Immediate Memory Index (IMI) and the GMI are not parallel in structure, making a direct comparison between these index scores (i.e., immediate vs. delayed memory variables) difficult. The IMI is composed of the sum of scaled scores of four subtests (Logical Memory I, Verbal Paired Associates I, Faces I, and Family Pictures I) while the GMI is composed of the sum of scaled scores of five subtests (Logical Memory II, Verbal Paired Associates II, Faces II, Family Pictures II and Auditory Recognition Delayed). Inclusion of Auditory Recognition Delayed in the GMI is also problematic as it is highly skewed and limited by extreme ceiling effects (see Tulsky, Chiaravalloti, Palmer, & Chelune, 2003). To remedy these problems, we present a new index score that does not include auditory recognition, the Delayed Memory Index. Normative tables for the new Delayed Memory Index based on the inclusion of the Faces subtest, or alternatively the Visual Reproduction subtest, are presented, and initial estimates of their psychometric properties are described.

Abstracting and Indexing↗

PubMed2004

Memory span on the Wechsler Scales.

This study had two goals. One was to assess whether the WMS-III Spatial Span subtest operates as a visual analogue of Digit Span while the second was to determine whether backward span is a more sensitive measure of working memory than the forward span condition. Analyses based on the WAIS-III-WMS-III standardization and clinical group data revealed some important distinctions between Digit and Spatial Span. The two tasks exhibited differences in patterns of performance on the forward versus backward conditions, in their relationships with age, and in their methodology. Moreover, the backward conditions of both Digit and Spatial Span did not appear more affected by risk factors such as aging or pathology than the forward scores. This runs contrary to the widespread notion that backward span provides differential sensitivity regarding working memory processing.

Adolescent↗

PubMed2004

Validation of the WMS-III Facial Memory subtest with the Graduate Hospital Facial Memory Test in a sample of right and left anterior temporal lobectomy patients.

A number of studies have shown visuospatial memory deficits following anterior temporal lobectomy (ATL) in the right, nondominant temporal lobe (RATL). The current study examines 26 patients with intractable temporal lobe epilepsy who underwent ATL in either the right (RATL, n = 16) or left temporal lobe (LATL, n = 10) on two tests of facial memory abilities, the Wechsler Memory Scale-III (WMS-III) Faces subtest and the Graduate Hospital Facial Memory Test (FMT). Repeated measures ANOVA on the FMT indicated a significant main effect of side of surgery. The RATL group performed significantly below the LATL group overall. Both groups showed a slight, but non-significant, improvement in performance from pre- to postsurgery on the FMT immediate memory, likely due to practice effects. Repeated measures ANOVA on the WMS-III Faces subtest revealed a significant interaction of group (RATL vs. LATL) by delay (immediate vs. delayed). Overall, the LATL group showed an improvement in recognition scores from immediate to delayed memory, whereas the RATL group performed similarly at both immediate and delayed testing. No effects of surgery were noted on the WMS-III. Following initial data analysis the WMS-III Faces I and II data were re-scored using the scoring suggested by Holdnack and Delis (2003), earlier in this issue. Repeated measures ANOVA revealed a trend toward significance in the three-way interaction of group (RATL vs. LATL) x time of testing (pre- versus postop) x delay (immediate vs. delayed memory). On the Faces I subtest, both the RATL and LATL groups showed a decline from preoperative to postoperative testing. However, on Faces II the LATL group showed an increase in performance from preoperative to postoperative testing, while the RALT group showed a decline in performance from preoperative to postoperative testing. While the FMT appears to be superior to the WMS-III Faces subtest in identifying deficits in facial memory prior to and following RATL, the application of the scoring methodology presented by Holdnack and Delis earlier in this issue does serve to increase the clinical utility of the WMS-III Faces subtest in this population.

Adult↗

PubMed2004

Replacement of the Faces subtest by Visual Reproductions within Wechsler Memory Scale-Third Edition (WMS-III) visual memory indexes: implications for discrepancy analysis.

