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The California Verbal Learning Test (CVLT) is one of the most common neuropsychological tests used in assessment of verbal memory.[1] The California Verbal Learning Test (CVLT) is a short assessment that takes around 30 minutes to fully administer. It was first created in 1987 and was revised in 2000.[2][3] It produces measures of immediate and delayed verbal recall along with retroactive interference and recognition. It has been found to be sensitive and an effective screening tool in many different clinical groups including multiple sclerosis, traumatic brain injury as well as dementia. Furthermore, the ability to assess encoding types also allows differentiation between dementia types; including Alzheimer's disease, Huntington's disease and Parkinson's disease.

History[edit]

The California Verbal Learning Test was first developed and published in 1987 by Dean Delis, Joel Kramer, Edith Kaplan and Beth Ober.[2] The California Verbal Learning Test - Second Edition (CVLT-II) was published in 2000 to update the test material and to address previous criticisms of the CVLT.[3] The CVLT-II updated the word list to higher familiarity words that would not be gender biased: part of the word lists for the original CVLT was a spice list including words such as paprika and nutmeg. The CVLT-II also allowed for flexible administration with a standard form which takes 30 minutes to administer and a short form, which takes 15 minutes. The short form can be used when less detailed information is needed, when similar neuropsychological tests are being used, or when assessment time is limited. The CVLT-II also provides parallel forms that can be used if the participant needs to be re-tested, so as not to bias their score. Parallel forms are variations of the initial main assessment tool that measure the same constructs in the same way but use different stimuli. This is to reduce false results of performance on tasks if they need to be repeated. The CVLT-II does this by consisting of the same categories but different words within them. As well as being a paper based assessment with the revised edition it has also been computerised allowing for quicker scoring and easier transportation. The CVLT-II is aimed for testing of older adolescents and adults, between the ages of 16 and 89. To provide an efficient assessment method for younger people the California Verbal Learning Test - Children's Version (CVLT-C) was created in 1994.[4] This version is suitable for children between the age of 5 and 16. This test uses a simpler word list to be effective for a younger age group and allows strategies and processes to be measured as well as produce memory scores. The CVLT-C is shorter to administer and takes 15-20 minutes plus an interval of 20 minutes to complete. It has recently been adapted so that it can be administered on tablet devices.[5]

Measures[edit]

The participant is read out a list of 16 common words from a 'Mondays shopping list'. These words will be grouped as 4 words in 4 categories, for example, 4 fruits, 4 animals etc but randomly organised within the list.

Immediate Recall[edit]

The participant is immediately asked to recall the 16 words which were verbally presented to them. This task will be repeated five consecutive times. Immediate recall can give us important information regarding how participants use chunking as well as their memory and working memory retrieval.

Interference[edit]

After the immediate recall has been administered 5 times the participant will now verbally be presented with 'Tuesdays shopping list'. They are then asked to recall as many words from the Mondays shopping list again. This tests whether the participant is able to keep the information separate. This retroactive interference allows for a great amount of information and detail in the participants' process of memory retrieval.

Long Recall[edit]

The participant will then complete either distractor tasks or other neuropsychological tests for 20 minutes. They will then be asked to recall as many of the original 16 words from Mondays shopping list as possible. This measure can provide important details on how the information has been encoded through the use of chunking but also other encoding processes and strategies, such as the use of category information.

Recognition[edit]

The final optional task is a recognition trial. The participant is given a list of words and asked which ones were included in the original list. As this task is a forced-choice answer, it allows the researcher to ensure no false results are previously reported due to fatigue or a lacking of effort in previous trials.


All these measures work together to provide the examiner with detailed information of how the participant encodes information, error types, strategies being used, and learning rates, as well as other memory process measures. The original assessment uses free recall and does not give any prompts for the words. However, some individual variations of the tasks will use prompts and cues when the participant is asked to recall the words. Note that some variations of this assessment tool may not use the title of a shopping list and may just use the word list.

