Performance on the California verbal learning test following right hemisphere stroke: a longitudinal study.(Clinical report)

Purpose: This longitudinal study examines performance of individuals with right hemisphere damage (RHD) on the California Verbal Learning Test (CVLT). Method: 18 participants were administered the CVLT during the acute phase (<3 months post onset) and then at subsequent times up to 2 years post onset. Results: Using List A, Trials 1-5, as a global measure of learning, participants at first testing demonstrated recall skills below the mean standard score of 50 (M = 32.56, SD = 13.90). There was significant improvement between initial and second testing (t = -2.92, p = .01). Changes between second and third testing and third and fourth testing were not significant. Key words: longitudinal, right hemisphere damage, stroke, verbal learning, word list recall

There have been few longitudinal studies that have tracked recovery of cognitive function in patients with right hemisphere stroke. These studies have focused primarily on general cognitive abilities and outcome (1-3) or have provided detailed information about specific aspects of learning and memory, but for only 3 months post stroke. (4) The purpose of this study is to assess performance on word list recall over a 2-year period in 18 individuals with right hemisphere damage after stroke. The participants followed in this study are a subset of those patients described in a previous article in Topics in Stroke Rehabilitation. (5) Information that addresses changes in new learning and recall over time is important for rehabilitation clinicians who work with patients with stroke.

Method

Participants

A total of 18 patients (13 males, 5 females) with unilateral right hemisphere damage following stroke participated in the study. The unilateral right hemisphere damage was confirmed by CT scan and clinical medical examination. Etiology was ischemic in 14 patients and hemorrhagic in 4 patients. Clinical CT scans were available on 12 patients, all of whom showed some right parietal involvement: 7 with frontoparietal lesions, 2 with temporoparietal lesions, 2 with frontotemporoparietal lesions, and 1 with temporoparietooccipital lesions. Subjects had at least an eighth-grade education, spoke English as a primary language, and were right-handed. The mean age was 66.38 (5D = 3.69), and mean education level was 12.89 (SD = 2.19). The mean length of time post onset at initial testing was 30.06 days (SD = 13.31), with a range of 13 to 66 days.

Procedures

All participants were administered the California Verbal Learning Test (CVLT) (6) during the acute phase (<3 months post onset). The CVLT was readministered for seven patients at three additional times (6-9 months, 12-18 months, and >18 months post onset). Four patients had the CVLT readministered two additional times and seven patients had it re-administered at one additional time. Table 1 provides information regarding the time intervals at which each participant was evaluated.

The CVLT was administered by a trained research assistant. All administrations were videotaped and responses were transcribed on-line, checked for any discrepancies from the videotape, and then manually scored. Portions of the videotapes were randomly selected for review by one of the principal investigators to ensure procedural reliability. Similarly, selected score sheets were checked to …