Neuropsychological Testing: Memory and Learning Results in Indonesian Population, Study Guides, Projects, Research of Psychology

The results of a longitudinal study on adapting neuropsychological tests into Indonesian norms, focusing on the Memory domains of Digit Span Forward, Digit Span Backward, Digit Span Sequence, Symbol Span Forward, and Auditory Verbal Learning. The study includes data on the percentage of subjects in different age groups and their performance on each test. The results indicate the ease or difficulty of remembering sequences of numbers and symbols, as well as words.

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symbol. The third test is Visual Reproductin, which
assessment or neuropsychological test is still limited.
The Adaptation of Neuropsychological Test
Adaptation: A Pilot Study for Memory Subtest
Lucia Trisni Widhianingtanti, Augustina Sulastri, Endang Widyorini,
Margaretha Sih Setija Utami, Haryo Goeritno, Monika Windriya Satyajati.
Faculty of Psychology, Unika Soegijapranata
Abstract
Current studies of neuropsychology have been widely developed in various countries.
neuropsychological assessment requires valid and reliable neuropsychological testing tools.
Meanwhile, in Indonesia, neuropsychological assessment has not been widely available nor
adapted. This study is a part of a longitudinal study to adapt neuropsychological tests into
Indonesian norms, particularly in Memory domains, namely Digit Span Forward (DSF), Digit
Span Backward (DSB) and Digit Span Sequence (DSS); symbol range, Visual Reproduction;
Auditory Verbal Learning. The subjects of this pilot study were 219 (two hundred and
nineteen) healthy adults with age range from of 18 to 64 years. Subjects were selected
randomly with some initial criteria for detecting the presence or absence of cognitive
dysfunction. This research uses quantitative descriptive analysis model, to determine the
difficulty level of each test items, and the results are shown using percentage of difficulty
level of each item based on memory ability of respondents.
Keywords:
Test adaptation, neuropsychology, test norms
Introduction
As a part of neuroscience studies, neurospcyhology
had develepoed into a special field in the study of
psychology. This includes on how psychology could
explain between what happens in the brain and what
people do. Perception, emotion, motivation, beliefs, and
many other topics in psychology could be explained
using neuropsychology. Thus, research conducted in
this field is developed rapidly in these recent years.
To get a deeper understanding about one’s
neuropsychological condition, first, a psychologist
should conduct a battery of assessment. A
comprehensive assessment could help psychologist and
other mental health professionals to identify the
problems in patients, which could help professionals to
conduct intervention, such as medical intervention,
rehabilitation therapy, or psychotherapy. Unfortunately,
in Indonesia, the numbers of neuropsychological
Thus, this research aims to create an adaption of
existing neuropsychological tests to be used in
Indonesian norms. Hambleton, Merendan, and
Spielberger (2005) stated that test adaptation is a series
of activity which include: measuring the same construct
and interpreting it into a different language and culture;
choosing the translator; deciding which utilities would
be used to prepare the test in second language; adapting
the test; and also checking the equity of the two
versions of the tests.
In this research, we adapt four neuropsychological
test batteries which measure memory. The first set of
tests Digit Spans, which includes Digit Span Forward
(DSF), Digit Span Backward (DSB), Digit Span
Sequence (DSS). Clients are asked to memorize a series
of numbers in these test in three modes, which are
forward, backward, and sequence. The second test is
Symbol Span, in which clients are asked to memorize
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pf5
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pf9
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symbol. The third test is Visual Reproductin, which assessment or neuropsychological test is still limited.

