國立臺灣大學理學院心理學研究所

碩士論文
Graduate Institute of Psychology
College of Science
National Taiwan University
Master Thesis

台灣健康成年人中文字詞次序學習測驗之
常模研究
A Normative Study on the Word Sequence Learning Test
in Healthy Individuals in Taiwan

陳威嘉

Wei-Chia Chen

指導教授：花茂棽 博士

Advisor: Mau-Sun Hua, Ph. D.

中華民國 103 年 6 月
June, 2014
 摘要

背景：中文字詞次序學習測驗隸屬於語文事件記憶測驗，本測驗主要特徵為

字詞間關係屬任意語意連結的特質，而具有此特質的學習測驗與內側顳葉結構

(medial temporal lobe structures)中的嗅緣皮質(the perirhinal cortex)有著密切的關

連性。阿茲海默病的神經病理研究指出，嗅緣皮質是早期出現神經病理現象的腦

區之一，因此該腦區所負責的語文事件記憶能力，也被視為阿茲海默病早期認知

功能改變的項目之一。然而，目前在台灣缺乏偵測該阿茲海默病前期(pre-AD)記

憶缺陷的工具與常模資料。目的：本研究的研究目的是建立台灣健康成年人中文

字詞次序學習測驗的常模資料，同時探討人口學變項對該測驗表現的影響，以及

檢驗本測驗的心理計量特性。方法：本研究共收集 307 位受試者的測驗資料，並

按照分層隨機抽樣，以年齡(16 至 90 歲)、教育程度(0 至 18 年)、性別以及台灣

地理分布等變項進行分組。隨機選取 30 位受試者進行信度的檢驗，另外再隨機

選取 33 位受試者進行校標關聯及建構效度的考驗。並且以回溯性方式收集 40

位具有失憶型輕度認知功能障礙(aMCI)的病人資料，以供進一步驗證本測驗之建

構效度。結果：人口學變項的影響主要出現在年齡與教育程度兩變項上，亦即本

測驗的表現會隨年齡增加而衰退，但隨著教育程度增加而測驗表現提升。本測驗

之再測信度係數在 0.6 左右，副本信度係數在各個分數上則分布較廣(.14 至.73)。

在校標關聯效度上，本測驗除了再認分數外，與其他語文事件記憶測驗的分數有

著中等程度的相關(.35 至.75)。除此以外，在病人回溯性研究結果顯示，本測驗

i
在偵測 aMCI 病人記憶缺陷的比例，較魏氏記憶量表第三版之邏輯記憶測驗為高。

結論：研究結果顯示年齡及教育變項皆明顯影響中文字詞次序學習測驗的表現，

因此在常模建立上，進行人口學變項的校正有其必要性。此外，研究結果亦顯示

中文字詞次序學習測驗具有適當的心理計量特性。有鑑於此，根據病人回溯性研

究結果，我們可預期該測驗的表現可作為偵測阿茲海默病前期的認知標記。未來

則應持續進行前瞻性病人研究，以了解中文字詞次序學習測驗在診斷阿茲海默病

前期的貢獻。

關鍵詞：中文字詞次序學習測驗、神經心理測驗、事件記憶、常模研究、人口學
變項、信效度、校正分數

ii
 A Normative Study on the Word Sequence Learning

Test in Healthy Individuals in Taiwan

Wei-Chia Chen

ABSTRACT

Background: The Word Sequence Learning Test (WSLT) is one of the verbal

episodic memory measures, and is characterized by arbitrary associates among words.

Processing this type of episode memory task is thought to be highly associated with

the perirhinal cortex functioning. Studies have shown that the pathological change of

the perirhinal cortex is one of the main features of the pre-Alzheimer’s disease

(pre-AD). Accordingly, it would be expected that the impairment of

arbitrary-associates verbal memory tests, such as the WSLT, would be evident in the

pre-AD. However, currently there is a lack of normative data of the WSLT in Taiwan.

Objective: The purpose of the present study was to establish the normative data of the

WSLT in Taiwanese healthy adults. Issues of the effects of demographic variables and

psychometric properties of the WSLT were also investigated. Methods: The study

included 307 healthy participants stratifying by age (ranging from 16 to 90 years old),

education level (ranging from 0 to 18 years), sex, and different geographical regions

in Taiwan. Thirty participants were randomly selected for examining reliabilities.

Thirty-three participants were also selected for examining the criterion-related and the

iii
construct validity. Forty patients with amnestic mild cognitive impairment (aMCI)

were also retrospectively collected for verifying the construct validity. Results:

Effects of age and education can be found in the WSLT. The correct, the position, the

learning, and the cued scores decreased as age increased. All sub-scores increased as

education level increased. The correlation coefficient of the retest reliability was

around 0.6 and the alternate-form reliability varied across different sub-scores

(ranging from .14 to .73). Sub-scores of the WSLT correlated moderately (ranging

from .35 to .75) with those of other verbal episodic memory measures, except for the

recognition score. The patient study revealed that the proportion of memory deficits

evident in patients with aMCI measured by the WSLT was higher than by the Logical

Memory subtest of the Wechsler Memory Scale-Third Edition. Conclusion: Age and

education have an influence on the WSLT, and thus the demographic-corrected norm

is needed. In addition, the WSLT has adequate reliability and validity. Based on the

retrospective patient study, it appears that the test performance could be taken as a

cognitive marker for AD. Further prospective study to validate this preliminary result

is necessary.

Keywords： Word Sequence Learning Test, neuropsychological assessment,

episodic memory, normative data, demographic variables,
reliability, validity, adjusted score

iv
 Table of Contents
Introduction ............................................................................................................... 1
Methods...................................................................................................................... 9
Participants ......................................................................................................... 9
Measurements .................................................................................................. 10
Procedure…….................................................................................................. 12
Statistical Analyses........................................................................................... 13
Results ...................................................................................................................... 15
Demographic Characteristics............................................................................ 15
Effects of Demographic Variables and Intelligence................................... 15
Psychometric Properties................................................................................. 18
Norm Established........................................................................................... 20
Discussion ................................................................................................................ 22
Effects of Demographic Variables and Intelligence on the WSLT......... 22
Psychometric Properties................................................................................ 25
Appropriacy of Norms..................................................................................... 28
Conclusion ............................................................................................................... 30
References................................................................................................................ 32
Appendix.................................................................................................................. 44
A: Informed Consent Form ............................................................................. 44
B: Administration and Scoring......................................................................... 46
Tables....................................................................................................................... 49
Figures..................................................................................................................... 68

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 Introduction

Episodic memory, which was first proposed by Tulving (1972), is a form of

declarative memory involving storage of events and episodes with specific

temporal-spatial relations. In clinical neuropsychological practice, subjective memory

complaints are one of the most common problems (Lezak, 2004). Memory

impairment has been a major concern in many neurological diseases, such as

Alzheimer’s disease (AD) or temporal lobe epilepsy (TLE) (Bell, Lin, Seidenberg, &

Hermann, 2011). A great number of studies have shown that episodic memory is the

earliest and the most prominent cognitive changes in AD, and is vital in early

detection of preclinical AD including amnestic mild cognitive impairment (aMCI)

(Backman, Jones, Berger, Laukka, & Small, 2005; Salmon & Bondi, 2009; Schwindt

& Black, 2009). Furthermore, episodic memory impairment is more likely to predict

the development of probable AD (Elias et al., 2000; Landau et al., 2010). Therefore,

the evaluation of memory deficits would be an important issue in the

neuropsychological assessment.

Medial temporal lobe (MTL) structures mainly include the hippocampus, the

perirhinal cortex, the entorhinal cortex, and the parahippocampal cortex (Squire &

Zola-Morgan, 1991). For decades, MTL structures have been demonstrated to play a

crucial role in episodic memory based on those patients receiving the surgical removal

1
of pathological tissues or suffering lesions primarily involving hippocampus and/or

amygdala (Frisk & Milner, 1990; Scoville & Milner, 1957; Squire, 2009; Victor &

Agamanolis, 1990; Zola-Morgan, Squire, & Amaral, 1986). Lately, brain imaging

research has reported that MTL activations are strongly linked to both the episodic

encoding (Cabeza & Nyberg, 2000; Martin, 1999) and the episodic retrieval (Nyberg,

McIntosh, Houle, Nilsson, & Tulving, 1996; Schacter, Alpert, Savage, Rauch, &

Albert, 1996). The prefrontal cortex (PFC) is also engaged in episodic memory

(Cabeza & Nyberg, 2000). More specifically, the left-sided PFC activation is

associated with the episodic encoding for verbal stimuli, and the PFC right-sided

activation is associated with the episodic retrieval (Cabeza & Nyberg, 2000).

