Archives of Clinical Neuropsychology
20 (2005) 1043–1051
Concurrent validity of WAIS-III short forms in a geriatric
sample with suspected dementia: Verbal, performance
and full scale IQ scores
Brian L. Brooks a,∗ , Linda E. Weaver a,b
a
Department of Psychology, University of Calgary, 2500 University Drive NW,
Calgary, Alta., Canada T2N 1N4
b
Seniors’ Health Ambulatory Care, Rockyview General Hospital, Calgary, Alta., Canada
Accepted 10 June 2005
Abstract
Evaluation of intellectual abilities using the WAIS-III is a common component of neuropsychological
assessments. However, clinicians might be interested in administering reliable and valid short forms
due to practical and clinical reasons. The present study examined the concurrent validity of eight short
forms of the WAIS-III with full form IQ scores in a sample (n = 43) of geriatric outpatients referred
for assessment of suspected dementia. There were no significant differences between the short and
full form VIQ scores at P < .01, while half of the short form PIQ and FSIQ scores were significantly
different from their respective full form scores at P < .01. Correlations between short and full form IQ
scores ranged from .89 to .99. Seven-subtest short forms were able to accurately estimate over 80% of
scores within ±2 S.E.M.s. This study supports limited use of WAIS-III short forms when conducting
evaluations of older adults with suspected dementia.
© 2005 National Academy of Neuropsychology. Published by Elsevier Ltd. All rights reserved.
Keywords: WAIS-III; Elderly; Assessment; Dementia; Abbreviation; Short form
1. Introduction
Psychological and neuropsychological evaluations of older adults often involve an assessment of intellectual abilities. One of the most widely used measures for evaluating intellectual
∗
Corresponding author.
E-mail address: [email protected] (B.L. Brooks).
0887-6177/$ – see front matter © 2005 National Academy of Neuropsychology. Published by Elsevier Ltd. All rights reserved.
doi:10.1016/j.acn.2005.06.005
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B.L. Brooks, L.E. Weaver / Archives of Clinical Neuropsychology 20 (2005) 1043–1051
abilities has been the Wechsler Adult Intelligence Scale (WAIS; Wechsler, 1955, 1981, 1997).
The popularity of the WAIS has come from its utility with various clinical populations and
large amount of research literature. In addition, the most recent revision of the WAIS, the
WAIS-III, has increased utility with geriatric patients compared to previous versions with the
normative data extended up to the age of 89 years (Wechsler, 1997).
Administration of the WAIS-III to obtain IQ scores includes six verbal (VIQ) and five performance (PIQ) subtests, with all 11 subtests contributing to a full-scale score (FSIQ). According
to the WAIS-III manual, estimated administration time ranges from 60 to 90 min, but these
times may increase to as long as two hours when being administered to some patient populations (Ryan, Lopez, & Werth, 1998), including geriatric patients with suspected dementia.
One technique for reducing the amount of time spent testing intellectual abilities has been to
employ short form versions of the WAIS, which involve only administering selected subtests
to obtain estimated IQ scores. Ryan et al. (1998) reported that 10 of the 11 short forms they
gave to patients reduced administration time by at least 50%.
Some of the WAIS short forms have included seven-subtest versions derived by Ward
(1990) and Paolo and Ryan (1993). Although these short forms were originally developed
with the WAIS-R, the same abbreviated forms have been extended to the WAIS-III. Overall,
many studies have reported that seven-subtest versions of the WAIS-III (i.e., Ward’s; Paolo &
Ryan’s) can be substituted for the full WAIS-III with various clinical populations, as they are
very highly correlated, provide estimates that are not significantly different from the original
scores, and are generally able to accurately classify persons compared to the full version
(Axelrod, Ryan, & Ward, 2001; Pilgrim, Meyers, Bayless, & Whetstone, 1999; Ryan & Ward,
1999). Accuracy of estimated scores with short form versions has been highest for VIQ and
FSIQ scores, while the ability to estimate PIQ scores has been less reliable. For example,
Axelrod (2002) found VIQ and FSIQ scores could be accurately estimated (97% of scores
within ±10 points for both IQ estimates) with a four-subtest version of the WAIS-III, while
the estimated PIQ scores were significantly higher than actual PIQ scores and only 76% of
cases fell within ±10 points of the WAIS-III PIQ scores.