Reliability and Validity[edit]

The California Verbal Learning Test has been found to have good construct validity for episodic verbal learning and memory in both clinical and non-clinical populations.[6] Individual validity and reliability scores have been found for seperate clinical populations, such as Traumatic Brain Injury[7] and Multiple Sclerosis, as well as overall validity and reliability measures using a healthy adult population.[8]

An alpha level of 0.001 is used to avoid making type I errors due to the large data and multiple comparisons. Test-retest results over a 1 month period displayed large test-retest correlation coefficients for the main measures on both the standard and parallel form.[9][10] The CVLT has similar test-retest reliability and practice effect values to other established list learning and memory tasks such as the Hopkins Verbal Learning Test.[11] The parallel form may decrease the reliability as there is a larger variability between test content, however, it decreases the practice effects when compared to test-retest of only the standard form.[10]

As well as being a reliable and valid measure it has been found to have strong ecological validity, which is lacking in many other neuropsychological tests of memory.[12] It has also been found to be a significant predictor of current level job performance when looking at the measures of immediate recall and long-term recognition memory and found that immediate recall correlated significantly with occupational status.[12]

Alternative Tests[edit]

Wechsler Memory Scale[edit]

The Wechsler Memory Scale (WMS) is a series of tests that measure many different forms of memory. It is also the only memory test to be co normed with the Wechsler Adult Intelligence Scale and Test of Premorbid Functioning allowing comparison between memory and assessment of intelligence.[13] It is one of the most common battery of memory tests used in the UK and USA. It is considered to be one of the more demanding test batteries but has good sensitivity. Ecological validity is considered to be poor in the WMS which may cause a lack in validity and cause predictability issues.[14] The WMS is unsuitable for continued assessing of abilities overtime due to no parallel tests. The WMS-III included word lists as an optional subtest, however with the update of WMS-IV the word lists subtest is no longer included and is recommended to use the CVLT for assessment of verbal list learning.[15][16]

Rivermead Behavioural Test[edit]

The Rivermead Behavioural Memory Test - Third Edition (RBMT-3) is used to predict memory problems and to monitor change over time.[17] It was originally used in patients with acquired, non-progressive brain injuries but has since been seen to be effective in different clinical populations and the third edition has collected a larger normative sample. The short story recall is a subtest of the RBMT-3. The examiner reads the examinee a short passage of prose and then they are asked to recall as much of the passage as possible. There is also a delayed recall element where they are later asked to recall the story again. This subtest is used to measure the ability to process verbal information and memory functions.[17] The revision of the RBMT-3 was to develop an assessment tool that had clinical applicability and utility as well as adapting the difficulty of test as it was previously deemed too difficult.[18] The RBMT-3 has an overall reliability co-efficient ranging between 0.57 and 0.86 and the short story recall has a reliability co-efficient of 0.9 or higher.[18] The RBMT-3 demonstrates good construct validity and ecological validity.[18] This test also includes measures of prospective memory which is not included in most memory tests.

BIRT Memory and Information Processing Battery[edit]

The Brain Injury Rehabilitation Trust (BIRT) Memory and Information Processing Battery was created in 2007 (BMIPB) and was based as a revision and extension from the Adult Memory and Information Processing Battery.[19] It includes four parallel tests allowing charted progress to be used if degenerative problems are suspected. This test focuses on information processing tasks as well as memory, and assesses how brain injury affects memory, which most neuropsychological memory tests do not. Gaining this information allows a plan of rehabilitation to be made. It is based on UK adult norms and also includes older population norms. It has been found to have good interrater reliability and test-retest reliability.[18]

The Doors and People Test[edit]

The Doors and People Test memory battery was created in 1994 and assesses both verbal and visual measures of recall and recognition.[20] Each measure is based on at least two subtests and can be used to identify patterns of deficit. It can be administered on individuals aged between 18 and 80 years and is considered to be a good standardised test of memory and one of the most enjoyable and engaging memory batteries.[18] It has good face validity and reasonable normative data is available.[21] Studies have indicated sensitivity among different clinical populations including, Alzheimer's disease and Down Syndrome.[22][23] However, it is considered to have low ecological validity and has no parallel test forms which may affect re-test results.[18]

