Journal of Clinical and Experimental Neuropsychology

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Convergent and Discriminant Validity of the CVLT

(Dementia Version)

John L. Woodard , Felicia C. Goldstein , Vicky J. Roberts & Colleen McGuire

To cite this article: John L. Woodard , Felicia C. Goldstein , Vicky J. Roberts & Colleen McGuire
(1999) Convergent and Discriminant Validity of the CVLT (Dementia Version), Journal of Clinical
and Experimental Neuropsychology, 21:4, 553-558

To link to this article: http://dx.doi.org/10.1076/jcen.21.4.553.878

Published online: 09 Aug 2010.

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1999, Vol. 21, No. 4, pp. 553-558 © Swets & Zeitlinger

Convergent and Discriminant Validity of the CVLT

(Dementia Version)*
John L. Woodard, Felicia C. Goldstein, Vicki J. Roberts, and Colleen McGuire
Department of Neurology, Emory University School of Medicine, Atlanta, GA
Downloaded by [University of California, San Diego] at 18:31 12 November 2015

ABSTRACT

This study investigated the convergent and discriminant validity of the 9-item ‘‘dementia version’’ of the
California Verbal Learning Test (CVLT-9) in a sample of 130 geriatric patients evaluated for memory
complaints. Moderate correlations were observed between the CVLT-9 sum of words recalled for trials 1–5
(Trial 1–5 Recall) and Long-Delay Free Recall (LDFR) measures and the immediate and delayed Logical
Memory (LM I and LM II) and Visual Reproduction (VR I and VR II) subtests from the Wechsler Memory
Scale-Revised (WMS-R). However, the CVLT-9 Trial 1–5 Recall and VR I measures demonstrated signifi-
cant correlations with a number of additional measures of language and visuospatial ability. The CVLT-9
LDFR, and the WMS-R LM I, LM II, and VR II showed less overlap with non-episodic memory function-
ing. A principal components analysis yielded a three-component solution consisting of a general or ‘‘g’’
component, a specific memory component, and a mood component. The CVLT-9 Trial 1–5 Recall and VR
I loaded on both the ‘‘g’’ and the memory components, whereas LM I, LM II, and VR II loaded on only the
memory component. We conclude that the CVLT-9 Trial 1–5 Recall and VR I demonstrate low
discriminant validity, suggesting diminished specificity as memory measures.

The California Verbal Learning Test (CVLT;
Delis, Kramer, Kaplan, & Ober, 1986) is a popu-
lar measure of verbal learning, delayed verbal
recall and recognition, and conceptual ability,
with a reported use of 36% in a sample of 250
surveyed members of the International Neuro-
psychological Society (Butler, Retzlaff, & Van-
derploeg, 1991). Despite its frequent use in neu-
ropsychological assessment, the standard 16-
word list may overwhelm and frustrate some
patients, raising questions regarding the validity
of this procedure in certain patient groups. A
nine-item ‘‘dementia version’’ of the CVLT
(CVLT-9) consisting of three items from each of
three semantic categories has been developed by
Libon and colleagues (Lezak, 1995; Libon et al.,
1996) in order to circumvent the problem of pre-
senting an overly long stimulus list. In this ini-
tial validation study, a principal component
analysis of the CVLT-9 summary measures pro-
duced a three-factor solution, corresponding to
immediate free recall, delayed recall and recog-
nition, and the production of intrusion re-
sponses. In addition, the CVLT-9 was able to
differentiate patients with Alzheimer’s disease
(AD) from those with ischemic vascular demen-
tia (IVD). Specifically, the IVD group made
substantially fewer intrusion errors on both free
and cued recall test trials and fewer false posi-
tive responses during delayed recognition test-
ing than the patients with AD. The IVD group
also showed significantly higher scores on all
measures of delayed free and cued recall mem-
ory, the saving score, and on the recognition