Pathological changes of MTL structures are major features of early AD

(Ronald C. Petersen et al., 2006). In fact, studies (Braak & Braak, 1991; Gomez-Isla

et al., 1996) found significant neurofibrillary tangles evident in the transentorhinal

brain region corresponding to the medial portion of the perirhinal cortex (Taylor &

Probst, 2008) and the entorhinal cortex in the pre-AD. Impairment of episodic

memory has been viewed as a neurocognitive marker for AD, and the clinical

evaluation of this function in old people thus becomes indispensable. However,

conventional episodic memory measures are heterogeneous in nature. Generally, these

tests primarily include the verbal and non-verbal ones. The verbal episodic memory

2
tests can be further classified into prose recall nature, such as the Logical Memory

(LM) subtest of the Wechsler Memory Scale-Third Edition (WMS-III) (Wechsler,

1997), and the list learning one, such as the California Verbal Learning Test (CVLT)

(Delis, Kaplan, Kramer, & Ober, 2000) or the Rey Auditory Verbal Learning Test

(RAVLT) (Schmidt, 1996). List learning tasks are perhaps the most favorable

measures of episodic memory when used to assess early cognitive changes in MCI

and AD, and to predict the conversion of MCI into AD. Tremont and colleagues (2010)

found that 80% of the MCI participants have defective performance on the delayed

recall of the Hopkins Verbal Learning Test-Revised (HVLT-R) compared to only

32.2% on the delayed recall of the LM (LM-II). Likewise, Rabin and colleagues

(2009) reported similar findings that the delayed recall or learning score of list

learning tests had a higher sensitivity to the diagnosis of the episodic memory

problem in MCI patients.

Recently, Saling (2009) proposed that different episodic memory tasks should

be emphasized their underlying cognitive features (i.e., the task-specificity). Some

studies (Rausch & Babb, 1993; Saling et al., 1993) have demonstrated that left-sided

mesial temporal foci are correlated with the learning performance on unrelated word

pairs of the Paired Associate Learning subtest of the WMS (WMS-PAL) (Wechsler,

1945) but not immediate recall of the passage. Because there are arbitrary associates

3
among these unrelated words, it makes patients with TLE hard to acquire this kind of

verbal materials, while it makes no difficulty in learning of the prose material, such as

the LM. Arbitrary associates or prosemantic learning can be seen as rote learning with

low semantic connections between word pairs (e.g., the WMS-PAL), or words in the

verbal list learning tests. Consequently, the dissociation of arbitrariness and semantic

components in verbal learning tasks which are respectively correlated with lateral and

mesial temporal structures can be represented in a semantico-syntactic continuum

depending on the extent of semantic loading (Saling, 2009). Researches (Fernández &

Tendolkar, 2006; Weintrob, Saling, Berkovic, Berlangieri, & Reutens, 2002) further

demonstrated the perirhinal cortex specifically playing an essential role in the learning

of arbitrary associates. Thus, it seems that the impairment of the learning tasks with

arbitrary associates could be regarded as a cognitive marker in detecting pathological

changes of the perirhinal cortex of the pre-AD.

The Word Sequence Learning Test (WSLT) (Hua, 1986) belongs to list

learning tests with several learning trials and a delayed recall phase, while the WSLT

is characterized by its abstract word list as the item materials. The semantic relations

among these words are low as well. In contrast to many other verbal episodic memory

tests mixing both arbitrary and semantic components, lesser extents of semantic

structures are involved in the WSLT. Based on the literature (Hermann, Seidenberg,

4
Haltiner, & Wyler, 1992; Saling, 2009), an increasing sensitivity to detect the

perirhinal cortex functioning using the WSLT for its underlying feature of arbitrary

associates learning would thus be expected. Moreover, the WSLT is also characterized

by the administration procedure of the incidental recall. This leads to increments in

ecological validity, because we always recall what has happened in daily life without

forewarning.

In addition to the association with MTL structures, normal performance of the

WSLT also requires the contribution of frontal lobes. In the learning phase of the test,

there is a position index score measuring the individual’s sequential learning ability.

Researches have confirmed a significant correlation between working memory (WM)

and sequential learning tasks, and suggest that sequential learning is linked with the

prefrontal cortex which also involves in WM (for a review, see Janacsek & Nemeth,

2013). In addition, the evidence of an increase of left posterior prefrontal activations

is significantly associated with the rote-rehearsal process (Kapur et al., 1996).

Accordingly, the position index score of the test would reflect the left prefrontal

cortex functioning. In general, it would be suggested that the WSLT is a multi-facet

memory with widespread neural networks, mainly involving frontal and temporal

cortices.

In regard to psychometric properties of two conventional verbal list learning

5
tasks, particularly the RAVLT and the CVLT, both of the test-retest and the

alternative-form reliabilities of most indices in normal adults are above the marginal

level of correlation coefficient ( > 0.6), with the exception of scores of the Trial 1

correct of the CVLT (Crawford, Stewart, & Moore, 1989; Delis, et al., 2000;

Mitrushina & Satz, 1991; Strauss, Sherman, & Spreen, 2006; Uchiyama et al., 1995).

In addition, the Word List Test of the WMS-III Taiwan version (Hua et al., 2005)

shows broad-ranged level of correlation coefficient of the test-retest reliability in two

normal age groups (the total recall index: .44 & .69; the long delayed recall index: .35

& .72). With respect to the validity, the available literature shows that most of the

indices of the RAVLT significantly correlates to other verbal episodic memory tasks,

such as the CVLT based on the normal adults and patients with traumatic brain injury

(Crossen & Wiens, 1994; Stallings, Boake, & Sherer, 1995) and the LM based on the

outpatient group (Johnstone, Vieth, Johnson, & Shaw, 2000). However, the Word List

Test correlates to the LM at an ordinary level ranging from .30 to .56 (Hua, et al.,

2005). Moreover, the CVLT-Taiwan version has been proved to have a sound validity

to distinguish Taiwanese AD from normal elderly people (Chang et al., 2010).

Demographic effects on these typical list learning tasks have also been

investigated. Some studies (Mitrushina, 2005; Schmidt, 1996) reported the age effect

with a non-linear correlation feature in which a slight improvement is found before 25

6
years old and a significant decline also appears in groups beyond 59 years old, while

the age effect is lesser apparent among 20- to 59-year-old group. Nonetheless, the

consistent age effect on performances of the RAVLT and the CVLT in which the

number of words recalled decreases as age increases has been reported in most

literature (Bleecker, Bolla-Wilson, Agnew, & Meyers, 1988; Chang, et al., 2010;

Dunlosky & Salthouse, 1996; Geffen, Moar, O'Hanlon, Clark, & et al., 1990;

Mitrushina, Satz, Chervinsky, & D'Elia, 1991; Uchiyama, et al., 1995). The

intelligence effect has also been reported, that is, a positive impact of FSIQ scores on

the total recall performance of the RAVLT and the CVLT (Delis, et al., 2000;

Steinberg, Bieliauskas, Smith, Ivnik, & Malec, 2005), and a correlation between IQ

scores and words recalled in learning trials of the RAVLT (Bolla-Wilson & Bleecker,

1986; Query & Megran, 1983). However, the education effect has demonstrated

inconsistent findings. Some research revealed a correlation between the educational

level and the testing performance in the RAVLT and the CVLT (Delis, et al., 2000;

Magalhaes & Hamdan, 2010; Miatton, Wolters, Lannoo, & Vingerhoets, 2004;

Norman, Evans, Miller, & Heaton, 2000; Pontón et al., 1996; Van der Elst, Van Boxtel,

Van Breukelen, & Jolles, 2005), but some did not (Bolla-Wilson & Bleecker, 1986;

Mitrushina, et al., 1991; Wiens, McMinn, & Crossen, 1988). In addition, Chang et al.

(2010) and Lee et al. (2002) found that the age and the education have a two-way

7
interaction that the performance on the CVLT and the RAVLT tends to be better in

younger and higher education groups than older and lower education groups. The

gender effect has been inconsistent. RAVLT studies (Bleecker, et al., 1988; Harris,

Ivnik, & Smith, 2002; Lee, et al., 2002) reported that women outperformed men while

others didn’t display the gender difference (Kurylo, Temple, Elliott, & Crawford,

2001; Pontón, et al., 1996; Savage & Gouvier, 1992).

Based on the aforementioned review of literature concerning issues of the

heterogeneity of the MTL structures in terms of memory function, the candidate of the

earliest and optimal neurocognitive marker of AD, and clinical utilities, the primary

aim of the present study was to build the normative data of the WSLT in Taiwanese

healthy adults. Thus, three specific objectives of the present study are as follow. First,

the study was to examine psychometric properties of the WSLT; secondly, the study

was also to explore the effects of demographic variables on the performance of the

test, and thirdly, the appropriacy of the normative data established by the present

study would be inspected as well.

8
 Methods

Participants

Three hundred and seven volunteers (139 males and 168 females) included in

this study were healthy and community dwelling Taiwanese people. According to data

from the 2012 Population Statistical Yearbook (Ministry of the Interior, 2013),

participants were stratified for age, education level, and different geographical regions

in Taiwan (see Table 1). All participants were independent of their personal care and

activities in daily life and society. Via a semi-structured clinical interview, individuals

who had a current or past history of alcohol or drug abuse, brain injury, stroke,

dementia, endocrine disorders (particularly of the thyroid gland), or any other

systemic failure, neurological disorders, or psychiatric illness were excluded.

