Developing learning slope scores for the repeatable battery for the assessment of neuropsychological status

Performance on the African neuropsychology battery using the learning ratio in a sample of healthy Congolese

“…By using LR, which accounts for the number of to-belearned stimuli after trial one, we illustrated how slope and initial learning are distinct aspects of learning sharing similar underlying constructs. Such consistently positive correlations between Trial 1 learning and LR scores are often not observed when simple difference scores (RLS) are used to represent learning efficiency (e.g., Spencer et al, 2020;Wechsler, 1998). LR robustly correlates with age and education.…”

“…Although clinical applications of LR within the ANB require further investigation, it is encouraging that prior research in clinical samples using LR methodology in other learning tests has shown that LR differentiates between those with and without neurocognitive impairments (Spencer et al, 2020;Hammers et al, 2021aHammers et al, , 2021b with receiver operating characteristics area under the curve (AUC) in the acceptable to excellent range. Further, LR scores correlate significantly with other neuropsychological tests of memory, Alzheimer's-related biomarkers, hippocampal volume, and genetic risk for Alzheimer's (Hammers et al, 2021b(Hammers et al, , 2021cSpencer et al, 2020). Similarly, we would expect LR scores from the ANB to show similar clinical utility, but additional research is needed.…”

“…Learning slopes Raw learning slope (RLS) and LR of each ANB memory test were computed (see Spencer et al, 2020). For each test, RLS was calculated as Trial 1 subtracted from the score of Trial 3.…”

“…Recent studies have developed LR aggregates by combining learning slope measures (i.e., List Learning and Story Memory on the RBANS), stabilizing resultant metrics. In fact, among studies using LR, aggregate scores show more robust psychometric properties relative to subtest specific metrics (Hammers et al, 2021a(Hammers et al, , 2021b(Hammers et al, , 2021cSpencer et al, 2020). Such an aggregated measure was introduced by developers of the WMS-III, but the enterprise was limited by employing RLS.…”

“…Approaches include subtracting the score on the first learning trial from best learning trial (e.g., Brief Visuospatial Memory Test-Revised [BVMT-R], Benedict, 1997) and the method of the CVLT – II and 3 (Delis et al, 2000; Delis et al, 2017), which computes a weighted average of the new words per trial an individual acquires. These alternative learning slope scores, which are psychometrically equivalent to traditional RLS methods, share one significant shortcoming – they are heavily influenced by the score on the initial learning trial (Spencer et al, 2020). Most problematically, obtaining high scores on the initial learning trial contributes to a ceiling effect resulting in minimal opportunities for improvement in the learning slope, thereby penalizing efficient learners.…”