Hopkins verbal learning test-revised and brief visuospatial memory test-revised: preliminary normative data for the Brazilian population
Hopkins verbal learning test-revised e brief visuospatial memory test-revised: referencial normativo preliminar para a população brasileira
Eliane Correa MiottoI; Kenia Repiso CampanholoII; Melissa Machado RodriguesII; Valéria Trunkl SerraoII; Mara C S de LuciaII; Milberto ScaffI
IDepartment of Neurology, Hospital das Clínicas, Universidade de São Paulo (USP), São Paulo SP, Brazil
IIPsychology Division, Hospital das Clínicas, Universidade de São Paulo (USP), São Paulo SP, Brazil
Correspondence Correspondence: Eliane Correa Miotto Divisão de Neurologia Clínica Departamento de Neurologia Avenida Dr. Enéas de Carvalho Aguiar 255 05403-900 São Paulo SP - Brasil E-mail: firstname.lastname@example.org
Memory functions are cognitive processes related to the ability to encode, store and retrieve information associated to the fronto-temporal neurocircuitry1. Episodic memory refers to the system that allows conscious recollection of personal events or episodes and their contexts (time and place)1. Clinical measures of episodic memory include immediate and delayed free recall and recognition of word lists and pictures. Amongst these measures, the Hopkins verbal learning test-revised2 (HVLT-R) and the brief visuospatial memory test-revised3 (BVMT-R) are used to assess verbal episodic memory and visuospatial episodic memory, respectively, both including immediate, delayed and recognition. Although they are adopted as measures of memory functions in clinical practice, there are no normative data for the Brazilian adult and elderly population. The aim of this study was to present preliminary normative data for the HVLT-R and BVMT-R in a sample of the Brazilian population.
The study, carried out at Department of Neurology and Psychology Division, Central Institute, Hospital das Clínicas, Universidade de São Paulo, Medical School, included 1,108 adult and elderly participants (18 to 85 years old and 0 to 17 years of education) recruited from different states in Brazil (São Paulo, Minas Gerais, Rio de Janeiro, Paraná, Santa Catarina, Goiás, Bahia e Alagoas). Subjects with neurologic and psychiatric disorders were excluded after answering a semi-structured interview questionnaire. The inclusion criteria was (a) Mini-mental state examination score above the cutoff for cognitive impairment based on education4; (b) Independence on daily-life activities; and (c) Hospital anxiety and depression scale scores below the cutoff for anxiety and depression5. The HVLT-R and BVMT-R were administered according to the test manual instructions and, for both tests, Form I was used. For HVLT-R, participants were instructed to memorize a list of 12 words (nouns) drawn from 3 semantic categories (precious stones, animals and human dwellings). The test includes an immediate recall derived from three learning trials, a delayed recall trail (after 2025 min) and a yes/no delayed recognition trial. For BVMT-R, six geometric visual designs were shown to the participants for 10 seconds and after that, they were asked to reproduce as many of the designs as possible in the same location. This test includes an immediate recall derived from the three learning trials, a delayed recall (25 minutes) and a recognition trial.
Descriptive analyses and non-parametric tests using SigmaStat 3.5 (Kruskal-Wallis, Mann Whitney and post-hoc test using Muller-Dunn) were performed in order to investigate the influence of age, education, and gender on test performance. Statistical significance was established at 0.05.
Participants' test performance is presented on Table. The results showed a significant influence of age (BVMT-R immediate: H=54.09, p<0.001; BVMT-R delayed: H=64.47, p<0.001; BVMT-R recognition: H=28.34, p<0.001; HVLT-R recognition: H=24.28, p<0.001) and years of education (BVMT-R immediate: H=206.29, p<0.001; BVMT-R delayed: H=205.14, p<0.001; BVMT-R recognition: H=70.13, p<0.001; HVLT-R immediate: H=286.85, p<0,001; HVLT-R delayed: H=248.48, p<0.001; HVLT-R recognition: H=77.87, p<0.001) on subjects test results. ROC curve analyses showed no significant influence of gender on test performance (p>0.05).
The HVLT-R and BVMT-R are neuropsychological tests validated for the assessment of verbal and visuospatial learning and episodic memory1. In the present, as well as, in the original data, there was a significant influence of age on both tests. In the current investigation, education also showed significant influence on the results possibly due to the different levels of education of the sample. In the majority of the studies, including the present one, gender had no influence on subjects' tests results. These findings demonstrate the importance of adequate normative data for memory assessment in clinical setting. They also present preliminary data for a sample of the Brazilian population, stratified according to age and education that can be useful in the learning and memory assessment of clinical conditions including mild cognitive disorders, dementia, traumatic brain injury, cerebral vascular accident and neuropsychiatry disorders..
Received 17 May 2012
Received in final form 28 May 2012
Accepted 06 June 2012
Conflict of interest: There is no conflict of interest to declare.
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04 Jan 2013
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