The University of British Columbia PRELIMINARY NORMS FOR 85-99 YEAR OLDS ON THE MEMORY TEST FOR OLDER ADULTS (MTOA:S) Anita M. Hubley University of British Columbia Vancouver, BC, Canada Poster presented at the 27th Annual Meeting of the National Academy of Neuropsychology, Scottsdale, Arizona, USA, November 14-17, 2007 Correspondence: Dr. Anita M. Hubley, Dept. of ECPS, 2125 Main Mall, University of British Columbia, Vancouver, BC, Canada, V6T 1Z4; e-mail: anita.hubley@ubc.ca ABSTRACT Objective: Normative data for the Memory Test for Older Adults: Short (MTOA:S) Word List and Figure are provided in the manual for 213 adults ages 55-84 years. The purpose of the present study was to provide preliminary norms for 85-99 year old adults. Methods: The sample consisted of 35 adults aged 85-99 years (M = 88.8, s = 3.7) with 4-21 years of education (M = 11.7, s = 4.1). Participants were recruited through local organizations, seniors buildings, local newspaper, and personal contacts in a rural community. Individuals with a history of stroke, head injury, or multiple cognitive risk factors were excluded as were individuals with low MMSE scores given their education or scores > 14 on the Geriatric Depression Scale (GDS). Participants typically were tested in one session. Results: Internal consistency estimates for MTOA:S subtest scores were satisfactory. The study sample showed considerably lower raw score performance on both MTOA:S subtests relative to the next youngest group (75-84 years) in the manual. Following the manual, norms were reported for learning and retention scores on MTOA:S Word List and Figure using cumulative percentiles. Conclusion: The MTOA:S Word List and Figure raw score performance by these 85-99 year old adults clearly demonstrates the need to extend the norms provided in the manual to include this age group. This study provides preliminary MTOA:S norms for adults ages 85 to 99 years and it is recognized that a larger normative sample will increase confidence in the study findings. INTRODUCTION The Memory Test for Older Adults (MTOA; Hubley & Tombaugh, 2002) may be used in the identification of various types of memory deficits for the purposes of diagnosis, placement, development of intervention strategies, or to establish baseline performance prior to clinical or medical interventions such as surgery or medication. There are two versions: MTOA: Long and MTOA: Short. Both versions consist of a brief set of measures for assessing verbal and visuospatial learning and memory performance in older adults. The MTOA-Short (MTOA:S) was designed to be used when an impairment is either obvious or has already been diagnosed and thus it consists of a short 10-item word list and a relatively simple geometric figure (see Figure 1). Normative data, based on 213 men and women ages 55-84 years, are available in the MTOA technical manual. The purpose of the present study is to extend the normative data to include men and women ages 85-99 years. Page 1 of 8
METHOD Participants Participants were a subset of a larger sample of community-dwelling older adults that took part in a study of Memory, Age, and Wellbeing. They were recruited through community organizations, seniors buildings, local newspaper, and personal contacts in a rural community. The preliminary normative sample presented here consisted of 35 individuals (7 men, 28 women) ages 85 to 99 years (M = 88.8, s = 3.66). Their education ranged from 4 to 21 years. Individuals with a history of stroke, head injury, or multiple cognitive risk factors (e.g., heart attack, diabetes) were excluded from the normative sample. Individuals with low Mini-Mental State Examination (MMSE; Folstein, Folstein, & McHugh, 1975) scores