*
Portions of these results were presented at the 25th Annual Meeting of the International Neuropsychological
Society, Chicago, IL, USA, February, 1996. Colleen McGuire is at the Department of Psychology, University of
Maryland.
Address correspondence to: John L. Woodard, Georgia State University, Memory Assessment Clinic and Alzhei-
mer’s Disease Program, One Park Place South, Suite 801, Atlanta, GA 30303-3083, USA. E-mail:
jlwoodard@gsu.edu
Accepted for publication: February 9, 1999.
 554 JOHN L. WOODARD ET AL.
discriminability index relative to the AD pa-
tients, lending support to the clinical validity of
this measure.
Aside from this initial study (Libon et al.,
1996), little information is available regarding
the psychometric properties of the CVLT-9, par-
ticularly with respect to convergent and discri-
minant validity. Validity studies of the standard
CVLT have reported moderate to high correla-
tions between the CVLT and other measures of
memory, suggesting generally good convergent
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validity (Delis, Cullum, Butters, Cairns, & Pri-
fitera, 1988) and the CVLT has been shown to
yield preclinical cognitive markers of AD (Bon-
di et al., 1994). However, a recent study from
our laboratory (Woodard, Hancock, Pennell, &
Henry, 1996a) reported that the standard CVLT
variables of the sum of words recalled over trials
1–5 and Long-Delay Free Recall correlated sig-
nificantly with numerous other neuropsycholog-
ical measures, including the Booklet Category
Test, Speech Sounds Perception Test, Seashore
Rhythm Test, and Finger Oscillation Test, while
the Logical Memory I and II and Visual Repro-
duction II subtests from the Wechsler Memory
Scale-Revised (WMS-R; Wechsler, 1987) dem-
onstrated little overlap with other non-episodic
memory neuropsychological measures. This
finding raises the question of whether the stan-
dard CVLT may be regarded as a specific mea-
sure of memory or a sensitive measure of gen-
eral neuropsychological functioning.
The purpose of this study was to examine the
convergent and discriminant validity of the
CVLT-9 in a sample of geriatric patients re-
ferred to a memory assessment clinic for neuro-
psychological evaluation. Given that the CVLT-
9 is generally used as an episodic memory mea-
sure, we hypothesized that it would show stron-
ger correlations with other episodic memory
measures (the WMS-R Logical Memory I and II
and Visual Reproduction II subtests) than with
non-episodic memory measures (verbal fluency,
naming, visuospatial reasoning, Mattis Demen-
tia Rating Scale, and Geriatric Depression
Scale). In addition, given previous factor ana-
lytic studies of the WMS and WMS-R suggest-
ing that Visual Reproduction I is related more to
a ‘‘Performance’’ factor than to a ‘‘Memory’’
factor, we expected to find a greater number of
significant correlations between this subtest and
other non-memory measures.
METHOD
Participants
Participants were 130 patients seen for evaluation
of memory complaints through a geriatric Memory
Assessment Clinic. The mean age of the sample
was 76.3 years (SD = 6.8), the mean number of
years of education was 12.1 (SD = 3.4), and the
mean Mattis Dementia Rating Scale score was
113.6 (SD = 20.3). Females comprised the majority
of the sample (68%), and the majority of patients
were right-handed (93%). Most patients were diag-
nosed with probable or possible Alzheimer’s dis-
ease, although vascular dementia, Parkinson’s dis-
ease, closed-head injury, amnestic syndrome, de-
pression, and frontal lobe dementia were also rep-
resented.
Procedure
The CVLT-9 and the WMS-R immediate and de-
layed Logical Memory (LM I and LM II) and Vi-
sual Reproduction (VR I and VR II) subtests were
administered to all patients as part of a larger neu-
ropsychological evaluation by a trained psychome-
trist or a licensed psychologist. Although there are
numerous performance measures that can be de-
rived from the CVLT-9, we focused on the sum of
words correctly recalled across trials 1–5 (Trial
1–5 Recall) and Long-Delay Free Recall because
these indexes are roughly analogous to the imme-
diate and delayed recall trials from the WMS-R,
respectively. Other measures that were adminis-
tered included Multilingual Aphasia Examination
(MAE) Visual Naming and Controlled Oral Word
Association Test (COWAT; Benton & des Ham-
sher, 1983), Animal Fluency (Goodglass & Kap-
lan, 1983), Mattis Dementia Rating Scale (MDRS;
Mattis, 1973), Geriatric Depression Scale (GDS;
Yesavage et al., 1983), and Judgment of Line Ori-
