This form structure is an organized set of data definitions for a copyrighted form

 General Details

Title:
Brief Visuospatial Memory Test - Revised (BVMT-R)
Short Name:
BVMTR
Description:
The Brief Visuospatial Memory Test - Revised (BVMT-R) is a commonly used assessment tool to measure visuospatial learning and memory abilities across research and clinical settings. Copyright PAR INC - http://www4.parinc.com/Products/Product.aspx?ProductID=BVMT Author: Ralph H. B. Benedict, PhD, ABCN A measure of visuospatial memory, the BVMT-R can be used as part of a large neuropsychological battery, as a screening measure, and as a repeat measure to document changes over time. Purpose: Measure visuospatial memory Age range:18 to 79 years.
Disease:
Traumatic Brain Injury , General (For all diseases)
Organization:
NIH
Required Program Form:
No
Standardization:
Standard NINDS CDE
Labels:
Form Type:
Clinical Assessment
Publication Date:
2016-11-16
Version:
1.0
Date Created:
2015-04-08
Owner:
Number of Data Elements:
49
eForms:
N

 Documentation


 Groups & Attached Data Elements

Logically grouped data elements with defined frequency at which they repeat.

# Title Short Description Variable Name Required? Type
1 GUID   Global Unique ID which uniquely identifies a subject GUID Required CDE
2 Subject identifier number   An identification number assigned to the participant/subject within a given protocol or a study. SubjectIDNum Optional CDE
3 Age in years   Value for participant's subject age recorded in years. AgeYrs Recommended CDE
4 Vital status   Status of participant/subject as alive or dead VitStatus Optional CDE
5 Visit date   Actual interview or visit date VisitDate Recommended CDE
6 Site name   The name of the site for the study SiteName Recommended CDE
7 Days since baseline   The number of days since baseline DaysSinceBaseline Optional CDE
8 Case control indicator   Indicator of whether subject is in the case or control arm of the study CaseContrlInd Optional CDE
9 General notes text   General notes GeneralNotesTxt Optional CDE

Additional Element Groups

Listed below are your additional element groups.

Form Administration (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 Context type  The context to which the questions were answered ContextType Recommended CDE
2 Context type other text  The free-text related to ContextType specifying other text ContextTypeOTH Recommended CDE
3 Data source  Source of the data provided on the case report form DataSource Recommended CDE
4 Data source other text  The free-text field related to Data source specifying other text. Source of the data provided on the case report form DataSourceOTH Recommended CDE

Brief Visuospatial Memory Test (Appears Up To 6 Times)

