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The Evolution of the Wechsler Memory Scale: A Selective Review

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Evolution of Wechsler’s Memory Scales: Content

and structural analysis

Phillip L. Kent

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APPLIED NEUROPSYCHOLOGY: ADULT
2017, VOL. 24, NO. 3, 232–251
http://dx.doi.org/10.1080/23279095.2015.1135798

Evolution of Wechsler’s Memory Scales: Content and structural analysis

Phillip L. Kent
Private Practice, Bettendorf, Iowa

ABSTRACT KEYWORDS
The Wechsler Memory Scale-1 was introduced to the professional community 70 years ago and has Assessment; memory theory;
been the most widely used standardized memory battery for over 50 years. Since its introduction, test development; Wechsler
the test has been revised three times, with the last revision occurring in 2009. Few clinicians are Memory Scale
aware that Wechsler developed a prior memory battery in 1917, which was used to assess retention
deficits in persons with Korsakoff psychosis. The purpose of the present article is to describe the
development of Wechsler’s memory scales from 1917 through 2009. Suggestions for the next
revision are offered.

When in 1907 the American Psychological Association

undertook through a committee the standardization
of psychological tests, the effort was spent mainly on
standardization of procedure. … As a result there
were produced tests of a fair degree of technical
merit.… … Now the pendulum is at the other extreme.
The emphasis is on standardization of results. Less
attention is often paid to the construction of the test
as such. (Wells, 1927)
Perhaps the chief obstacle to a more rapid analytical
development of tests has been the desire to express
results in quantitative terms is order to establish norms
for comparative purposes. To accomplish this aim …
investigators have been forced to posit and assume that
the particular test which they were standardizing tested
only one quality, as memory, imagination, form percep-
tion, or rate of movement. If, however, the investigator
was aware that other factors were involved … he failed
to give them the prominence and emphasis necessary
to prevent others from falling into the error of being
content to assume that only one quality is being
tested … . (Young, 1916)
When a life history (assuming it to be accurate) is in
disagreement with the “psychometric,” it is well to
pause before attempting a classification on the basis
of tests alone. (Wechsler, 1939)
The Psychological Assessment Work Group of the
Competencies Conference identified eight core compe-
tencies in assessment. … Childs and Eyde (2002)
analyzed program materials and course syllabi from
APA-accredited clinical psychology doctoral programs
in relation to many of those competencies. … Sixty
percent of programs covered validity and reliability. …
(Reported in Ready & Veague, 2014).
Introduction
Nearly a century ago, Wells (1927) criticized psycho-
logical tests for what would be described as their lack
of construct validity. He was echoing, to a certain
extent, the views of Young (1916), who criticized test
makers that pursued quantitative expression and stan-
dardization at the expense of content validity. Likewise,
Wechsler (1939) was critical of purely quantitative
approaches to assessment, especially those which failed
to take into account the person’s life history. He was
one of the earliest fighters in the battle between those
who espoused a quantitative as opposed to a qualitative
approach to assessment. In discussing the assessment of
intelligence, he recognized that factors other than
intellectual ability, such as drive and incentive, enter
into intelligent behavior. Even a cursory reading of his
seminal book on intelligence (Wechsler, 1939), and
his paper introducing the Wechsler Memory Scale
(Wechsler, 1945), reveals that Wechsler was well aware
that human behavior has multiple determinants. For
Wechsler, assessment was more than just testing. As
we shall see, theory, research and clinical observation
influenced Wechsler when he developed his
instruments.
Flash forward to the present. One would assume that
all neuropsychological tests these days would be firmly
anchored in an explicit theoretical base, and be
informed by our current understanding of brain-
behavior relationships and evidence-based practice (that
is, the best available research evidence bearing on
which tests best identify the specific neuropsychological
deficits of various clinical groups). Such is not the case.

CONTACT Phillip L. Kent plkent@mchsi.com 3630 Deer Springs Drive, Bettendorf, IA 62722, USA.
© 2017 Taylor & Francis Group, LLC

One need look no further than the Wechsler Memory
Scale-4 (WMS-4; 2009), which was published in 2009.
It is not anchored in an explicit theory of memory
(Kent, 2013), and the technical manual provides a
relative paucity of information regarding how the test
performs with various clinical groups. How is this poss-
ible, with all the push for theory- and evidence-based
practice in the past 20 years?
All current training models in doctoral clinical
psychology programs recognize the need for training in
science; the models differ primarily in how much empha-
sis is given to training in research and the scientific foun-
dations of psychology. At present, the dominant training
model in clinical psychology, the Practitioner-Scholar
model, primarily emphasizes preparation for a career
in clinical practice (Murray, 2000). An unintended
consequence of this model may be clinicians who are
not well-grounded in basic psychometric theory, and
who are thus unlikely to be able to intelligently read,
understand, and critique test manuals.
With the shift in emphasis on how most clinical psy-
chologists are trained, there is evidence that interest in
the history of psychology, and by extension, the history
of ideas, is on the decline. The only doctoral program in
the history and theory of psychology in the United
States ended in 2009. Concerns have been expressed
that we may be witnessing a decline in the number of
psychology departments teaching courses in the history
of psychology. Despite the decline in interest in the his-
tory of psychology, all APA-accredited programs
require coursework in history and systems of psy-
chology. By implication, it is implied that sound clinical
practice dictates that practitioners have a working
understanding of the theoretical foundations of the
instruments they use and the domains they assess. For
instance, if a clinician is using a test of memory, the
clinician should be conversant with the theoretical foun-
dations of the test, which components of memory are
purportedly being assessed, and why.
To understand test construction, one has to be fam-
iliar with the concepts of reliability and validity, and
how they are operationalized and measured. According
to a recent study by Childs and Eyde (2002) of APA-
accredited clinical psychology programs, only 60% of
the programs surveyed covered validity and reliability
when teaching psychological assessment. It appears that
a significant number of psychologists practicing today
are uninformed about these critical concepts, even
though they are considered part of the core competen-
cies in assessment. As a result of their lack of training,
they may fail to appreciate the complex relationship
between a test’s reliability and validity, and fail to grasp
that even though a test may be perfectly reliable, it may
APPLIED NEUROPSYCHOLOGY: ADULT 233
nonetheless invalid for the intended clinical use
(Sternberg, 1995). This trend in training, that is, the lack
of universal training in basic psychometric theory, is
alarming, and does not bode well for the future of
psychological or neuropsychological assessment.
By the time the original Wechsler Memory Scale
(WMS) was introduced in 1945, it had been in clinical
use since 1940 (Wechsler, 1945). By 1946, it was already
among the top 90 most frequently used tests (Louttit &
Browne, 1947). By 1969, the WMS was the nineteenth
most used test and the most used memory battery
(Lubin, Wallis, & Paine, 1971), and by 1994, the
Wechsler Memory Scale–Revised (WMS-R) was the
ninth most used test by clinical psychologists, and the
third most used test by neuropsychologists who conduc-
ted assessments five or more hours per week (Camara,
Nathan, & Puente, 2000). By 2011, it was among the
10 most popular psychological tests taught in clinical
psychology programs and the most frequently taught
memory battery (Ready & Veague, 2014). Suffice to
say, the WMS has “stood the test of time,” despite
ongoing concerns about its structure, lack of anchoring
in an explicit theory of memory, and a variety of other
concerns. Because the WMS has been in clinical use for
over 75 years, it is doubtful the average clinician is
aware of its historical roots, the theoretical rationale
for its original content, and how it has evolved over
time.
As far as the present writer could determine, this is
the first paper to trace the development of Wechsler’s
memory scales from 1917 through 2009. Since this
article focusses on Wechsler’s thinking about how to
assess memory, special attention will be paid to the
1917, 1945, and 1987 scales, since these were the ones
Wechsler directly developed (Wechsler, 1917, 1945,
1987). In 1946, a second version (the WMS-2) of the test
was published (Stone, Girdner, & Albrecht, 1946). It is
unclear if Wechsler was an author of the WMS-2, since
he was not listed as an author in the original paper
describing the scale, although his name appears along
with Stone’s on the test manual. Since it is unclear if
Wechsler was an author of the WMS-2, the content of
the scale will not be discussed.
The Wechsler Memory Scale-3 (WMS-3) and
Wechsler Memory Scale-4 (WMS-4) list Wechsler as
author, although they were developed long after his death
by a team of psychologists connected with Pearson
Assessment (formerly The Psychological Corporation).
Although the WMS-3 and WMS-4 were not developed
by Wechsler, their content will be discussed to illustrate
how the WMS has evolved over time, and to identify
the problems that have plagued each revision. Due to
space constraints, the WMS-3-Abbreiated Form and the
234 P. L. KENT
WMS-4 Older Adult Battery will only be briefly
mentioned.
In terms of method of investigation, the present article
will review primary source material for Wechsler’s (1917,
1945, 1987) scales, and selected publications by Wechsler
relating to his conceptualizations of memory. In regard
to the WMS-3 and WMS-4, the analysis is based pri-
marily on a review of each scale’s administrative and
technical manuals, and a clinical guide to the use of the
WMS-4. This paper will address the adequacy of assess-
ment of memory, as exemplified by the Wechsler mem-
ory scales, in light of what is considered good clinical
practice. The terms test, scale, and battery will be used
interchangeably. The term WMS will be used generically
to refer to the scales bearing Wechsler’s name, with 1, R
(for revised), 3, and 4 referring to each version. Since
other writers have discussed the limitations of the
Wechsler scales in terms of reliability, validity, and stan-
dardization, these issues will not be discussed in depth.
Since there is no current gold standard on how to
assess memory, the following criteria will be used to
assess the adequacy of each of memory scales discussed
in this article. As the emphasis of the present paper is on
the clinical assessment of memory, it is assumed the
characteristics of an adequate assessment procedure
should include the following. Prior to formal memory
testing, a screening should be completed to ensure the
subject has adequate sensory and motor functioning,
is not aphasic or psychotic, and is sufficiently motivated
to be tested (Lezak, Howieson, Bigler, & Tranel, 2012).
As part of the screening procedure, attention should
be assessed using any of the major models of attention,
such as Mirsky’s (Koziol, Joyce, & Wurglitz, 2014), to
identify any deficits that might affect the subject’s mem-
ory functioning. After the screening is completed, it is
assumed that the clinician will primarily assess episodic
declarative or explicit memory.
Registration or short term and working memory
should be evaluated in verbal and nonverbal modalities
to determine the memory span of the individual, and
the capacity for the temporary storage and manipulation
of information (Baddeley, Allen, & Hitch, 2011). Encod-
ing (short term learning and recall) should be assessed
through the immediate recall of verbally and visually pre-
sented meaningful material (Lezak et al., 2012). Retention
of learned material should be assessed using measures of
delayed recall of verbally and visually presented material
via free recall and recognition paradigms.
The 1917 scale
In 1917, David Wechsler published a paper based on his
Master’s thesis which investigated retention in 5
patients with Korsakoff psychosis. His study was notable
because he identified a key deficit defining the condition
(the inability to form new associations), and because he
devised a verbal memory scale which was a precursor to
the WMS-1. His test battery was designed to assess if
defective retention in Korsakoff psychosis was due to:
1) impaired registration; 2) defective encoding or “a
failure to link new associations with old”; and 3) a
fading of associations, or forgetting and retention prob-
lems. For Wechsler, retention was basically synonymous
with memory. He defined retention as the ability to
reproduce new impressions after a given interval of
time. As part of the literature review to justify his
method of study, Wechsler cited the works of Ebbin-
ghaus (1885), Brodmann (1902), and other famous
memory researchers and clinical investigators. His test
was thus firmly anchored in the experimental and clini-
cal research of the day, as indicated by the structure and
content of his battery. As the reader is unlikely to be
familiar with Wechsler’s first memory battery, it will
be described in some detail. The battery consisted of
the following measures.
Screening
A Questionnaire was used to assess personal and
current information and orientation.
Registration
Auditory Memory Span for Digits consisted of digit
span forwards, beginning with a 4 digit series until 2
consecutive misses occurred; three lists were presented;
memory span determined by averaging scores across
three trials.
Auditory Memory Span for Unrelated Words was
assessed by measuring the subject’s recall of two lists
of concrete words. The lists ranged in length from 3
to 8 words. (It should be noted that Wechsler actually
stated the word lists ran from 4 to 8 words in his paper,
and the maximum score was 66. For the maximum
score to be 66, the word lists had to run from 3 to 8
words). Prior to being read the word list, the subject
was told how many words were in each list and that
he or she was expected to repeat the words in the same
order as presented by the examiner. One point was
awarded for each word recalled and one point was
awarded if the word was recalled in correct order. The
subject’s score was based on an average of the two lists.
The word lists were obtained from Pyle (1913).
Visual Memory Span for Movement was assessed by
administration of the Knox Cube Test and the Modified
Knox Cube Test. In the latter, the examiner touched