However, in order to avoid recruiting “hyper-normal” subjects, individuals with mild

hypertension or other systemic problems under medical control were not excluded.

The Mini-Mental State Examination (MMSE) served as a screening test of cognitive

abilities. Individuals were excluded when the performance on the MMSE was lower

than 24/30, or 18/30 for individuals with less than 2 years of education (Wang, 2007).

Participants were asked to sign a written informed consent form (see Appendix A)

approved by the Ethical Committee of the Department of Psychology, National

Taiwan University.

9
 The retrospective study was also taken and included 40 patients with amnestic

mild cognitive impairment (aMCI: 27 single domain and 13 multiple domain). The

demographic characteristics of the patient group are presented in Table 2. This group

was used for examining the construct validity. Each patient had been diagnosed by

neurologists and clinical neuropsychologists based on a serial of comprehensive

evaluation, such as neuropsychological assessment, brain imaging and general

neurology examination, and the diagnostic criteria proposed by Petersen and

co-workers (2004). All patients were rated as 0.5 in Clinical Dementia Rating (CDR)

and subjective memory complaints were also noted.

Measurements

The Word Sequence Learning Test (Hua, 1986). A 6-item word list in

which each word belongs to abstract words and has little semantic associations

between each other was read aloud by the examiner. Each participant was then asked

to immediately recall the word list exactly in the same word order as the examiner

presented. The learning phase stopped when the subject recalled correctly in two

consecutive trials, otherwise the subject learned up to 10 trials. Three sub-scores were

calculated in the learning phase including the correct, the position, and the learning

scores. The correct score is the number of words correctly recalled in each trial. The

position score is the number of words correctly recalled in the absolute position of the

10
word list. Subjects got a total of two points in the learning score when recalling the

word list correctly and in right order, while some conditions are counted one point in

the learning score (see Appendix B for detailed scoring rules). After 10-minute delay,

the recall phase which is composed of the free recall, the cued recall and the yes/no

recognition was applied to subjects incidentally. In the free recall trial, subjects were

asked to recall words which had learned before without forewarning. The order of the

word list was not required in the free recall. The cued recall trial should be given

when subjects didn’t recall all of the six words. In the cued recall trial, subjects were

given the first character of words which didn’t answer correctly in the free recall trial.

The recall and the cued recall scores are words correctly recalled. The recognition

trial should be given when subjects still didn’t correctly get the 6-word cued recall. In

the recognition trial, subjects identified six target words from 24 foils, also abstract

words. The recognition score derives from an equation that hits plus 24 and substrate

false positives. Detailed instructions and scoring rules were listed in Appendix B.

Neuropsychological assessments. The IQ effect in the WSLT is inspected in

the present study. Therefore, the estimated full-scaled intelligence quotient (FSIQ)

was obtained by the Wechsler Adult Intelligence Scale-Third Edition (WAIS-III)

Taiwan version (Chen & Chen, 2002). The short-form was advised to include the

Similarity, the Matrix Reasoning, the Arithmetic, and the Digit-Symbol Substitution

11
subtests (Chen, Hua, Zhu, & Chen, 2008). The WSLT is one kind of list learning tasks

which generally considered as a form of verbal episodic memory. Thus, the Logical

Memory subtest and the Word List Test of the WMS-III Taiwan version (Hua, et al.,

2005) were included as references for evaluating the criterion-related validity. In

addition, the WSLT is characterized by its abstract word list and very low semantic

relations among words. The LM and the Word List Test could be assigned to high to

moderate semantic relations. Hence, these two tests were also contained in the

evaluation of the construct validity.

Procedure

Each participant was introduced the aim and the following procedure of tests,

firstly. An informed consent form was then asked to signed, and subjects filled in a

background questionnaire about personal information and current health status.

Afterwards, the MMSE was administered for the screening of cognitive abilities, and

the WSLT was administrated to all participants. Other neuropsychological

assessments including the WAIS-III short-form (Taiwan version), the LM subtest and

the Word List Test of the WMS-III (Taiwan version) were selectively administered to

some participants in a standardized procedure. The whole process of the testing took

20 minutes to one and half hours, the time varying with the participants’ performances

and the number of tests administered. Thirty participants were randomly selected for

12
examining the test-retest and the alternate-form reliability. Thirty-three participants

were also randomly selected for examining the criterion-related and the construct

validity. In the retest group, subjects receive the second administration of the WSLT at

least two months later (ranging from 57 to 132 days). In the alternate-form group, two

other forms with different word lists of the WSLT were administered in a

counter-balanced study design. In the validity group, subjects completed extra LM

and the Word List Test.

Statistical Analyses

SPSS version 22.0 was used in all statistical analyses. Descriptive statistics

were calculated for raw sub-scores of the WSLT and demographic characteristics of

all samples. The Kolmogorov-Smirnov test was used to examine whether or not the

raw sub-scores of the WSLT are normal-distributed, and further determine if

non-parametric statistical procedures were needed to do data analysis. Scatter plots

and curve estimates were used to determine the most fitted model for the data of these

sub-scores under different demographic influences. Multiple regression analysis and

stepwise regression were then performed to clarify relative contributions of

demographic variables to the WSLT performance. Mann-Whitney U test and

Kruskal-Wallis one-way analysis of variance by ranks were used to determine whether

these different demographic groups differed on various sub-scores of the WSLT, and

13
procedures for conducting multiple comparisons in the post hoc test were proposed by

Siegel & Castellan (1988). The post hoc test was employed to specify the pairwise

comparison of groups with Bonferroni corrections. In order to establish normative

data, demographic effects on sub-scores of the WSLT were adjusted, and the

regression coefficients were used to derive corrected equations and then generate

adjusted sub-scores and their percentile ranks. With regard to the psychometric

properties of the WSLT, Pearson correlation and Spearman’s rho were employed to

calculate the test-retest reliability and the alternate-form reliability. Wilcoxon signed

rank test was conducted to examine the practice effect. Likewise, similar correlation

procedures were also employed to investigate the relationships between the WSLT

and other verbal episodic memory tasks to explore the criterion-related and construct

validity. Age effects on the WSLT performances were analyzed as well to examine

construct validity. In addition, the patient group and healthy controls were compared

by Mann-Whitney U test, and the percentage of scores below 5th percentile in two

memory tests (the WSLT and the LM) was also analyzed to provide further evidence

of construct validity.

14
 Results

Demographic Characteristics

The descriptive data of demographic characteristics are presented in Table 3.

No age difference was noted in gender (t = 0.81, p > .05), while male participants had

higher education level than their female counterparts in this study (t = -3.42, p < .05).

Effects of Demographic Variables and Intelligence

Descriptive statistics of raw sub-scores by age, education level, and gender

groups are presented in Table 4. Generally, mean sub-scores are lower as age

increases and as education level decreases. No significant performance difference was

noted between male and female participants by the Mann-Whitney test (all sub-scores

p > .05).

The relationship between two demographic variables (age and education) and

sub-scores was examined by scatter plots and curve estimates. It presented that all

sub-scores had a quadratic relationship to age and education, with the exception of a

linear relationship between the recall score and age, and between the learning score

and education. The linear and/or quadratic terms of age and education were centered

for reducing multicollinearity, and then entered into multiple regression analysis to

determine which variable significantly predicted the sub-scores (for the result, see

Table 5). However, there was no gender effect after the above statistical analyses were

15
used. Stepwise regression analysis is presented in Table 6. Education accounted for

the most variances in the correct, the position and the learning scores (31.4% to

35.9% of variance), followed by age (3% to 6.7% of variance) and education2 (0.8%

to 4.8%). In the delayed recall, the cued and the recognition scores, education2 could

account for the most variances (9.8% to 14.2% of variance), followed by age2 (2.4%

to 2.9% of variance) and education (1.2% of variance). In total, education in linear or

quadratic term had more conspicuous effects on explaining variances in the WSLT

sub-scores than age.

The Kruskal-Wallis one-way analysis of variance by ranks is presented in

Table 7. The result showed that a significant between-group difference of age groups

was evident in the correct, the position, the learning, and the cued recall scores (all

sub-scores p < .005), while the recognition score approached the significant level (p

= .053). In the pairwise comparisons of different age groups, the post hoc test (see

Table 8) showed that the oldest group ( > 74 years old) had a significant decline in

these four sub-scores compared to groups 16-24 and 25-34, with the exception of

non-significant decline in the correct score compared to the 25-34 group and in the

cued score compared to the 16-24 group. The 65-74 group also showed a significant

discrepancy with groups 16-24 and 25-34 in the four sub-scores, with the exception of

non-significant discrepancy with the 16-24 group in the cued score. When the 65-74

16
group and the above-74 group emerged, the new group ( > 64 years old) performed

significantly worse than groups 25-34 and 45-54 in the four sub-scores, and also had a

decline in the correct, the position, and the learning scores compared to the 16-24

group and/or the 35-44 group. Thus, there seems an obvious decline in the WSLT

sub-scores for those above the 64 year-old subjects. Because there was no age effect

on the recall score, we further controlled learning trials by dividing subjects into three

groups: 2-4 trials group, 5-7 trials group, and 8-10 trials group. The ANOVA result

still showed no difference among age groups (see Table 16).

