Process models of verbal memory in cancer survivors: Bayesian process modeling approach to variation in test scores

ABSTRACT

Introduction

Verbal memory is a complex and fundamental aspect of human cognition. However, traditional sum-score analyses of verbal learning tests oversimplify underlying verbal memory processes. We propose using process models to subdivide memory into multiple processes, which helps in localizing the most affected processes in impaired verbal memory. Additionally, the model can be used to address score and process variability. This study aims to investigate the effects of cancer and its treatment on verbal memory, as well as provide a demonstration of how process models can be used to investigate the uncertainty in neuropsychological test scores.

Method

We present an investigation of memory process scores in non-CNS cancer survivors (n = 184) and no-cancer controls (n = 204). The participants completed the Amsterdam Cognition Scan (ACS), in which classical neuropsychological tests are digitally recreated for online at-home administration. We analyzed data from the ACS equivalent of a Verbal Learning Test using both traditional sum scores and a Bayesian process model.

Results

Analysis of the sum score indicated that patients scored lower than controls on immediate recall but found no difference for delayed recall. The process model analysis indicated a small difference between patients and controls in immediate retrieval from both the partially learned and learned states, with no differences in learning or delayed retrieval processes. Individual-level analysis shows considerable uncertainty for sum scores. Sum scores were more certain than single trials. Retrieval parameters also showed less uncertainty than learning parameters.

Conclusion

The Bayesian process model increased the informativity of Verbal Learning test data, by showing uncertainty of the traditional sum score measurements as well as how the underlying processes differed between populations. Additionally, the model grants insight into underlying memory processes for individuals and how these processes vary within and between them.

KEYWORDS:

• Memory and learning tests
• psycho-oncology
• statistical models
• Bayesian approach
• process scores

Disclosure statement

No potential conflict of interest was reported by the author(s).

Author contributions

All authors contributed to the study conception and design. Analyses were performed by RP. The first draft of the manuscript was written by RP and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/13803395.2024.2313256

Notes

1. The description here most closely resembles the original Rey Auditory Verbal Learning Test (Rey, 1958), and its digital derivative that we will use in this article (Feenstra, Murre, et al., 2018). Other verbal learning tests (Brandt, 1991; Delis et al., 2000) are somewhat different in their setup, although the gist is the same. A recognition task is typically also included, but is not discussed here, because both the scoring method and underlying processes are different from recall, which we focus on here.

Additional information

Funding

This work was supported by the Dutch Cancer Society under Grant KWF-YIG 13760.