Axelrod (2002) also examined the accuracy of another method for estimating IQ scores, the
Wechsler Abbreviated Scale of Intelligence (WASI; Psychological Corporation, 1999). The
WASI consists of four subtests (vocabulary, similarities, block design, and matrix reasoning,
with different questions compared to the WAIS-III), has its own manual, normative data, and
provides a table for estimating WAIS-III FSIQ scores from WAIS FSIQ scores. While the
manual suggests the WASI should have strong concurrent validity with the WAIS-III, Axelrod
(2002) found that abbreviated versions of the WAIS-III had higher accuracy compared to
the WASI for VIQ, PIQ, and FSIQ scores in a mixed clinical sample. In addition, it took
significantly longer to administer the WASI than the comparable four-subtest version of the
WAIS-III. Further research is needed to examine the WASI and how it compares to abbreviated
versions of the WAIS-III in various clinical samples.
Studies examining the accuracy of WAIS-III short forms have used either normal controls or
mixed clinical populations (e.g., Axelrod, 2002), and have typically only examined one or two
short forms with the population of interest. Information regarding the accuracy of different short
form versions of the WAIS-III with a geriatric population referred for assessment of suspected
dementia is limited. Wymer, Rayls, and Wagner (2003) examined three abbreviated forms
B.L. Brooks, L.E. Weaver / Archives of Clinical Neuropsychology 20 (2005) 1043–1051
1045
[Ward’s seven-subtest version, the Satz–Mogel select-item version (Satz & Mogel, 1962), and
a clinically derived select-item version] of the WAIS-III in a sample of 20 geriatric patients
between the ages of 59 and 85 years with suspected dementia and found that all three short
forms provided highly correlated scores (r’s ranged from .98 to .99) and accurately classified the
majority of FSIQ scores within the same categories (i.e., 90% in same category with Ward’s
seven-subtest, and 95% in same category with both the Satz–Mogel and clinically derived
versions). Although the three versions used in Wymer et al. (2003) provided nearly equivalent
results, select-item versions (i.e., only administering selected items from all subtests) are not the
most desirable (Sattler, 2001), especially with geriatric patients. Administering every second
or third item in a subtest results in the difficulty of the items increasing two to three times as
quickly compared to the original administration and reduces the amount of subtest-specific
practice that is important on unfamiliar tasks.
Given the lengthy history of abbreviated versions of the WAIS (Himelstein, 1957a, 1957b)
and the continued use of brief measures of intellectual functioning (Thompson, LoBello,
Atkinson, Chisholm, & Ryan, 2004), it is important to examine the accuracy of short form
versions of the WAIS-III. Evaluating the utility of short form versions of the WAIS-III is
critical for geriatric patients with suspected dementia, as the reduced tolerance for testing may
necessitate using short forms of measures. In addition, it is important to extend the literature that
examined short form versions of the WAIS-R in persons with suspected dementia (Margolis,
Taylor, & Greenlief, 1986; Osato, Van Gorp, Kern, Satz, & Steinman, 1989; Randolph, Mohr,
& Chase, 1993) to the updated WAIS-III.
The purpose of this study was to examine the accuracy of eight short form versions of
the WAIS-III in geriatric patients referred for neuropsychological assessment. Older adults
can be susceptible to test fatigue and clinicians may need to consider abbreviated versions of
measures during an assessment. Having information about older adults’ performance on short
forms of the WAIS-III will help clinicians decide: (1) whether short forms are appropriate,
and if they are, (2) which subtests to administer and (3) the level of clinical accuracy.
2. Methods
2.1. Participants
Tests data was obtained from archival neuropsychological charts for outpatients referred for
the investigation of suspected memory decline or general cognitive impairment. The sample
(n = 43) consisted of 24 (56%) men and 19 (44%) women, with a mean age of 63.8 years
(S.D. = 7.2; Range = 54–85) and 13.6 mean years of education (S.D. = 3.9; Range = 6–21).