four or five cubes in a specific order and the patient was
asked to reproduce the specific sequence.
Method of Retained Members consisted of the repro-
duction of two lists of 10 unrelated (examples: red, dog,
buy) and two lists of 10 related (examples: river, water,
brook) word lists longer than memory span. The word
lists were obtained from Norsworthy (1906). Each word
list was read to the subject within one minute, and the
subject was expected to repeat the word lists. This
subtest was similar in nature to a paired associates test,
without the associates.
Encoding
Formation of Preformed Associates was a paired associ-
ate learning task. The subject was verbally presented a
list of 10 word pairs, which were considered easy associ-
ates, until the subject linked all the associates correctly
or until 20 trials had elapsed. If subject supplied an
incorrect associate, the examiner corrected the subject.
Two sets of word pairs were used.
Formation of New Associations was also a paired
associated learning task and consisted of the learning
of new paired associates, such as crush-dark and
school-grocery. The lists of new paired associates were
taken from an unpublished work of R. S. Woodworth
with some modifications. Wechsler used a list of 10
pairs of new or hard associates and a 5-pair list. The
subject was administered the aforementioned word lists.
Retrieval
Curve of forgetting for intervals of 15”, 30”, 60”, 1’, 3’,
and 10’
Assessing retrieval was accomplished through three
procedures. (1) Recall of a series of digits after a single
repetition: The digit series administered was unknown,
but described as one digit shorter than the subject’s
memory span. The subject had to repeat them immedi-
ately after intervals ranging from 15″–10′ 12 observa-
tions were made for intervals 15″–3′ and 6
observations were made for 10′; efforts were made by
examiner to prevent subject from rehearsing digits. (2)
Recall of colors after a single presentation: The colors
used for this procedure are unknown, except for
color-blind subjects, where the colors red, green, blue,
yellow were used. A color was shown and the subject
was asked to name it. The method of presentation for
colors was similar to digits. (3) Recall of single unrelated
associates after one repetition: The associates used are
unknown; the purpose of the procedure was to deter-
mine how fast a connection was lost between two unre-
lated associates established by a single repetition. Recall
APPLIED NEUROPSYCHOLOGY: ADULT 235
was tested at 15″, 30″, 1′, and 3′; 12 observations were
made for all intervals except 1’, for which 6 were made.
Discussion
Wechsler’s battery did not formally screen for aphasia,
or other conditions that would render his subjects
untestable, because the “screening” had been completed
by the physicians who diagnosed and referred the
patients to Wechsler for his study. Since Wechsler was
conducting a research study, it is understandable
he did not complete a formal screening procedure.
Wechsler did, however, use a questionnaire to collect
information regarding each subject’s personal and cur-
rent information, and orientation. This information
was qualitative, and presented in his clinical descrip-
tions of the six patients (five with Korsakoff psychosis
and one with general paralysis (presumably general
paresis) who participated in his study.
In regard to assessing registration, Wechsler’s (1917)
test was unusual in that it used several measures (recal-
ling digits, unrelated words, and movements) to
accomplish this goal. Even though he noted that all tests
were auditorily presented, the Visual Span for Movement
appears to have assessed visual working memory. It is
unclear from his paper why he used the Method of
Retained Members, which consisted of assessing the sub-
ject’s recall of word lists longer than their memory span.
Wechsler spends very little time describing the procedure
in his article, but does make a reference to Whipple
(1915) who describes this method as a measure of rote
memory. Whipple (1915) states that the length of series
is chosen so the subject cannot attain complete mastery,
and also notes that many span tests “ … actually become
tests of the degree of mastery” (p. 151). By this, he pre-
sumably means rote learning. The measures Wechsler
chose to assess registration would currently be con-
sidered measures of short term and working memory.
In regard to the Method of Paired Associates, it is sig-
nificant to note that he included “preformed associates”
and “new associations.” Preformed associates contained
word pairs which “ … stood in some simple logical
relations and had been strongly established through
frequency of previous association, e.g., come-go,
lead-pencil, metal-iron … ” (Wechsler, 1917, p. 420).
They are considered easy associates, and presently would
be considered a measure of semantic memory. New
associations (i.e., associates) were unrelated word pairs.
Unrelated word pairs were used to assess if his subjects
could form “new” associations, which was felt to be the
essence of encoding. New associates were considered
hard associates. Wechsler wanted to test the hypothesis
that people with Korsakoff’s might evince a difference
in their ability to learn both types of word pairs, and
236 P. L. KENT

