Contextual Memory Test
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Contextual Memory Test

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Purpose

The Contextual Memory test (CMT) assesses immediate and delayed recall of 20 objects related to a scene in children and adults with memory impairments. In addition, questions before and immediately after recall objectively assess awareness of memory abilities and strategy use.

It can also be used as a screening tool to identify if a patient has a memory impairment present or if further tests need to be performed.

Link to Instrument

Contextual Memory Test 2 (CMT-2)

Acronym CMT

Area of Assessment

Attention & Working Memory
Cognition
Reasoning/Problem Solving

Assessment Type

Performance Measure

Administration Mode

Computer

Cost

Not Free

Actual Cost

$142.00

Cost Description

CMT-2 (2019): Free
Original CMT (1993): Complete test kit = $142; Package of 25 additional score sheets = $55.50

CDE Status

Not a CDE as of July 2023

Populations

Sensory Disorders
Older Adults and Geriatric Care
Alzheimer's Disease and Progressive Dementia
Brain Injury

Key Descriptions

  • The CMT was designed to objectively measure awareness and strategy use. Testing procedures are flexible to assess various areas of recall and recognition.
  • The original paper version of the CMT was developed and published for use with adults with memory disorders in 1993. The CMT-2 is an updated, computerized version released in 2019. The CMT-2 is similar to the original CMT, but it uses colored photos and includes some item updates; Additionally, 2 scenes (morning and school) have been added for use with children.
  • Part I and II each measure 3 domains: immediate recall, delayed recall, and self-recognition
  • Part I: A picture card containing 20 related, everyday objects is presented for 90 seconds. After the 90 seconds, the screen remains hidden from the client. The therapist performing the test should say: “Tell me everything that you just saw”. The therapist will then select from a list on their computer the correct responses their client gives.
  • Part II: In this portion, the client is given a cue by being told the theme of the pictures given before viewing the pictures. Time will go for 15 minutes.
  • The scores for immediate recall, delayed recall and recognition range between 0–18 for each part of the CMT. Higher scores indicate better memory performance.
  • Scores for entire test can be summed for an overall score: Within Normal Limits = 166+; Suspect = 146 - 165; Mild = 132 - 145; Moderate = 107 -131; and Severe = 1-106 (Toglia, 1993).

Number of Items

16

Equipment Required

  • Manual
  • 2 test cards
  • 14 cut-apart sheets (80 picture cards)
  • 25 score sheets

Time to Administer

20-60 minutes

Part I takes 10-20 minutes, then there is a 15-20 minute delay before Part II if additional testing is needed.

Required Training

Reading an Article/Manual

Required Training Description

The CMT-2 was designed to be used by licensed occupational therapists, or other licensed health professionals such as speech language pathologists and psychologists. The manual is lengthy and should be understood thoroughly prior to testing.

Examiner should be aware of administration protocol and be able to correctly score and interpret the test. Examiner should also know how to perform a dynamic assessment, including providing cues to the patient and identifying strategies to help the client optimize their performance.

Age Ranges

Children

7 - 17

years

Adults

18 - 65

years

Elderly adults

+

years

Instrument Reviewers

Clara Gannon, MS (Rosalind Franklin University Medical School)

Jennifer Burns (SRAlab)

ICF Domain

Body Function
Activity

Measurement Domain

Activities of Daily Living
Cognition

Considerations

 