Rey Auditory Verbal Learning Test[edit]

The Rey Auditory Verbal Learning Test (AVLT) is most similar to the CVLT as it is an independent test rather than a memory battery.[24] The test consists of 15 unrelated words and measures immediate recall, delayed recall, interference and recognition. There have been many parallel forms created and was found to have good test re-test reliability after one year.[25][26]

Research Populations[edit]

The California Verbal Learning Test has been found to be effective in detecting memory abilities in many different clinical populations. By detecting memory problems and deteriorations we can plan effective rehabilition and stuff.

Traumatic Brain Injury[edit]

The CVLT was first created to investigate learning and memory capacities in traumatic brain injury (TBI), yet there has since been conflicting evidence of whether the CVLT is an informative and sensitive measure in TBI assessment. Several studies have found it to be a sensitive and multifactorial measure of learning and memory after TBI and can help define the particular memory deficits patients are experiencing.[27][28] On the contrast, a longitudinal study across 5 years on CVLT performance found that although within the first year of a TBI there were higher rates of rapid forgetting, over the five year period there was no difference between TBI patients and controls.[29] Many studies acknowledge that in isolation it can not be used to determine the presence or absence of an acquired memory impairment it can be used for clinical treatment recommendations.[29] Additionally, although the CVLT was not created to detect proactive interference, and it is different to traditional proactive interference paradigms, it is a sensitive measure in assessing the buildup and release of proactive interference in TBI patients.[30]

Alzheimer's Disease[edit]

The CVLT has been used in many neuropsychological assessments in Alzheimer's disease due to memory being a function affected. The CVLT has been found to be able to differentiate between different types of dementia, specifically the assessment of encoding strategies.[6][31] Patients with Alzheimer's disease are unable to use the category information to help them process and consolidate the memory.[32] This leads to an error when recalling the words back. The list may include the 4 fruits: banana, apple, melon, and orange, but the participant may only remember the first three. A participant with Alzheimer's would recall a fourth unrelated word to the category, such as tree, as they have been unable to recognise the pattern and use of category. Other dementia types are able to use the category information available to them if they are unable to remember a word, such as in this case, peach. As research found that categorical memory tasks were important in the assessment of dementia, a specific dementia 9 word version of the CVLT was created to reduce difficulty - so investigation of encoding strategies could be researched and assessed further.[33][32][34]

Parkinson's Disease[edit]

The CVLT has also been found to be effective in the assessment of Parkinson's disease due to patterns of encoding type. Typical error types in Parkinson's disease are more likely to be repetition errors - for example, banana, apple, melon, banana.[35] In Alzheimer's disease motor skills are not affected but verbal memory skills are negatively affected, whereas in Parkinson's disease both are affected. Even though verbal memory is affected in both the CVLT has been found to be able to accurately distinguish between them and a sensitive measure in detecting different dementias.[36]

Multiple Sclerosis[edit]

The CVLT is a standard clinical test used for assessing memory difficulties in multiple sclerosis and to chart progression and early diagnosis of any difficulties. Most multiple sclerosis patients do not have severe memory difficulties and the CVLT has been found to have good reliability and validity in detecting and assessing mild multiple sclerosis memory decline.[8][37][38] Episodic memory is mainly effected in multiple sclerosis and was also found influence five other distinct factors on the CVLT: measures of memory consolidation, primary/recency effect, proactive interference and learning reinforcement.[38] Results on the CVLT have also been found to correlate with neural correlates in multiple sclerosis patients for severity.[39] The CVLT has also been found to be able to discriminate between employed and work-disabled multiple sclerosis patients.[38]

See Also[edit]

References[edit]