indeed this was the case. He found that his subjects’ (i.e., The Wechsler Memory Scale-1
persons with Korsakoff psychosis) performance on
Approximately 30 years after his first memory battery,
preformed associates was essentially normal, and their
Wechsler (1945) introduced the Wechsler Memory
performance on new associates impaired. It is significant
Scale-1 (WMS-1) to the professional community. He
to note that the reasoning for his inclusion of both word
had released the Wechsler-Bellevue Intelligence Scale
pair types, which were also used in the WMS-1, was not
(WBIS) in 1939. During the time Wechsler was working
included in the 1945 test manual. The purpose for
on the WBIS, he was developing the WMS-1. Wechsler
including both paired associate types appears to have
states he worked intermittently on the scale for 10 years,
gone largely unnoticed in the clinical literature on the
which suggests he began work on the scale in about
WMS. The paired associates test was administered up
1935. According to Wechsler, he wanted a scale which
to 20 trials or until the subject was able to recall all the
was “rapid, simple, and practical.” The manual for the
word pairs correctly, so it was in essence a paired associ-
WMS-1 runs a scant nine pages, and no data are pre-
ate learning test. Paired associate learning procedures
sented about its reliability or validity. It should be
were assumed to be an index of a person’s ability to learn
remembered, however, that the test was developed dur-
new information. Thorndike (1908) noted that quick
ing World War II, and was intended for the assessment
learners are good retainers, and Wechsler cited
of soldiers and sailors with head injuries.
Thorndike in his study.
It is important to emphasize that Wechsler was a
As noted, Wechsler assessed retrieval/forgetting by
pragmatist when it came to test selection. Pragmatism,
examining the recall of digits, colors, and single associ-
along with theory, guided his selection of WBIS and
ates after one repetition (1917). Wechsler was strongly
WMS-1 subtests. He wanted tests which were clinically
influenced by the work of Ebbinghaus (1885) in his
useful, easy to administer, and which related to real
effort to systematically assess retrieval/forgetting. He
world behaviors. He was well aware of the need for tests
used multiple learning trials and time intervals up to
to have ecological validity.
10 minutes to assess this process. Wechsler explicitly
In the introduction to the manual, Wechsler refers to
designed his 1917 test to be a verbal memory battery,
the Memory Examination described in Wells and
since previous research had suggested that patients with
Martin (1923) and Wells (1927), which he considered
Korsakoff’s may have deficits in “the range of visual
unsuitable for clinical work, although he adopted the
perception” (Wechsler, 1917, p. 417).
term mental quotient (MQ) for his scale from Wells.
He described the mental quotient as being analogous
Interim summary
to the intelligence quotient.
Wechsler’s first memory battery was remarkably exten-
Although Wechsler was developing the WMS-1
sive. Based on the criterion for a sound memory exam
along with the WBIS, there is no mention of the former
discussed earlier, he used multiple measures (verbal
in his book describing the development of the WBIS,
and nonverbal) to assess registration or short term
although he does reference his 1917 scale (Wechsler,
and working memory, including a test to assess memory
1939, p. 68). Wechsler presented the following table in
for “words longer than memory span.” He used easy
his book, which was based on a similar table by Wells
and novel paired associate tasks to tease out the exact
(1927). Table 1 presents Wechsler’s review of the litera-
nature of encoding deficits, although he did not assess
ture summarizing how various diagnostic groups had
the delayed recall of visually presented material except
historically performed on some standard psychological
colors. He systematically investigated forgetting/
tests. As we will see, he obviously used the table to guide
retrieval across intervals ranging from 15 seconds to
his subtest selection, although this is not explicitly
10 minutes, although he did not utilize recognition
mentioned in his 1945 manual.
techniques. Nowhere in Wechsler’s paper is there a ref-
The WMS-I was comprised of seven subtests. They
erence to his theory of memory, if he had one. Despite
will be briefly presented.
this, his work was clearly anchored in the experimental
and clinical research of the day. His descriptions of
Screening
patients indicate that he differentiated between memory
for old events and recent events, and he was aware that Personal and current information
even though he used a test called Visual Memory Span This subtest was derived from a standard mental status
for Movement, because it was auditorily presented, it exam; six items are similar in nature to those used in
did not primarily assess visual memory span. His the Wells and Martin (1923) Memory Examination.
research was influenced by the associationist school of Wechsler included this subtest to identify people with
memory, as described by James (1890). suspected aphasia and dementia.
 APPLIED NEUROPSYCHOLOGY: ADULT 237

Table 1. Intellectual disabilities in different mental disorders as indicated by low score performance on different tests.
Schizophrenia General Paresis Organic brain syndrome Korsakoff’s Senile dementia
Vocabulary – – * – X
Current information – – X X X
Sentence repetition – X * – X
Paragraph recall X X X X XX
Digits forward – X XX X X
Digits backward – X XX XX XX
Easy associates – X X * X
Hard associates X X XX XX XX
Counting backwards * X XX * X
Block design * X XX X X
Design reproduction * X XX XX XX
Gestalt test (1) * X X X XX
Note. Revised and Adapted from Wechsler, 1939, p. 68. – ¼ No significant decline; X ¼ Poor XX ¼ Markedly poor. *Often poor, but sometimes unaffected (1):
Gestalt test ¼ Bender Gestalt Test.

Orientation Associate learning

This subtest was derived from a standard mental status This subtest consists of 10 paired associates (six were
exam; five questions were asked to assess the subject’s easy associates, four were hard associates). Subjects are
orientation to place and time. given three learning and recall trials. The word pairs
were derived from Wechsler’s (1917) scale.

Registration
Mental control
This subtest consisted of three items: counting
backwards from 20 to 1, counting by threes beginning
with 1 up to 40, and reciting the alphabet.
Memory span
This subtest was the same subtest used in the WBIS with
the exception that the maximum number of digits was
limited to 8 forward and 7 backwards. It is similar
to the Auditory Memory Span for Digits used in
Wechsler’s (1917) scale.
Encoding
Visual reproduction
This subtest was a measure of visual working memory,
although it was verbally and visually presented. The
content of the subtest was derived from the Binet scale
and the Army Performance Test. The subject was
presented three simple geometric designs, one at a time,
for 10 seconds. After the design was removed, the
subject was asked to draw the design from memory.
This test assesses visual short term memory as well as
motor functioning.
Logical memory
This subtest consisted of the immediate recall of
two verbally presented paragraphs consisting of mean-
ingful material. The paragraphs were modifications of
Passages 1 and 5 of the Army Performance Scale
(Government Printing Office, 1921).
Discussion
Wechsler was aware of the need to screen patients for
suspected aphasia, dementia and disorientation. He
included questions designed to identify these conditions
in the Personal and Current Information and
Orientation subtests.
Wechsler assessed registration through two subtests.
Mental Control is considered a measure of working
memory. Wechsler (1945) considered it to be harder
than Memory Span and used it to assess “cases of
organic brain disease that are not too far gone but show
defects which would not be made evident by simple rote
memory items” (pp. 87–88). In his 1939 book, Wechsler
noted that although digit span had long been used by
psychiatrists as a measure of retentiveness, or the ability
to learn new information, he cited research that
indicated digit span backwards problems correlated
with difficulties with attention and concentration. He
also noted that a modest digit span forward capacity
was associated with people with limited intelligence
and certain organic conditions. Wechsler deliberately
used the combined the scores of digit span forward (rote
memory) and backward (attention) to minimize the
amount each contributed to the total score. Nonetheless,
it appears he included both digit span forwards and
backwards so clinicians could use these scores to assess
different parameters of functioning, although this is not
clearly stated in his 1945 manual. Wechsler likely
assumed that users of his scale were familiar with the
WBIS and had read his book describing the develop-
ment of the test, since it was expected that each patient
had to be administered the WBIS so IQ-MQ compari-
sons could be made.
238 P. L. KENT
Visual Reproduction, in assessing the immediate
recall of simple geometric designs after exposure of 10
seconds, appears to be a measure of the ability to encode
and recall visually presented material. Logical Memory
assessed the encoding and recall of two verbally pre-
sented paragraphs containing meaningful information.
The use of “logical memory” (or paragraph recall) tech-
niques dated back to the nineteenth century. As noted,
the Associate Learning subtest (previously called the
Formation of Preformed and New Associates), was
derived from Wechsler’s (1917) scale. The purpose of
the subtest was to assess how quickly the subject could
learn new information.
Scores from the seven subtests were added up to
obtain a raw score, to which a constant was added based
on the subject’s age group. This weighted score was then
converted to a MQ. Since the WMS-1 MQ had been
standardized against the Full Scale IQ of the WBIS, it
was assumed that MQs significantly lower than IQs
indicated memory dysfunction, an assumption that
has been questioned in the literature (see, for instance,
Dennis et al., 2009). It is noteworthy that Wechsler
never explicitly stated how large the IQ-MQ disparity
had to be to be clinically significant, although it prob-
ably was 1 standard deviation. As has been noted
elsewhere, the WMS-1 has been extensively criticized
for lack of information regarding its reliability and val-
idity (Hall & Toal, 1957), limited standardization
(Lezak, 1976), and a variety of other issues.
The astute reader will note a striking correspondence
between Table 1 and the content of the WMS-1. It is
clear Wechsler chose subtests because the research
and clinical literature suggested various clinical groups
had defects in those domains. This use of the research
and clinical literature was a procedure which would
currently be called an evidence-based practice.
In comparison to the 1917 scale, the two overlapped
in formally assessing auditory digit span and paired
associate learning. Both contained screening ques-
tions. Each assessed the domains of registration and
encoding.
Factor analytic studies of the WMS-1 revealed it
assessed 2 factors: memory and attention and concen-
tration (Kear-Colwell, 1973). It was primarily a measure
of short term, episodic declarative verbal memory.
Interim summary
In many ways, Wechsler’s (1917) scale was superior to
the WMS-1. Compared to the WMS-1, the 1917 scale
did a more thorough job of assessing short term mem-
ory. In regard to encoding, although both batteries used
the paired associates procedure, the 1917 scale consisted
of many more learning trials. Up to 20 trials were
administered, compared to three for the WMS-1. The
1917 also did a good job of assessing retention over time
periods up to 10 minutes. The 1917 scale was more
explicitly linked to the experimental and clinical mem-
ory assessment literature than the WMS-1. Neither test
was anchored in an explicit theory of memory. The
WMS-1 did not present any data about how the test per-
formed with various clinical groups, like people with
dementia, head injuries, and so forth. The WMS-1
was designed to be a rapid assessment device to be used
in clinical, as opposed to research settings, and it
achieved that goal. It was developed at the same time
as the WBIS, and overlapped in content, to some degree,
with Wechsler’s (1917) scale. Wechsler designed the test
as a screening instrument, and its content was dictated
by what was known about the cognitive deficits of
people with various neurocognitive disorders including
schizophrenia, organic brain syndromes, Korsakoff’s
due to alcoholism, general paresis, and dementia in per-
sons 65 or older. With the WMS-1, Wechsler evaluated
registration or short term and working memory using
verbally and visually presented information. Encoding
was assessed using Visual Reproduction, Logical Mem-
ory, and Paired Associates. His test was notably
deficient in not formally evaluating long term retrieval.
The WMS-1 was primarily a measure of short term
verbal memory.
The Wechsler Memory Scale-revised
The WMS-R was published in 1987, six years after
Wechsler died, and 42 years after the publication
of the original scale. According to the test manual,
Wechsler was listed as author of the test because he
was extensively involved in its revision. He began work
on the revision in the late 1970s, and was responsible for
the major changes in the instrument (Wechsler, 1987).
By the time the revision was published, virtually every
aspect of the original scale had received numerous
and scathing criticisms. For example, the WMS-1 was
criticized for lacking information about its reliability
and validity (Cohen, 1950; Hall & Toal, 1957), standar-
dization issues involving provisional and limited norms
(Prigatano, 1978), scoring issues (Mack, 1986), and use
of a Memory Quotient (Lawrence, 1984). The scale was
also criticized for its lack of theoretical adequacy, and as
it aged, its failure to reflect advances in the state of
knowledge about memory functioning and neuropsy-
chological functioning. Lezak (1976), in discussing
verbal memory and learning tests in general, wrote: ” …
the examiner’s choice of memory tests must depend
more on his clinical judgment than on scientific demon-
stration that this or that test is most suitable for