entation (JOLO; Benton, Sivan, Hamsher, Varney,
& Spreen, 1994). Although every patient was ad-
ministered the memory measures, the nature of the
referral question often dictated administration of
other neuropsychological measures.
Data Analysis
Pearson product-moment correlations were com-
puted between the CVLT-9 summary scores (Trial
1–5 Recall and long-delay free recall) and the re-
maining neuropsychological measures. Because
 VALIDITY OF THE CVLT (DEMENTIA VERSION)
the sample size varied depending on the number of
persons who were administered the supplementary
neuropsychological measure, each correlation is
based on pairwise deletion of missing cases (i.e., if
there is missing data for one of the two measures
in the correlation, the entire case is deleted). In
order to deal with missing variables in the princi-
pal component analysis, we substituted the grand
mean of a given variable for its respective missing
value and computed the correlation matrix based
on this mean substitution method. We then per-
formed a principal component analysis using a
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varimax rotation in order to identify those con-
structs on which each measure loaded.
RESULTS
Table 1 shows the pattern of correlations be-
tween the CVLT-9 variables and WMS-R mem-
ory subtests. As expected, these correlations
were moderate in magnitude and were all signif-
icant (p < .001). The magnitude of the correla-
tions between two measures of immediate epi-
sodic recall and between two measures of de-
layed episodic recall tended to be larger than
correlations between one measure of immediate
episodic recall and one measure of delayed epi-
sodic recall. Table 2 depicts the correlations be-
tween the episodic memory measures and the
other non-episodic memory measures. For the
CVLT-9 Trial 1–5 Recall, significant correla-
tions were observed with all non-episodic mem-
ory measures except GDS, and the correlations
with several of the non-episodic memory mea-
sures were as large or larger than the correlation
of this variable with other episodic memory
measures (see Table 1). Although the CVLT-9
Long-Delay Free Recall Measure showed signif-
icant overlap with all non-episodic memory
measures except Visual Naming and GDS, the
Table 1. Correlations between CVLT-9 Variables and WMS-R Subtests
Variable LM I
CVLT-9 Trials 1–5 Sum 0.46
CVLT-9 Long-Delay Free Recall 0.41
Note. N = 130. CVLT-9 = California Verbal Learning Test (Dementia Version); WMS-R = Wechsler Memory
Scale-Revised; LM = Logical Memory; VR = Visual Reproduction. The correlation between CVLT-9 Trials 1-5
Sum and CVLT-9 Long-Delay Free Recall was .50. All correlations are significant (p < .001).
555
magnitude of these correlations was smaller than
was seen with the CVLT-9 Trial 1–5 Recall.
Among the WMS-R variables, as expected,
VR I showed significant and large overlap with
all non-episodic memory measures except GDS.
The magnitude of these correlations tended to be
as large or larger than the relationship between
VR I and the two CVLT-9 variables (see Table
1). With the exception of significant correlations
between Visual Naming and LM I and between
JOLO and VR II, the WMS-R variables (LM I,
LM II, and VR II) showed no other overlap with
Visual Naming, COWAT, or JOLO. Animal
Fluency and the MDRS correlated significantly
with all measures of memory. Of all the WMS-R
variables, LM II showed the least overlap with
non-episodic memory measures, both in terms of
number and magnitude of significant correla-
tions. The GDS was not associated with any of
the cognitive measure.
The principal component analysis yielded a
three-component solution, accounting for 63%
of the total variance. The component loadings
are presented in Table 3. Component 1, account-
ing for 27.9% of the variance, corresponded to a
specific memory measure. Component 2 ac-
counted for 25.7% of the variance and suggested
a ‘‘general cognitive ability’’ or ‘‘g’’ compo-
nent. Component 3, composed solely of GDS
score, indicated a mood component and ac-
counted for 9.3% of the variance. A loading of
0.35 or greater was used to identify significant
variable-component relationships. As can be
seen, the CVLT-9 Trial 1–5 Recall and VR I
showed considerable overlap across components
1 and 2, whereas the remaining variables
showed no such overlap. The CVLT-9 Long-
Delay Free Recall variable demonstrated a sig-
nificant loading only on the memory component.
LM II VR I VR II
0.35 0.49 0.41
0.49 0.33 0.60
 556 JOHN L. WOODARD ET AL.