Regarding diagnoses, 65.1% had suspected dementia (39.5% had Alzheimer’s dementia and
25.6% had vascular or mixed dementia), 20.9% had depression, and 14% had subjective, but
not objective deficits (i.e., “worried-well”). Suspected aetiologies for cognitive decline were
given by a registered psychologist (LEW) and were based on clinical interview with patient and
available family members, medical history, and comprehensive neuropsychological evaluation.
Diagnostic criteria were based on the Diagnostic and Statistical Manual for Mental Disorders,
fourth edition (DSM-IV; American Psychiatric Association, 1994).
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B.L. Brooks, L.E. Weaver / Archives of Clinical Neuropsychology 20 (2005) 1043–1051
Table 1
Subtest combinations and prorating used for calculating verbal and performance IQ scores from short form versions
of the WAIS-III
Subtest combinations and prorating
Version
Verbal IQ
Performance IQ
Full WAIS-III
Ward – 7a
Paolo/Ryan – 7b
Sattler – 7c
Sattler – 6c
Sattler – 5c
Sattler – 4c
Sattler – 3c
Sattler – 2c
V + S + I + A + DS + C
2 × (I + S) + DS + A
1.5 × (I + A + DS + S)
1.5 × (I + A + DS + S)
2 × (I + V + S)
2 × (I + V + A)
3 × (V + I)
3 × (V + I)
6 × (V)
PC + CD + BD + MR + PA
2 × (PC + BD) + CD
1.67 × (PC + CD + BD)
1.67 × (PC + CD + MR)
1.67 × (PC + BD + MR)
2.5 × (PC + MR)
2.5 × (BD + MR)
5 × (BD)
5 × (MR)
Note. V: Vocabulary; S: Similarities; A: Arithmetic; DS: Digit Span; I: Information; C: Comprehension; PC: Picture
Completion; CD: Digit Symbol – Coding; BD: Block Design; MR: Matrix Reasoning; PA: Picture Arrangement.
FSIQ scores were calculated using the sums of the prorated VIQ and PIQ scores.
a
Ward (1990).
b
Paolo and Ryan (1993).
c
Sattler (2001).
2.2. Procedure
Participants were administered the full form WAIS-III. Data for short forms were obtained
by re-scoring the original full WAIS-III protocol. Prorating of short form VIQ, PIQ and FSIQ
scores was performed according to recommendations for seven-subtest versions from Ward
(1990), Paolo and Ryan (1993), and Sattler (2001). In addition, six-, five-, four-, three- and
two-subtest versions were selected from Sattler (2001) based on having the highest reliability
and validity with the WAIS-III FSIQ in a non-clinical sample. A full list of the short form
versions and calculations for prorating used in this study is provided in Table 1. FSIQ scores
were calculated by adding the prorated VIQ and PIQ standard scores.
2.3. Analyses
In order to examine the effectiveness of the different short form versions of the WAIS-III
with this clinical population, different types of analyses were conducted for VIQ, PIQ, and
FSIQ. First, repeated measures analyses of variance and correlations between the short form
and full form scores were performed. To protect Type I error rate when performing multiple
comparisons, significance was set at P < .01. Second, clinical accuracy was examined by calculating the percentage of short form scores that fell within ±2 standard errors of measurement
(S.E.M.s) or within the same classification range. The S.E.M. for each IQ score was calculated
as the average S.E.M. for the age groups above 55 years old in the standardization sample (see
Wechsler, 1997, Table 3.4). For this study, 2 S.E.M.s for VIQ, PIQ, and FSIQ were 5.07, 7.04,
and 4.50 points, respectively. Classification ranges were based on Wechsler (1997) and defined
as: Extremely Low (standard score <70; <1st percentile); Borderline (standard score = 70–79;
B.L. Brooks, L.E. Weaver / Archives of Clinical Neuropsychology 20 (2005) 1043–1051
1047
2–9th percentile); Low Average (standard score = 80–89; 10–24th percentile); Average (standard score = 90–109; 25–75th percentile); High Average (standard score = 110–119; 76–90th
percentile); Superior (standard score = 120–129; 91–97th percentile); and Very Superior (standard score >129; >97th percentile).