The Adaptation of Neuropsychological Test

Adaptation: A Pilot Study for Memory Subtest

Lucia Trisni Widhianingtanti, Augustina Sulastri, Endang Widyorini, Margaretha Sih Setija Utami, Haryo Goeritno, Monika Windriya Satyajati. Faculty of Psychology, Unika Soegijapranata Abstract Current studies of neuropsychology have been widely developed in various countries. neuropsychological assessment requires valid and reliable neuropsychological testing tools. Meanwhile, in Indonesia, neuropsychological assessment has not been widely available nor adapted. This study is a part of a longitudinal study to adapt neuropsychological tests into Indonesian norms, particularly in Memory domains, namely Digit Span Forward (DSF), Digit Span Backward (DSB) and Digit Span Sequence (DSS); symbol range, Visual Reproduction; Auditory Verbal Learning. The subjects of this pilot study were 219 (two hundred and nineteen) healthy adults with age range from of 18 to 64 years. Subjects were selected randomly with some initial criteria for detecting the presence or absence of cognitive dysfunction. This research uses quantitative descriptive analysis model, to determine the difficulty level of each test items, and the results are shown using percentage of difficulty level of each item based on memory ability of respondents. Keywords: Test adaptation, neuropsychology, test norms Introduction As a part of neuroscience studies, neurospcyhology had develepoed into a special field in the study of psychology. This includes on how psychology could explain between what happens in the brain and what people do. Perception, emotion, motivation, beliefs, and many other topics in psychology could be explained using neuropsychology. Thus, research conducted in this field is developed rapidly in these recent years. To get a deeper understanding about one’s neuropsychological condition, first, a psychologist should conduct a battery of assessment. A comprehensive assessment could help psychologist and other mental health professionals to identify the problems in patients, which could help professionals to conduct intervention, such as medical intervention, rehabilitation therapy, or psychotherapy. Unfortunately, in Indonesia, the numbers of neuropsychological Thus, this research aims to create an adaption of existing neuropsychological tests to be used in Indonesian norms. Hambleton, Merendan, and Spielberger (2005) stated that test adaptation is a series of activity which include: measuring the same construct and interpreting it into a different language and culture; choosing the translator; deciding which utilities would be used to prepare the test in second language; adapting the test; and also checking the equity of the two versions of the tests. In this research, we adapt four neuropsychological test batteries which measure memory. The first set of tests Digit Spans, which includes Digit Span Forward (DSF), Digit Span Backward (DSB), Digit Span Sequence (DSS). Clients are asked to memorize a series of numbers in these test in three modes, which are forward, backward, and sequence. The second test is Symbol Span, in which clients are asked to memorize

Proceeding of ICPSY 2018 asked clients to memorize an image and reproduce it. The last is Auditory Verbal Learning (AVL). This AVL test measure client’s ability to memorize two series of words repeatedly. memory in the STM is erased after some period of time. The second option is that the memory in STM moved into long-term memory (LTM). In this part, memory will be stored for long period of time. It could be stored for months and even years. Memory Feldman (2012) defined memory as a cognitive Neuropsychological measurement There are several ways of measuring function which include the brain. The process of memory includes coding, storing, and retrieving old information which was stored in the brain. Most scientists view memory as a relation between our own experience and past history. The stimuli that once were experienced by someone had left a perception on the brain. That perception were then stored in the mind, and could be retrieved again when we met the same kind of stimuli. Thus, memory includes the process of learning, retention, and remembering. The same definition of memory was also explained by Slamet (2010) and Chaplin (2011). The two references stated that past experience is one important part before someone could interpret the stimuli they are facing now. Theories Related to Memory Disuse Theory This theory stated that memory will slowly be erased after certain periods of time unless it trained repeatedly, just like we trained our body and muscles. Memory will also slowly fade from the mind if someone felt that the information is not important, regardless of the time. Interference Theory This theory defined memory as candle or canvas. Knowledge is “painted” in canvas and it is memorized in the brain. But after some period of time, there canvas will be “re-painted” again when we get new knowledge. This process called interference. It is more difficult for us to memorized knowledge that is interfered with the same kind of new knowledge. Information Processing This memory describe how memory processed. At first, new knowledge are stored in sensory storage, then it is being processed in short-term memory (STM). In STM, there are two options. The first one is that the neuropsychology as below: Technical Neuroimaging Computerized Axial Tomography (CAT) using X- rays compiled by a computer Magnetic Resonance Imaging (MRI) uses non- harmful radio frequencies and the interaction with the brain, which then measured by the computer to create brain images. Positron Emitted Tomography (PET) uses a radioactive solution which is injected to study the metabolic activity of the brain Electroencephalography (EEG) records the electrical activity of the brain ("brain waves") of cables attached to the surface of the scalp Psychological Tests Test Battery: Reitan-Halstead Other battery approaches : WAIS (Wechsler Adult Intelligence Scale) assessment of cognitive function; LNNB 1 (Luria Nebraska Neuropsychological Battery ) and LNNB 2 In this article, Memory is chosen the variable. Thus, the neuropsychological test consisting from 4 subtests were being translated then tested to subjects. The tests has free license and was used in various countries. We tested whether the construct of the aitems would suit Indonesian norms. Research Subjects The research subjects consisted of 219 people with various backgrounds. The percentage of female subjects were 61.64% (n=135), and male subjects were 38.36% (n=84). The subjects came from various age groups, from adolescent age group (16- 19 years) to the elderly group (over 60 years). The highest percentage of subjects is in the age group 20 - 24 years (38.36%, n=84), 16-19 years (15.98%, n=35), and 25- 29 years

