WMS Report

Psychodiagnostic Lab

MPS 251

Pallavi Chopra

2239336

Submitted to

Dr Sherin P Antony

`
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Introduction

While there have been many speculations about memory, and how it operates, presently it

is defined as a system that encodes, stores and retrieves information. It is necessary for a person

to have gone through the three major steps of memory—encoding, storage, and retrieval—to

“remember” a piece of information. Encoding is the process through which information derived

from the stimuli in the environment is encrypted into the mind. The second part is storage, where

the encoded information is accumulated. The third part of the process is retrieval, which depends

on the two earlier parts of the process; if there is an issue in encoding or storing the information,

the individual might have a harder time retrieving the information (Frankland et al. 2019).

Atkinson and Shiffrin proposed a multi-modal memory system which consisted of

sensory memory, short-term memory, and long-term memory (Atkinson & Shiffrin, 1968). The

structural model is presented in a way where stimuli are registered in the sensory memory and

reach the short-term memory before finally reaching the long-term memory. The sensory

memory holds the information for the shortest period of time—just the briefest period to register

the stimuli. There are three types of sensory memory: iconic memory (visual representation),

Echoic Memory (auditory representation), and Haptic memory (sense of touch). However, not all

of the information from stimuli makes it into one’s storage area or even gets encoded into one’s

brain. The existence of more than one stimulus forces the brain to manage, and prioritize which

information gets encoded or stored; this is known as selective attention. Some of the early

selection models provide evidence that the “filter” of selective attention lies just right after the

brain detects the stimuli, while the late-selection models suggest that the information is filtered

after one recognises its meaning, and thus decides if it is important enough to get stored (Alperin
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et al. 2013). Once it gets stored in short-term memory, with the help of recall and rehearsal,

information reaches long-term memory.

Working Memory

However, thinking the existing model is rudimentary, Braddley and Hitch published the

Working Memory—a revised model of Atkison and Shriffin’s short-term memory, which viewed

it as a space to retain information (Baddeley & Hitch, 1974). The revised model, however, views

short-term memory as a system which has many different parts that work together to both retain

and process information instead of just functioning as a storage system. These elaborated parts

are the central executive system, episodic buffer, the phonological loop and the visuospatial

sketch pad. The phonological loop consists of two components: the phonological store and the

auditory control process. The phonological store (inner ear) functions as a storage and recall area

for speech-based information and the auditory control process (inner voice) allows the constant

rehearsing of information of the store to prevent decay.

The visual-spatial sketchpad functions in a similar way to the phonological loop but is

involved in visual information. It contains a visual cache which deals with information regarding

colour and form, and a component called a visual scribe which focuses on spatial information.

The episodic buffer integrates information from these components and fixes them into a

particular sequence which is sensitive to time into an “episode”. Finally, the central executive

system manages three of these major components and allocates attention accordingly depending

on the action being performed.

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It is noted that item strengths such as familiarity of the information, frequency,

intelligence, medical and mental conditions, emotions, etc. affect the working memory capacity

(Blasiman & Was 2018).

Wechsler Memory Scale (WMS)

The Wechsler Memory Scale WMS is a widely-used neuropsychological assessment tool

designed to evaluate an individual's memory abilities. This test is designed to assess various

aspects of memory, including immediate memory, working memory, and delayed memory, as

well as recognition and recall abilities. WMS is used in clinical, rehabilitation and research

settings to assess memory functioning in psychiatric, neurological and neurosurgical conditions.

The WMS is considered to be one of the most comprehensive and reliable memory

assessment tools available and has been used extensively in both clinical and research settings. It

is frequently used by neuropsychologists, psychologists, and other healthcare professionals to

diagnose and assess memory impairment in individuals with a variety of neurological and

psychiatric conditions, including Alzheimer's disease, traumatic brain injury, and stroke. The

WMS includes 11 subtests that assess different aspects of memory function, including verbal and

visual memory, working memory, immediate and delayed recall, and recognition. The test is

designed to be used with individuals aged 16 years and older, and it takes approximately 60-90

minutes to administer.