Within discrepancy analysis differences between scores are examined for abnormality. Although larger differences are generally associated with rising impairment probabilities, the relationship between discrepancy size and abnormality varies across score pairs in relation to the correlation between the contrasted scores in normal subjects. Examinee ability level also affects the size of discrepancies observed normally. Wechsler Memory Scale-Third Edition (WMS-III) visual index scores correlate only modestly with other Wechsler Adult Intelligence Scale-Third Edition (WAIS-III) and WMS-III index scores; consequently, differences between these scores and others have to be very large before they become unusual, especially for subjects of higher intelligence. The substitution of the Faces subtest by Visual Reproductions within visual memory indexes formed by the combination of WMS-III visual subtests (creating immediate recall, delayed recall, and combined immediate and delayed index scores) results in higher correlation coefficients, and a decline in the discrepancy size required to surpass base rate thresholds for probable impairment. This gain appears not to occur at the cost of a diminished sensitivity to diverse pathologies. New WMS-III discrepancy base rate data are supplied to complement those currently available to clinicians.

Face↗

PubMed2004

Is speed of processing or working memory the primary information processing deficit in multiple sclerosis?

OBJECTIVE: To examine whether processing speed or working memory is the primary information processing deficit in persons with MS. DESIGN: Case-control study. SETTING: Hospital-based specialty clinic. PARTICIPANTS: 215 adults with clinically definite MS. MAIN OUTCOME MEASURE: Mean demographically corrected T-scores, prevalence rates of impairment and relative risk of impaired Processing Speed and Working Memory Index Scores from the WAIS-WMS III. RESULTS: Deficits in Processing Speed were much more common than Working Memory in all comparisons. This was observed for both relapsing remitting (RRMS) and secondary progressive MS (SPMS) subjects, but accentuated in the latter group. CONCLUSIONS: Results strongly suggest that the primary information processing deficit in persons with MS is in speed of processing.

Adult↗

PubMed2003

The joint WAIS-III and WMS-III factor structure: development and cross-validation of a six-factor model of cognitive functioning.

During the standardization of the Wechsler Adult Intelligence Scale (3rd ed.; WAIS-III) and the Wechsler Memory Scale (3rd ed.; WMS-III) the participants in the normative study completed both scales. This "co-norming" methodology set the stage for full integration of the 2 tests and the development of an expanded structure of cognitive functioning. Until now, however, the WAIS-III and WMS-III had not been examined together in a factor analytic study. This article presents a series of confirmatory factor analyses to determine the joint WAIS-III and WMS-III factor structure. Using a structural equation modeling approach, a 6-factor model that included verbal, perceptual, processing speed, working memory, auditory memory, and visual memory constructs provided the best model fit to the data. Allowing select subtests to load simultaneously on 2 factors improved model fit and indicated that some subtests are multifaceted. The results were then replicated in a large cross-validation sample (N = 858).

Adolescent↗

PubMed2003

Measurement of quality of life in rehabilitation medicine: emerging issues.

The articles in the current supplement (Part II) present emerging issues in the measurement of quality of life (QOL). The articles were prepared based on presentations at a meeting held in November 2001. Part I (December 2002) provided important background information, definitions, and approaches that have been used in various rehabilitation populations. The articles in the current supplement are intended to provide information about new advances in QOL measurement. They review issues such as measuring QOL from the individual's perspective, adapting instruments for different cultures and illiteracy, and using advanced psychometric techniques to build a computer-adapted measurement system. Novel solutions are offered. We hope that this information can be used to set a research agenda for improving the measurement of QOL in rehabilitation medicine. The present article outlines these issues and provides a context for the information that has been presented in the 2 supplements.

Activities of Daily Living↗

PubMed2003

A view of the future Model Spinal Cord Injury System through the prism of past achievements and current challenges.

