The Clinical Neuropsychologist

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Comparison of the Cerad and CVLT List-Learning

Tasks in Alzheimer’s Disease

Leah B. Kaltreider , Antoinette R. Cicerello , Laura H. Lacritz , Larry S. Honig ,

Roger N. Rosenberg & Munro C. Cullum

To cite this article: Leah B. Kaltreider , Antoinette R. Cicerello , Laura H. Lacritz , Larry S.
Honig , Roger N. Rosenberg & Munro C. Cullum (2000) Comparison of the Cerad and CVLT List-
Learning Tasks in Alzheimer’s Disease, The Clinical Neuropsychologist, 14:3, 269-274

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 The Clinical Neuropsychologist 1385-4046/00/1403-269$15.00
2000, Vol. 14, No. 3, pp. 269-274 © Swets & Zeitlinger

Comparison of the Cerad and CVLT List-Learning Tasks in

Alzheimer’s Disease*
Leah B. Kaltreider, Antoinette R. Cicerello, Laura H. Lacritz, Myron F. Weiner, Larry S. Honig,
Roger N. Rosenberg, and C. Munro Cullum
The University of Texas Southwestern Medical Center at Dallas
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ABSTRACT

This investigation examined the relationship of the word list from the CERAD neuropsychological battery
to the California Verbal Learning Test (CVLT) in a sample of 138 subjects with Probable Alzheimer’s
disease (AD). Results revealed modest but statistically significant associations between the two measures
on many key variables. Total words learned showed the strongest association, with lower correlations for
delayed recall, intrusion errors, and recognition variables. As expected, the CERAD and CVLT assess
similar aspects of verbal learning in patients with AD. However, the modest level of many of the correla-
tions suggests that caution should be exercised in applying the same interpretive strategies derived on more
comprehensive measures to shorter ones.

A thorough diagnostic evaluation of patients
with known or suspected Alzheimer’s disease
(AD) often involves extensive neuropsychologi-
cal testing, although initial screening is fre-
quently carried out using briefer examinations.
The Consortium to Establish a Registry for Alz-
heimer’s Disease (CERAD; Morris et. al., 1988)
developed one such screening battery composed
of various carefully selected cognitive tasks.
Although the CERAD battery is widely used,
there have been relatively few studies examining
the relationship of its component tests to other
well-established measures in clinical neuropsy-
chology. The verbal memory portion of the
CERAD is of particular interest, given the im-
portance of memory assessment in the diagnosis
of AD. The CERAD assesses verbal memory in
the form of a 10-item list-learning task which
evaluates the individual’s ability to remember
words presented visually across three trials. On
each trial, the subject is shown 10 unrelated
words at a rate of one every 2 seconds, and the
presentation order changes with each trial. De-
layed free recall and recognition testing follow a
brief delay (several minutes) during which non-
verbal tasks are administered. Reliability studies
for control subjects and subjects with AD using
this measure have shown modest to high test-
retest reliability coefficients for Total Words
Recalled (r = .62 to .83), whereas Short-Delay
Free Recall (r = .43 to .64) and Recognition (r =
.36 to .44) reliability values were low to modest
(Morris et. al, 1988).
The rapid forgetting of newly learned verbal
information is one of the most distinguishing
aspects of memory disturbance in AD (Butters et
al., 1988; Welsh, Butters, Hughes, Mohs, &
Heyman, 1992). Whereas forgetfulness is com-
monly associated with normal aging, the calcu-
lation of a ‘‘forgetting rate’’ (the percent of
learned information lost following a delay) helps
to differentiate these individuals from people