The result of ANOVA revealed a significant between-group difference among

different education groups in all sub-scores. The post hoc test further showed that the

above-12th grade group had a better performance in the correct, the position, and the

learning scores compared to other three groups. In addition, the above-12th grade and

the 10-12th grade group also performed significantly better than the 0-6th grade group

in the recall, the cued, and the recognition scores.

The IQ effect was examined by Pearson correlation between age-corrected

sub-scores and the estimated FSIQ. The position, the learning, and the recall scores

were positively correlated with the estimated FSIQ (ranging from .26 to .30, p < .05).

However, the correct, the cued and the recognition scores had a non-significant

correlation with the estimated IQ (ranging from .09 to .22, p > .05).

17
Psychometric Properties

Reliability. The test-retest reliability is presented in Table 11. The correct,

the position, the learning and the cued scores had above marginal test-retest reliability

(ranging from .61 to .64). The recall and the recognition scores had an approaching

marginal test-retest reliability (.54 and .51 respectively). In addition, the practice

effect was found in the position, the learning, the recall, and the cued scores with at

least 2 months of interval time (mean = 87.93 days). With regard to the alternate-form

reliability (see Tables 12 & 13), the coefficient fell among .26 to .61 for form 1 versus

form 2, .14 to .73 for form 1 versus form 3, and .37 to .65 for form 2 versus form 3. In

addition, the performances between form 1 versus form 2, form 1 versus form 3, and

form 2 versus form 3 showed no significant differences except for form 2 versus form

3 in the recall score (p < .05).

Criterion-related validity. The WSLT sub-scores significantly correlated

with other measures of verbal episodic learning and memory including the LM and

the Word List Test of the WMS-III (see Table 14). The correct, the position, the

learning, and the recall scores correlated moderately well with corresponding

sub-scores in two criteria (ranging from .42 to .75). The cued score correlated

significantly with the LM-II (r = .35), while no significant correlation was found with

the Word List Test-II (r = .15). Moreover, the recognition score didn’t significantly

18
correlated with corresponding recognition score in two criteria (-.01 and .29

respectively).

Construct validity. The extent of semantic relations among words could be

a crucial factor to differentiate verbal episodic memory tasks. A continuum dimension

of the extent of semantic relations was differently assigned to the WSLT, the Word

List Test, and the LM. We considered the LM to be abundant of semantic structures in

its learning stimuli, and followed by the Word List Test and the least extent of

semantic relations in the WSLT. Based on the assumption of different extent of

semantic relations in these three tests, the construct validity was verified by

comparing correlation coefficients in sub-scores of three verbal episodic memory

tasks. The result showed that the WSLT correlated much higher with the Word List

Test in all sub-scores except for the recognition score (see Table 14).

Since aging process was found to be associated with a deterioration of

temporal and frontal lobe (Salthouse, Atkinson, & Berish, 2003; Schretlen et al., 2000;

St. Jacques, Rubin, & Cabeza, 2012) which were the main brain regions involved in

the WSLT. Age effect was then provided to further evaluate the construct validity of

the WSLT. The results of the ANOVA test and the regression analyses revealed

obvious age effects on each sub-scores of the WSLT (see Tables 5, 6, and 7). The post

19
hoc comparison also showed that a significant decline in the performance was found

among above 64 year-old groups (see Table 8).

A retrospective patient study was also employed for examining the construct

validity. Patients with aMCI performed worse than healthy controls in all sub-scores

of the WSLT (see Table 15). We further investigated performances on two memory

tests among these patients with aMCI. The result found that 77.5% (31/40) of patients

had a defective picture in the WSLT compared to only 20% (8/40) in the LM (see

Figure 4-1), and the proportion differed significantly ( (1) = 21.16, p < .001). In

addition, if we only included patients with aMCI-single domain, 74.07% (20/27) of

patients presented memory deficits in the WSLT compared to only 11.11% (3/27) in

the LM (see Figure 4-2), and the proportion discrepancy reached a statistically

significant level ( (1) = 15.21, p < .001).

Norms Established

Regression coefficients were used for ruling out demographic effects on the

WSLT performances, and corrected equation of each sub-score was then provided as

follow:

Adjusted score = raw sub-score – bedu × (edu – 13.84) – bedu2 × (edu – 13.84)2

– bage × (age – 42.16) – bage2 × (age – 42.16)2.

20
 The bedu, bedu2, bage, and bage2 refer to the unstandardized coefficients of

education, the square of education, age, and the square of age respectively. The

numbers 13.84 and 42.16 derived from the average age (by year) and the average

education level (by year) of all samples. Corrected equations of all sub-scores are

presented in Table 9. All raw sub-scores of our samples were adjusted by these

corrected equations and were ranked by percentile. The referential table for percentile

rank of adjusted sub-scores is presented in Table 10. To identify the defective level of

these adjusted sub-scores, Lezak and colleagues (2004) advised that the fifth

percentile might be a cut-off point.

21
 Discussion

The present study was aimed to identify effects of age, education level, gender,

and intelligence on the WSLT, and further to provide equations for correcting the

demographic effects and a referential table for percentile rank. Psychometric

properties of the WSLT were also investigated. Thus, demographic effects,

psychometric properties and appropriacy of norms are discussed in the following.

Effects of Demographic Variables and Intelligence on the WSLT

Effect of age. The age-related decline in the correct, the position, and the

learning scores is reported in the results of the ANOVA test and the multiple

regression analyses. These are consistent with previous findings that words recalled

on the learning phase show greater age effects (Dunlosky & Salthouse, 1996; Incalzi,

Capparella, Gemma, Marra, & Carbonin, 1995; Mitrushina, et al., 1991; Uchiyama, et

al., 1995). However, a linear relationship between scores on the learning phase and

age contradicts Mitrushina’s meta-analysis study (2005) that a quadratic relationship

was found. The present results also exhibited that the recognition score had an

approaching significant level of between-group difference, and some studies have

found that recognition shows less age effects compared to other memory indices

(Bleecker, et al., 1988; Mitrushina, et al., 1991). It is worth noting that the recall score

shows no age effect in the ANOVA test and regression analyses (also see Figure 2-2)

22
which contrast with previous studies (Incalzi, et al., 1995; Magalhaes & Hamdan,

2010). It is possibly due to the learning material of the WSLT comprises abstract

words and the unrelated word list that distinctly differ from other list learning tests. In

addition, another reason could be the stop rule of the consecutive two-trial corrects in

the learning phase causing less exposure to the learning material. Most young subjects

get higher learning scores will have fewer trials to learn, and get poorer score in the

recall. Accordingly, we further investigated the age effect in the recall score with a

control of learning trials. However, the result revealed that even under similar

learning trials, no age effect was found. Thus, the reason for a lack in the age effect on

the recall score is still unclear, and further investigations are required.

Effect of education. There is a striking effect of education in all sub-scores,

and education accounts for more variances than age. This is not common in most

previous studies, but still many studies have reported education effects on the RAVLT

and the CVLT (Messinis, Tsakona, Malefaki, & Papathanasopoulos, 2007; Miatton, et

al., 2004; Norman, et al., 2000; Van der Elst, et al., 2005). The post hoc test shows

that the highest-education group performed significantly well than other three groups

in the learning phase. The reason for this phenomenon might be resulted from the

words used in the WSLT. These words belong to abstract and function words. Subjects

with higher education level might be proficient in abstract verbal ability and further in

23
favor of learning these abstract words. Moreover, in the post hoc test, subjects with

the lowest level of education evidenced a significant decline in sub-scores of the

recall phase. Education also has a quadratic model in the recall, the cued and the

recognition scores. The possible explanation is the differences in word frequency to

Mandarin and Taiwanese. In our samples, some low-education subjects are Taiwanese

language users. The WSLT words could be low-frequency words to Taiwanese

language users, and this causes great difficulty in learning these words. Nevertheless,

an apparent education effect on the WSLT should be explored strictly in the future.

Effects of gender and intelligence. With regard to effects of gender and

intelligence, our data showed no gender difference in all sub-scores of the WSLT.

However, the position, the learning, and the recall scores significantly correlate with

the estimated FSIQ. Comparing to other studies, correlations between the WSLT and

the intelligence are milder. It might be partially associated with different measures of

evaluating the intelligence. Some studies employed verbal intelligence to represent

the intelligence (Bolla-Wilson & Bleecker, 1986). Another reason might be due to

high-average IQ (mean IQ = 114.66) of our samples. Steinberg and colleagues (2005)

found that the AVLT correlated better at a moderate level of the FSIQ than higher and

lower IQ.