answering the question under concern” (p. 356).
Clearly, she was not talking just about the WMS-1.
By the time the revision was published, it was esti-
mated that the number of revisions or variations of
the original scale exceeded 50 (Kent, 1992). The most
popular revision was that by Russell (1975), which con-
sisted of immediate and delayed recall of the Logical
Memory and Visual Reproduction subtests. Despite
numerous criticisms in the professional literature, the
original scale is still occasionally used for clinical and
research purposes (for example, see Ardila, 1999).
Between the original scale and its first official revision,
there had been explosion of knowledge in the fields of
neurology, biology, and neuropsychology. Clinical neu-
ropsychology had come of age, and major findings
emerged about our understanding of memory, partly
due to the pioneering investigations of Scoville and
Milner (1957) and their study of H. M., and the work
Penfield and Jaspers (1954) on brain mapping. By the
early 1980s, the neuroanatomical substrates of memory
were being identified (Luria, 1976; Squire, 1982).
Responding to many criticisms of the WMS-1, the
WMS-R was designed to assess memory for verbal
and figural stimuli, meaningful and abstract material,
and delayed as well as immediate recall (Wechsler,
1987). The WMS-R contained a series of brief subtests
with each purportedly designed to measure a different
facet of memory. The subtests are presented in the
following sections.
Screening
Information and orientation questions
This test was used for screening purposes and was not
included in scoring. It contained questions about bio-
graphical data, orientation, and information from
long-term memory. It included seven slightly modified
questions from the WMS-1, and another seven ques-
tions assessing orientation, hand preference, and
sensory problems.
Registration
Mental control
This subtest involved counting backwards from 20 to 1,
saying the alphabet, and counting by 3’s from 1 to 40. It
used the same items as WMS-1, and was designed to
assess overlearned material. It also assessed verbal
working memory.
Digit span
This subtest was similar to tasks on the original scale,
except subjects begin repeating a series of digits of
APPLIED NEUROPSYCHOLOGY: ADULT 239
forward and backward series that were one digit shorter
than WMS-1 version. The subtest assessed attention and
verbal short term and working memory.
Visual memory span
This test was intended to be a visual analogue of Digit
Span. The subject was asked to touch a series of colored
squares in a predetermined order, which had first been
demonstrated by examiner. The test purportedly
measured visual short term memory.
Encoding
Logical memory 1
This subtest consisted of the immediate recall of two
verbally presented paragraphs of meaningful material.
One paragraph was derived from the WMS-1; the other
was a new story.
Verbal paired associates 1
The subtest contained the same paired associates
(Associate Learning) used in the WMS-1, with the
exception that eight rather than 10 pairs were adminis-
tered. The eight pairs consisted of four easy and four
hard associates. Two easy word pairs were eliminated
to shorten the test. The examinee was given up to six
trials to learn the pairs to the criterion of one perfect
repetition. Only the first three trials were scored.
Figural memory
The subject was shown a set of abstract designs, and
after each set was removed, the subject was asked to
identify the designs within a group of larger designs.
The subtest appeared to assess learning and recall of
visually presented material, via a recognition paradigm.
In constructing this test, it was assumed that the
abstract stimuli would be difficult to verbally encode.
Visual paired associates-1
This subtest was developed as a visual analog to Verbal
Paired Associates. The subject was required to learn the
color associated with each of six abstract line drawings.
To minimize the role of verbal mediation in memoriza-
tion and responding, the color names were not used in
presenting the items or responding to them. Up to six
learning trials were presented until the subjects
answered all six items correctly, although only the first
three presentations were scored.
Visual reproduction 1
This subtest was similar to the Visual Reproduction
subtest from the WMS-1. The subject was asked to
immediately draw simple geometric designs following
240 P. L. KENT
a 10 second exposure. One item from the WMS- scale
was dropped, and two new added. The scoring was
revised from the WMS-1.
Retention
Logical memory 2
This subtest consisted of a delayed-recall trial 30 minutes
after Logical Memory I was administered. It assessed the
delayed recall of the encoding of two paragraphs of
verbally meaningful material.
Verbal paired associates 2
This subtest consisted of a delayed-recall trial 30 minutes
after Verbal Paired Associates I was administered. It
assessed the delayed recall of a person’s ability to encode
and retain easy and hard associates.
Visual paired associates 2
This subtest consisted of a delayed-recall trial 30 minutes
after Visual Paired Associates 1 was administered. It
assessed the delayed recall of the encoding of visually
presented abstract drawings.
Visual reproduction 2
This subtest consisted of a delayed-recall trial 30 minutes
after Visual Reproduction I was administered. It
assessed the delayed recall of the encoding of simple
geometric drawings and motor ability.
Discussion
In general, the WMS-R was a significant improvement
over the WMS-1. No longer was the WMS merely a
measure of short term verbal memory. The directions
for administration and scoring were significantly
improved. The WMS-1 had been normed on “approxi-
mately” 200 males and females aged 25–50, to which a
correction was added to extend its use to age 64.
Remarkably, although the WMS-R was normed on
16–74 year olds, it used extrapolated norms for some
age groups, and was based on a sample of only 316
people. The small norming sample was surprising, in
light of the resources of the Psychological Corporation,
the amount of time that had occurred until the first
revision, and the popularity of the scale. As we have
seen, the content was updated, an attempt to measure
non-verbal memory was made, and measures of delayed
recall were added. Although the manual presented data
on WMS-R scores with selected clinical groups, the
group sizes were small and samples of convenience,
thereby limiting the clinical usefulness of the infor-
mation. This was unfortunate, since the manifest
content of the scale had been significantly improved.
Due to the addition of some new subtests, clinicians
could now compute index scores for verbal memory,
visual memory, attention and concentration, delayed
recall. A general memory score, similar to a memory
quotient, could also be computed, but it was only based
on measures of immediate recall, a detail unlikely
appreciated by many test users.
In terms of content, the Information and Orientation
Questions were used for screening purposes, and no
longer entered into scoring, and the content of the subt-
est was revised to be more clinical useful. In regard to
registration, the Mental Control and Digit Span subtests
were carried over from the WMS-1 in revised form, and
an attempt was made to measure non-verbal memory
span in the form of the Visual Memory Span subtest.
Unfortunately, the new subtest had a significant verbal
component, although factor analysis indicated it loaded
on the Attention and Concentration factor (Wechsler,
1987, p. 75), helping to provide validation for that index
score. Assessing registration was significantly improved
compared to the previous scale.
In regard to encoding, the test now included
purported measures of verbal and nonverbal memory
functioning. Figural Memory and Visual Paired Associ-
ates 1 joined the Visual Reproduction 1, Logical
Memory 1, and Verbal Paired Associates 1 subtests. It
is unlikely many users understood why Wechsler
included both easy and hard associates in the paired
associate learning subtest. As noted, easy associates were
considered easy because they assessed what would pre-
sently be called semantic memory (or what some might
call crystallized intelligence); hard associates were felt to
assess the essence of encoding, or new learning.
While the WMS-1 assessed immediate verbal mem-
ory, the WMS-R was biased, on the surface, toward
assessing immediate visual memory. Unfortunately,
factor analytic studies discussed in the manual state
indicated that the WMS-R consisted of only two pri-
mary factors: a general memory and learning factor,
and an attention-concentration factor. Although the
factor analysis provided support for the use of the
General Memory Index, it did not support the assertion
of the author that the test measured memory for figural
stimuli, meaningful and abstract material, and delayed
recall. A later study by Franzen and Iverson (2000)
suggested the WMS-R assessed three factors: learning
and immediate recall of verbal and visual information,
attention and concentration, and orientation and the
ability to recall information from one’s personal history.
Once again, a delayed recall factor did not emerge.
Retention was assessed through the 30 minute
delayed recall of the Verbal Paired Associates 2, Logical
Memory 2, Visual Reproduction 2, and Visual Paired