*
This work was supported in part by NIH, NIA grant # PHSAG12300-06 (Principal Investigator R. Rosenberg).
Address correspondence to: C. Munro Cullum, ABPP, UT Southwestern Medical Center, 5323 Harry Hines
Blvd., Dallas, TX 75390-8898, USA. Tel.: ++1 (214) 648-3353. Fax: ++1 (214) 648-2450. E-mail: mcullu@med-
net.swmed.edu.
Accepted for publication: August 13, 1999.
 270 LEAH B. KALTREIDER ET AL.
with dementia. Not surprisingly, results from
validity studies of the CERAD word list showed
delayed recall to be the best discriminator of all
CERAD measures between subjects with AD
and normal controls, and one of the few CERAD
variables which was able to adequately identify
those in the early stages of AD (Welsh et al.,
1992; Welsh, Butters, Hughes, Mohs, & Hey-
man, 1991). In the later stages of AD, intrusion
errors and recognition performance were found
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to be helpful in differentiating between de-
mented and nondemented individuals. Although
the CERAD word list appears useful in detecting
memory impairment associated with AD, the
utility of this test in comparison to more estab-
lished verbal learning measures has yet to be
examined.
The California Verbal Learning Test (CVLT;
Delis, Kramer, Kaplan, & Ober, 1987) has been
rigorously studied in a variety of research and
clinical settings. The CVLT consists of a 16-
item shopping list (four items from each of four
categories) presented orally over five trials, and
provides indices of learning, memory, ability to
benefit from cues, recognition ability, and an
assessment of error types. The CVLT has shown
clinical utility and diagnostic accuracy in assess-
ing patterns of memory impairment in disease
processes such as Alzheimer’s disease (Delis et
al., 1991; Kohler, 1994; Kramer, Levin, Brandt,
& Delis, 1988). Despite the need for more brief
assessment tools in some situations, comparison
of other list-learning tasks with the more estab-
lished CVLT have been rare.
Simple 3-word recall has been shown to be
modestly correlated (r = .26; p < .05) with the
CVLT in healthy older adults (Cullum, Thomp-
son, & Smernoff, 1993), although the variability
inherent in such a brief procedure results in a
significant range restriction on scores, hence
limiting the magnitude of the correlation. Re-
sults from a study using the 6-word learning task
(6-VLT) revealed a stronger relationship with
the CVLT (r = .42; p = .02) than with 3-word
recall (r = .21; p = .26; Kaltreider, Cullum,
Lacritz, Brewer, & Filley, 1999). Lacritz and
Cullum (1998a) previously compared scores
from the CVLT and the 12-item Hopkins Verbal
Learning Test (HVLT; Brandt, 1991) in a
healthy elderly sample. Overall learning scores
(r = .74; p < .001) and recognition variables
(i.e., discrimination; r = .46; p = .02) were sig-
nificantly correlated, but error scores were unre-
lated. Utilizing a revised version of the HVLT
that includes a delayed recall trial (HVLT-R;
Benedict, Schretlen, Groninger, & Brandt, 1998)
in a sample of patients with AD, Lacritz and
Cullum (1998b) found that learning, recall, and
recognition variables were significantly corre-
lated with similar variables from the CVLT.
Furthermore, intrusion errors showed a modest
significant relationship, but no linear association
was found for perseverative errors between mea-
sures. It was concluded that, even though some
briefer memory measures may adequately assess
learning capacity, their ability to evaluate more
qualitative aspects of verbal learning and recall
(e.g., error types) has not been well substanti-
ated. Along these lines, the purpose of the cur-
rent study was to investigate various memory
and error indices from the 10-item CERAD
word list in comparison to the more comprehen-
sive CVLT in a population of patients with prob-
able AD.
METHOD
Subjects included 138 individuals evaluated at the
Clinic for Alzheimer’s and Related Diseases at the
University of Texas Southwestern Medical Center
at Dallas between 1994 and 1999 who had received
a diagnosis of Probable AD using standard clinical
criteria (McKhann et al., 1984). The CERAD and
the CVLT were administered as part of a compre-
hensive multidisciplinary diagnostic evaluation
that included neurological, psychiatric, neuropsy-
chological, neuroimaging, and routine laboratory
studies. The CERAD battery was always com-
pleted at least one day prior to the CVLT. The
words contained in the CERAD list and the CVLT
are presented in Table 1.
Results from the CVLT and CERAD lists ap-
proximated a normal distribution and were com-
pared using Pearson correlation coefficients, with
alpha set at .05. Similar variables were selected
from each measure for analysis. Because recogni-
tion discriminability is not a standard variable for
the CERAD list, the discriminability formula
found in the CVLT manual (Delis et al., 1987) was
used to derive a comparable index. Intrusion errors
 A COMPARISON OF LIST-LEARNING TASKS 271

Table 1. CERAD and CVLT List Contents.