24
Psychometric Properties

Reliability. In the retest reliability, most of the scores fall above marginal

level (ranged from .61 to .64). The recall and the recognition scores fall near to

marginal level (.54 and .51 respectively). The correlation coefficients are all

significant and are similar to the previous researches (Mitrushina & Satz, 1991;

Uchiyama, et al., 1995). In addition, many other studies found practice effects on the

RAVLT after at least 1 month retest. Our results also showed the same practice effect

on the position, the learning, the recall, and the cued scores. Hence, in the clinical

practice, it might be noticed that the practice effect still exists at least 2 months retest

in normal subjects. As for the alternate forms in the WSLT, results show nearly no

practice effect between different versions. Higher alternate-form reliability mostly

appeared in sub-scores of the learning phase, while low correlation coefficients

appeared in sub-scores of the recall phase. Thus, it should be careful to use corrected

equations in forms II and III of the WSLT which might cause more biases in

explaining the adjusted scores. The possible explanation for low level of retest and

alternate-form reliabilities in the recall score is the violation of the incidental recall.

Subjects who received the WSLT more than twice might realize a following recall

phase and violated the incidental recall. In addition, due to the rules about the

selective administration in the cued and the recognition, the truncated sample in these

25
two sub-scores might also influence the reliability. However, the WSLT generally

provides adequate reliability for Taiwanese samples.

Criterion-related validity. Most sub-scores of the WSLT correlate

significantly with the corresponding indices in the LM and the Word List Test. The

result is consistent with prior findings (Crossen & Wiens, 1994; Johnstone, et al.,

2000; Stallings, et al., 1995; Strauss, et al., 2006). However, the recognition score had

non-significant correlations to both two criterion tests, although a low correlation

between the AVLT and the CVLT has also been reported by Crossen & Wiens (1994).

The reason for the non-significant correlation in the recognition score might be due to

low difficulty in the recognition of the Word List Test. Foils in the Word List Test are

not involved words of the interference list. Thus, subjects with higher recognition

score in the Word List Test might perform variously in the WSLT. In addition, the

truncated problem in the recognition subtest might also lower the criterion-related

validity.

Construct validity: comparisons of semantic relations. According to the

aforementioned assumption of different semantic relations among verbal episodic

memory measures, we expect a closer correlation between the WSLT and the Word

List Test than to the LM. The results (see Table 14) showed that all sub-scores of the

WSLT except for the recognition had higher correlation coefficient with the Word List

26
Test. This finding verifies the semantic-syntactic continuum in the verbal episodic

memory measures, and confirms that the WSLT has the least semantic structures in its

word list compared the other tests. That is, the WSLT could be considered as a higher

arbitrary-associates loaded test which specifically associates with the perirhinal cortex

functioning.

Construct validity: aging effect. The WSLT is associated with the temporal

lobe which dominates learning and memory, and is associated with the frontal lobe

which is responsible of the sequential learning. Likewise, these brain regions are

found to correlate with aging process, and age-related decline in the episodic learning

and memory is expected (Salthouse, et al., 2003; St. Jacques, et al., 2012; Stranahan

& Mattson, 2010). Thus, it is expected that the performance of the WSLT should be

worse in the aging group. The results presented in Table 8 and the Figures 2-1 & 2-2

agree with our expectations, and could be a supporting evidence of validity in the

WSLT.

Construct validity: patient study. We make a preliminary study by

collecting patients’ data retrospectively for further examining the clinical validity of

the WSLT. The result shows that all sub-scores differ between the patient group and

healthy controls (see Table 15). It suggests that the performance on the WSLT can

truly reflect memory impairments of patients with aMCI. Furthermore, when we

27
compared performances on the WSLT and the LM, the WSLT reveals a higher

percentage in designating episodic memory deficits of patients with aMCI or

aMCI-single domain (see Figures 4-1 & 4-2). This finding is in accordance with the

previous studies (Rabin, et al., 2009; Tremont, et al., 2010). According to the criteria

of MCI proposed by Petersen (2004), patients with subjective complaints should also

be confirmed objective memory impairments by neuropsychological tests. Thus, the

result reveals that the WSLT can reflect more memory deficits of patients with

subjective memory complaints. It may suggest that the WSLT is a more sensitive tool

in detecting early memory changes of aMCI and AD.

Appropriacy of Norms

Mehrens and Lehman (1987) have proposed that an appropriate norm

possesses three characteristics: representativeness, recency, and relevance. The

present study included 307 participants stratified by age, education, gender and

geographic distribution in Taiwan. Except for a lack of participants in the 35-44

year-old group, the above-75 year-old group, the 0-6 education group, and the 7-9

education group, our samples matched the distribution of population. Therefore the

representativeness of the sampling is adequate. Second, the norms collected from May

2011 to April 2014 have good recency. Third, the normative data was corrected by

demographic variable, and the samples are relevant to the clinical patients for the

28
same cultural background and compatible demographic characteristics. Thus, the

normative data has good relevance.

29
 Conclusion

The present study provides a normative data of the WSLT. In addition, the

effects of demographic variables are explored and further be corrected in the

normative data. The psychometric properties are also examined, and the result reveals

that the WSLT has adequate reliability and validity.

In the clinical use, it has always been lacking a verbal episodic memory task

with good psychometric properties suitable for Taiwanese people. Thus, to establish

the normative data of the WSLT could be helpful in the clinical practice of Taiwan for

identifying episodic memory deficits in different neurological disorders. Furthermore,

according to results of the construct validity in the present study, the WSLT is proven

to have more arbitrary associates than other verbal memory measures. The

task-specificity is confirmed in the present study. The patient study also shows that

the WSLT has a higher sensitivity in detecting memory deficits in aMCI compared to

the LM. Hence, we infer that the WSLT has high sensitivity in detecting the perirhinal

cortex functioning, and play a crucial role in the early detection of memory deficits in

Alzheimer’s disease.

Some limitations of the present study should be noticed. First, a relatively

more participants in the highest education level group ( > 13 years) and less

participants in the highest age range ( > 74 years old) were included in the present

30
study. With a trend of aging society, the normative data might lose its

representativeness in the old-old subjects ( > 74 years old). Future studies could

recruit the old-old subjects specifically for exploring the performance on the WSLT.

Second, the interpretation of the patient study should be taken with care for its

retrospective approach. Therefore, a future prospective study is necessary to verify the

clinical significance of memory deficits which are supported by the WSLT, and even

to see whether the WSLT could contribute to detect conversion to AD or to compare

sub-scores of the WSLT for clarifying different contributions in AD diagnosis. Third,

the alternative-form reliability shows low level of correlation coefficient in the recall,

the cued, and the recognition scores, and the corrected equations might be unsuitable

for forms II and III. Thus, extra normative data for forms II and III is required in

future studies.

31
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43
 Appendix

Appendix A: Informed Consent Form

參與研究同意書
國立臺灣大學心理學研究所

您好：
首先，感謝您參與本次的研究。本研究名稱為「台灣正常人中文字詞次序學
習測驗之常模研究」。此研究之主要目的在於建立台灣地區中文字詞次序學習測
驗之常模，並探討台灣地區人口學變項與中文字詞次序學習測驗表現之相關性。
同時評估中文字詞次序學習測驗在台灣正常人使用上之信度與效度等，期能使臨
床實務工作者在衡鑑與追蹤病人認知功能狀況時能做更有效的評估。

本研究過程為透過問卷填寫以及神經心理測驗評估之方式完成，對個人並無
侵入性危險。主要分成以下幾個部分：
1. 施測前：主試者簡介研究目的，研究參與者閱讀並填寫同意書、基本資料、
與疾病史等相關問卷。
2. 正式施測：由研究者對參與者進行神經心理功能測驗評估。

基於我們對於您個人權益的尊重，本研究對您有以下的承諾：
※您有權隨時停止作答，並且不會因此而受到懲罰。
※您有權要回您的資料，並且撤銷被納入分析。
※您有權在本研究結束後知道研究結果。
※如有任何疑問，您可隨時經由參與者聯中所附之聯絡方式與研究人員進行
聯絡。

本研究之結果，僅供學術使用，將不做其他用途；本研究的資料沒有對錯或
好壞的判斷，您的所有資料將被匿名保密，請您放心填答，謝謝您的合作！

如您同意參與本研究，請於簽上您的姓名與聯絡方式，謝謝您。
本人已詳細閱讀本同意書，並同意參與研究。
參與者簽名：__________ 聯絡方式：___________日期：____年____月____日
再次感謝您。
實驗/主試者：陳威嘉
國立臺灣大學心理學研究所/臨床心理學組/碩士班研究生
聯絡地址：國立台灣大學心理學系南館 118 室
聯絡電話/手機：02-23695438/0963117197
指導老師：花茂棽

44
 國立臺灣大學心理學系教授
聯絡地址：國立台灣大學心理學系南館 118 室
聯絡電話/手機：02-23695438
研究者簽名：__________ 日期：_____年____月____日

45
Appendix B: Administration and Scoring

施測：
指導語：
一、學習：等一下我會唸出一些字詞讓你學習，你就照你聽到的把它背誦出
來，由於這些字詞較長一點，可能你第一次無法完全記得，但是
我會重複念這些字詞讓你學。
二、回想：(10 分鐘後)之前我有請你記一些詞，你還記得有哪些嗎？你回憶
看看。
三、線索回憶：(如果受試者無法回想)現在我給你剛才那些字詞的第一個字，
你把完整的字詞說出來。
四、再認：(如果受試者也無法完成線索回憶)現在我念一些字詞，你告訴我
是不是剛才曾經聽過的。