  1. ^ Rabin, Laura; Barr, William; Burton, Leslie (2005). "Assessment practices of clinical neuropsychologists in the United States and Canada: A survey of INS, NAN, and APA Division 40 members". Archives of Clinical Neuropsychology. 20 (1): 33–65. doi:10.1016/j.acn.2004.02.005. PMID 15620813.
  2. ^ a b Delis, Dean; Kramer, Joel; Kaplan, Edith; Ober, Beth (1987). The California Verbal Learning Test. New York: The Psychological Corporation.
  3. ^ a b Delis, Dean; Kramer, Joel; Kaplan, Edith; Ober, Beth (2000). California Verbal Learning Test: Second Edition. New York: The Psychological Corporation.
  4. ^ Delis, Dean; Kramer, Joel; Kaplan, Edith; Ober, Beth (1994). California Verbal Learning Test - Children's Version. New York: The Psychological Corporation.
  5. ^ Delis, Dean; Kramer, Joel; Kaplan, Edith; Ober, Beth. "California Verbal Learning Test - Children's Version".
  6. ^ a b Delis, Dean C.; Freeland, John; Kramer, Joel H.; Kaplan, Edith (1988). "Integrating clinical assessment with cognitive neuroscience: Construct validation of the California Verbal Learning Test". Journal of Consulting and Clinical Psychology. 56 (1): 123–130. doi:10.1037/0022-006X.56.1.123. PMID 3346437.
  7. ^ Jacobs, M.; Donders, J. (2007). "Criterion validity of the California Verbal Learning Test-Second Edition (CVLT-II) after traumatic brain injury". Archives of Clinical Neuropsychology. 22 (2): 143–149. doi:10.1016/j.acn.2006.12.002. PMID 17207963. S2CID 25084463.
  8. ^ a b Elwood, Richard W. (1995). "The California Verbal Learning Test: Psychometric characteristics and clinical application". Neuropsychology Review. 5 (3): 173–201. doi:10.1007/BF02214761. PMID 8653108. S2CID 12708590.
  9. ^ Woods, S.; Delis, D.; Scott, J.; Kramer, J.; Holdnack, J. (2006). "The California Verbal Learning Test – second edition: Test-retest reliability, practice effects, and reliable change indices for the standard and alternate forms". Archives of Clinical Neuropsychology. 21 (5): 413–420. doi:10.1016/j.acn.2006.06.002. PMID 16843636.
  10. ^ a b Delis, Dean C.; Massman, Paul J.; Kaplan, Edith; McKee, Richard; Kramer, Joel H.; Gettman, Dennis (1991). "Alternate form of the california verbal learning test: Development and reliability". Clinical Neuropsychologist. 5 (2): 154–162. doi:10.1080/13854049108403299.
  11. ^ Lacritz, L.; Cullum, C. (1998). "The Hopkins Verbal Learning Test and CVLTA Preliminary Comparison". Archives of Clinical Neuropsychology. 13 (7): 623–628. doi:10.1016/S0887-6177(98)00004-3.
  12. ^ a b Kibby, M. (1998). "Ecological Validity of Neuropsychological Tests Focus on the California Verbal Learning Test and the Wisconsin Card Sorting Test". Archives of Clinical Neuropsychology. 13 (6): 523–534. doi:10.1016/S0887-6177(97)00038-3. PMID 14590636.
  13. ^ Tulsky, David S.; Price, Larry R. (2003). "The joint WAIS-III and WMS-III factor structure: Development and cross-validation of a six-factor model of cognitive functioning". Psychological Assessment. 15 (2): 149–162. doi:10.1037/1040-3590.15.2.149. PMID 12847775.
  14. ^ Wilson, Barbara A. (1993). "Ecological validity of neuropsychological assessment: Do neuropsychological indexes predict performance in everyday activities?". Applied and Preventive Psychology. 2 (4): 209–215. doi:10.1016/S0962-1849(05)80091-5.