History of WMS

David Wechsler first developed the original version of WMS in 1945 after noticing that memory

capability was an important component of psychological evaluation in psychiatric hospitals.

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WMS-I included seven subtests including, a visual memory subtest, several auditory memory

tests and as well as attention tasks. The aim of WMS-I according to Wechsler was to provide a

rapid, simple and practical memory evaluation. It would take only 15-20 minutes to complete the

test and it would give you a single score which was called memory quotient (Dzikon, 2020).

There were a lot of criticisms for WMS-I as the norms were considered inadequate.

Critics also felt that due to the nature of memory, the test was unable to extrapolate norms for

younger and older patients. Other criticisms include that the test gave too much weight to verbal

material and made it difficult to distinguish between problems with visual memory and

visuomotor skills. The single memory quotient number, in the opinion of many psychologists,

failed to adequately reflect the real nature and complexity of memory functioning (Dzikon,

2020).

During the 1960s- 70s, memory and its components were extensively studied. New

research revealed a number of memory subcomponents, including verbal and visual memory, and

indicated that the various types were localized to various regions of the brain. Numerous

investigations also demonstrated the existence of both short-term and long-term memory. Elbert

Russell, a neuropsychologist developed a new test called the WMS-R where he included two

original subtests: a story recall, and a visual recall of information. Additionally, he added a

"delay condition" that assessed how much knowledge was retained after 30 minutes of delivering

the first test (Russell,1975).

Weschler’s second edition, WMS- II included eight subtests, including tests to measure

delayed recollection. Additional tests were added to measure visual memory and a concentration

test. Additionally, the scoring system was modified to provide more precise criteria and to enable
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the computation of scores for each memory component rather than just a single memory

quotient, which increased the test's reliability across examiners. Criticisms for WMS-II included

that a number of the visual memory tests seemed to involve several cognitive processes, and

some were observed to test attention rather than visual memory. The test was also criticized as it

may not have been able to accurately reflect how high or low some individuals could have scored

because it was difficult to distinguish between people at the extreme ends of the scoring range.

Additionally, critics pointed out that the exam did not evaluate recognition memory (Dzikon,

2020).

WMS-III

The third edition of WMS was published in 1997 and was called WMS-III. This version

included several optional tests the examiner could use when more information was required, as

well as six subtests that took about 45 minutes to give. As the scoring system developed, it

became possible to calculate working memory, total memory, immediate and delayed memory,

and recognition of both auditory and visual material. Additionally, you could calculate scores

that represented the quantity of information retained from a first trial and the learning slope

(Dzikon, 2020).

The scores could be interpreted by comparing them to the normative data which was

gathered from over 1000 individuals with ages ranging from 16-89. In order to compare various

cognitive skills, the normative sample for the WMS-III was also the sample used for the third

version of the Wechsler Scale of Intelligence. WMS-III has been praised for its improved

reliability and for the inclusion of subtests that made it possible to distinguish between problems

with psychomotor and visual memory and the addition of more visual memory tasks. By
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differentiating between encoding and retrieval impairments, the ability to evaluate recognition

improved treatment planning (Dzikon, 2020).

WMS-III was published after a lot of revision. Abstract visual designs were removed and

replaced with common stimuli like pictures of faces (Faces subtest) and pictures of a family

doing various activities (Family Pictures subtest). WMS-III also added a subtest to measure

delayed recognition memory. These changes increased the ecological validity of the test.

WMS-III also incorporated process scores and reconceptualized attention and concentration

factors in the working memory index. Eight main index scores, three global composite scores

(working memory, general memory (delayed recall), and immediate memory), and five

additional index scores (assessing auditory and visual immediate and delayed memory, as well as

auditory recognition) were all included in the WMS-III (Dzikon, 2020).

Criticism

Criticisms in the WMS-III were revealed after extensive use of the test in. It was found

that while one of the visual subtests was sensitive to individuals with social awareness deficits, it

was insufficient for evaluating visual memory in other individuals. Another visual subtest

frequently left older people perplexed and seemed prejudiced against particular cultural groups.