given their educational level or scores > 14 on the Geriatric Depression Scale (GDS; Yesavage et al., 1983) were also excluded from this sample. Table 1 shows the mean mental status scores, depression screen scores, education, and vocabulary scores for this group and for the next youngest age group (75-84 years) reported in the MTOA manual (n = 71). Procedure Participants typically completed the MMSE, GDS, WAIS-R Vocabulary (Wechsler, 1981), MTOA:S Word List and Figure (and other measures not relevant to this report) in one session. For the MTOA:S Word List, participants were read a list of 10 words that they were asked to first recall in any order (free recall). For any words that were missed, they were given the category from which the word comes (e.g., It s a flower; cued recall) to assist in recalling the word. There were 3 learning trials, a 10-minute delayed recall trial (also with free and cued recall), and a recognition task in which participants identified the 10 target words from a list of 30 words. A learning score (max. = 30), delayed recall score (max. = 10), and recognition score (max. = 10) were computed. The MTOA:S Figure consisted of 3 learning trials during which participants studied the figure for 15 seconds and then reproduced it from memory, a 10-minute delayed recall trial during which they did not view the figure again, and a copy trial to assess visuoconstructive functioning. A learning score (max. = 54), retention score (max. = 18), and copy score (max. = 18) were computed. Performance on the MTOA:S RESULTS Tables 2 and 3 show the mean (SD) performance on the MTOA:S Word List and Figure of the 85-99 year old group in this study and the next youngest age group (75-84 years) reported in the manual. MTOA:S Reliability and SEM The primary set of norms for the MTOA:S consists of the learning and retention scores. Thus, Table 4 presents the internal consistency reliability estimates (α) and standard error of measurement (SEM) information for these scores for the 85-99 year age group. Page 2 of 8
MTOA:S Preliminary Norms for Men and Women Ages 85-99 Years Preliminary normative data for the MTOA:S Word List (see Tables 5 and 6) and Figure (see Tables 7 and 8) are presented using cumulative percentiles. A cumulative percentile shows the percentage of the normative sample whose scores fall at or below a given raw score. Cumulative percentiles are used whenever a distribution is skewed or truncated as is the case for most learning and memory tests. CONCLUSION The MTOA:S Word List and Figure raw score performance by these 85-99 year old adults clearly demonstrates the need to extend the norms provided in the manual to include this age group. Performance by this group is substantially lower than the next youngest age group (75-84 year olds) reported in the MTOA manual. Internal consistency reliability estimates and standard error of measurement (SEM) information were computed for scores obtained by this sample so that this information can be used to compute 95% confidence intervals for individual scores (i.e., raw score + 2 SEM = 95% confidence interval). Preliminary MTOA:S Word List and Figure norms are presented for adults ages 85 to 99 years. However, it is recognized that a larger normative sample is recommended for clinical purposes. Thus, the final goal is to obtain a normative sample of approximately n = 70 for this age group. REFERENCES Folstein, M. F., Folstein, S. E., & McHugh, P. R. (1975). Mini-Mental State : A practical method of grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189-198. Hubley, A. M. & Tombaugh, T. N. (2002). Memory Test for Older Adults (MTOA). Toronto, ON: Multi- Health Systems. Wechsler, D. (1981). WAIS-R