OBJECTIVE: To examine the contributions of the Model Spinal Cord Injury System (MSCIS) program to the evaluation and care of individuals with spinal cord injury (SCI) and to acknowledge today's challenges to chart the future course of the MSCIS. METHODS: Retrospective review of the literature and prospective development of consensus by task force members and consultants. Integration of recent reported findings from panel presentations and publications regarding the MSCIS 2000 through 2005. FINDINGS: Significant strides have been made toward the improvement of care for individuals with SCI, which can be attributed to the quality of clinical investigation and education. This has been achieved through the leadership of MSCIS directors in partnership with members from national and international voluntary organizations. These efforts include more than 2,000 peer-reviewed publications from the MSCIS, which have served as a basis for practice guidelines in the field. Although much has been accomplished with regard to reducing medical and behavioral complications, mortality, and length of stay in the hospital and increasing successful return to the community, more is needed. CONCLUSION: The MSCIS has a unique opportunity to provide solutions because of its world-renowned database and center, outcome measures, and infrastructure for trials. To maximize this opportunity, the MSCIS must continue to address the appropriate investigational and service issues by defining the best approach to data collection, rigorous clinical studies, and behavioral strategies in the next decade.

Delivery of Health Care↗

PubMed2003

Detecting malingering on the WAIS-III. Unusual Digit Span performance patterns in the normal population and in clinical groups.

In several studies, suppressed Digit Span performance has been proposed as a potential marker for deliberately poor performance in a neuropsychological evaluation. The purpose of this study was to document Digit Span performance patterns in the Wechsler Adult Intelligence Scale-Third Edition (WAIS-III; ) standardization sample and selected clinical groups. Base rate tables were generated for the Digit Span scaled score, longest span forward, longest span backward, and the Vocabulary-Digit Span difference score. Cut-off scores for suspecting negative response bias were proposed, and clinical case examples were used to illustrate these scores.

Adolescent↗

PubMed2002

Quality of life measurement in rehabilitation medicine: building an agenda for the future.

In November 2001, a conference convened to discuss the state of the science of measuring of quality of life (QOL) in rehabilitation medicine. The meeting brought together leading researchers in areas of behavioral health and physical medicine and rehabilitation to address the fragmentation that exists across specialty areas and disciplines. The goal was to bridge terminology, techniques, and advances across the fields of behavioral and rehabilitation medicine. The 5 topic areas included: (1) general versus targeted measurement, (2) QOL in policy development, (3) measuring QOL from the patient's perspective, (4) cultural aspects of QOL measurement, and (5) the future of QOL research. This introduction synthesizes the information presented at the conference and provides context to the articles contained in this 2-part supplement.

Cultural Characteristics↗

PubMed2002

The impacts of the model SCI system: historical perspective.

BACKGROUND: The Model Spinal Cord Injury System (MSCIS) program, which began in 1 970, has had a positive impact on the health and well being of thousands of individuals with disabilities. Not only has the program been instrumental in improving the delivery of services for individuals with spinal cord injury (SCI), but also MSCIS is acknowledged as a leader in the advancement of science and practice in SCI rehabilitation. MSCIS is funded by grants awarded in 5-year cycles by the National Institute on Disability and Rehabilitation Research. In the current cycle (2000-2005), 1 6 SCI programs received funding as "model systems." SUMMARY: This series (1) describes the impact of the MSCIS since its inception; (2) reviews the national, multicenter data collection effort and its effects on the field; (3) reviews the initial goals and objectives of current research projects, and (4) forecasts the impact of current work on the field of SCI medicine. This introductory article provides an overview for this special section, as well as a brief synopsis of the history of the MSCIS program.

History, 20th Century↗

PubMed2000

Updating to the WAIS-III and WMS-III: considerations for research and clinical practice.

The Wechsler Adult Intelligence Scale-Revised (WAIS-R) and the Wechsler Memory Scale-Revised (WMS-R) are the most commonly used intelligence and memory scales in both clinical and neuropsychology. In 1997, updated versions of these instruments (the WAIS-III and WMS-III) were published. Because of the extensive use of the WAIS-R and WMS-R in the field and the body of accumulated research, there is naturally some reluctance by clinicians and researchers to update to the new versions. It is sometimes difficult for clinicians who test individuals on repeated occasions to switch over to the new versions of the scales because of the difficulty of interpreting score discrepancy between the 2 versions. Researchers, especially those conducting longitudinal research, have a similar difficulty in changing measurement devices because of the possible threat of internal validity. This article reviews the substantive revisions of the scales and outlines those issues that users should take into consideration when updating to the new versions.

Adolescent↗