計分：
一、學習：每一個字詞 1 分。橫列計正確分數，每次 trial 有 6 個，共 10 次
trials，滿分 60 分。縱列計位置分數，有 6 個詞，每個詞有 10
次 trials，滿分 60 分。學習分數是以受試者的答案符合位置且項
目皆正確來計算，每題 2 分，共 10 題，滿分 20 分。倘若受試者
的答案是符合位置、項目正確連續二次，即停止施測，以下 trials
皆以 2 分計之。在如下四種情形可給予每一 trial1 分：
1. 漏了一個詞，但其他項目、位置全對。
2. 多了一個詞，但其他項目、位置全對。
3. 錯了一個詞，但其他項目、位置全對。
4. 全部的詞皆對，只是鄰近的兩個詞位置顛倒。
二、回想：每個詞 1 分，共 6 個詞，滿分 6 分。
三、線索回憶：每個詞 1 分，共 6 個詞，滿分 6 分。
四、再認：計算受試者 O (Hit ≤ 6)中對了幾個，減去 N 中錯的個數，再加上 24。
滿分 30 分。

46
 中文字詞次序學習測驗
國立台灣大學心理學系 花茂棽教授

姓名： 施測編號：
性別： 出生日期：
學歷： 施測日期：

圈出施測之序列
選擇題本 刺激詞
Ⅰ 相當 原來 不但 時候 服務 從此
Ⅱ 已經 還是 雖然 什麼 其中 覺得
Ⅲ 至少 以後 原則 任何 完全 當時
受試者之反應--逐字記錄在空表上，受測者能連續正確地背誦出兩次時，就停止
繼續施測，同時對於其他的嘗試給予分數。

正確 學習
分數 分數
1. _______ _______ _______ _______ _______ _______ ___/6 ____

2. _______ _______ _______ _______ _______ _______ ___/6 ____

3. _______ _______ _______ _______ _______ _______ ___/6 ____

4. _______ _______ _______ _______ _______ _______ ___/6 ____

5. _______ _______ _______ _______ _______ _______ ___/6 ____

6. _______ _______ _______ _______ _______ _______ ___/6 ____

7. _______ _______ _______ _______ _______ _______ ___/6 ____

8. _______ _______ _______ _______ _______ _______ ___/6 ____

9. _______ _______ _______ _______ _______ _______ ___/6 ____

10._______ _______ _______ _______ _______ _______ ___/6 ____

位置分數 總學習分數

____/10 ____/10 ____/10 ____/10 ____/10 ____/10 ______

總正確分數=______ 總位置分數=______ #加入非刺激之字數______

47
Recall (10 minutes later) Cueing
Response Correct score Response Correct score
1._______ _______ 1._______不 _______
2._______ _______ 2._______相 _______
3._______ _______ 3._______時 _______
4._______ _______ 4._______原 _______
5._______ _______ 5._______從 _______
6._______ _______ 6._______服 _______
Total _______ Total _______

Recognition
I
1.原來______O 11.雖然______N 21.時候______ O
2.同時______N 12.相當______O 22.當時______ N
3.覺得______N 13.應該______N 23.表示______ N
4.不但______O 14.完全______N 24.已經______ N
5.至少______N 15.從此______O 25.任何______ N
6.原則______N 16.當然______N 26.可以______ N
7.開始______N 17.其中______N 27.以後______ N
8.如何______N 18.特別______N 28.服務______ O
9.繼續______N 19.還是______N 29.什麼______ N
10.可能______N 20.結果______N 30.決定______ N

(1) HIT=______/6
(2) FALSE ALARM=______/24
(3) TOTAL=______/30 【(1) + 24 – (2)】

48
 Tables
Table 1
Demographic Distribution of Samples
Age
16-24 25-34 35-44 45-54 55-64 65-74 ≥75 Total Exp. N
Area
Northern 32 31 23 15 23 7 4 135 135
Western 8 24 10 14 6 2 2 66 74
Southern 9 20 11 21 16 13 5 95 84
Eastern - 3 3 2 2 1 - 11 7
Education
0-6 - - - 1 10 11 6 28 46
7-9 1 - - 5 5 3 1 15 40
10-12 10 10 5 21 16 4 3 69 96
≥13 38 68 42 25 16 5 1 195 118
Gender
Female 23 39 28 33 24 17 4 168 151
Male 26 39 19 19 23 6 7 139 149
Total 49 78 47 52 47 23 11 307 300
Exp. N 48 56 56 56 44 22 18 300
Note. Exp. N: expected number of sampling.

49
Table 2
Demographic characteristics of Samples for the Construct Validity
N Agea Educationa % of female
NC 40 70.10 (7.20) 13.18 (2.79) 50.00
aMCI 40 (27/13)b 70.13 (8.40) 13.10 (3.49) 50.00
Note. NC: normal control group.
a
mean (standard deviation). b number of single domain and multiple domain

50
Table 3
Descriptive Statistics of Demographic Characteristics
N Age Edu
a b
Total 307 42.16 (16.95) [16-90] 13.84 (3.68) [0-18]
Age
16-24 49 21.63 (1.79) 14.18 (1.78)
25-34 78 28.24 (2.76) 15.91 (1.77)
35-44 47 38.79 (2.50) 16.09 (1.95)
45-54 52 49.87 (2.72) 13.77 (3.00)
55-64 47 59.62 (2.66) 11.40 (3.76)
65-74 23 68.74 (2.58) 9.52 (4.81)
≥75 11 80.09 (5.43) 7.91 (5.41)
Education
0-6 28 66.93 (7.80) 5.25 (1.94)
7-9 15 56.73 (14.69) 8.87 (0.52)
10-12 69 46.77 (16.90) 12.00 (0.00)
≥13 195 35.85 (13.29) 16.11 (1.38)
Gender
Female 168 (54.72%) 42.87 (16.51) 13.22 (4.12)
Male 139 (45.28%) 41.30 (17.49) 14.60 (2.91)
Note. a mean (standard deviation). b [minimum-maximum].

51
Table 4
Descriptive Statistics of Raw Sub-scores by Age, Education, and Gender
Correct Position Learning Recall Cued Recognition
M Md M Md M Md M Md M Md M Md
(SD) (R) (SD) (R) (SD) (R) (SD) (R) (SD) (R) (SD) (R)
Total 54.08 56 45.79 50 12.75 15 3.48 4 4.87 5 28.64 30
(6.72) (22-60) (12.64) (6-60) (6.09) (0-20) (1.47) (0-6) (1.30) (0-6) (1.98) (14-30)
Age
16-24 56.78 58 51.27 55 15.31 17 3.86 4 4.96 5 29.04 30
(4.52) (33-60) (9.41) (18-60) (5.10) (0-20) (1.23) (2-6) (1.02) (2-6) (1.32) (26-30)
25-34 56.49 58 51.38 54 15.47 17 3.68 4 5.22 5.5 29.14 30
(4.37) (32-60) (9.64) (13-60) (4.67) (0-20) (1.27) (1-6) (0.98) (2-6) (1.29) (25-30)
35-44 55.89 57 48.77 51 14.19 15 3.34 3 4.77 5 28.57 29
(3.70) (43-60) (9.08) (22-60) (4.45) (4-20) (1.40) (1-6) (1.22) (2-6) (1.74) (24-30)
45-54 54.58 57 45.85 49 12.75 14 3.42 4 5.08 6 28.88 30
(5.74) (25-60) (10.35) (15-58) (5.22) (0-19) (1.51) (0-6) (1.23) (1-6) (1.69) (23-30)
55-64 51.70 53 40.02 42 9.43 9 3.66 4 4.96 5 28.55 29
(6.28) (33-59) (12.39) (12-57) (6.04) (0-19) (1.55) (1-6) (1.29) (1-6) (1.84) (23-30)
65-74 45.13 48 31.00 28 5.57 3 2.91 3 3.96 5 27.09 28
(8.63) (28-58) (12.49) (13-56) (5.73) (0-18) (1.62) (0-5) (1.72) (0-6) (3.73) (14-30)
≥75 43.82 46 24.27 22 5.09 2 1.73 1 3.09 3 26.18 26
(11.74) (22-58) (13.19) (6-47) (6.27) (0-17) (1.90) (0-6) (1.97) (0-6) (2.96) (20-30)

52
Table 4 (continued)

Correct Position Learning Recall Cued Recognition

M Md M Md M Md M Md M Md M Md
(SD) (R) (SD) (R) (SD) (R) (SD) (R) (SD) (R) (SD) (R)
Education
0-6 42.14 41.5 25.82 22.5 4.14 1.5 2.36 3 3.54 3.5 26.86 27.5
(9.03) (22-57) (13.15) (6-50) (5.28) (0-15) (1.55) (0-5) (1.88) (0-6) (2.64) (20-30)
7-9 48.07 51 34.40 33 6.67 4 2.27 2 4.40 5 27.40 29
(9.51) (25-58) (11.30) (15-51) (6.22) (0-16) (1.44) (0-4) (1.64) (1-6) (4.19) (14-30)
10-12 53.57 55 42.30 45 10.81 12 3.52 4 5.10 5 29.00 30
(5.29) (33-60) (11.51) (12-59) (5.75) (0-19) (1.47) (0-6) (1.15) (1-6) (1.56) (23-30)
≥13 56.44 58 50.76 53 15.14 17 3.72 4 5.02 5 28.87 30
(3.82) (32-60) (8.69) (15-60) (4.44) (0-20) (1.35) (1-6) (1.09) (1-6) (1.55) (23-30)
Gender
Female 53.92 57 45.51 50.5 12.64 15 3.42 4 4.85 5 28.67 30
(7.48) (25-60) (13.48) (6-60) (6.53) (0-20) (1.50) (0-6) (1.37) (0-6) (2.15) (14-30)
Male 54.28 56 46.13 49 12.88 14 3.55 4 4.90 5 28.61 29
(5.70) (22-60) (11.59) (11-60) (5.54) (0-20) (1.44) (0-6) (1.21) (1-6) (1.76) (23-30)
Note. M: mean. SD: standard deviation. Md: median. R: range.

