Benton's Visual Retention Test in the Differentiation of Depression and Early Dementia

Abstract

The study examined the effectiveness of Benton's (1955) Visual Retention Test in discriminating between depression and early dementia. The test was given, in three versions, using the three different methods of administration in balanced order, to a group of 18 depressed patients and to a group of 18 patients referred because of the suspicion of early dementia, and subsequently confirmed as dementing after a follow-up of at least a year. The depressives performed considerably worse than Benton's control group, but the demented patients were much worse than Benton's brain-damaged group, so there was still a useful discrimination.The standard administration (A) turned out to be the best of the three for this particular purpose.Among the various tests of learning and memory used to distinguish between depression and early dementia in middle-aged patients, Benton's Visual Retention Test (Benton, 1955) has the advantage of being quick and not too demanding for the patient. There are a number of reports on its usefulness (e.g. L'Abate, 1962)) but they usually employ groups of mixed types of brain damage. The first aim of this study was to conduct a prospective study of the ability of this test to discriminate between depression and early dementia. A secondary aim was to examine the alternative versions of the test; in addition to the standard administration A with 10 sec. exposure for each design and immediate reproduction, Benton suggests as alternative methods administration D, 10 sec. exposure with 15 sec. delay before reproduction, and administration B, 5 sec. exposure with immediate reproduction. Clinicians have personal preferences for one or other of these methods, and it was decided to use all three administrations to determine which is in fact the most useful for the purpose described above. METHODThere are three equivalent forms of the test, C, D and E. Each patient did a l l three, form C with administration A (CA), form D with D (DD) and form E with B (EB); six orders were thus required to balance the order of presentation. Patients suffering from endogenous depression were tested soon after admission and before the start of treatment. If, by the end of that admission, no question of dementia (or any other condition) had been raised, they were retained in the group. For the group of dementias, patients who were referred as possibly demented were tested. They were thus people in whom the diagnosis was doubtful. If, after at least a year, they were regarded as definitely demented they were retained in the group. 66

Clinical tests of memory in dementia, depression, and healthy aging.

“…Benton (1974) noted in the VRT scoring manual that evidence for distinctive qualitative features in brain-damaged patients’ copies of designs is tentative, and he recommended that the existence of such features be viewed as a hypothesis to be investigated, rather than as an established fact. Neither our data nor those of Crookes and McDonald (1972) provide clear support for this hypothesis in the case of dementia versus depression or healthy aging.…”

“…In our study, however, it is the relatively poor performance of the depressed group that generates concern; 40% of these participants could copy no more than 2 of the 10 designs correctly. Crookes and McDonald (1972), investigating somewhat younger (mean age = 55 years) depressed and demented patients, also found poor performance on the VRT in both groups. Moreover, a mean correct VRT score of only 2.5 has been reported for hospitalized elderly patients without specific mental disorders (Klonoff & Kennedy, 1966).…”

The Short GDS

“…Promising directions for research may be to include items that reflect levels of cognitive function that are relatively independent of formal education. In particular, qualitative features of cognitive performance, that is, the types of errors made (e.g., those who are depressed make errors of omission rather than commission, but do not show organic features such as rotation) have been demonstrated to be useful discriminators of depression which are relatively culture-free (Crookes and McDonald, 1972;Whitehead, 1973).…”