  15. ^ McDowell, B.; Bayless, J. D.; Moser, D. J.; Meyers, J. E.; Paulsen, J. S. (2004). "Concordance between the CVLT and the WMS-III word lists test". Archives of Clinical Neuropsychology. 19 (2): 319–324. doi:10.1016/S0887-6177(03)00023-4. PMID 15010095.
  16. ^ Holster, Jessica (2012). "An evaluation of the CVLT-II substitution on the WMS-IV amongst a mixed clinical and nonclinical population". Archives of Assessment Psychology. 2 (1). {{cite journal}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
  17. ^ a b Wilson, Barbara (2008). Rivermead Behavioural Memory Test - Third Edition. London: Pearson Assessment. {{cite book}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
  18. ^ a b c d e f Goldstein Laura H; McNeil Jane E, ed. (23 April 2012). Clinical neuropsychology: A practical guide to assessment and management for clinicians (2nd ed.). Chichester, West Sussex: Wiley-Blackwell. ISBN 978-0-470-68371-2.{{cite book}}: CS1 maint: multiple names: editors list (link)
  19. ^ Coughlan, Anthony (2007). BIRT Memory and Information Processing Battery (BMIPB). London: Brain Injury Rehabilitation Trust. {{cite book}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
  20. ^ Baddeley, Alan (1994). Doors and People. London: Thames Valley Test Company. {{cite book}}: Unknown parameter |coauthors= ignored (|author= suggested) (help)
  21. ^ Strauss, Esther H (2006). A Compendium of Neuropsychological Tests: Administration, Norms, and Commentary. UK: Oxford University Press.
  22. ^ Jarrold, Christopher; Baddeley, Alan D.; Phillips, Caroline (2007). "Long-Term Memory for Verbal and Visual Information in Down Syndrome and Williams Syndrome: Performance on the Doors and People Test". Cortex. 43 (2): 233–247. doi:10.1016/S0010-9452(08)70478-7. PMID 17405669. S2CID 4477813.
  23. ^ Greene, John D.W.; Baddeley, Alan D.; Hodges, John R. (1996). "Analysis of the episodic memory deficit in early Alzheimer's disease: Evidence from the doors and people test". Neuropsychologia. 34 (6): 537–551. doi:10.1016/0028-3932(95)00151-4. PMID 8736567. S2CID 27563156.
  24. ^ Schmidt, Michael (1996). Rey Auditory Verbal Learning Test: A Handbook. Los Angeles: Western Psychological Services.
  25. ^ Geffen, G.; Butterworth, P.; Geffen, L. B. (1994). "Test-retest reliability of a new form of the auditory verbal learning test (AVLT)". Archives of Clinical Neuropsychology. 9 (4): 303–316. doi:10.1016/0887-6177(94)90018-3. PMID 14589623.
  26. ^ Lezak, Muriel, D (2004). Neuropsychological Assessment (4th ed.). Oxford University Press.{{cite book}}: CS1 maint: multiple names: authors list (link)
  27. ^ Crosson, Bruce; Novack, Thomas A.; Trenerry, Max R.; Craig, Paul L. (1988). "California verbal learning test (CVLT) performance in severely head-injured and neurologically normal adult males". Journal of Clinical and Experimental Neuropsychology. 10 (6): 754–768. doi:10.1080/01688638808402812. PMID 3235649.
  28. ^ Wiegner, Sandra; Donders, Jacobus (1999). "Performance on the California Verbal Learning Test After Traumatic Brain Injury". Journal of Clinical and Experimental Neuropsychology (Neuropsychology, Development and Cognition: Section A). 21 (2): 159–170. doi:10.1076/jcen.21.2.159.925. PMID 10425514.
  29. ^ a b Jacobs, M.; Donders, J. (2008). "Performance discrepancies on the California Verbal Learning Test—Second Edition (CVLT-II) after traumatic brain injury☆". Archives of Clinical Neuropsychology. 23 (1): 113–118. doi:10.1016/j.acn.2007.09.003. PMID 17959354.
