1 Examining Gender Invariance in Repeatable Battery for the Assessment of Neuropsychological Status Learning Ratio

Abstract

Objective:

Process-based measures of verbal learning, such as the recently described learning ratio (LR; Hammers et al., 2022) may add valuable data to neuropsychological assessment. Women tend to have higher episodic verbal memory ability compared to men at all ages, including older adulthood (Golchert et al., 2019; Maitland et al., 2004). However, it is unclear whether gender is related to the process of learning, as quantified through measures of learning slope and ratio. To date only one study has examined this, with Hammers et al. (2021) finding no gender differences on LR in the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS); therefore, further study is necessary. We examined whether men and women differed in LR, learning over time (LOT), and raw learning slope (RLS) in a healthy older adult sample, as well as whether these learning process variables predicted delayed memory equally for men and women.

Participants and Methods:

203 cognitively healthy community-dwelling adults aged 50 and above (mean age 67.7; 133 women) were taken from a larger archival database; all were administered the RBANS in the context of other studies. LR, LOT, and RLS were calculated from the List Learning task. We examined whether men and women differed in these learning process measures. We then examined whether process measures differentially predicted performance on list recall and delayed memory index (DMI) of the RBANS for men and women.

Results:

Men and women did not differ in age or years of education. After accounting for age and education, there were no gender differences on LR (p=.455) or RLS (p=.502) but LOT was lower in women (p=.013).

LR was equally predictive of list recall across genders (p<.001 for LR; p=.21 for gender). Correlations between LR and list recall were r=.65 (p<.001) for men and r=.56 (p<.001) for women. Both LR (p<.001) and gender (p=.008) predicted DMI but the interaction was nonsignificant. Correlations between LR and DMI were r=.52 for men (p<.001) and r=.46 for women (p<.001).

RLS predicted list recall equally across genders (p<.001 for RLS; p=.07 for gender; p=.18 for interaction). Correlations between RLS and list recall were r=.43 for men (p<.001) and r=.23 for women (p=.008). RLS (p<.001) and gender (p=.002; p=.19 for interaction) predicted DMI scores. Correlations between RLS and DMI were r=.31 for men (p=.008) and r=.21 for women (p=.015).

LOT predicted list recall equally across genders (p<.001; p=.97 for gender; p=.80 for interaction). Correlations between LOT and list recall were r=-.50 for men (p<.001) and r=-.60 for women (p<.001). LOT also predicted DMI equally across genders (p<.001; p=.084 for gender; p=.159 for interaction). Correlations between LOT and DMI were r=-.46 for men (p<.001) and r=-.49 for women (p<.001).

Conclusions:

Of the three process variables, LR was the only one that did not show gender differences and was related to delayed memory outcomes with medium to large effect across both genders. Results suggest that LR can be used consistently across genders. As this sample consisted of healthy, independently-living older adults, future study should examine LR by gender in MCI and dementia samples.