Since the sample was completing both the WMS and the WAIS, concerns about fatigue emerged,

leading to criticism of the norms as well. There were also worries that the sample might have

included individuals with undiagnosed dementia, which would have decreased the test's

sensitivity to identify memory impairment (Dzikon, 2020).

Scoring
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Five of the 11 subtests in the WMS-III are optional and does not affect any of the index

results. The subtests assess working memory, auditory memory (immediate and delayed), visual

memory (immediate and delayed), and delayed recollection and recognition. Each subtest is

administered in its entirety, except for spatial span and letter-number sequencing which follow a

discontinuity rule, where the test is stopped after two or three consecutive failures of a single

trial. The main subtests take 30-35 minutes to administer, while the supplemental subtests take

15-20 minutes. Age-adjusted scaled scores are created from raw scores, using the scoring

manual. These scores are then added to produce Index scores and percentile ratings (Chlebowski,

2011).

WMS- Indian Adaptation

The Indian edition of the WMS, called the Wechsler Memory Scale - Indian Adaptation

(WMS-IA), was developed by Dr Pushpalatha Gurappa of the Department of Mental Health and

Social Psychology at the National Institute of Mental Health and Neurosciences (NIMHANS),

Bangalore, India in collaboration with Pearson Clinical and Talent Assessment. The WMS-IA

has been standardized on a sample of Indian individuals, and it is used by clinicians and

researchers in India to assess memory function in a range of settings, including clinical and

forensic contexts. Adaptation changes were made to 6 of the 11 subtests including Faces and

Family Pictures. Indian norms are also presented in the form of percentile ranks. New reliability

coefficients were also developed based on Indian normative data. Several verbal subtests have

translations available in Indian languages (Pearson, 2009).

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Clinical Application

The WMS-III can be applied in a variety of contexts to evaluate memory and its different

aspects in clinically significant ways. It can be used as part of a comprehensive

neuropsychological assessment to identify and localize cerebral dysfunction as well as to help

identify dementias and neurodegenerative diseases. WMS-III can also be used in educational

environments to identify how memory deficiencies could contribute to academic challenges and

learning disorders. The WMS-III is also useful in rehabilitation settings for identifying areas of

weakness that need to be addressed through interventions and those spared memory functions

that can be used for compensation. Furthermore, it can also be used to monitor development and

evaluate the effectiveness of treatments (Chlebowski, 2011).

The WMS-III has been used extensively in clinical research settings. It has been used to

identify neuropsychological profiles of dementia which then helps in distinguishing between

patients who have Lewy body dementia and Alzheimer's disease. An accurate diagnosis helps in

understanding cognitive decline and aids treatment. WMS-III has also been used to understand

the learning deficits that people with schizophrenia face. Additionally, WMS-III has also been

effective in identifying malingering. The primary indices of WMS-III can also accurately

identify neurocognitive dysfunction and malingering in patients with mild Traumatic Brain

Injury (Chlebowski, 2011).

Test description

WMS-III is an individually administered measure of memory that uses:

- Verbal and Figural stimuli

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- Meaningful and Abstract stimuli

- Delayed and Immediate recall

There are 8 memory indices that are included in test

1. Auditory immediate memory

The auditory immediate memory is the ability to listen to oral information and be able to

repeat it immediately.

2. Auditory delayed memory

The auditory delayed memory is the ability to listen to oral information and be able to

recall it after time has passed since the initial presentation of the stimulus.

3. Auditory Recognition

auditory recognition memory is the ability to listen to oral information and be able to

recognise it when presented with it usually after some time has passed.

4. Visual immediate memory

visual immediate memory is the ability to remember visual information in the context of

its spatial location immediately after the visual stimulus is presented. It includes the

ability to relate the visual information and the relationship among the elements of the

visual information within the spatial context.

