188? Atkinson Shiffrin Matlin, 1994 ; Baddeley, 1992 ; 1974Baddeley HitchBaddeley, 1992 dual-task technique Baddeley 1992, p.556 : phonologica

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97 502187-199 Chinese Journal of Psychology 2008, Vol. 50, No.

1 Chinese Journal of Psychology 2008, Vol. 50, No. 2, WAIS-III : 1 1, 2 1, , : 07B10; : ;: ;: ; : : huams@ntu.edu.tw WAIS-III WAIS-III 179 WAIS-III ROC Receiver Operating Characteristic 94% 63% 50% 67% 86% 58%92% WAIS-III - ; :

2 188? Atkinson Shiffrin Matlin, 1994 ; Baddeley, 1992 ; 1974Baddeley HitchBaddeley, 1992 dual-task technique Baddeley 1992, p.556 : phonological loop visuospatial sketchpad central executive M a g n e t i c Resonance Imaging, MRI Functional Magnetic Resonance Imaging, fmri Rorden & Karnath, 2004; Müller & Knight, 2006Müller Knight 2006 :Brodmann, s Area, BA, 39, 40 BA 44, 45, 47 Baddeley BA 19BA 7, 39 BA 46, 9,BA 8, 10 superior cerebellumsimplex lobule crus I inferior cerebellum Chen & Desmond, 2005; Ziemus et al., 2007 Gottwald, Wilde, Mihajlovic, & Mehdom, 2004; Chen & Desmond, 2005; Ziemus et al., 2007 Baddeley Wechsler Adult Intelligence Scale- Third EditionWAIS-III Arithmetic Digit Span Number- Letter Sequence Gold Carpenter Randolph Goldberg Weinberger 1997 Letter-Number LN Span Gold :11% WAIS-III WAIS-RWAIS-III Saklofske, Hildebrand, & Gorsuch, WAIS-III : Grégoire, 2004Burton Ryan Axelrod Schellenberger Richards 2003 WAIS-III Wechsler 1991 WAIS-R:

3 WAIS-III WAIS-III Kaufman & Lichtenberger, 2006 Kaufman & Lichtenberger, 1999 WAIS-III r =.66 r =.60 WAIS-III WAIS-III :0.71 :0.51;WAIS-III :0.72 : ? Wilde, Strauss, & Tulsky, 2004Banken 1985 Kaplan 1991 Lezak, Howieson, Loring, Hannay, & Fischer, 2004Kaplan Forward Span Score, FSS Backward Span Score, BSS FSS - BSS Lezak2004 BSSFSS3 FSS - BSS 3 ;Wilde 2004WAIS-III : Myerson Emery White Hale 2003 WAIS-III : 1 ; 2 the scaled score of the Arithmetic subtest, ARIsthe scaled score of the Digit Span subtest, DSs ;3 retrospective ~ amnestic Mild Cognitive Impairment, amci12 Early stage Alzheimer, s Disease, Early stage AD 13Alzheimer, s Disease, AD9Parkinson, s Disease, PD11 Parkinsonism 9- Frontotemporal Dementia, FTD3Huntinton, s Disease, HD3Vascular Dementia, VaD15 Normal Pressure Hydrocephalus, NPH1 Traumatic Brain Injury, TBI28Epilepsy 21Brain Tumor5 Neurointoxication1Wilson, s Disease1Neurosyphilis 1Cerebral Vascular Disease 8Hypoxic Encephalopathy 3Encephalitis8 Demyelinating Disease2 Leukoencephalopathy2 Spinocerebellar Ataxia, SCA3 Amyotrophic Lateral Sclerosis, ALS1Becker Muscular Dystrophy1 Alcoholic

4 190 1 :122 ;:57 :18 ~ :6 ~ P r o g r e s s i v e Supranuclear Palsy, PSP1 Multiple Sclerosis, MS1 Mitochondrial Encephalomyopathy Lactic Acidosis, and Strokelike, MELAS1 13 WAIS-III WAIS-III 103 4: 1 VocabularySimilarities Information ; 2Perceptual Organization Index, POI Picture Completion B l o c k D e s i g n M a t r i x Reasoning; 3 Working Memory Index, WMI Arithmetic Digit Span- Letter-Number Sequencing ;4Processing Speed Index, PSI -Digit Symbol- Coding Symbol Search WAIS-III- Magnetic Resonance Imaging, MRI Computer Tomography, CT Positron Emission Tomography, PET Single-Photon Emission Computed Tomography, SPECT WAIS-III WAIS-III SPSS10 Microsoft Excel Receiver Operating CharacteristicROC ROC1950 diagnostic test 2 : binary classification positive negative2 : 1True Positive, TP : ; 2True Negative, TN : ; 3False Positive, FP : ;4 False Negative, FN :

