V P IQ DISCREPANCIES: A CLINICAL APPROACH in .NET

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V P IQ DISCREPANCIES: A CLINICAL APPROACH
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clinically stable phase of the disease. Twentynine of the 34 patients had a relapsing remitting course and 5 patients had a relapsing progressive course. The sample was 32% male, with a mean age of 38.5 years, 9 years of education on average (range 5 18), and an average of 10 years since the onset of symptoms. The results showed that the mean V-IQ (94.9) was 5.1 points higher than the mean P-IQ (89.8), demonstrating the predicted V > P pattern. The highest mean scaled scores (10) were on Information and Similarities (both 10) and the lowest (6 7) were on Digit Symbol and Picture Arrangement. Maurelli et al. indicated that, in their sample, neither disease duration nor disability scores were related to cognitive functioning. Even patients with mild disability and who were in the early phases of the disease showed disturbances in intelligence and memory functions (p. 127). With the addition of Matrix Reasoning to the WAIS-III, Picture Completion is no longer the only Performance subtest that does not require fine-motor skill. Add to the mix the fact that Object Assembly was bumped off the Performance scale, and it is likely that WAIS-III research on MS patients will produce V > P profiles smaller in magnitude than the ones found on the WAIS and WAIS-R. With the Processing Speed versus Perceptual Organization dichotomy within the Performance Scale, examiners are now able to separate out fine-motor skill and speed from perceptual organizational skill, which is quite useful in assessing those with motor difficulties, such as those who suffer from MS. Performance Deficits in Huntington s Disease Huntington s disease is associated with progressive motor deficits as well as symptoms of dementia and tends to be accompanied by V > P Wechsler profiles (Brandt et al., 1984; Butters, Sax, Montgomery, & Tarlow, 1978; Fedio, Cox, Neophytides, Canal-Frederick, & Chase, 1979; Josiassen, Curry, Roemer, DeBease, & Mancall, 1982; Randolph, Mohr, & Chase, 1993). Whereas
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the motor symptoms in this genetically transmitted disease involve involuntary, spasmodic, often tortuous movements that ultimately become profoundly disabling (Lezak, 1995, p. 231), the V > P profile emerges in the very early stages of the disease (Butters et al., 1978) and for patients suffering only minor movement disorders (Josiassen et al., 1982). In the Josiassen study, for example, the 13 Huntington s patients (mean age = 45.5 years, mean education = 12.7 years) scored 9.4 IQ points lower on the WAIS Performance than Verbal scale. Brandt et al. s 13 patients with recent onset of chorea (abnormal movements) had V > P of 5.5 WAIS IQ points compared to a 9.4-point discrepancy for 44 patients with advanced chorea. The patients with advanced Huntington s disease showed significant decrements on the performance, but not the Verbal, subtests; nonetheless, intellectual differences between the recent and advanced patients were far more moderate in magnitude than differences in adaptive and social functioning (Brandt et al., 1984). Randolph et al. s study of 36 patients with Huntington s disease showed a WAIS-R V > P pattern of 6.9 points. In the studies by Butters et al. and Josiassen et al., the Huntington s patients earned their highest Performance scaled score on the nonmotoric Picture Completion subtest, while generally scoring low on visual motor and timed tasks (including Arithmetic). Their deficiency on the Performance scale was matched by a clear-cut weakness on sequential subtests. Good performance on Picture Completion compared to the other nonverbal tasks may not only be related to the motor demands of Wechsler s subtests, however; Huntington s patients generally seem to have difficulty with tasks that lack familiarity and structure, are perceptually complex, or require a complex response (Aminoff, Marshall, Smith, & Wyke, 1975; Fedio et al., 1979; Lezak, 1995). Yet the motor component cannot be minimized. Brandt et al. s (1984) advanced Huntington s patients and Randolph et al. s (1993) Huntington s patients showed their greatest disabilities on the two subtests requiring the most motor coordination, Digit Symbol and Object Assembly.
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