CERAD LIST CVLT LIST

1. Butter 1. Drill
2. Arm 2. Plums
3. Shore 3. Vest
4. Letter 4. Parsley
5. Queen 5. Grapes
6. Cabin 6. Paprika
7. Pole 7. Sweater
8. Ticket 8. Wrench
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9. Grass 9. Chives
10. Engine 10. Tangerines
11. Chisel
12. Jacket
13. Nutmeg
14. Apricots
15. Pliers
16. Slacks

Note. Presentation order is varied across trials on the CERAD, whereas the CVLT list order remains the same on
all five learning trials.

were summed across all learning and free recall
trials only to arrive at similar total intrusion scores
for each measure. Paired t tests were performed on
selected variables for which normative CERAD
word list data were available (Welsh et al., 1994).
RESULTS
The sample included 49 males and 89 females
with a mean age of 74.4 (SD = 7.6; range = 40-
90) and mean education level of 12.9 years (SD
= 3.2; range = 3-20). The level of dementia of
the sample fell in the mild to moderate range
using both the Mini-Mental State Examination
(MMSE; Folstein, Folstein, & McHugh, 1975;
M = 20.6, SD = 3.9) and the Dementia Rating
Scale (DRS; Mattis, 1988; M = 112.6, SD =
13.9). Descriptive statistics for selected CERAD
and CVLT variables are presented in Table 2.
Despite the differences in test length, composi-
tion, and administration procedures, the means

Table 2. Descriptive Statistics.