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5. Visual delayed memory

The visual delayed memory is the ability to remember visual information in the context

of its spatial location after some time has passed since the initial presentation of the

stimulus. It includes the ability to relate the visual information and the relationship

among the elements of the visual stimulus within the spatial context it is presented in

after a significant amount of time has passed.

6. Immediate Memory

The immediate memory is the ability to recall both auditory and visual information

immediately after the stimuli have been presented while delayed memory is the ability to

recall both visual and auditory information after a significant amount of time has passed

since the first presentation of the stimulus.

7. General Memory

The general memory is the ability to remember general details in life that are helpful in

daily functioning like the days of the week.

8. Working memory

There are two main components of working memory that have been assessed in WMS.

The auditory working memory is the ability to temporarily store and manipulate auditory

information. The visual working memory is the ability to temporarily store and

manipulate visual information and the spatial locations.

WMS uses 11 subtests:

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1. Information and orientation-

This includes taking basic demographic information from the client, including name, age,

date of birth, and questions regarding their mental status and orientation including asking

them to name the prime minister of their country.

2. Logical memory

There are two components for this subtest: Logical Memory I and Logical Memory II.

The first subtest includes a narration of story A and B and then the participant is asked to

repeat the stories with as much detail as possible one after another. This component is

used to measure narrative memory using a free-recall method. Narrative memory is part

of episodic and semantic memory that allow for an individual to remember the details in

a narrative format.

The second component of the subtest is administered 20-25 minutes after the first test and

the participant is asked to recall the story A and B with as much detail as possible without

being presented the story again. This is meant to measure long-term narrative memory.

After this, the participant is given the details of the test and is asked to respond in positive

or negative and this tests their recognition abilities.

3. Verbal Paired Associates

This subtest aims to measure auditory memory and auditory recognition. It has 2 parts,

VPA-I and VPA-II. It involves narrating a list of eight word pairs, and asking the client to

recall the word pair after being asked for one of the words. The same list of word pairs is
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repeated over four trials but in different sequences and the response for each of them are

noted. VPA-II includes both recall and recognition and is done after 25-35 minutes after

the administration of VPA-I. In the recall condition the client is asked to recall the word

pairs after the first word is given and in the recognition condition a list of 24 word pairs

are narrated to the client and they are asked to recognise the first eight word pairs that

were practiced over four trials in VPA-I.

4. Faces

This subtest is also done in two parts. The first part involves showing the client 24

pictures of human faces for two seconds and asking them to remember the face. After

which you show the client a set of 48 pictures and ask them to recognise the faces from

the first set of 24 pictures that were shown. The subtest is scored based on whether the

client is able to correctly identify the faces or not. The subtest measures visual immediate

memory, visual delayed memory, and general memory. Faces-II is a recognition condition

where the client is shown a set of 48 faces and is asked to recognise the set of 24 faces

from them that were shown earlier and asked to remember.

5. Family Pictures

Family pictures subtest also includes two parts and is used to assess visual immediate

memory, visual delayed memory and general memory. Family picture includes

introducing the client to a family by showing them a picture with all of the family

members including parents, grandparents, children and a pet. The client is then shown
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four different scenes consecutively involving various family members involved in

different activities. The client is asked to remember as much of the scene as possible.

After this the client is asked to remember all the four different scenes and identify the

characters in them, their location in the scene as well as the activity that they were

performing. The client’s responses are recorded verbatim and scored based on how

accurately they were able to remember the entire scene, including all the accurate

characters, their locations and the activities they were performing.

Family Pictures-II is a delayed recall condition and is administered after 25-35 minutes

after the administration of Family Pictures-I. Here the client is asked to recall all the four

scenes from the first trial and asked to name the characters involved, their location and

the activity they were performing.

6. Word Lists

Word list is an optional test in WMS-III that measures general and working memory in

the client. This subtest involves two lists of words of 12 words each. List A is narrated to

the client and then in Trial 1 they are asked to recall all the words that they can in any

order and the responses are noted. After this List A is repeated again and the client is

asked to repeat as many words as they can in any order. There are a total of 4 trials that

are done with List A.