53
Table 5
Summary of Multiple Regression Model
Education Education2 Age Age2
t b t b t b t b
Correct 4.87*** 0.556 -4.39*** -0.070 -3.53*** -0.074 -1.22 -
Position 5.28*** 1.149 -1.93 - -5.00*** -0.199 -1.63 -
Learning 7.11*** 0.648 - - -5.23*** -0.103 -0.82 -
Recall 1.58 - -2.84** -0.012 -0.87 - - -
Cued 0.21 - -4.13*** -0.015 -0.37 - -2.83** -0.001
Recognition -0.27 - -3.87*** -0.022 -1.87 - -2.20* -0.001
Note. b: unstandardized coefficients. t: t value.
*p < .05. **p < .01. ***p < .005.

54
Table 6
Explained Variance in Stepwise Multiple Regression Analyses
Education Education2 Age Age2 Total
2 2 2 2
ΔR ΔR ΔR ΔR R2
Correct 35.90% 4.80% 3.00% - 43.70%
Position 34.40% 0.80% 6.70% - 41.90%
Learning 31.40% - 6.50% - 37.90%
Recall 1.20% 9.80% - - 11.00%
Cued - 14.20% - 2.90% 17.10%
Recognition - 13.20% - 2.40% 15.60%
Note. ΔR2: R Square Change.

55
Table 7
Comparisons between Different Age and Education Groups by Kruskal-Wallis
One-Way Analysis of Variance by Ranks
a b
Age group 6 Education group 3

Correct 30.51*** 64.85***

Position 60.00*** 66.40***
Learning 45.23*** 60.34***
Recall 11.07 26.25***
Cued 21.57*** 13.41***
Recognition 12.45 12.56**
Note. a Partial out the education effect. b Partial out the age effect.
**p < .01. ***p < .005.

56
Table 8
Pairwise Comparisons between Different Age and Education Groups by Post Hoc Test
with Bonferroni Corrections
Comparisons between different groups
a age groupsa
age groups education groupsb
(add group F’)
(alpha = .0012) (alpha = .0042)
(alpha = .0017)
a, b, c < d;
Correct A, B > F; A > G A, B, D > F’
a<c
A, B, C, D > G; A, B, C, D, E > F’ a, b, c < d;
Position
A, B > E, F; A > C, D A, B > E; A > C, D a<c
A, B, C, D > F’; a, b, c < d;
Learning A, B > E, F, G
A, B > E; A > C, D a<c
Recall - - a, b < c, d
Cued B > F, G B, D > F’ a < c, d
Recognition - - a < c, d
Note. A: 16-24 year-old group. B: 25-34 year-old group. C: 35-44 year-old group. D: 45-54
year-old group. E: 55-64 year-old group. F: 65-74 year-old group. G: > 74 year-old group. F’ : >
64 year-old group. a: 0-6 years. b: 7-9 years. c: 10-12 years. d: > 12 years.
a
Partial out the education effect. b Partial out the age effect.

57
Table 9
Corrected Equations of Raw Sub-scores
Adjusted score Equation
Adj_Correct = Correct – 0.556 × (edu – 13.84) + 0.07 × (edu – 13.84)2 +
0.074 × (age – 42.16)
Adj_Position = Position – 1.149 × (edu – 13.84) + 0.199 × (age – 42.16)
Adj_Learning = Learning – 0.648 × (edu – 13.84) + 0.103 × (age – 42.16)
Adj_Recall = Recall + 0.012 × (edu – 13.84)2
Adj_Cued = Cued + 0.015 × (edu – 13.84)2 + 0.001 × (age – 42.16)2
Adj_Recognition = Recognition + 0.022 × (edu – 13.84)2 + 0.001 × (age –
42.16)2

58
Table 10
Referential Table for Percentile Rank of Adjusted WSLT Sub-scores
Percentile Adj_Correct Adj_Position Adj_Learning Adj_Recall Adj_Cued Adj_Recog.
1 32.70 15.70 -2.36 0.29 2.08 23.50
2 39.11 18.31 -0.08 1.00 2.29 24.97
3 41.97 22.25 2.75 1.04 2.49 25.31
4 43.08 25.47 3.22 1.04 2.85 25.42
5 44.71 26.77 3.94 1.06 3.07 25.82
6 45.74 28.10 4.15 1.13 3.11 26.19
7 47.48 28.87 4.48 1.21 3.17 26.38
8 48.62 29.90 4.98 1.32 3.27 26.44
9 48.97 30.57 5.55 1.74 3.30 26.49
10 49.37 31.32 5.74 2.00 3.40 26.73
11 49.86 32.32 6.18 2.02 3.47 27.09
12 49.99 32.79 6.40 2.04 4.00 27.13
13 50.34 33.54 6.69 2.04 4.08 27.17
14 50.51 34.07 6.85 2.04 4.12 27.23
15 50.82 34.70 7.38 2.06 4.19 27.34
16 51.29 35.56 7.83 2.06 4.25 27.40
17 51.45 36.09 7.95 2.06 4.27 27.40
18 51.71 36.52 8.04 2.06 4.29 27.44
19 52.01 36.75 8.36 2.06 4.32 27.51
20 52.23 37.58 8.52 2.06 4.36 27.57
21 52.70 37.97 8.67 2.21 4.37 27.87
22 52.79 38.93 8.88 2.21 4.42 28.11
23 52.85 39.49 9.15 2.21 4.46 28.14
24 52.98 40.27 9.47 2.23 4.49 28.22
25 53.19 40.67 9.70 2.29 4.50 28.24
26 53.45 40.87 9.91 2.41 4.55 28.28
27 53.60 41.61 10.01 2.74 4.64 28.34
28 53.70 41.92 10.19 3.00 5.02 28.39
29 53.78 42.36 10.34 3.00 5.07 28.45
30 53.86 42.67 10.56 3.02 5.07 28.57
31 53.94 42.93 10.79 3.04 5.09 28.79
32 54.13 43.23 10.91 3.04 5.11 29.08
33 54.52 43.43 11.26 3.04 5.12 29.10
34 54.60 43.57 11.70 3.04 5.13 29.11
(continued)

59
Table 10
Referential Table for Percentile Rank of Adjusted WSLT Sub-scores
Percentile Adj_Correct Adj_Position Adj_Learning Adj_Recall Adj_Cued Adj_Recog.
35 54.68 43.77 11.82 3.05 5.14 29.14
36 54.78 44.09 11.85 3.06 5.15 29.17
37 55.00 44.20 11.89 3.06 5.20 29.20
38 55.19 44.40 11.94 3.06 5.23 29.33
39 55.33 44.81 12.08 3.06 5.26 29.37
40 55.44 45.29 12.26 3.06 5.28 29.40
41 55.52 45.56 12.45 3.21 5.31 29.42
42 55.60 45.91 12.55 3.21 5.35 29.45
43 55.71 46.09 12.62 3.21 5.36 29.48
44 55.75 46.43 12.67 3.40 5.38 29.52
45 55.86 46.72 12.78 3.74 5.40 29.58
46 55.89 47.04 12.89 3.74 5.42 29.66
47 55.93 47.11 13.23 4.00 5.44 29.89
48 55.96 47.20 13.46 4.00 5.46 30.00
49 56.00 47.34 13.58 4.01 5.49 30.05
50 56.06 47.62 13.63 4.02 5.50 30.10
51 56.13 48.19 13.77 4.02 5.52 30.11
52 56.25 48.35 13.88 4.04 5.54 30.11
53 56.32 48.47 14.00 4.04 5.61 30.12
54 56.51 48.71 14.23 4.04 5.76 30.13
55 56.66 48.85 14.27 4.04 5.99 30.14
56 56.70 49.09 14.63 4.04 6.04 30.15
57 56.75 49.20 14.68 4.04 6.08 30.17
58 56.78 49.46 14.80 4.05 6.08 30.19
59 56.85 49.48 14.90 4.06 6.09 30.20
60 56.86 49.75 15.01 4.06 6.10 30.22
61 56.88 50.22 15.04 4.06 6.11 30.23
62 56.88 50.56 15.05 4.06 6.11 30.25
63 56.93 50.79 15.07 4.06 6.13 30.27
64 56.99 50.95 15.12 4.06 6.15 30.28
65 57.02 51.20 15.14 4.06 6.17 30.29
66 57.08 51.36 15.21 4.06 6.19 30.30
67 57.09 51.49 15.25 4.06 6.21 30.30
68 57.15 51.50 15.30 4.18 6.23 30.33
(continued)