Associates 2 subtests. Each delayed-recall subtest loaded
on the same factor with its immediate recall counterpart
(Wechsler, 1987, p. 76). Thus, although the WMS-R was
a significant improvement over the WMS-1 in terms of
manifest content and structure, the attempt to measure
delayed recall was not realized.
Interim summary
On the surface, in terms of content and structure, the
WMS-R was a significant improvement over the
WMS. The scoring and manifest content of the scale
were improved. Purported measures of delayed recall
were added. It was able to be used with a wider age
group (16–74 vs. 20–64 year olds). It was normed on
a larger sample of individuals (316 versus approximately
200). As we have seen, however, the WMS-R suffered
from a substandard norming procedure, as the standar-
dization sample was pitifully small. In addition, the
manual lacked good quality information about its utility
and validity with various clinical populations, and factor
analytic study reported in the manual did not support
that it assessed delayed memory. In light of the afore-
mentioned, it is perhaps not unexpected that a new
revision would arrive on the scene a mere decade later.
The first revision missed its mark.
Wechsler Memory Scale-3
The WMS-III was published in 1997. The instrument was
developed by a panel of experts employed by or consult-
ing with The Psychological Corporation. According to the
administration manual, the revision was based on an
extensive literature review and expert opinion (Wechsler,
1997). As can be seen from Table 2, there were 8 new
subtests (Faces 1 and 2, Family Pictures 1 and 2, Word
List 1 and 2, Letter Numbering Sequence, Spatial Span),
two of which were optional (Word Lists 1 and 2). In
addition, the Mental Control and Visual Reproduction 1
and 2 subtests, which had been part of the standard
WMS-R battery, were now optional. Three subtests new
to the WMS-R were eliminated (Visual Memory Span,
Visual Paired Associates, and Figural Memory).
Needless to say, the WMS-3 was a major revision. It
used a substantially larger normative sample based on
the 1995 census (see Table 3). Like its predecessor, the
new revision was responding to criticism of deficient
norming procedures and concerns about content. The
new revision was co-normed with the Wechsler Adult
Intelligence Scale-3. The test was designed to yield so
many scores that computer scoring was recommended.
Possibly in response to anticipated criticism of the time
it took to administer and score the instrument, an
abbreviated form of the instrument was published which
APPLIED NEUROPSYCHOLOGY: ADULT 241
reportedly cut the administration time to 20–25 minutes.
The abbreviated form will not be discussed further.
While scoring the WMS-R was relatively easy, brief
and straight forward, scoring of the WMS-3 was cum-
bersome and time consuming and yielded a multitude
of scores of questionable clinical significance (Kent,
2013). If the WAIS-3 or Wechsler Individual Achieve-
ment Test (WIAT) was also administered, as was often
the case, the clinician could make a wide range of com-
parisons between WAIS-3 and WIAT and WMS-3
scores. As the number of comparisons increased, so
did the likelihood of findings of statistically significant
differences. Again, the assumption was that if there
was a significant discrepancy between performance on
the WAIS-3 and performance on the WMS-3 (that is,
the latter being statistically significantly lower), this sug-
gested likely memory dysfunction. Researchers have
strongly criticized the practice of making assumptions
about discrepancies in functioning on IQ and tests of
memory (see, for example, Ardila, 1999).
For the first time, the publisher split the technical
manual (Psychological Corporation, 1997) apart from
the administrative and scoring manual (Wechsler,
1997). Few clinicians who purchased the WMS-3 prior
to 2002 are probably aware that the technical manual
was significantly updated in 2002 (Psychological
Corporation, 2002). In the first technical manual, the
publisher asserted that a confirmatory factor analysis
yielded three factors: (1) immediate and delayed audi-
tory memory; (2) immediate and delayed visual memory;
and (3) working memory. This conclusion was retracted
in the updated manual, which stated that factor analysis
had failed to confirm the immediate and delayed distinc-
tion. A confirmatory factor analysis by Millis, Malina,
Bowers, and Ricker (1999) revealed that the WMS-3
yielded the following three factors: (1) auditory memory,
(2) visual memory, and (3) working memory.
The WMS-3 contained the following subtests.
Screening
Information and orientation (Optional)
This subtest was similar to the previous version with the
exception that one question was reworded. It was
scored, but the score did not contribute to any index
or composite.
Registration
Letter number sequencing
This was a new subtest. A series of letters and numbers
were verbally presented, and the subject was asked to
242
Table 2. Wechsler’s memory scales across time.
1917 Scale WMS-1 WMS-R WMS-III WMS-IV-AB
Screening Questionnaire for personal and Personal & Current Information Information & Orientation Questions Information and Orientation-(O) Brief Cognitive Status Exam
current information, and Orientation (includes Mental Control) (O)
orientation
Registration Auditory memory span for digits Digit Span Digit Span Digit Span (O) Spatial Addition
Auditory memory span for Mental Control Mental Control Mental Control (O) Symbol Span
unrelated words Visual Memory Span Letter-Number Sequencing
Visual memory span for Spatial Span
movements
Method of retained members
Encoding Formation of preformed & new Associate Learning Verbal Paired Associates 1 Verbal Paired Associates 1 Verbal Paired Associates 1
associations Logical Memory Logical Memory 1 Logical Memory 1 Logical Memory 1
Visual Reproduction Visual Reproduction 1 Visual Reproduction 1 (O) Visual Reproduction 1
Visual Paired Associates 1 Faces I Designs 1
Figural Memory Family Picture 1
Word List 1(O)
Retention Curve of forgetting for intervals Verbal Paired Associates 2 Verbal Paired Associates 2 Verbal Paired Associates 2
using digits, colors, associations Logical Memory 2 Logical Memory 2 Logical Memory 2
Visual Reproduction 2 Visual Reproduction 2 (O) Visual Reproduction 2
Visual Paired Associates 2 Faces 2 Designs 2
Family Pictures 2
Word List 2(O)
Note. Core subtests in bold; optional subtests identified by (O); new subtests italicized.
 APPLIED NEUROPSYCHOLOGY: ADULT 243

Table 3. WMS age ranges, number of subtests, and norming procedures.

Time between Testing Time: Minutes
immediate and (does not include
Age range # Subtests delayed subtests scoring time Norming
1917 Scale Not applicable 7 Not applicable 30 Not normed
WMS-1 (1945) 20–64 7 Not applicable 15 “approximately” 200 normal males
and females aged 25–50; used
extrapolated norms to extend age
ranges; Memory Quotient scores
derived from comparison with
WBIS
WMS-R (1987) 16–74 13* 30 minutes 45–60 316 people based on 1980 Census;
norms for 18–19 years old, 25–34
years old, and 45–54 year old were
estimated; approximately equal
numbers of males and females;
subjects selected based on race
(White vs. Nonwhite), geographic
region, education, IQ based on
WAIS-R
WMS-3 (1997) 16–89 10 primary 25–35 minutes 100** 1,032 based on 1995 Census;
7 optional weighting procedures used to
extend sample to 1,250; subjects
selected based on age, sex, race/
ethnicity, educational level, and
geographical region; co-normed
with WAIS-3
WMS-4 (2009) 16–90 12 primary 1 20–30 minutes 65–80**** 1,400; co-normed with WAIS-4;
optional*** representative sample based on
2005 Census; co-normed with
WAIS-4
*The WMS-R Information and Orientation Questions not scored.
**Administration of complete WMS-3 battery.
***The WMS-4 Brief Cognitive Stats Exam scored, but results not used to calculate any index score; also, the CVLT-II could be administered to obtain the
Auditory Memory Index and supplement the Immediate Memory Index and Delayed Memory Index in the WMS-4 Adult Battery and Older Adult Battery.
****Time to administer including the 20–30 minutes needed between immediate and delayed subtests.