3. Results
The following subtests were included in the analyses: Vocabulary (mean = 11.5,
S.D. = 3.5); Similarities (mean = 10.8, S.D. = 3.7); Arithmetic (mean = 10.5, S.D. = 3.8);
Digit Span (mean = 9.8, S.D. = 3.5); Information (mean = 11.1, S.D. = 2.8); Comprehension (mean = 11.6, S.D. = 3.7); Picture Completion (mean = 9.4, S.D. = 3.3); Digit Symbol
– Coding (mean = 8.9, S.D. = 3.4); Block Design (mean = 9.9, S.D. = 3.5); Matrix Reasoning (mean = 10.9, S.D. = 3.4); and, Picture Arrangement (mean = 9.7, S.D. = 3.3). For
this sample, the full form VIQ (mean = 105.9; S.D. = 19.5; 95% CI = 100.3–112.7), PIQ
(mean = 99.2; S.D. = 19.0; 95% CI = 92.4–104.7) and FSIQ (mean = 103.6; S.D. = 19.8; 95%
CI = 97.2–109.9) scores were calculated.
Short form VIQ, PIQ and FSIQ scores are presented in Table 2. The estimated VIQ scores
using the seven-subtest version suggested by Paolo and Ryan (1993) and Sattler (2001) was
significantly lower than the full VIQ score [F(1, 42) = 9.28, P = .004]. The other short form
estimates of VIQ did not differ significantly from the full form VIQ score at P < .01. For PIQ
scores, the seven-subtest versions from Ward (1990) [F(1, 42) = 9.42, P = .004] and Paolo and
Ryan (1993) [F(1, 42) = 14.06, P < .001] were significantly lower than the mean full form PIQ
score. The five-subtest [F(1, 42) = 11.49, P = .002], four subtest [F(1, 42) = 11.15, P = .002]
and two-subtest versions [F(1, 42) = 26.01, P < .001] were all significantly higher than the full
form PIQ score. The other short form PIQ scores did not differ significantly from the full form
PIQ score at P < .01.
Regarding short form FSIQ scores, the seven-subtest versions from Ward (1990) [F(1,
42) = 14.71, P < .001] and Paolo and Ryan (1993) [F(1, 42) = 22.77, P < .001] were both significantly lower than the full form FSIQ score, whereas, the four-subtest [F(1, 42) = 17.06,
P < .001] and two-subtest [F(1, 42) = 20.91, P < .001] FSIQ scores were significantly higher
than the full form FSIQ score. The other short form FSIQ scores did not differ significantly
from the full form FSIQ score at P < .01 and are presented in Table 2.
Pearson correlations between the full form and short form VIQ, PIQ and FSIQ scores are
also presented in Table 2. All correlations were significant at P < .01. Correlations between the
short and full form VIQ scores ranged from .89 for Sattler’s (2001) two-subtest version to .98
for Ward’s (1990) seven-subtest version. Correlations between short and full form PIQ scores
ranged from .80 for the three-subtest version to .97 for Ward’s seven-subtest version. And
finally, correlations between short and full form FSIQ scores ranged from .93 (two-subtest
version) to .99 (Ward’s seven-subtest version).
The percentage of abbreviated scores falling within ±2 S.E.M.s or the same classification
range is presented in Table 3. Seven-subtest versions from Ward (1990), Paolo and Ryan
(1993), and Sattler (2001) performed very similar, with the percentage of estimated IQ scores
within ±2 S.E.M.s ranging from 83 to 85% for VIQ, 83 to 90% for PIQ, and 72 to 85% for
1048
Verbal IQ
WAIS-III
Ward – 7
Paolo/Ryan – 7
Sattler – 7
Sattler – 6
Sattler – 5
Sattler – 4
Sattler – 3
Sattler – 2
a
Performance IQ
Mean (S.D.)
F (P)a
rb
Mean (S.D.)
F (P)a
rb
Mean (S.D.)