Proceeding of ICPSY 2018 The results of an analysis of DSF questions can be reported in table 1 below: Table 1. Digit Span – Forward No. Tested Numbers Testee Amounts Correct Answer %

  1. 1A 218 99. 1B 219 100
  2. 2A 218 99. 2B 217 99.
  3. 3A 213 97. 3B 212 96. 4 4A 192 87. 4B 176 80.
  4. 5A 115 52, 5B 106 48.
  5. 6A 45 20, 6B 49 22.
  6. 7A 15 6. 7B 18 8, 8 8A 2 0. 8B 4 1. In table 1, it can be seen that questions number 1 through 4 indicate that the numbers that are easy to remember by testee. From 219 testees, 176 (80.37%) up to 219 (100%) testee were able to remember the range number which consists of a range of 2 numbers up to 5 numbers in the correct order. The 5 and 6 series has moderate difficulty level. Only 48.4% - 52.51% testee were able to recall the sequence of numbers in these series in sequence and correctly. While the range no. 6 to 8 which consists of a range of 7 numbers up to 9 numbers is the most difficult to remember by testee that is indicated by 0.91% - 20.55% testee that were able to remember correctly. b) Digit Backward Span (DSB) DSB comprises 8 range of numbers that each comprised of 2 until 9 range of numbers mentioned by the tester. The tester calls a row number and testee were requested to mentioned the number in reverse. DSB Each range of numbers in DSB consisted of two trial, Trial A and Trial B. The B part is the second trial that were given only if testee failed the first trial. If testee failed at both trial, then DSB has to be stopped. The results of the analysis of DSB questions isreported in table 2. In table 2 it can be seen that the questions number 1 through 3 (3A) indicate that the question were easy to remember by testee. From 219 testee, 162 (73.97% ) up to 219 (100%) testee were able to remember the range of numbers well, which consists of a range of 2 numbers up to 4 numbers in a correct sequence. Range no. 3 (3B) and 4 (4A) consisting of a range of 4 - 5 numbers is a range of numbers with a moderate difficulty level that is indicated by 41.55% - 54.79% testee who were able to recall the sequence of numbers in sequence and correctly. While the range is no. 4 (4B) up to 8 which consists of a range of 5 numbers up to 9 digits is a range of numbers that is difficult to remember by testee that is indicated by 0% - 34.7% testee who are able to remember correctly in sequence and correctly. Table 2. Digit Span – Backward No. Tested Numbers Testee Amounts Correct Answer %
  7. 1A 219 100 1B 219 100
  8. 2A 198 90. 2B 202 92,
  9. 3A 162 73. 3B 120 54. 4 4A 91 41, 4B 76 34.
  10. 5A 44 20. 5B 37 16.
  11. 6A 6 2. 6B 11 5.
  12. 7A 3 1. 7B 3 1. 8 8A 0 0 8B 1 0

c) Digit Span Sequence (DSS)

Proceeding of ICPSY 2018 DSS comprises about a range of numbers from 2 digits to 9 digits 9 number that mentioned orally. The tester mentioned a series of number, and testee were asked to repeat the numbers in different order. Testee had to reorder the numbers from the smallest to the biggest one. The results of this test is reported in table 3. It shows that questions number 1 through 3 indicated as easy. From 219 testees, 159 (72.6%) up to 219 (100%) testee were able to remember the numbers correctly. The moderate difficulty of repeating numbers in sequence were seen in question no 4 to 5. This was indicated by 52.97% and 54.79% of testee who were able to recall the sequence of numbers correctly. Item no. 5 to 8 which consists of a range of 6 numbers up to 9 digits is a range of numbers that is difficult to remember by testee. This was indicated by only 1.83% - 34.7% of the testees who are able to remember correctly in sequence and correctly. Table 3. Digit Span – Sequencing No. Tested Numbers Testee Amounts Correct Answer %