CERAD CVLT

Mean (SD) Range Mean (SD) Range

Learning and Memory
Total Words 10.17 3.63 2–191 19.59 7.76 12–401
First Trial Recall 2.19 1.31 0–611 2.60 1.54 10–611
Last Trial Recall 4.27 1.70 0–811 4.67 2.04 10–111
Short-Delay Recall 1.29 1.33 0–811 1.34 1.81 10–101
Forgetting Rate % 70.87 29.43 0–100 73.61 31.73 10–100
Recognition Hits 8.11 2.05 0–101 11.77 3.55 10–161
Discriminability % 67.94 20.06 5–100 64.74 12.39 36–931
Errors
Free Recall Intrusions 3.08 3.18 0–191 9.29 8.11 12–401
False Positives 2.26 2.03 0–911 11.35 6.27 10–281
 272 LEAH B. KALTREIDER ET AL.
for many of the variables (e.g., First Trial Re-
call, Last Trial Recall, Short-Delay Free Recall)
were quite similar.
The correlational results in Table 3 reveal
significant associations for the total number of
words learned, words recalled on the first and
the last learning trials of each test, and short-
delay free recall. In addition, recognition and
discriminability scores (adjusting for false posi-
tive errors) were moderately correlated between
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the measures. No linear relationship was found
for forgetting rates, which were highly variable.
With respect to error scores, significant relation-
ships were found between measures for the total
number of intrusion and false positive errors.
Paired t test results comparing z scores on se-
lected variables revealed that subjects performed
significantly worse on the first trial of the CVLT
(z = –2.1) than on the CERAD (z = –1.8) [t (134)
= 2.5; p = .01], while their scores on short-delay
free recall were lower on the CERAD (z = –3.1)
compared to the CVLT (z = –2.8) [t (134) =
–3.7; p < .001], and they made fewer recognition
hits (z = –2.0) on the CERAD than they did on
the CVLT (z = –.9) [t (133) = –4.8; p < .001].
No significant differences were found between
the measures for subjects’ performance on the
last learning trial or in their forgetting rates.
DISCUSSION
Consistent with the AD literature, subjects dem-
onstrated limited learning of verbal information
over serial trials and showed rapid forgetting
and impaired recognition on both the CERAD
Table 3. Correlation Coefficients for Selected CERAD and CVLT Variables.
Variable
Total Words
First Trial Recall
Last Trial Recall
Short-Delay Free Recall
Forgetting Rate Percent
Recognition Hits
Discriminability Percent
Total Intrusions
False Positives
and the CVLT. These findings are also similar to
other studies comparing shorter list-learning
tasks to the CVLT in individuals with AD, al-
though the number of significant correlations in
this study exceeded some of the other studies.
For example, Lacritz and Cullum (1998b) found
that performances on the CVLT and the HVLT-
R in a group of 40 patients with mild to moder-
ate AD were similar on many of the same vari-
ables as in the present study, with the exception
of recognition discriminability, which showed
no linear relationship.
The memory variables that are generally con-
sidered to be among the most important ele-
ments in the identification of AD include de-
layed recall and forgetting rates. In this study,
short-delay recall scores were significantly
lower on the CERAD (z = –3.1) than the CVLT
(z = –2.8) and only modestly related, and forget-
ting rates failed to show a significant association
between the measures, despite very similar
scores (CVLT = 73.61%; CERAD = 70.87%). A
likely explanation for these findings is the re-
stricted range of delayed recall scores, which
would reduce the possibility of achieving a sta-
tistically significant correlation. Not surpris-
ingly, patients with AD did very poorly on the
delayed recall trial from both measures, with
47% and 35% of the subjects showing complete
forgetting on the CVLT and CERAD, respec-
tively.
It should be noted that the CERAD word list
was administered first to all patients, and could
have influenced subjects’ performance on the
CVLT by increasing their familiarity with the
list-learning paradigm. However, order effects
r p
.65 < .001
.39 < .001
.48 < .001
.25 .003
.13 .15
.40 < .001
.35 < .001
.30 < .001
.22 .01
 A COMPARISON OF LIST-LEARNING TASKS
have been minimal in similar studies using this
population (e.g., Lacritz & Cullum, 1998b) and
are not thought to have significantly influenced
these results. Other potential factors that may be
contributing to some of the limited correlations
are differences in test characteristics. It has been
suggested that the ability to accurately interpret
and compare test results from two measures can
be difficult when there are differences in task
administration and task demand (Schmidt, Tom-
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baugh, & Faulkner, 1992). For example, Ma-
cartney-Filgate and Vriezen (1988) found a con-
siderable degree of intra-subject variability
when comparing four verbal-learning tests that
differed in their composition and presentation
styles (e.g., entire list repeated over trials vs.
selective reminding of missed words). Items on
the CVLT are read aloud to the examinee,
whereas the CERAD list requires the examinee
to read words printed on cards, yet both tests
require verbal responses. In addition, words on
the CVLT are always presented in the same or-
der but the words on the CERAD are read in a
different order each time. The effects of such
cross-modal assessment paradigms have not
been systematically explored, although the pres-
ent results suggest reasonably robust relation-
ships and convergent validity, despite different
administration modalities. Other such factors
include differences in the number of learning
trials, and the fact that only the words on the
CVLT can be semantically categorized. Future
studies focusing on administration techniques
(e.g., comparing an oral vs. visual presentation
of CERAD words) could help elucidate the ef-
fects of presentation style.
Modest correlations were seen across mea-
sures between intrusion and false positive errors.
The strength of these relationships may have
been reduced by the restricted range of such er-
rors on the CERAD in comparison to the CVLT,
as subjects made less than half the number of
intrusion and false positive errors on the
CERAD (means = 3.08 and 2.26, respectively)
compared to the CVLT (means = 9.29 and
11.35, respectively). Furthermore, nearly a quar-
ter of subjects did not make any intrusion errors
(21%) or false positive errors (25%) on the
273
CERAD, whereas only 1% did not make any
such errors on the CVLT. Nevertheless, the cor-
relations between error variables across tests are
promising, as these types of errors are character-
istic of memory dysfunction in AD (Kramer et
al., 1988).
The results from this study suggest that the
CERAD word list may be a good alternative in
clinical situations where administration of the
more complex and lengthy CVLT is not feasible.
However, as with other brief list-learning tasks,
the CERAD does not appear to ‘‘pull’’ for errors
to the same degree as the CVLT. Moreover, the
modest level of some significant correlations
supports prudent application of interpretive
strategies commonly used on the CVLT to the
CERAD. Nevertheless, the relationships ob-
served between the CERAD list and CVLT pro-
vide additional support for the utility of shorter
list-learning tasks among patients with mild to
moderate AD.
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