F (P)a
rb
105.8 (19.5)
104.2 (19.1)
103.8 (19.4)
103.8 (19.4)
107.4 (20.1)
106.7 (19.8)
108.6 (19.5)
108.5 (19.5)
110.3 (23.1)
–
5.82 (.020)*
9.28 (.004)**
9.28 (.004)**
2.41 (.129)
0.94 (.339)
5.65 (.022)*
5.65 (.022)*
6.40 (.015)*
–
.98
.97
.97
.95
.97
.94
.94
.89
99.2 (19.0)
96.4 (19.5)
95.8 (19.3)
98.7 (20.3)
100.9 (20.9)
101.8 (21.9)
103.7 (22.9)
99.9 (24.6)
107.2 (24.7)
–
9.42 (.004)**
14.06 (.001)**
0.08 (.780)
4.82 (.034)*
11.49 (.002)**
11.15 (.002)**
0.12 (.729)
26.01 (.001)**
–
.97
.97
.97
.97
.96
.91
.80
.90
103.6 (19.8)
100.7 (19.9)
100.0 (20.1)
101.2 (20.5)
105.4 (21.0)
105.0 (21.7)
107.0 (21.6)
105.2 (21.8)
109.7 (24.1)
–
14.71 (.001)**
22.77 (.001)**
4.82 (.034)*
6.74 (.013)*
6.45 (.015)*
17.06 (.001)**
3.86 (.057)
20.91 (.001)**
–
.99
.98
.98
.98
.97
.96
.94
.93
F(1, 42).
All Pearson correlations are significant at P < .01.
∗
P < .05.
∗∗
P < .01.
b
Full scale IQ
B.L. Brooks, L.E. Weaver / Archives of Clinical Neuropsychology 20 (2005) 1043–1051
Table 2
Mean verbal, performance and full scale IQ scores using the full WAIS-III and eight short form versions in a geriatric sample with suspected dementia
B.L. Brooks, L.E. Weaver / Archives of Clinical Neuropsychology 20 (2005) 1043–1051
1049
Table 3
Clinical accuracy of verbal, performance and full scale IQ scores using the full WAIS-III and eight short form
versions in a geriatric sample with suspected dementia
Verbal IQ
Ward – 7
Paolo/Ryan – 7
Sattler – 7
Sattler – 6
Sattler – 5
Sattler – 4
Sattler – 3
Sattler – 2
Performance IQ
Full scale IQ
±2 S.E.M.a
Same classb
±2 S.E.M.c
Same classb
±2 S.E.M.d
Same Classb
85
83
83
61
73
46
46
42
78
76
76
56
63
54
54
41
85
83
90
83
76
52
41
45
73
63
85
68
68
50
29
50
85
72
80
74
67
50
43
33
85
82
82
74
72
85
60
63
a
2 S.E.M.s for the WAIS-III VIQ = 5.07.
Percentage of short form scores that remained within the same classification category [e.g., low average,
average, high average from Wechsler (1997)] as the full form scores.
c
2 S.E.M.s for the WAIS-III PIQ = 7.04.
d
2 S.E.M.s for the WAIS-III FSIQ = 4.50.
b
FSIQ. Clinical accuracy of scores generally decreased concomitantly with decreasing number
of subtests. With the exception of one estimated PIQ score using a six-subtest version (Sattler,
2001), short forms with less than seven subtests fell below the a priori criteria for clinical
accuracy (>80% within ±2 S.E.M.).
4. Discussion
Assessments of older adults with suspected dementia typically evaluate multiple cognitive
domains while considering the patient’s stamina for testing. A possible solution to the breadth
versus brevity consideration is to employ short forms of tests that provide accurate measurement while reducing the amount of testing time. This study sought to evaluate eight short form
versions of the WAIS-III in a clinical population of older adults with suspected dementia.
Previous research has generally supported seven-subtest short forms of the WAIS-III as the
most clinically accurate (Axelrod et al., 2001; Pilgrim et al., 1999; Ryan & Ward, 1999; Wymer
et al., 2003). The present study also found high clinical accuracy (>80% of estimated with ±2
S.E.M.) scores when using seven-subtest short forms to estimate VIQ, PIQ, and FSIQ scores.