After this another list of words of 12 words each, List B is narrated immediately after the

first four trials of List A. The client is asked to recall as many words as they can from the

new list and repeat them back in any order. After this is done, the client is asked to
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remember the words from List A without narrating the list again and asked to repeat as

many words as they can from List A in any order. The test aims to measure any latency

and recency effects of short-term memory.

Word list-II has both recall and recognition conditions and is administered after 25-35

minutes after Word List-I. First the client is asked to recall words from List A and repeat

as many as they can in any order. After which a recognition condition is there where the

client is presented with a list of 24 words one by one and is asked to recognise words

from List A and identify them accurately.

7. Visual Reproduction

This subtest is used to assess spatial memory for unfamiliar non-verbal visual stimuli

namely immediate and delayed visual-spatial memory. It includes two components:

Visual Reproduction I and Visual Reproduction II. During the first component, a set of

designs are shown for 10 seconds and the participant is asked to recreate the drawing

without aid. This is meant to assess the immediate visual-spatial memory. Once the test is

administered, the participant is informed that they are going to be asked to recall them

later.

During the delayed condition, the participant is asked to draw the figures from the

immediate condition in any order. Later, to assess recognition, the participant is shown a

set of six designs and is asked to choose the right design that has been shown during the

immediate condition.

8. Letter Number Sequencing

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This subtest is used as a part of measuring working memory capacity. It contains 7 items

with 7 trials each. The participant is orally presented with a list of letters and numbers

jumbled together and is asked to repeat the sequence with the letters in the alphabetical

order and the numbers in ascending numerical order. The subtest increases in difficulty

with the sequence growing longer as the test progresses. This subtest allows for

measuring the visual-spatial and auditory working memory, especially language, and the

ability to manipulate data more than digit span.

9. Spatial Span

This subtest is administered to measure working memory mainly visuo-spatial memory

and the implicit visual-spatial learning abilities of an individual. It is often considered to

be the non-verbal equivalent of the digit span test. In this test, there is a set of blocks

which are tapped in a specific order by the examiner, and the participant is expected to

tap the blocks in the same order after each trial. The difficulty is increased as the test

progresses with the increase of the number of blocks used.

10. Digit Span

This optional subtest is administered to assess working memory capacity mainly auditory

and visual-spatial working memory. It contains two components–forward and backward

Digit Span. In the Forward Digit Span, the participant is orally presented with 8 items

containing two trials each. Each item contains a set of numbers with the first item

containing 2 digits while the last item containing 9 digits. The participant is expected to

repeat the numbers in the sequence they are presented with. In the Backward Digit Span,
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the participant is once again presented with 7 items containing 2 trials each, and the

participant is dictated to a sequence of digits and then they are expected to recall the

numbers in a backward sequence.

11. Mental Control

The subtest includes 8 trials in which the participant is asked to count from 1 to 20, say

the alphabet from A to Z, report the days in order from Sunday to Saturday, and say the

months from January to December in their correct order. After this, the same trails are

repeated but the participant is expected to do them in the reverse order–count from 20 to

1, say the alphabet backwards, relay the days from Saturday to Sunday and recall the

months from December to January. The mental control of the participant is assessed

through the number of errors and their accuracy.

Reliability and Validity

A stratified representative group of 1,250 people between the ages of 16 and 89 was used

to norm the WMS-III. The Wechsler Adult Intelligence Scale (WAIS) was co-normed with

WMS-III which allows for meaningful comparisons between intellectual ability and memory

functioning. For WMS-III subtest results across age groups, the average reliability coefficients

vary from 0.74 to 0.93, with a median reliability of 0.81. The Primary Indexes' average reliability

coefficients vary from 0.74 to 0.93, with 0.87 serving as the median reliability.

All of the subtests had excellent inter-rater reliability, averaging over 0.90. WMS-III has

strong associations with other tests, such as the WMS-R, Children's Memory Scale (CMS), and
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the Wechsler Individual Achievement Test (WIAT), which provides evidence of its concurrent

validity (Chlebowski, 2011).