Table 2. Correlations between Episodic Memory and Non-Episodic Memory Variables

Variable Visual Animal MDRS

Naming COWAT Fluency JOLO Total GDS
Score
CVLT-9 Trials 1–5 Sum 0.29** 0.29** 0.56*** 0.45*** 0.40*** 0.01
CVLT-9 Long-Delay Free Recall 0.14 0.20* 0.43*** 0.29* 0.25** 0.06
WMS-R LM I 0.27* 0.03 0.34*** 0.14 0.34*** -0.05
WMS-R LM II 0.04 -0.05 0.19 -0.02 0.21* 0.03
WMS-R VR I 0.55*** 0.37*** 0.47*** 0.67*** 0.40*** 0.07
WMS-R VR II 0.16 0.09 0.33*** 0.29* 0.33*** 0.06
n 87 111 110 66 124 109
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Note. CVLT-9 = California Verbal Learning Test (Dementia Version); WMS-R = Wechsler Memory Scale-
Revised; LM = Logical Memory; VR = Visual Reproduction; MAE = Multilingual Aphasia Examination;
COWAT = Controlled Oral Word Association Test; JOLO = Judgment of Line Orientation Test; MDRS = Mattis
Dementia Rating Scale; GDS = Geriatric Depression Scale.
***
p < .001; ** p < .01; * p < .05.

The WMS-R LM I, LM II, and VR II measures DISCUSSION

loaded only on the memory component, whereas
Animal Fluency, COWAT, and the MDRS
loaded on the ‘‘g’’ component. As noted above,
the GDS loaded on its own mood component.
In summary, the WMS-R VR I and CVLT-9
Trial 1–5 Recall demonstrated significant over-
lap with the remaining WMS-R memory mea-
sures, as well as with measures typically associ-
ated with attention, language, and visuospatial
processing. In contrast, LM II showed the least

Table 3. Component Loadings for Episodic and Non-Episodic Memory Measures Based on Rotated Component
Matrix.

Component

1 2 3
CVLT-9 Trials 1-5 *.575 *.518 .071
CVLT-9 LDFR *.691 .227 .141
LM I *.842 .044 –.187
LM II *.882 –.127 –.095
VR I *.490 *.599 .187
VR II *.763 .199 .155
MAE Visual Naming .027 *.732 –.101
COWAT –.040 *.745 –.191
Animal Fluency .331 *.663 –.066
JOLO .045 *.766 .138
MDRS Total .345 *.519 –.289
GDS .053 –.119 *.914