60
Table 10
Referential Table for Percentile Rank of Adjusted WSLT Sub-scores
Percentile Adj_Correct Adj_Position Adj_Learning Adj_Recall Adj_Cued Adj_Recog.
69 57.29 51.58 15.44 4.21 6.24 30.33
70 57.37 51.69 15.51 4.21 6.26 30.33
71 57.49 51.71 15.61 4.21 6.27 30.36
72 57.52 51.89 15.72 4.21 6.27 30.36
73 57.63 51.90 15.75 4.28 6.27 30.38
74 57.67 52.16 15.84 4.74 6.27 30.38
75 57.73 52.34 15.97 4.74 6.28 30.39
76 57.81 52.46 16.00 5.00 6.30 30.40
77 57.87 52.50 16.12 5.01 6.30 30.40
78 57.93 52.59 16.16 5.04 6.30 30.41
79 58.00 52.70 16.20 5.04 6.30 30.42
80 58.00 52.82 16.26 5.04 6.32 30.43
81 58.09 52.89 16.39 5.04 6.33 30.43
82 58.28 53.29 16.55 5.06 6.33 30.44
83 58.43 53.50 16.62 5.06 6.35 30.45
84 58.54 53.65 16.74 5.06 6.36 30.47
85 58.62 53.89 16.76 5.06 6.40 30.47
86 58.68 54.07 16.83 5.06 6.41 30.47
87 58.73 54.28 16.93 5.06 6.43 30.48
88 58.80 54.50 16.98 5.06 6.44 30.50
89 58.84 54.56 17.14 5.06 6.44 30.51
90 58.97 54.89 17.32 5.06 6.45 30.53
91 59.12 55.59 17.69 5.21 6.48 30.55
92 59.32 56.08 17.99 5.21 6.48 30.56
93 59.60 57.01 18.25 5.21 6.52 30.60
94 59.93 57.09 18.41 5.40 6.54 30.61
95 60.27 58.26 18.97 6.00 6.57 30.64
96 60.57 58.62 19.26 6.04 6.64 30.71
97 60.84 58.77 19.71 6.04 6.88 30.83
98 61.06 59.28 19.84 6.06 7.04 31.02
99 61.65 59.66 20.09 6.06 7.41 31.18
Note. The cut-off point is the 5th percentile.

61
Table 11
Test-Retest Reliability of the WSLT Sub-scores
Test and retest performances
Participants
Variable practice
(n = 30 ) rb 1st 2nd effect
45.67 56.63 57.20
Age a Correct .64** (3.02) (2.92) Z = 1.243
(19-90)
13.77 49.33 51.90
Education Position .61** (8.81)
(6-18) (8.51) Z = 2.029*
14.00 15.83
Female (%) 13 (43%) Learning .63** Z = 2.555*
(4.86) (4.29)
Interval time 87.93 3.87 4.40
Recall .54** Z = 2.286*
(day) (57-132) (1.20) (1.38)
5.17 5.63
Cued .62** Z = 2.841**
(0.99) (0.62)
29.00 29.23
Recognition .51** Z = 0.902
(1.55) (1.43)
Note. a mean (range). b Pearson correlation. Z: Z test by Wilcoxon signed rank test.
**p < .01.

62
Table 12
Alternate-Form Reliability of the WSLT Sub-scores
Participants Coefficientsb
Variable (n = 30 ) Form I - II Form I – III Form II - III
a
41.00
Age Correct .61 .73 .51
(19-74)
14.27
Education Position .62 .61 .65
(6-18)
16
Female (%) Learning .64 .68 .62
(53%)

Recall .37 .32 .65

Cued .36 .14 .43

Recognition .26 .31 .37

Note. a mean (range). b Pearson correlation.

63
Table 13
Comparisons of the performances in the WSLT between different forms
Form Ia Form IIa Form IIIa I vs IIb I vs IIIb II vs IIIb
Correct 55.40 56.27 54.87 Z = -1.07 Z = -0.72 Z = -1.23
Position 48.70 47.50 49.83 Z = -0.70 Z = -0.36 Z = -1.01
Learning 14.00 13.60 14.17 Z = -0.89 Z = -0.28 Z = -0.55
Recall 3.77 3.83 3.30 Z = -0.06 Z = -1.52 Z = -2.24*
Cued 5.23 5.50 5.37 Z = -1.71 Z = -0.69 Z = -0.92
Recognition 29.10 28.50 28.13 Z = -0.60 Z = -1.72 Z = -1.14
Note. a mean scores. b Z test by Wilcoxon signed rank test
* p < .05

64
Table 14
Correlation Coefficients between the WSLT Sub-scores and Criterion
Test (N) Correcta Positiona Learninga Recallb Cuedb Recog.b
LM1c (33) .46** .60** .66** - - -
LM2c (33) - - - .42* .15 -
LM_recog.c (33) - - - - - .29
WL1c (33) .57** .69** .75** - - -
WL_shortc (33) .43* .58** .64** .30 .39* -
WL2c (33) - - - .49** .35* -
WL_recog.c (33) - - - - - -.01
FSIQd (66) .22 .27* .26* .30* .13 .09
Note. LM: Logical Memory subtest of the WMS-III. WL: Word List Test of the WMS-III.
WL_short: short-delayed recall score of the Word List Test. FSIQ: Full scale IQ of the WAIS-III.
a
Pearson correlation. b Spearman’s rho. c raw score. d correlation between FSIQ and age-corrected
sub-scores
*p < .05. **p < .01.

65
Table 15
Comparison between aMCI (N = 40) and Healthy Controls
Correct Position Learning Recall Cued Recog.
a
Z score -2.81** -3.46*** -3.33*** -5.21*** -4.65*** -3.65***
M (SD) of 55.20 47.80 14.28 3.67 5.55 29.18
HC (5.42) (11.31) (5.68) (1.70) (1.50) (2.02)
M (SD) of 50.40 40.44 9.73 1.38 3.71 26.25
P’t (8.41) (10.56) (5.59) (1.42) (1.67) (4.94)
Note. M: mean adjusted sub-scores. SD: standard deviation. a Mann-Whitney U test
**p < .01. ***p < .005

66
Table 16
Comparisons between Different Age Groups in the recall score by Kruskal-Wallis
One-Way Analysis of Variance by Ranks
a
Age group 6

Recall
2-4 trials group 9.55
5-7 trials group 4.59
8-10 trials group 7.81
Note. a Partial out the education effect.

67
 Figures

60
Education-corrected Sub-scores
of the WSLT (Median) 50

40
correct
30
position
20 learning
recognition
10

0
16-24 25-34 35-44 45-54 55-64 65-74 75+
Age Group

Figure 1-1. Medians of the WLST sub-scores in different age groups (7 groups)

7
Education-corrected Sub-scores

6
of the WSLT (Median)

3 recall
cued
2

0
16-24 25-34 35-44 45-54 55-64 65-74 75+
Age Group

Figure 1-2. Medians of the WLST sub-scores in different age groups (7 groups)

68
 60

Education-corrected Sub-scores
50

of the WSLT (Median)

40
correct
30
position
20 learning
recognition
10

0
16-24 25-34 35-44 45-54 55-64 65+
Age Group

Figure 2-1. Medians of the WLST sub-scores in different age groups (6 groups)

7
Education-corrected Sub-scores

6
of the WSLT (Median)

3 recall
cued
2

0
16-24 25-34 35-44 45-54 55-64 65+
Age Group

Figure 2-2. Medians of the WLST sub-scores in different age groups (6 groups)

69
 60

Age-corrected Sub-scores
50

of the WSLT (Median)

40
correct
30
position
20 learning
recognition
10

0
0~6 7~9 10~12 13+
Education Group

Figure 3-1. Medians of the WLST sub-scores in different education groups

7
Age-corrected Sub-scores

6
of the WSLT (Median)

3 recall
cued
2

0
0~6 7~9 10~12 13+
Education Group

Figure 3-2. Medians of the WLST sub-scores in different education groups

70
 100

77.5%
80

60
Percent

40

20%
20

0
WSLT LM
Memory test

Figure 4-1. Percentage of scores below 5th percentile among patients with aMCI

100

80 74.07%

60
Percent

40

20 11.11%

0
WSLT LM
Memory test

Figure 4-2. Percentage of scores below 5th percentile among patients with aMCI-single domain

71