Demographic Details

Name: MM

Age: 23

Sex: Female

Educational Background: MSc Clinical Psychology

Occupation: Student

Family Type: Joint

Purpose of Test

This test was administered to assess the participants' current cognitive and memory functions. It

was conducted solely for academic purposes only.

Behavioural Observation

The participant seemed enthusiastic about performing the tasks and wasn’t stressed about them.

She seemed to prefer the tasks which involved the use of her immediate memory and had issues

with the tasks that involved delayed memory. This was observed by her fidgeting and twitching

of her facial muscles.

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Test Results

Table 1

Index Score

Scale Sum of Index Percentile Confidence Range

Scaled Scores Interval
Scores

Auditory 32 138 99 130-141 Very

Immediate Superior

Visual 23 109 73 97-118 High

Immediate Average
Index

Immediate 38 96 39 90-103 Average

Memory

Auditory 30 132 98 119-137 Very

Delayed Superior

Visual 20 100 50 90-110 Average

Delayed

Auditory 13 115 84 100-122 High

Recognition Average
Delayed

50 100 50 92-108 Average

General
Memory

Working 25 115 84 104-122 High

Memory Average
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The capacity to temporarily store knowledge in mind for a little amount of time,
typically just a few seconds or less, is known as immediate or short-term memory. It is important
for performing daily tasks like memorising a phone number or paying attention to directions. In
contrast, storing information for a longer length of time—typically 20 minutes or longer—is
what is meant by general, delayed, or long-term memory. Personal experiences, general
knowledge, and skills are just a few examples of the information that can be stored and retrieved
from this sort of memory over the course of a lifetime. In the Auditory Immediate memory
index, the participant performed better than 99% in her age group and was in the range of very
superior in tasks that required her to remember information after a single auditory presentation.
The participant scored better than 73% of individuals in her age group in the Visual Immediate
memory index and was in the high average category in tasks that required her to remember
information after a single visual presentation. However, her Immediate Memory score is above
only 39% of individuals in her age group and was in the average category.

For Auditory Delayed Memory, her index score falls in the superior range and she is
better than 98% of people in her age group in tasks that required her to recall recently learned
auditory information after a 25- to 35-minute delay. In Visual Delayed Memory, the participant
fell in the average category and is above 50% of those in her age group. The task involved the
retrieval of visual information that was acquired after a delay of 25-35 minutes from the initial
presentation.

The participant’s Auditory Recognition Delayed percentile was 84% which is impressive
and she fell in the high average category for a task that required her to recognize information
20-25 minutes after it was recently obtained auditory information.

The participant is better than 50% of those in her age group in General Memory and falls
under the average category on tasks that measured her diverse auditory and visual memory
abilities. On Working Memory the participant is better than 84% of those in her age group and
falls under the high average category in tasks that required her to manage multitasking demands
using visual information.

The participant’s auditory immediate memory is 29 points more than the visual
immediate and her auditory delayed is 32 points more than the visual delayed. It can be inferred
WMS REPORT 21

that the participant’s ability to store and retrieve auditory information is better than visual
information, in both short and long-term memory. Clinicians can use auditory-memory strategies
such as mnemonic devices to help the participant grasp visual information better. Good auditory
memory is very beneficial to professionals like telephone operators. customer service
representatives as they need to process and recall information which they receive via the phone.

The difference between the participant’s visual immediate and visual delayed index
scores is 9 points and 6 points between auditory immediate and auditory delayed. This difference
suggests that the participant’s short-term retention of auditory and visual information is better
than long-term memory retention. This ability can be advantageous in professions where quick
decision-making and multi-tasking are required such as emergency response, sales, etc.

The participant’s working memory score is 19 points more than her immediate memory
and 15 points more than her general memory. This implies that she can multitask better than
learning information after a single presentation of the material. Working memory is also better
than immediate and general memory. Working memory is a predictor of academic success, and
working memory deficiencies have been connected to a variety of neuropsychological problems
like ADHD, dyslexia, and schizophrenia. Therefore, this has clinical implications.
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