repeat back the series, stating the numbers first (in order
from lowest to highest), and then the letters in order.
The sequences ranged from 2 to 8 items, and three trials
were presented for each series. The test was discontin-
ued after the subject failed all three trials of an item.
This subtest measured verbal working memory.
Spatial span
This was a new subtest. The subject was asked to exactly
reproduce a series of tapping sequences on an array of
blocks which were first demonstrated by the examiner.
The series ranged from 2 to 9 blocks for the forward
and backward sequences. Two trials were administered
for each series. The test was discontinued when the sub-
ject missed both trials of spatial span forward and spa-
tial span backwards. Spatial span was a measure of
visual working memory and procedural learning.
Digit span (Optional)
This subtest is identical to the WAIS-3 version, and was
slightly modified from the WMS-R. Subjects were asked
to repeat a series of digits ranging from 2 to 9 forward,
and 2–8 backwards. Digit Span Forward was considered
a measure of attention and short term verbal memory
span; Digit Span Backwards was considered a measure
of working memory.
Mental control (Optional)
This subtest contained eight items like counting back-
ward from 20 to 1, saying the alphabet, and saying the
days of the weeks backward. This subtest was expanded
considerably from the WMS-R. It measured verbal
working memory.
Encoding
Logical memory 1
This subtest consisted of the immediate recall of two
verbally presented paragraphs of meaningful material.
Story A from the WMS-R was retained, with slight
rewording, and a new paragraph was devised which
was more neutral in emotional content than its prede-
cessor. There were slight modifications made to the
scoring procedure.
Faces 1
This was a new subtest. Each subject was presented a
series of 24 faces to remember. The subject was then
244 P. L. KENT
presented a series of 48 pictures which contained the 24
pictures the subject was asked to remember, and 24
foils. The subject was to identify the faces he or she
was asked to remember. This task involved the learning
and recall of visually presented faces using a recognition
format.
Verbal paired associates 1
This subtest contained eight new word pairs of hard
associates. The subject was read a total of eight word
pairs, one word pair every three seconds. During the
recall phase, the subject is read the first word of each
pair, and asked to provide the correct associate. If the
correct associate was not provided in five seconds, the
correct response was provided. Four learning trials were
given. This subtest was a verbally presented associative
learning task.
Family pictures 1
This was a new subtest. The subject was shown a series
of four drawing of family scenes, one at a time, for 10
seconds each, and told to study the picture and remem-
ber as much as possible about the scene. After all four
pictures were viewed, they were removed and the sub-
ject was asked to recall who was in each picture, where
they were in the picture, and what they were doing. The
test purportedly measured the immediate recall of visu-
ally presented, complex meaningful information, and
spatial memory. This test was designed to be a visual
analog of the Logical Memory subtest.
Word lists 1 (Optional)
This was a new subtest. It consisted of a list learning
task similar in nature to the California Verbal Learning
Test. The subject was read List A, which consists of 12
unrelated words and asked to recall as many words as
possible. Four learning trials were presented for each
trial. The subject was then read another word list (List
B) which consisted of 12, new unrelated words and
asked to recall as many words as possible. The subject
was then asked to recall as many words from List A
as he or she could. This test measured the recall of
a word list, after an interference task. It assessed the
temporal recall of verbally presented information.
Visual reproduction 1 (Optional)
Similar to previous versions, the subject was asked to
draw a visually presented design from memory. The
subtest was expanded to five designs, with several
designs retained from the WMS-R. This subtest pur-
portedly assessed visual short term memory of simple
geometric designs.
Retention
Logical memory 2
This subtest consisted of the delayed recall of the encod-
ing of two verbally presented paragraphs of meaningful
material. It was administered 25–30 minutes after
Logical Memory 1. Recognition memory was assessed
through asking the subject a series of yes and no ques-
tions about each paragraph.
Faces 2
A total of 25–35 minutes after the administration of
Faces I, the subject was presented 48 pictures, 24 of
which were the original faces to be remembered. The
subject was asked to identify the 24 faces he or she
was asked to remember for Faces 1. This task involved
the delayed recall of the encoding of visually presented
faces using a recognition format.
Verbal paired associates 2
After 25–30 minutes, the subject was presented the first
word of each word pair used in Verbal Paired Associates
1, and asked to provide the correct associate. A recog-
nition test was then presented: 24 word pairs were read;
the subject was then asked to answer yes or no if the
presented word pair was one of the original word pairs
used in Verbal Paired Associates 1. This subtest mea-
sured the delayed recall of the encoding of verbally pre-
sented paired associates via a free recall and recognition
format.
Family pictures 2
A total of 25–35 minutes after administration of Family
Pictures 1, the subject was asked to recall as many pic-
tures as possible, who was in the picture, and where they
were located. This task was a delayed recall measure of
the encoding of visually presented complex meaningful
information and spatial memory.
Word lists 2 (Optional)
A total of 25–35 minutes after the administration of
Word List 1, the subject was asked to recall as many
words as she or he can. This task measured the delayed
recall of the encoding of a verbally presented word list.
A recognition trial was then administered: 24 words
were read, which contained the 12 words presented in
Word List 1, and 12 new words. The subject was asked
to answer yes or no if the word was part of the original
list.
Visual reproduction 2 (Optional)
Administered 25–35 minutes after Visual Reproduction
1, the subject was asked to draw the five designs from