Note: CVLT-9 = California Verbal Learning Test (Dementia Version); LDFR = Long-Delay Free Recall; LM =
Logical Memory; VR = Visual Reproduction; MAE = Multilingual Aphasia Examination; COWAT = Controlled
Oral Word Association Test; JOLO = Judgment of Line Orientation Test; MDRS = Mattis Dementia Rating
Scale; GDS = Geriatric Depression Scale.
 VALIDITY OF THE CVLT (DEMENTIA VERSION)
amount of overlap with non-episodic memory
measures, suggesting that it might be regarded
as the ‘‘purest’’ measure of episodic memory
functioning among the measures evaluated in
this study. The number and magnitude of signif-
icant correlations between the WMS-R measures
(LM I, LM II, and VR II) and non-episodic
memory measures were diminished as compared
to the corresponding correlations for VR I and
CVLT-9 Trial 1–5 Recall.
The significant correlations between Animal
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Fluency, the MDRS, and all CVLT-9 and WMS-
R measures were not surprising, given that per-
formance on these measures and on episodic
memory tasks is typically compromised in de-
mentia (Woodard, Salthouse, Godsall, & Green,
1996b). In contrast, given that the diagnostic
entity of pseudodementia has been traditionally
associated with cognitive impairment, particu-
larly with episodic free recall tasks and mea-
sures of verbal fluency (King & Caine, 1990), it
is noteworthy that there was absolutely no rela-
tionship between GDS score and any cognitive
measure. However, it is important to draw a dis-
tinction between an elevated score on the GDS,
which may not necessarily be diagnostic of an
underlying depressive disorder, and actually
meeting specific criteria for a mood disorder,
which was the case for a very small proportion
of our sample. On the other hand, the lack of
correlation between the cognitive and mood
measures may be taken as evidence of discri-
minant validity.
Taken together with the results of our prior
study (Woodard et al., 1996a), the results of this
study suggest that VR I, and the CVLT-9 Trial
1–5 Recall might best be regarded as measures
sensitive to level of cognitive functioning rather
than as specific measures of memory. In con-
trast, LM II in particular appears to measure
memory functioning more specifically than as-
sessing more general neuropsychological func-
tioning. LM I, VR II, and CVLT-9 Long-Delay
Free Recall demonstrated some degree of over-
lap with non-episodic memory measures but
showed stronger relationships with other epi-
sodic memory tasks. At least one other study
using the standard CVLT in a sample of young
adult males seen for neuropsychological assess-
557
ment has reported that the Trial 1-5 Recall
shows significant relationships across a variety
of executive function measures, including the
Wisconsin Card Sorting Test, COWAT, Trail
Making Test, and Wechsler Adult Intelligence
Scale-Revised (WAIS-R) Digit Span, Similari-
ties, and Block Design (Vanderploeg, Schinka,
& Retzlaff, 1994). In addition, this same study
found that Long-Delay Free Recall demon-
strated significant correlations with only the
Trail Making Test and WAIS-R Similarities.
This pattern of relationships is suggestive of
greater sensitivity to executive functioning tasks
for CVLT Trial 1-5 Recall, possibly due to reli-
ance on multiple cognitive processes to perform
verbal learning across multiple trials, and dimin-
ished sensitivity to executive functioning for the
CVLT Long-Delay Free Recall.
The sample size of the present study is com-
parable to the initial validation study reported by
Libon and colleagues (Libon et al., 1996), al-
though the sample composition differed to some
extent in that we did not include a normal con-
trol group and our sample included a small num-
ber of individuals with more diverse dementia
etiologies. Interestingly, using a principal com-
ponent analysis including only CVLT-9 vari-
ables obtained from their non-demented sample,
Libon and co-workers found that the CVLT-9
sum of Trials 1-5 variable loaded on multiple
components tapping delayed recall and immedi-
ate free recall, whereas the CVLT-9 Long-Delay
Free Recall Variable loaded only on a delayed
recall component. In contrast, these two vari-
ables loaded on the same general memory com-
ponent in their sample of demented patients.
Whether or to what extent our obtained compo-
nent structure would differ in a normal elderly
population would be an important follow-up to
our present results in the clinical sample. The
ability of CVLT-9 and WMS-R measures to dif-
ferentiate between multiple diagnostically ho-
mogenous groups is another important future
consideration in establishing the validity of
these measures.
It is important to note that other performance
measures from the CVLT-9 were not systemati-
cally examined in order to limit the number of
correlations performed. The initial validation
 558 JOHN L. WOODARD ET AL.
study of the CVLT-9 (Libon et al., 1996), along
with other detailed studies of individual vari-
ables from the standard CVLT (Vanderploeg et
al., 1994) suggest their potential utility for dif-
ferentiating between diagnostic groups and for
performing detailed characterization of aspects
of memory functioning. Thus, the validity and
utility of other CVLT-9 measures should be ex-
amined in future studies.
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