  1. 1A 219 100 1B 216 98.
  2. 2A 210 95. 2B 193 88.
  3. 3A 172 78. 3B 159 72, 4 4A 116 52. 4B 120 54.
  4. 5A 76 34. 5B 50 22.
  5. 6A 16 7. 6B 30 13,
  6. 7A 7 3. 7B 7 3. 8 8A 8 3. 8B 4 1. Symbol Span (Symbol Range) Symbol span is a visual working memory test to assess one’s functioning to memorize symbols. This test consists of two parts. Each part contains of eight series of symbols. Testee are asked to memorize the symbols in 5- 15 seconds, then mention it orally. Symbol Span Forward (SSF) The first symbol span subtest is symbol span forward (SSF). In this subtest, testee are asked to memorize the number in the same order with the series given. 219 testee joined this test. Question number 1 and 2 in this test are indiviated as easy because 71.69% (n=157) to 95.89% (n=210) had done the test correctly. Item number 3 had moderate difficulty since 43.38% to 51.6% testee succeeded to do the test correctly. Question number 4 to 8 are categorized as dificcult since no more than 24.2* testee succeeded to answer correctly. Table 4. Symbol Span – Forward No. Tested Numbers Testee Amounts Correct Answer %
  7. 1A 209 95. 1B 210 95. 2 2A 181 82. 2B 157 71.
  8. 3A 113 51. 3B 95 43. 4 4A 37 16. 4B 53 24.
  9. 5A 31 14. 5B 38 17,
  10. 6A 13 5. 6B 14 6.
  11. 7A 9 4, 7B 10 4. 8 8A 8 3. 8B 6 2.

b) Symbol Backward Span (SSB)

In table 5, it can be seen that SSB questions number 1 and 2 indicated as easy since 201 (91.78%) testees

Proceeding of ICPSY 2018 Results of analysis of auditory questions Verb l Learning can be reported in tables 7 to 15 as follows: Table 7. Auditory Verbal Learning - A No. T est List of Words Testee Amounts Correct Answer % 1 PIPE 205

2 WALL 185

3 HOUR 125

4 SUGAR 84

5 STUDENT 102

6 MOTHER 123

7 STAR 39

8 PHOTO 21

9 BAG 64

10 PADI 81

11 MOUTH 78

12 CHICKEN 121

13 SOUND 102

14 ROOF 112

15 LAKE 156

From table 7 of Auditory Verbal Learning - A1, it can be seen that the words pipe, wall and lake are words that are easy to remember by testee, which are sequentially indicated by the number of testees who correctly answered as many as 205 (93.61%) testee for pipes. , 185 (84.47%) testee for the wall, and 156 (71.23%) testee for the lake; on the contrary words that are difficult to remember when sorted from the hardest to difficult ones are photos (9.59%), stars (17.81%), bags (29.22%), mouths (35.62%), rice (36.99%), and sugar (38.36%). While hours (57.08%), mothers (56.16%), chickens (55.25%), roofs (51.14%), students (46.58%), and sound (46.58%) were words that are quite a bit still quite difficult to remember by testee. In table 8 Auditory Verbal Learning - A2 which is a repetition of the Auditory Verbal Learning - A1, shows that more words were easy to remember, which are pipes (89.95% ), walls (89.95%), lakes (89.95%), mothers (78.54%), sounds (76.26%), students (75.50%), hours (75.34%), roof (71.23%), chicken (70.32%), mouth (67.58%), and sugar (61.64%).The words that are moderately difficult to be memorized are rice (50.68%), bags (48.40%), and stars (43.84%). The most difficult word to remember by testee was photos (27.85%). Table 9 Auditory Verbal Learning - A3 is the result of two times repetition after A1 and A2. More easily remembered words were shown but the word ‘photo’ was still considered to be the most difficult to remember. This indicated by 55.71% (n=122) correct answer. Table 8. Auditory Verbal Learning - A No. Test List of Words Testee Amounts Correct Answer % 1 PIPE 197 89. 2 WALL 197 89. 3 HOUR 165 75, 4 SUGAR 135 61. 5 STUDENT 166 75. 6 MOTHER 172 78. 7 STAR 96 43. 8 PHOTO 61 27. 9 BAG 106 48. 10 PADI 111 50, 11 MOUTH 148 67. 12 CHICKEN 154 70. 13 SOUND 167 76. 14 ROOF 156 71. 15 LAKE 197 89.