With the exception of the estimated PIQ score with the six-subtest version (Sattler, 2001),
short-form versions with less than seven-subtests did not meet the a priori level of clinical
accuracy.
For the clinician, determining which short form to use depends on the purpose for evaluating intellectual functioning. The use of a short form is not recommended for all situations,
particularly when “intellectual abilities are central to clinical, psychoeducational, or programming decisions” (p. 254, Sattler, 2001). Reasons for selecting a short form of the WAIS-III
may include: (1) research purposes, (2) screening purposes, (3) a quick check on the patient’s
mental status, and/or (4) practical reasons such as patient fatigue (Sattler, 2001). Situations
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B.L. Brooks, L.E. Weaver / Archives of Clinical Neuropsychology 20 (2005) 1043–1051
involving research may emphasize brevity and non-significant differences between short and
full form scores (i.e., Sattler’s three-subtest version). In clinical situations where the use of a
short form WAIS-III is deemed appropriate based on practical, economic, or clinical reasons,
there is likely to be an emphasis on accuracy of individual short form scores. In this study,
only the seven-subtest versions from Ward (1990) and Sattler (2001) were able to estimate
more than 80% of scores within our specified range for accuracy.
There are some limitations of this study that may reduce the generalizability of the results.
First, the small sample size of this study may make it more difficult to generalize these results
to other clinics with different base rates of disorders in those geriatric patients referred for
neuropsychological assessment. A second limitation is that the sample does not consist of only
those with dementia, but also has some participants with depression and without confirmed
cognitive decline. Participants without dementia were purposely included, as this sample mix
closely represents those referred an outpatient clinic for evaluation of a suspected dementia.
A third limitation of this study is that the present sample may be higher functioning than
participants in other studies. Although IQ scores fell within the average range for this sample,
this may be higher than would be expected for this clinical population. For example, Axelrod
(2002) reported on a sample that had subtest mean scores within the Low Average (6.2) to
Average (8.2) ranges and IQ scores within the Low Average range on the WAIS-III, while the
present study sample had subtest means and IQ scores that were all within the Average range.
A fourth limitation involves the method for calculating short forms in this study, which may
actually be underestimating IQ scores. One of the purposes of administering a short form is to
reduce the test fatigue of geriatric patients; however, this research examined patients who were
administered the full 11-subtest WAIS-III and then short form IQ scores were calculated by
re-scoring the original protocol. Further research is needed to determine whether administering
only the selected subtests has an effect on patient fatigue and estimated IQ scores.
This study supports the limited use of short forms of the WAIS-III in evaluations of geriatric
patients with suspected dementia when the full form WAIS-III cannot be administered. If a
clinician deems it is appropriate to use a short form version of the WAIS-III, then caution
should be exercised when choosing which short form best complements the purpose of the
assessment. While there are other options for short-form estimates of IQ scores available
to clinicians (e.g., WASI), previous research has suggested that abbreviated versions of the
WAIS-III obtain higher levels of clinical accuracy than the WASI when estimating WAIS-III
IQ scores (Axelrod, 2002). The present research suggests that the highest level of accuracy
when estimating WAIS-III IQ scores is achieved with seven-subtest versions. In particular, the
seven-subtest versions provided by Ward (1990) and Sattler (2001) met the stringent a priori
level of clinical accuracy for estimating all three IQ scores and it is recommended seven be the
minimum number of subtests used to estimate IQ scores with geriatric patients with suspected
early dementia.
Acknowledgement
This study was supported by a Mental Health Studentship from the Alberta Heritage Foundation for Medical Research (AHFMR) to the first author. The authors would like to thank Dr.
B.L. Brooks, L.E. Weaver / Archives of Clinical Neuropsychology 20 (2005) 1043–1051
1051
Charles T. Scialfa at the University of Calgary for his assistance with the statistical analyses
and helpful comments regarding the manuscript, as well as Norma Cassini (past director) and
Dr. Patricia Jean in the Seniors’ Health Ambulatory Care program at the Rockyview General
Hospital.
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