# Title Short Description Variable Name Required? Type
1 Brief Visuospatial Memory Test - Revised (BVMT-R) - Form administered number  Number of form administered for the Brief Visuospatial Memory Test - Revised (BVMT-R) BVMTRFormAdministeredNum Recommended CDE
2 Brief Visuospatial Memory Test - Revised (BVMT-R) - Trial 1 raw score  Raw score for Trial 1 portion of Brief Visuospatial Memory Test - Revised (BVMT-R) BVMTRTrial1RawScore Recommended CDE
3 Brief Visuospatial Memory Test - Revised (BVMT-R) - Trial 1 T-score  T-score for Trial 1 portion of Brief Visuospatial Memory Test - Revised (BVMT-R) BVMTRTrial1TScore Recommended CDE
4 Brief Visuospatial Memory Test - Revised (BVMT-R) - Trial 1 percentage value  Percentile for Trial 1 portion of Brief Visuospatial Memory Test - Revised (BVMT-R) BVMTRTrial1Percentile Recommended CDE
5 Brief Visuospatial Memory Test - Revised (BVMT-R) - Trial 2 raw score  Raw score for Trial 2 portion of Brief Visuospatial Memory Test - Revised (BVMT-R) BVMTRTrial2RawScore Recommended CDE
6 Brief Visuospatial Memory Test - Revised (BVMT-R) - Trial 2 T-score  T-score for Trial 2 portion of Brief Visuospatial Memory Test - Revised (BVMT-R) BVMTRTrial2TScore Recommended CDE
7 Brief Visuospatial Memory Test - Revised (BVMT-R) - Trial 2 percentage value  Percentile for Trial 2 portion of Brief Visuospatial Memory Test - Revised (BVMT-R) BVMTRTrial2Percentile Recommended CDE
8 Brief Visuospatial Memory Test - Revised (BVMT-R) - Trial 3 raw score  Raw score for Trial 3 portion of Brief Visuospatial Memory Test - Revised (BVMT-R) BVMTRTrial3RawScore Recommended CDE
9 Brief Visuospatial Memory Test - Revised (BVMT-R) - Trial 3 T-score  T-score for Trial 3 portion of Brief Visuospatial Memory Test - Revised (BVMT-R) BVMTRTrial3TScore Recommended CDE
10 Brief Visuospatial Memory Test - Revised (BVMT-R) - Trial 3 percentage value  Percentile for Trial 3 portion of Brief Visuospatial Memory Test - Revised (BVMT-R) BVMTRTrial3Percentile Recommended CDE
11 Brief Visuospatial Memory Test - Revised (BVMT-R) - Total recall raw score  Raw score for Total Recall portion of Brief Visuospatial Memory Test - Revised (BVMT-R) BVMTRTtlRecallRawScore Recommended CDE
12 Brief Visuospatial Memory Test - Revised (BVMT-R) - Total recall t-score  T-score for Total Recall portion of Brief Visuospatial Memory Test - Revised (BVMT-R) BVMTRTtlRecallTScore Recommended CDE
13 Brief Visuospatial Memory Test - Revised (BVMT-R) - Total recall percentage value  Percentile for Total Recall portion of Brief Visuospatial Memory Test - Revised (BVMT-R) BVMTRTtlRecallPercentile Recommended CDE
14 Brief Visuospatial Memory Test - Revised (BVMT-R) - Learning raw score  Raw score for Learning portion of Brief Visuospatial Memory Test - Revised (BVMT-R) BVMTRLearnRawScore Recommended CDE
15 Brief Visuospatial Memory Test - Revised (BVMT-R) - Learning T-score  T-score for Learning portion of Brief Visuospatial Memory Test - Revised (BVMT-R) BVMTRLearnTScore Recommended CDE
16 Brief Visuospatial Memory Test - Revised (BVMT-R) - Learning percentage value  Percentile for Learning portion of Brief Visuospatial Memory Test - Revised (BVMT-R) BVMTRLearnPercentile Recommended CDE
17 Brief Visuospatial Memory Test - Revised (BVMT-R) - Delayed recall raw score  Raw score for Delayed Recall portion of Brief Visuospatial Memory Test - Revised (BVMT-R) BVMTRDelayRecallRawScore Recommended CDE
18 Brief Visuospatial Memory Test - Revised (BVMT-R) - Delayed recall T-score  T-score for Delayed Recall portion of Brief Visuospatial Memory Test - Revised (BVMT-R) BVMTRDelayRecallTScore Recommended CDE
19 Brief Visuospatial Memory Test - Revised (BVMT-R) - Delayed recall percentage value  Percentile for Delayed Recall portion of Brief Visuospatial Memory Test - Revised (BVMT-R) BVMTRDelayRecallPercentile Recommended CDE