5 WAIS-III ROCdiagnostic test positive negative positive c PPV negative d NPV a b Sensitivity Specificity : a / b / c / d / Pepe, Altman & Bland, 1994a, 1994b; Swets, 1988 : 1Sensitivity : ; 2Specificity : ; 3 Positive Predictive Value PPV : ; 4 Negative Predictive Value NPV : ; Swets, 1988 :1.0 ~ 0.9: excellent ;0.9 ~ 0.8: good ;0.8 ~ 0.7: fair ;0.7 ~ 0.6: poor ;0.6 ~ 0.5: fail : Müller & Knight, WAIS-III WAIS-III2002 Lezak2004 cutpoint WMI 70 2 Scaled Score 4 3 FSSBSS FSS BSS

6 192 WAIS-III p.3836 ; Lezak 2004FSS BSS 3 : DSs & FSS DSs & BSS DSs & FSS-BSS FSS & BSS FSS & FSS-BSS BSS & FSS-BSS FSS & BSS & FSS-BSS 3179WAIS-III 0~1 FSS - BSS2.66Lezak : WMI WAIS-III specificity = 99%PPV = 94%NPV = 94% sensitivity = 63% 6 specificity = 96% NPV = 92%sensitivity = 50%PPV = 67% 7 specificity = 99% NPV = 92% PPV = 86%sensitivity = 50% 67 PPV = 86% PPV =67% ROC 8 sensitivity58% FSS BSS 97% 86%~89% 15%~ 83% WAIS-III : 1 ; 2 ;3 94% ROC: FSS BSS : WAIS-III Baddeley Hitch 1974 Baddeley, 1992

7 WAIS-III WAIS-III WAIS-III

8 194 5ROC WMI 70 = 15 = 1 = 94% WMI > 70 = 9 = 144 = 94% = 63% = 99% 6 ROC ARIs 4 = 12 = 6 = 67% ARIs > 4 = 12 = 139 = 92% = 50% = 96% 7ROC DSs 4 = 12 = 2 = 86% DSs > 4 = 12 = 143 = 92% = 50% = 99%

9 WAIS-III 195 8ROC FSS 29% 97% 58% 89% BSS 21% 98% 63% 88% 58% 43% 15% 86% FSS-BSS 29% 99% 78% 89% DSs & FSS 17% 99% 80% 88% DSs & BSS 21% 99% 83% 88% DSs & FSS-BSS 13% 99% 60% 87% FSS & BSS 4% 99% 33% 86% FSS & FSS-BSS 13% 99% 60% 87% BSS & FSS-BSS 4% 99% 33% 86% FSS & BSS & FSS-BSS WAIS-III sensitivity = 63% : 1Baddeley Hitch 1974 Baddeley, 1992 Gold1997LN Span task ; Crowe : WAIS-III - - visual spatial working memory over-estimation 2 Baddeley Hitch 1974 Baddeley, 1992 Müller & Knight, 2006 Fehr Code Herrmann 2007 fmri precuneus compensation

10 196 over-inclusion over-estimation over-inclusion hit rate ? ROC: ; false positive WAIS-III Lezak false negative rate - WAIS-III- WAIS-III 2002 ;Grégoire 2004 Ryan Paolo 2001Burton % 92% PPV = 86% PPV = 67% PPV Kaplan BankenLezak, 2004

11 WAIS-III 197 Myerson2003Wilde2004 FSS BSSFSS - BSS Wilde, et al., 2004 ROC 58% FSS - BSS 58%43% FSS - BSS 3 FSS BSS FSS4 BSS 33FSSBSS Lezak2004 FSS 6 ± 1BSS FSS1 94% 63% - : % mild brain atrophy PET SPECT 2 prospective study WAIS-III N-Back task 2002 : 2007WAIS-III Altman, D. G., & Bland J. M. (1994a). Diagnostic tests 1: Sensitivity and specificity. British Medical Journal, 308, Altman, D. G., & Bland J. M. (1994b). Diagnostic tests 2: Predictive values. British Medical Journal, 309, 102. Baddeley, A. (1992). Working memory. Science, 255, Burton, D. B., Ryan, J. J., Axelrod, B. N., Schellenberger, T., & Richards, H. M. (2003). A confirmatory factor analysis of the WMS-III in a clinical sample with crossvalidation in the standardization sample. Archives of Clinical Neuropsychology, 18, Chen, S. H., & Desmond, J. E. (2005). Cerebrocerebellar networks during articulatory rehearsal and verbal working memory tasks. Neuroimage, 24, Crowe, S. F. (2000). Does the letter number sequencing task measure anything more than digit span? Assessment, 7, Fehr, T., Code, C., & Herrmann, M. (2007). Common brain regions underlying different arithmetic operations as revealed by conjunct fmri BOLD activation. Brain Research, 1172, Gold, J. M., Carpenter, C., Randolph, C., Goldberg, T. E., & Weinberger, D. R. (1997). Auditory working memory and Wisconsin Card Sorting Test performance in schizophrenia. Archives of general