memory. The subtest presumably measured the delayed
recall of the encoding of visually presented information.
The subtest also contained a 48-item recognition task,
a copy task to screen for motor dysfunction, and a
seven-item discrimination task.
Discussion
As can be seen from the aforementioned information,
the WMS-3 was a significant revision of the WMS.
Although the administrative and scoring manual stated
it had six primary and five optional subtests, it actually
had 12 primary subtests assuming the delayed versions
of the primary subtests were administered. Screening
was accomplished through the Information and
Orientation subtest, which unfortunately, was now an
optional procedure. The subtest could be scored.
In regard to registration, the Digit Span and Mental
Control subtests were now optional; they were standard
procedures in the WMS-R. Working memory was now
primarily assessed via Letter Number Sequencing, a
measure of verbal working memory, and Spatial Span,
presumably a measure of visual working memory.
Encoding was assessed through the administration of
Logical Memory 1 and Verbal Paired Associates 1, as in
the WMS-R. In addition, two new primary measures
were introduced: Faces 1 and Family Pictures 1. Visual
Reproduction 1 was now an optional subtest, and the
WMS-3 introduced another optional new subtest called
Word List 1, which was similar to the California Verbal
Learning Test.
Retention was assessed through Logical Memory 2,
Faces 2, Family Pictures 2, and Verbal Paired Associates
2. If administered, retention could also be assessed
through Word Lists 2 and Visual Reproduction 2.
On the surface, the content of the WMS 3 met the
criteria established earlier for an adequate clinical
assessment of memory, assuming one administered
the Information and Orientation subtest. The problem
is, what the test purported to measure, and actually
measured, did not correspond. As noted, like the
WMS-R, factor analysis revealed that the WMS-3 did
not assess delayed recall (see Table 4), although it did
assess auditory, visual, and working memory.
Although the publisher acknowledged that the
WMS-3 did not assess delayed recall, it nonetheless
recommended the continued use of the immediate
and delayed index scores “on the basis of both clinical
and theoretical considerations” (Psychological Corpor-
ation, 2002, p. 102). This recommendation was remark-
able for a field which had been urging its practitioners
to engage in evidence based practice for at least two dec-
ades. Two other major problems with the WMS-3 were
the amount of time it took to administer the battery
APPLIED NEUROPSYCHOLOGY: ADULT 245
Table 4. Selected factor analytic studies of the Wechsler
Memory Scales.
Battery Factor analysis results
1917 Scale Not completed
WMS-1 2 factors: memory; attention/concentration (Kear-Colwell,
1973)
WMS-R 3 factors: learning & immediate recall of verbal and visual
material; attention & concentration; orientation & ability
to recall information from one’s personal history (Franzen
& Iverson, 2000)
WMS-3 3 factors: auditory memory; visual memory; working
memory (Millis et al., 1999; Psychological Corporation,
2002)
WMS-4 3 factors: auditory memory; visual memory; visual working
memory (Holdnack & Drozdick, 2009); 2 factors: auditory
learning/memory & visual attention/memory (Hoelzle et
al., 2011)
(about 100 minutes if the entire battery were given),
and the amount of time it took to score the test if a
computer based scoring program was not used.
Interim summary
Although improved on the surface, the WMS-3 was still
much the same test it had always been if one looked
strictly at factor analytic studies of the WMS-1, WMS-R,
and the WMS-3 (see Table 4). On the surface, like its
predecessors, it screened for sensory dysfunction and
disorientation, which could invalidate the test results.
It evaluated registration and encoding, and attempted
to assess retention, although it failed in this regard, such
as the WMS-R, using supporting factor analysis studies
as a criterion of success. The WMS-3 introduced a
number of new subtests, none of which were retained
in the WMS-4. Like its two predecessors, Verbal Paired
Associates, and Logical Memory were part of the core
battery. Mental Control, Visual Reproduction, and Digit
Span were also retained, but were now optional proce-
dures (see Table 3). An abbreviated version of the scale
was marketed, which significantly reduced the adminis-
tration time, but its use limited the amount of clinically
useful information available to the examiner. As noted,
the technical manual was split off from the administrat-
ive and scoring manual. A myriad of new scores of
questionable clinical utility could be derived and com-
parisons made to scores from the WAIS-3 and WIAT.
Scoring the WMS-3 almost mandated the use of a com-
puter-based scoring system. The length of time it took
to administer and score the test decreased its clinical
usefulness. In light of the aforementioned findings, it
is perhaps not surprising that the WMS-4 appeared 12
years later.
WMS-4
Like the WMS-3, the WMS-4 was revised based on
multiple concerns about its predecessor. In brief, the
246 P. L. KENT
WMS-3 was criticized as being too long, especially when
testing seniors; lacking factor analysis support,
especially for the visual memory index; difficulty with
subtest administration and scoring; and the question-
able content of several new subtests (Drozdick,
Holdnack, & Hilsabeck, 2011). In addition, there were
concerns about the reliability and the validity of some
subtests (Pearson, 2015). Like its predecessor, the
WMS-4 was revised using a team of assessment experts
associated with Pearson (Wechsler, 2009). Reviews of
the psychometric literature on shortcomings of the prior
instrument were completed, customer service data
examined, and a panel of researchers and experts on
memory were consulted to shape the new instrument.
Compared to the WMS-3, the WMS-4 technical
manual contains more information regarding the scale’s
linkages to the burgeoning literature on memory assess-
ment and advances in our knowledge of the neurologi-
cal underpinnings of memory functioning. The authors
of the scale clearly attempted to link theory with prac-
tice, although the new scale, like its predecessors, was
not based on a clearly articulated theory of memory.
A training video on how to administer the test was
developed, and supplemented by webinars on the test
development and administration. Scoring of some
subtests was revised.
The new scale includes an Adult Battery for persons
19–69 and an Older Adult Battery for persons 65–90. A
person who was 65 can be administered either battery,
although the latter is shorter because it contains fewer
subtests (Designs 1 and 2, Spatial Span, and Symbol
Span are not administered). In addition, several alterna-
tive batteries have been devised for special evaluations.
Tablet based administration is available. Computerized
scoring has been enhanced. For the first time, the
California Verbal Learning Test 2 scores can be used
in place of scores from the Verbal Paired Associates 1
and 2.
The manifest structure of the WMS changed once
again (see Table 2). Three new subtests were added
(Spatial Addition, Symbol Span, Designs 1 and 2), three
were revised (Logical Memory, Verbal Paired Associ-
ates, and Visual Reproduction), and eight subtests were
eliminated (Information and Orientation, Spatial Span,
Mental Control [it was rolled into an optional Brief
Cognitive Status Exam], Digit Span, Letter Number
Sequencing, Family Pictures, Word List, and Visual
Memory Span). For the first time, verbal working
memory is not assessed; instead, only visual working
memory is assessed through the Spatial Addition and
Symbol Span subtests.
The WMS-4 has five index scores (Auditory
Memory, Visual Memory, Visual Working Memory,
Immediate Memory, and Delayed Memory). Unfortu-
nately, factor analytic studies have once again not
supported separate immediate and delayed index scores.
Some factor analytic studies have indicated the scale has
either a 3 factor structure consisting of: (1) auditory
memory, (2) visual memory, and (3) visual working
memory (Holdnack & Drozdick, 2009); or a two factor
structure consisting of: (1) auditory learning/memory,
and (2) visual attention/memory (Hoelzle, Nelson, &
Smith, 2011).
The repeated failure of the WMS to assess delayed
recall has been noted by several researchers. According
to Hoelzle et al. (2011), this failure is due to a significant
shared variance between immediate and delayed mem-
ory tasks, and is consistent with psychometric theories
of cognitive ability based on factor analytic studies like
that conducted by Carroll (1993). It should be noted
that other popular tests of memory which purport to
assess delayed recall also suffer from this problem. For
instance, studies of the California Verbal Learning
Test-2 yields six factors, none of which is delayed recall.
One of the factors, general verbal learning, is composed
of several measures of level of immediate and delayed
recall and recognition (Strauss, Sherman, & Spreen,
2006). In a recent study of immediate and delayed
memory for verbal and visuospatial information involv-
ing over 100,000 verbal and visuospatial immediate and
delayed tests presented via the Internet to over 28,000
participants ranging in age from 11 to 80, factor analysis
yielded an immediate but not a delayed dimension
(Murre, Janssen, Rouw, & Meeter, 2013). Findings such
as these along with research involving brain imaging
have questioned the relationship between immediate
and delayed recall, and whether it is possible to assess
delayed recall, at least as it has been conceptualized.
The WMS-4, Adult Battery contains the following
subtests. The procedures described in the following
section were adapted from descriptions by Drozdick
et al. (2011).
Screening
Brief cognitive status exam (Optional)
This subtest was derived, in part, from the Information
and Orientation and Mental Control subtests of the
WMS-3. It was significantly revised and renamed, and
includes measures of orientation, time estimation, men-
tal control, clock drawing, incidental recall, inhibition,
and verbal production. The test results are quantifiable,
and norms are available based on one’s age and level of
education. The subtest is the same for the Adult and
Older Adult Batteries.

Registration
Spatial addition
This subtest is a measure of visual and spatial working
memory. It is a subtest based on the n-back
procedure. In brief, the subject is shown two grids,
each for five seconds. Each grid contains a red and/
or blue circles and the subject is told to pay attention
to where the blue circles are located across the grids,
while ignoring the red circles. The subject is asked to
mentally combine the blue circles across the grids.
The subject is expected to reproduce the combined
grids by placing a blue card on the appropriate cell
on the record form.
Symbol span
This subtest is another measure of visual working mem-
ory and the mental manipulation of visual details. The
subject is shown a series of designs for five seconds
and asked to recall and select the correct designs in
sequence from a larger array of designs.
Encoding
Logical memory 1
This subtest consists of two verbally presented stories.
After the presentation of each story, the subject is
instructed to retell the story, starting at the beginning.
This subtest assesses the encoding and immediate recall
of two verbally presented meaningful paragraphs.
Verbal paired associates 1
The subject is administered a list 14 paired associates,
four of which are easy, and 10 of which are hard. The
word pairs are administered in varying order. The sub-
ject is then given the first word of each word pair, and is
expected to provide the correct associate. Four word
pair trials are given. This is a classic associative learning
task of verbally presented word pairs, and assesses the
encoding and immediate recall of semantically-related
and unrelated word pairs.
Visual reproduction 1
The subject is presented five designs, one at a time, and
asked to draw each design immediately after its presen-
tation. Each item is presented for 10 seconds. This subt-
est assesses the encoding and immediate recall of simple
geometric designs.
APPLIED NEUROPSYCHOLOGY: ADULT 247
Designs 1
For this subtest, the subject is shown a grid with four
designs in the grid cells for 10 seconds. A blank grid
and eight cards are then given to the subject, and the
subject is expected to select the correct cards and to
place them on the blank grid in the same array as
demonstrated earlier. This procedure is repeated four
times with four new grid patterns. This test assesses
the encoding and immediate retrieval of visual details
and visual-spatial locations of geometric designs. For
detailed instructions on test administration, please
consult the test manual.
Retention
Logical memory 2
Administered 20–30 minutes after Logical Memory 1,
this subtest assesses the delayed encoding and recall of
two verbally presented meaningful paragraphs.
Verbal paired associates 2
Administered 20–30 minutes after Verbal Paired
Associates 1, a delayed recall measure is given of the
14 word pairs. A recognition test is then administered
in which the subject is asked to correctly identify the
14 word pairs out of a list of 40 word pairs. This test
assesses the delayed encoding and recall of semanti-
cally-related and semantically-unrelated word pairs
using free recall and recognition procedures.
Visual reproduction 2
Administered 20–30 minutes after Visual Reproduction
1, this subtest assesses the delayed encoding and recall
of simple geometric designs. It also has a recognition
procedure and optional copy procedure.
Designs 2
This test is administered 20–30 minutes after immediate
recall, and contains a recognition trial. The subject is
asked to recreate the four designs he or she was shown
during Designs 1. This measure assesses the delayed
encoding and recall of visual details and spatial loca-
tions of geometric designs.
Discussion
This discussion will concentrate primarily on the con-
tent of the Adult Battery, listed in the previous section.
In regard to screening, the Brief Cognitive Status Exam
248 P. L. KENT
remains an optional procedure, and it has been con-
siderably enhanced compared to the WMS-3 version.
The results are quantifiable and provide some infor-
mation about the subject’s functioning. As noted, norms
are available to analyze the subtest scores based on the
subject’s age and level of education.
Registration is assessed through two new subtests
(Spatial Addition and Spatial Span). No attempt is made
to measure verbal working memory. It is significant to
note that if a poorly trained examiner used only the
WMS-4 to assess working memory, information critical
to many individuals’ functioning might be missed. This
situation could occur, for instance, for Social Security
disability examinations when an applicant alleges mem-
ory problems. In the region where the present writer
practiced, sometimes these examinations are completed
by a sub-doctoral school psychologist under the purview
of a doctoral level psychologist.
Encoding is now assessed through four subtests, two
assessing auditory memory (Logical Memory 1 and
Verbal Paired Associates 1), and two assessing visual
memory (Designs 1 and Visual Reproduction 1). If the
California Verbal Learning Test 2 is administered before
or after the WMS-4, then scores from that instrument
can be substituted for scores from the Verbal Paired
Associates 1 and 2.
Retention is assessed after a period of 20–30 minutes
through administration of the delayed versions of the
subtests administered during the encoding phase. As
noted earlier, the WMS-4 assesses retention through a
combination of recall and recognition procedures.
Recall and recognition procedures are used for Logical
Memory 2, Verbal Paired Associates 2, Designs 2, and
Visual Reproduction 2 subtests. In addition, Verbal
Paired Associates 2 has an optional word recall pro-
cedure, where the subject is asked to recall words from
the word pair list without the constraint of correct word
pairing, and Visual Reproduction 2 has an optional
copy procedure wherein the subject is shown the
original stimuli and is asked to replicate the design
while it is displayed (Drozdick et al., 2011).
Interim summary
In some ways, the WMS-4 is the most radical of all the
revisions. Lezak et al. (2012) consider it a whole new
test, raising the issue to what extent validity studies
of previous versions apply to the present test. It no
longer measures verbal working memory. Although it
can be administered in significantly less time than
the WMS-3, but still takes longer to administer and
score than the WMS-1 and WMS-R. For the first time,
the test can be administered by a tablet in an
interactive fashion. The comparability of tablet admin-
istration compared to traditional paper and pencil
administration is open to debate. To the best of this
writer’s knowledge, most all of the factor analysis stu-
dies of the WMS-4 to date have been based on the tra-
ditional administration method. Tablet administration
changes the stimulus value of the test, and likely what
it measures. Like its immediate predecessor, the WMS-
4 allows the clinician to calculate a myriad of scaled,
index, process scores. In a popular guide on how to
administer and interpret the test, Drozdick et al.
(2011) list 56 possible scores! The actual clinical use-
fulness of these scores to the average, busy clinician
in these days of managed care is questionable.
Conclusions and recommendations
It has been said that the more things change, the more
they stay the same. In some ways, this aphorism applies
to the content of the WMS. Looking only at the results
of the cited factor analysis studies, it is significant to
note that after three decades of trying, the WMS still
does not measure delayed recall. Although this finding
is well known to researchers in the field, it is not known
just how well this finding has been disseminated to the
clinical community, since even a cursory examination of
psychological and neuropsychological reports reveals
clinicians talk about immediate and delayed recall when
reporting WMS findings. In fairness, the WMS is not
the only test of memory which suffers this shortcoming.
As noted, even such popular tests as the California
Verbal Learning Test-II suffer from this shortcoming.
In light of the failure of the WMS and other tests of
memory to assess delayed recall (Carroll, 1993; Murre
et al., 2013), as validated by factor analytic studies, it
has been argued that the time has come to abandon this
measure until such time it can be reliably demonstrated
through carefully controlled research studies.
One problem in abandoning the purported measure-
ment of delayed memory is that regardless of its validity
based on the results of factor analytic studies, several
purported measures of delayed recall are useful for dis-
tinguishing various clinical groups. For example, Lezak
et al. (2012) note that diminished WMS-3 Verbal Paired
Associates II scores from the WMS-3 statistically dis-
tinguished between patients with temporal love epilepsy
who had left or right seizure foci, and Alzheimer’s
patients characteristically perform poorly on Logical
Memory II. Since the WMS has been in use for over
75 years, there has been a large amount of research on
how various scales and indices correlate with various
clinical groups, such as those with Alzheimer’s, Hun-
tington’s, epilepsy, and other types of brain impairment.