20 Brief Visuospatial Memory Test - Revised (BVMT-R) - Percent retained raw score  Raw score for Percent Retained portion of Brief Visuospatial Memory Test - Revised (BVMT-R) BVMTRPercntRetainRawScore Recommended CDE
21 Brief Visuospatial Memory Test - Revised (BVMT-R) - Percent retained percentage value  Percentile for Percent Retained portion of Brief Visuospatial Memory Test - Revised (BVMT-R) BVMTRPercntRetainPercentile Recommended CDE
22 Brief Visuospatial Memory Test - Revised (BVMT-R) - Recognition hits raw score  Raw score for Recognition Hits portion of Brief Visuospatial Memory Test - Revised (BVMT-R) BVMTRHitsRawScore Recommended CDE
23 Brief Visuospatial Memory Test - Revised (BVMT-R) - Recognition hits percentage value  Percentile for Recognition Hits portion of Brief Visuospatial Memory Test - Revised (BVMT-R) BVMTRHitsPercentile Recommended CDE
24 Brief Visuospatial Memory Test - Revised (BVMT-R) - Recognition false alarm raw score  Raw score for Recognition False Alarms portion of Brief Visuospatial Memory Test - Revised (BVMT-R) BVMTRFalseAlarmRawScore Recommended CDE
25 Brief Visuospatial Memory Test - Revised (BVMT-R) - Recognition false alarm percentage value  Percentile for Recognition False Alarms portion of Brief Visuospatial Memory Test - Revised (BVMT-R) BVMTRFalseAlarmPercentile Recommended CDE
26 Brief Visuospatial Memory Test - Revised (BVMT-R) - Recognition discrimination index raw score  Raw score for Recognition Discrimination portion of Brief Visuospatial Memory Test - Revised (BVMT-R) BVMTRDiscrimIndxRawScore Recommended CDE
27 Brief Visuospatial Memory Test - Revised (BVMT-R) - Recognition discrimination index percentage value  Percentile for Recognition Discrimination Index portion of Brief Visuospatial Memory Test - Revised (BVMT-R) BVMTRDiscrimIndxPercentile Recommended CDE
28 Brief Visuospatial Memory Test - Revised (BVMT-R) - Recognition response bias raw score  Raw score for Recognition Response Bias portion of Brief Visuospatial Memory Test - Revised (BVMT-R) BVMTRResponsBiasRawScore Recommended CDE
29 Brief Visuospatial Memory Test - Revised (BVMT-R) - Recognition response bias percentage value  Percentile for Recognition Response Bias portion of Brief Visuospatial Memory Test - Revised (BVMT-R) BVMTRResponsBiasPercentile Recommended CDE
30 Brief Visuospatial Memory Test - Revised (BVMT-R) - Copy raw score  Raw score for Copy portion of Brief Visuospatial Memory Test - Revised (BVMT-R) BVMTRCopyRawScore Recommended CDE
31 Brief Visuospatial Memory Test - Revised (BVMT-R) - Comparison group text  Description of comparison group for Brief Visuospatial Memory Test - Revised (BVMT-R) BVMTRComparisonGroupTxt Recommended CDE
32 Brief Visuospatial Memory Test - Revised (BVMT-R) - Trial 3 completion time  Time the participant/subject completed Trial 3 portion of Brief Visuospatial Memory Test - Revised (BVMT-R) BVMTRTrial3CompleteTime Recommended CDE
33 Brief Visuospatial Memory Test - Revised (BVMT-R) - Delayed recall start time  Time started delayed recall trials for Brief Visuospatial Memory Test - Revised (BVMT-R) BVMTRDelayRecallStartTime Recommended CDE
34 Brief Visuospatial Memory Test - Revised (BVMT-R) - Delay interval minute time  Time of delay interval in minutes for Brief Visuospatial Memory Test - Revised (BVMT-R) BVMTRDelayIntervalTime Recommended CDE
35 Brief Visuospatial Memory Test - Revised (BVMT-R) - Copy image status  Copy image created by the subject, as part of Brief Visuospatial Memory Test - Revised (BVMT-R) BVMTRCopyImage Recommended CDE
36 Brief Visuospatial Memory Test - Revised (BVMT-R) - Stimulus image status  Stimulus image plate (8x11-inch ) containing six geometric visual designs in a 2x3 matrix, as part of Brief Visuospatial Memory Test - Revised (BVMT-R) BVMTRStimulusImage Recommended CDE

 Change History

 Administrative Change History