Proceeding of ICPSY 2018

Table 10 shows the result of A4 series.

Most of the words were considered as easy.

More than 73.06% testee could remember

the words correctly. Similarly, table 11

shows the result of A5 series. More than

75.34% testee could memorized all the 15

words correctly.

Table 12. Auditory Verbal Learning - B No.Test List of Words Testee Amounts Correct Answer % 1 CHAIR 177 80. 2 SECURITY 188 85. 3 CAGE 76 34. 4 SLIPPERS 92 42. 5

REFRIGERA

TOR 54 24.

Table 10. Auditory Verbal Learning - A No. List of Words Testee Amounts Correct Answer % 1 PIPE 211 95. 2 WALL 212 96. 3 HOUR 178 81. 4 SUGAR 181 82.

5 STUDENT 193 88.

6 MOTHER 192 87.

7 STAR 172 78.

8 PHOTO 142 64.

9 BAG 171 78.

10 PADI 160 73.

11 MOUTH 161 73.

12 CHICKEN 169 77,

13 SOUND 201 91.

14 ROOF 189 86.

15 LAKE 207 94.

Table 9. Auditory Verbal Learning - A No.Test List of Words Testee Amounts Correct Answer % 1 PIPE 198 90. 2 WALL 205 93. 3 HOUR 181 82. 4 SUGAR 158 72. 5 STUDENT 186 84. 6 MOTHER 191 87. 7 STAR 153 69. 8 PHOTO 122 55. 9 BAG 151 68. 10 PADI 146 66. 11 MOUTH 157 71. 12 CHICKEN 164 74. 13 SOUND 185 84. 14 ROOF 175 79. 15 LAKE 210 95. Table 11. Auditory Verbal Learning - A No.Test List of Words Testee Amounts Correct Answer % 1 PIPE 215 98. 2 WALL 212 96. 3 HOUR 198 90. 4 SUGAR 188 85. 5 STUDENT 202 92, 6 MOTHER 200 91. 7 STAR 185 84. 8 PHOTO 165 75, 9 BAG 179 81. 10 PADI 165 75, 11 MOUTH 170 77. 12 CHICKEN 176 80. 13 SOUND 207 94. 14 ROOF 183 83, 15 LAKE 213 97.

CONCLUSION

This study is a pilot study to test the adaptation of a neuropsychological test, spesifically the memory domain. All the adapted tests were translated to Bahasa Indonesia and administered to 219 participants. Results showed the percentage of correct answers for each items. The percentage showed no major variances between the original tests. The sequence of the items that were translated showed no major differences with the items in the original versions. These item were administered in the same order with the real ones starting from the easiest item to most difficult item in each subtest. No major changes in the percentage result showed that this pilot study needs to be continued. The items are considered qualified for the real adaptation process, which would include a bigger number of participants from a wider areas in Indonesia. REFERENCES Chaplin, J.P. (2011). Kamus Lengkap Psikolog. Jakarta: Rajagrafindo Perkasa. Feldman, R. (2012). Essentials of Understanding Psychology. New York: McGraw Hill Hambleton, R.K., Merenda, P.F., & Spielberger, C.D. (2005). Adapting Educational and Psychological Test for Cross- cultural Assessment. Mahwah, NJ: Lawrence Erlbaum Slamet (2010). Belajar dan Faktor-faktor yang Mempengaruhi. Jakarta: Rineka Cipta. Proceedi 27 ng of ICPSY 2018 BOMB 191 87. 28 PAPER 111 50. 29 HALL 144 65. 30 SHRIMP 110 50.