  30. ^ Numan, Bobbi; Sweet, Jerry J.; Ranganath, Charan (2000). "Use of the california verbal learning test to detect proactive interference in the traumatically brain injured". Journal of Clinical Psychology. 56 (4): 553–562. doi:10.1002/(SICI)1097-4679(200004)56:4<553::AID-JCLP8>3.0.CO;2-Q. PMID 10775047.
  31. ^ Delis, Dean C.; Massman, Paul J.; Butters, Nelson; Salmon, David P.; Cermak, Laird S.; Kramer, Joel H. (1991). "Profiles of demented and amnesic patients on the California Verbal Learning Test: Implications for the assessment of memory disorders". Psychological Assessment. 3 (1): 19–26. doi:10.1037/1040-3590.3.1.19.
  32. ^ a b Davis, Kelly L.; Price, Catherine C.; Kaplan, Edith; Libon, David J. (2002). "Error Analysis of the Nine-Word California Verbal Learning Test (CVLT-9) Among Older Adults With and Without Dementia". The Clinical Neuropsychologist (Neuropsychology, Development and Cognition: Section D). 16 (1): 81–89. doi:10.1076/clin.16.1.81.8330. PMID 11992230. S2CID 7077689.
  33. ^ Libon, David J.; Mattson, Robert E.; Glosser, Guila; Kaplan, Edith; Malamut, Barbara L.; Sands, Laura P.; Swenson, Rodney; Cloud, Blaine S. (1996). "A Nine—Word dementia version of the california verbal learning test". The Clinical Neuropsychologist. 10 (3): 237–244. doi:10.1080/13854049608406686.
  34. ^ Woodard, John L.; Goldstein, Felicia C.; Roberts, Vicky J.; McGuire, Colleen (1999). "Convergent and Discriminant Validity of the CVLT (Dementia Version)". Journal of Clinical and Experimental Neuropsychology (Neuropsychology, Development and Cognition: Section A). 21 (4): 553–558. doi:10.1076/jcen.21.4.553.878. PMID 10550812.
  35. ^ Massman, Paul J.; Delis, Dean C.; Butters, Nelson; Levin, Bonnie E.; Salmon, David P. (1990). "Are all subcortical dementias Alike?: Verbal learning and memory in Parkinson's and huntington's disease patients". Journal of Clinical and Experimental Neuropsychology. 12 (5): 729–744. doi:10.1080/01688639008401015. PMID 2147923.
  36. ^ Kramer, Joel H.; Levin, Bonnie E.; Brandt, Jason; Delis, Dean C. (1989). "Differentiation of Alzheimer's, Huntington's, and Parkinson's disease patients on the basis of verbal learning characteristics". Neuropsychology. 3 (2): 111–120. doi:10.1037/h0091766.
  37. ^ Benedict, Ralph HB; Cox, Darcy; Thompson, Laetitia L.; Foley, Fred; Weinstock-Guttman, Bianca; Munschauer, Frederick (2004). "Reliable screening for neuropsychological impairment in multiple sclerosis". Multiple Sclerosis. 10 (6): 675–678. doi:10.1191/1352458504ms1098oa. PMID 15584493. S2CID 33358521.
  38. ^ a b c Stegen, Shane; Stepanov, Igor; Cookfair, Diane; Schwartz, Eben; Hojnacki, David; Weinstock-Guttman, Bianca; Benedict, Ralph H. B. (2010). "Validity of the California Verbal Learning Test–II in Multiple Sclerosis". The Clinical Neuropsychologist. 24 (2): 189–202. doi:10.1080/13854040903266910. PMID 19953426. S2CID 9493210.
  39. ^ Fink, Frauke; Eling, Paul; Rischkau, Eva; Beyer, Nicole; Tomandl, Bernd; Klein, Jan; Hildebrandt, Helmut (2010). "The association between California Verbal Learning Test performance and fibre impairment in multiple sclerosis: evidence from diffusion tensor imaging". Multiple Sclerosis. 16 (3): 332–341. doi:10.1177/1352458509356367. PMID 20150400. S2CID 5575268.
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