12 198 psychiatry, 54, Gottwald, B., Wilde, B., Mihajlovic, Z., & Mehdorm, H. M. (2004). Evidence for distinct cognitive deficits after focal cerebellar lesions. Journal of Neurology, Neurosurgery, and Psychiatry, 75, Grégoire, J. (2004). Factor structure of the French version of the Wechsler Adult Intelligence Scale-III. Educational and Psychological Measurement, 64, Kaufman, A. S., & Lichtenberger, E. O. (1999). The Essentials of WAIS-III Assessment, New York: John Wiley & Sons. Kaufman, A. S., & Lichtenberger, E. O. (2006). Assessing adolescent and adult intelligence (3rd ed.), New York: John Wiley & Sons. Lezak, M. D., Howieson, D. B., Loring, D. W., Hannay, H. J., & Fischer, J. S. (2004). Neuropsychological Assessment (4th ed.). New York: Oxford University Press. Matlin, M. W. (1994). Cognition (3rd ed.). Harcourt Brace. Müller, N. G., & Knight, R. T. (2006). The functional neuroanatomy of working memory: Contributions of human brain lesion studies. Neuroscience, 139, Myerson, J., Emery, L., White, D. A., & Hale, S. (2003). Effects of age, domain, and processing demands on memory span: Evidence for differential decline. Aging Neuropsychology and Cognition, 10, Pepe, M. S. (2003). The statistical evaluation of medical tests for classification and prediction. New York: Oxford. Rorden, C., & Karnath, H. O. (2004). Using human brain lesions to infer function: A relic from a past era in the fmri age? Nature Reviews Neuroscience, 5, Ryan, J. J., & Paulo, A. M. (2001). Exploratory factor analysis of the WAIS-III in a mixed patient sample. Archives of Clinical Neuropsychology, 16, Saklofske, D. H., Hildebrand, D. K., & Gorsuch, R. L. (2000). Replication of the factor structure of the Wechsler Adult Intelligence Scale third edition with a Canadian sample. Psychological Assessment, 12, Swets, J. A. (1988). Measuring the Accuracy of Diagnostic Systems. Science, 240, Wilde, N. J., Strauss, E., & Tulsky, D. S. (2004). Memory Span on the Wechsler Scales. Journal of Clinical and Experimental Neuropsychology, 26, Ziemus, B., Baumann, O., Luerding, R., Schlosser, R., Schuierer, G., Bogdahn, U., et al. (2007). Impaired working-memory after cerebellar infarcts paralleled by changes in BOLD signal of a cortico-cerebellar circuit. Neuropsychologia, 45,

13 WAIS-III 199 The Clinical Applicability of the Arithmetic, Digit Span Subtests of the Taiwan WAIS-III, and their Composite in Reflecting the Working Memory Index: A Retrospective Study Wei-Han Wang 1, Mau-Sun Hua 1, 2, Chi-Cheng Yang 1, 3, Yi-Chuan Chu 4, Ting-Wen Cheng 2, Ping-Keung Yip 2, Ming-Chang Chiu 1, 2, Ta-Fu Chen 2, Sheng-Jean Huang 3, Hsien-Tsung Chen 4, and Wen-Chun Hsu 4 1 Department of Psychology, National Taiwan University 2 Department of Neurology, National Taiwan University Hospital 3 Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital 4 Department of Neurology, Chang-Gung Memorial Hospital There are many issues in regards to whether or not the composite of Arithmetic and Digit Span subtests used to determine the working memory index of the Taiwan WAIS-III is compatible with that of the English WAIS-III, and whether the individual Arithmetic and Digit Span subtests, and the span scores of the Digit Span subtest are adequate for measuring working memory. This study was thus to make an attempt to examine these issues. In this retrospective study, receiver operating characteristic (ROC) analyses were employed, using brain imaging data of 179 patients with various CNS diseases as the gold standard, to identify the working-memory-related scores in the Taiwan WAIS-III. The results, as estimated by a composite of the Arithmetic and the Digit Span subtests, revealed all the specificity, negative predictive value, and positive predictive value of the Taiwan WAIS-III working memory index were each at or above 94%, yet the sensitivity was only 63%. The sensitivities of the Arithmetic and the Digit Span subtests were even poorer, measuring only 50%. However, the positive predictive value of the Digit Span subtest was 86% while the Arithmetic subtest was 67%. In addition, the forward and backward span scores of the Digit Span subtest had good negative predictive value (all of them were above 92%), but poor sensitivity (all of them were below 58%). Based on the present findings, it appears that all the Taiwan WAIS-III working memory index, the single Arithmetic and the Digit Span subtests, and the span scores of the Digit Span subtest could adequately discriminate individuals without working memory impairment, but had poor sensitivity on detecting the patients who evidenced working memory impairment. Accordingly, it is suggested that clinicians should gauge the working memory index by a composite of the Arithmetic, the Digit Span, and the Letter-Number Sequencing subtests if possible. Otherwise, a caveat should be taken with care to interpret the working memory index, as estimated by a composite of the Arithmetic and the Digit Span subtests, because the chance of the increasing false negative rate becomes ineludible. Respecting the limitations of retrospective study, however, it is necessary to make a prospective study to re-approach this issue. Keywords: WAIS-III, working memory, arithmetic, digit span

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