Pearson Assessments has advocated for the contin-
ued use of the immediate and delayed indexes, after
acknowledging that factor analytic studies have failed
to validate these indexes, apparently for the aforemen-
tioned reason: that despite the failure of factor analytic
studies to validate the immediate and delayed indexes,
research has demonstrated the clinical utility of the
indexes.
Delayed recall measures, as currently clinically con-
ceptualized, are more or less synonymous with long
term or permanent memory storage (Baddeley, Eysenck,
& Anderson, 2009). According to Lezak et al. (2012),
consolidation can occur immediately, or take a con-
siderable amount of time. Consolidation is a process.
The authors describe a type of short term memory that
can be distinguished from immediate memory in that it
lasts from an hour or so to one or two days, longer than
a reverberating circuit could be maintained by active
rehearsal. They describe this process as an intermediate
step, and it has also been described as an intermediate
phase (Tribhowan, Rucker, & McDiarmid, 1971), or
intermediate memory (Rucker, 1972). It appears that
when tests purport to assess delayed recall, they actually
are assessing the intermediate step or intermediate
memory, since most measures of delayed recall are
customarily assessed 25–35 minutes after tests of
immediate recall have been administered. Recommen-
dation 1: Based on the aforementioned analysis, it is
recommended that the delayed recall index be renamed
the intermediate recall (or memory) index.
On the surface, the WMS has been measuring the
right things since its beginning, with the exception of
the WMS-1 that did not assess delayed recall. All ver-
sions have recognized the need for screening the patient
for motor and sensory competence, language problems,
and attention and orientation. All versions have assessed
what we presently would call short term and working
memory. With the exception of the WMS-4, all versions
assessed verbal working memory through digit span, the
ability to encode and recall verbally presented logically
related material through Logical Memory, and the ability
to form new associations through Verbal Paired Associ-
ates. With the exception of Digit Span, all subtests which
were introduced in the WMS-1 have remained part of
the core battery, although they have vacillated from
revision to revision as to whether they are optional.
Although all core subtests have undergone changes in
their content, scoring, and administration over time,
the essence of what Wechsler was trying to measure with
his original battery (and to some extent, with his 1917
battery) remains remarkably unchanged.
In looking at the last two revisions, it is remarkable
how many new subtests have been eliminated and
APPLIED NEUROPSYCHOLOGY: ADULT 249
added. The addition and elimination of so many subt-
ests suggest that these measures were not properly
vetted during the standardization process. If history
repeats, it is anticipated that several of the new subtests
will not survive to the next revision.
The subtests which have survived nearly all iterations
of the WMS are: Logical Memory, Verbal Paired Associ-
ates, Digit Span, Visual Reproduction, Mental Control,
Personal and Current Information. These are also the
subtests that appear to have been most widely studied
across time, since they are repeatedly referenced by such
authorities as Lezak in all editions of her classic text-
book of neuropsychology. They are the essence of the
WMS, despite the fact that the most recent revision
dropped the verbal Digit Span subtest. Nearly all factor
analytic studies of the four versions of the WMS have
identified core factors relating to attention and concen-
tration and working memory, and learning and
memory.
Recommendation 2: Based on the above analysis, it is
recommended that the “core” of the next revision
include the aforementioned subtests, including Digit
Span. Along with this, it is suggested the test publisher
provide extensive documentation regarding the known
correlates between the aforementioned subtests and
various clinical groups to assist future clinicians and
researchers.
As noted, the amount of time it takes to administer
and score the WMS has been of concern to many clin-
icians, since in the last two revisions numerous new
subtests have been added and scoring has become
increasingly complex. Concern has expressed regarding
the large number of questionable scores that can be
derived from the WMS-3 and 4.
Recommendation 3: Based on the aforementioned
information, it is recommended that the test battery
be shortened, if possible, to be more patient and clin-
ician friendly. Ideally, testing, interpretation, and scor-
ing should take no more than an hour and one half.
In addition, interpretation should be made more
explicit and straightforward.
Repeated concerns have been expressed that none of
the versions of the WMS has been anchored in an
explicit neuropsychological memory theory or model,
consistent with evidence-based practice.
Recommendation 4: It is therefore recommended
that the next revision be anchored in an explicit neurop-
sychological theory or model of memory.
As noted, there has been ongoing concern about how
little useful information the WMS technical manuals
have presented about the test’s use with various clinical
groups. The data which have been presented are
frequently based on heterogeneous clinical groups of
250 P. L. KENT
small size, and which are often samples of convenience.
In light of the popularity of the WMS, the resources
available to the publisher, and the amount of research
which has been generated on various subtests from
the WMS since 1945, this shortcoming should be
addressed in the next revision.
Recommendation 5: It is recommended that the tech-
nical manual for the next revision contain extensive use-
ful information on how pertinent, well-defined, clinical
groups of adequate size (N ¼ 50 or more) perform on
the new instrument.
The importance of assessing prospective memory is
increasingly being recognized as an essential component
of an adequate evaluation of seniors who have suspected
cognitive impairment, and people suspected of suffering
from frontal lobe damage (Lezak et al., 2012).
Recommendation 6: It is recommended the next ver-
sion of the WMS contain well-validated measures of
prospective memory, since this capacity is essential to
the adaptive functioning.
The last revision of the WMS does not have an alter-
nate form, which would be useful for test-re-testing
purposes.
Recommendation 7: It is recommended the next
revision of the WMS include a well-validated alternate
form.
The importance of assessing effort and validity is
increasingly being recognized as a necessary standard
component for all neuropsychological evaluations
(Larrabee, 2015).
Recommendation 8: It is recommended that the next
revision of the WMS contain well-validated measures of
effort and test validity.
In summary, the WMS has a long history and has
been in continuous use since 1945. It has been revised
three times in roughly the past three decades. As a result
of its widespread use in research and clinical domains, a
massive amount of information regarding the scale has
accumulated. Nearly all revisions of the WMS have
suffered from the same aforementioned problems. It is
likely a new revision of the instrument will appear in
the next five years. It is hoped that the next revision will
not continue to suffer the shortcomings of those that
have come before it.
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