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typically stronger for individuals with MS (eg, Picture Completion), and the weakest performance is typically seen on the highly speeded subtests of Object Assembly and Digit Symbol Heaton et al (1985) administered the WAIS and Halstead-Reitan Battery to 100 patients with MS Of this sample, 57 patients had a relapsing remitting disease course, and had been in remission for one month or longer when assessed, and 43 patients had a chronic progressive form of MS, never experiencing significant remission Both patient groups displayed the predicted V > P profile As expected, however, the discrepancy was larger for the chronic progressive sample (V-IQ = 110, P-IQ = 98, discrepancy = +12 points) than for the MS patients with remission (V-IQ = 111, P-IQ = 106, discrepancy = +5 points).

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The subtest profile on the Performance Scale was not revealing for the relapsing remitting patients, but for the chronic patients it conformed closely to the hypothesized pattern based on the supposed amount of motor coordination demanded by each WAIS-R Performance subtest: The chronic progressive MS patients earned their highest mean Performance scaled score (10) on Picture Completion and their lowest (81 2) on Object Assembly and Digit Symbol The motor coordination difficulties of the MS patients were clearly documented by their performance on the Halstead-Reitan neuropsychological battery and by clinicians ratings Five of the neuropsychological subtests administered measure sensory motor functioning without a clear-cut cognitive component The total group of MS patients performed significantly more poorly than did 100 matched normal controls on all five sensory motor tests, and the chronic progressive MS patients scored significantly lower than the relapsing remitting patients on three of the five tasks.

Further, the clinicians motor ratings classified 100% of the chronic patients as having motor impairment, compared to 77% of the patients in remission and 3% of the controls (Heaton et al, 1985) Maurelli et al (1992) administered the WAIS to a sample of 34 patients with MS who were in a.

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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 385 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 (949) was 51 points higher than the mean P-IQ (898), 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.

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