manual. New York: The Psychological Corporation. Yesavage, J. A., Brink, T. L., Rose, T. L., Lum, O., Huang, V., Adey, M., & Leirer, V. O. (1983). Development and validation of a geriatric depression screening scale: A preliminary report. Journal of Psychiatric Research, 17, 34-49. Disclosure of Potential Conflict of Interest: Dr. Hubley is one of the authors of the MTOA, which is distributed through Multi-Health Systems (MHS) and may be purchased on-line (www.mhs.com), by phone (1-800-456-3003 or 1-800-268-6011) or in-person at their conference booth (see their catalogue for prices). Page 3 of 8
Figure 1 MTOA-Short Word List Geometric Figure orchid champagne mosquito sapphire aluminum lemon salmon drill taxi jacket Table 1 Background Information for the 85-99 and 75-84 Year Age Groups 85-99 Years 75-84 Years (current) (manual) M SD M SD Mini-Mental State Examination (MMSE) 26.3 2.32 28.9 1.06 Geriatric Depression Scale (GDS) 6.3 3.55 5.3 3.46 Education (in years) 11.7 4.10 11.3 2.56 WAIS-R Vocabulary age corrected scale scores 11.2 3.04 --- --- Note: Higher scores represent better mental status, higher depressive symptomatology, and better vocabulary, respectively. Page 4 of 8
Table 2 Performance on the MTOA:S Word List Free Recall Free Recall + Cued Recall Recognition 85-99 Yrs 75-84 Yrs 85-99 Yrs 75-84 Yrs 85-99 Yrs 75-84 Yrs Trial 1 3.7 (1.33) 5.1 (1.34) 6.2 (1.92) 7.7 (1.80) Trial 2 6.0 (2.35) 7.3 (1.46) 8.3 (1.89) 9.5 (0.91) Trial 3 6.6 (2.70) 8.3 (1.38) 8.7 (1.81) 9.8 (0.55) Learning 16.2 (5.90) 20.7 (3.44) 23.2 (5.06) 27.0 (2.63) Retention 5.6 (3.46) 7.4 (1.80) 7.6 (2.81) 9.4 (0.87) 9.3 (1.11) 9.9 (0.26) Note: Learning consists of the sum of the scores over the 3 learning trials. Maximum score is 10 for Trials 1-3 and the Retention Trial but 30 for Learning. Recognition scores are only obtained on the Retention Trial. Table 3 Performance on the MTOA:S Figure 85-99 Yrs 75-84 Yrs Trial 1 7.9 (4.24) 11.5 (3.87) Trial 2 10.7 (4.30) 14.7 (2.93) Trial 3 12.0 (4.38) 15.7 (2.45) Learning 30.5 (12.40) 41.9 (8.38) Retention 11.4 (4.60) 15.4 (2.77) Copy 16.9 (1.49) 17.3 (0.98) Note: Learning consists of the sum of the scores over the 3 learning trials. Maximum score is 18 for Trials 1-3, Retention, and Copy but 54 for Learning. Page 5 of 8
Table 4 Internal Consistency and SEM for MTOA:S Word List and Figure Learning Retention Alpha SEM Alpha SEM Word List (FR).82 2.50.88 1.20 Word List (FR + CR).77 2.43.86 1.05 Figure.85 4.80.80 2.06 Note: FR = free recall, CR = cued recall, SEM = standard error of measurement. Table 5 Cumulative Percentile Norms for MTOA:S Word List Learning FR FR+CR FR FR+CR 30 100 100 14 40 11 29 100 94 13 37 6 28 100 86 12 31 3 27 100 77 11 26 <3 26 100 69 10 22 25 100 66 9 18 24 97 57 8 14 23 86 46 7 9 22 83 34 6 6 21 77 29 5 5 20 69 23 4 3 19 66 22 3 <3 18 63 20 2 17 57 19 1 16 46 17 0 15 43 14 Page 6 of 8
Table 6 Cumulative Percentile Norms for MTOA:S Word List Retention FR FR+CR Recognition 10 100 100 100 9 91 74 37 8 69 40 17 7 60 29 11 6 54 28 3 5 40 26 <3 4 37 17 3 34 14 2 23 11 1 17 3 0 14 <3 Table 7 Cumulative Percentile Norms for the MTOA:S Figure Learning Learning Learning Learning 54 100 35 65 16 20 53 99 34 63 15 17 52 97 33 54 14 9 51 96 32 51 13 6 50 95 31 49 12 3 49 94 30 46 11 <3 48 93 29 45 10 47 91 28 44 9 46 90 27 43 8 45 88 26 42 7 44 86 25 40 6 43 83 24 39 5 42 82 23 38 4 41 80 22 37 3 40 77 21 34 2 39 74 20 31 1 38 71 19 29 0 37 69 18 26 36 67 17 23 Page 7 of 8
Table 8 Cumulative Percentile Norms for the MTOA:S Figure Retention and Copy Retention Copy 18 100 18 100 17 97 17 57 16 86 16 26 15 77 15 14 14 63 14 6 13 54 13 5 12 49 12 4 11 47 11 3 10 45 10 <3 9 43 9 8 34 8 7 31 7 6 20 6 5 14 5 4 6 4 3 <6 3 2 2 1 1 0 0 Page 8 of 8