  • The CMT was designed to objectively measure awareness and strategy use. Testing procedures are flexible to assess both recall and recognition. Administering the CMT is simple, but the scoring and interpretation is complex. Users are encouraged to consult the original CMT manual. Assessment results are associated with treatment plans and suggested areas for additional testing
  • The CMT is not a diagnostic test. This test must be used along with other tests for diagnosis of memory impairments. Information obtained on awareness, strategy use and recall are interpreted together and are used, along with other data and tests, for the purposes of choosing and planning rehabilitation interventions.
  • The CMT-2 is appropriate for adults with traumatic brain injury (TBI), stroke, brain tumor, multiple sclerosis, Parkinson’s Disease, mild cognitive impairment (MCI), mild-mod dementia, depression, bipolar disease, schizophrenia, substance abuse disorders and other neurological or mental health conditions that can affect memory. Similarly, the CMT-2 can be used for children with neurological, developmental or mental health conditions such as intellectual developmental disability (IDD), autism, fetal alcohol syndrome, childhood brain tumor, childhood depression.
  • Not an appropriate instrument for patients with moderate or severe aphasia or visual perceptual (neglect or object recognition) deficits.
  • The CMT-2 may not be sensitive to patients with subtle memory deficits.
  • The test utilizes familiar objects as the items tested for memory. However, language and cultural barriers may affect the efficacy of the CMT if the patient is not able to recognize the items utilized in the CMT. However, It was found that the CMT can be properly used in Israeli participants, indicating that the CMT way be appropriate for use in different populations across regions. (Josman, 2000)

Older Adults and Geriatric Care

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Standard Error of Measurement (SEM)

Mild Cognitive Impairment: (Liao, 2020; n = 83; Age Range= 57.5-80; Taiwanese Mandarin-speaking sample)

  • SEM for healthy individuals (n=44): Ranged from 0.34 - 2.75.
  • SEM for individuals with MCI (n=39): Ranged from 0.42 - 2.12.

Minimal Detectable Change (MDC)

Mild Cognitive Impairment: (Liao et al, 2020)

  • Individuals with MCI (n=39): 
    • Acceptable random measurement error for five domains (self-awareness, self-perception/evaluation of performance, immediate/delayed/total recall): MDC% all below 30%
    • Large measurement error for the TSS domain (Part II): MDC% = 35.14%
  • Individuals with no cognitive impairment (n=44): 
    • Acceptable random measurement error for five domains (self-awareness, self-perception/evaluation of performance, immediate/delayed/total recall): MDC% all below 30%
    • Large measurement errors for the self-efficacy domain (prediction discrepancy) and TSS domain (Part II): MCD% = 32.22% and 35.24%, respectively

Test/Retest Reliability

Mild Cognitive Impairment: (Liao, 2020; number of subjects (n = 39); age (Mean Age (SD) = 69.44 (10.56)

  • ICC for healthy individuals (n=44): 
    • Moderate to excellent test-retest reliability for five domains (self-awareness, self-perception/evaluation of performance, immediate/delayed/total recall): ICC = 0.63 - 0.92
    • Moderate to poor test-retest reliability for self-efficacy (estimation discrepancy, Part I and II) and TSS (Part II) domains: ICC = 0.24 – 0.59
  • ICC for individuals with MCI (n=39): 
    • Excellent test-reliability for five domains (self-awareness, self-perception/evaluation of performance, immediate/delayed/total recall): ICC = 0.73 – 0.95
    • Moderate to poor test-retest reliability for the self-efficacy (estimation discrepancy, Part I and II) and TSS (Part II) domains: ICC = 0.07 – 0.48
  • In examining the agreement between repeated measurements, a significant practice effect shown by these mean differences (MD) was found for the following sub-scales of the CMT:
    • Immediate Recall MD (SD) = 1.59 (1.83)
    • Total Recall: 3.79 (3.46)
    • Delayed Recall: 2.2 (2.8)

Alzheimer's Disease and Progressive Dementia

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Normative Data

Alzheimer’s Disease (AD): (Gil, 2001; n = 60; Age range: 68-90 years; Hebrew-speaking sample)

  • Mean (SD) subscale scores for elderly participants with AD (n=30, mean age (SD) = 81.51 (5.42)); Mean age: 81.5):
    • Immediate Recall I: 5.1 (3.2)
    • Immediate Recall II: 5.87 (3.1)
    • Delayed Recall I: 2.87 (3.45)
    • Delayed Recall II: 3.13 (3.44)
    • Recognition I: 9.00 (4.16)
    • Recognition II: 8.67 (4.23)
  • Mean (SD) subscale score for elderly participants with no memory problems (n=30):
    • Immediate Recall I: 10.97 (3.12)
    • Immediate Recall II: 12.23 (3.5)
    • Delayed Recall I: 10.13 (3.29)
    • Delayed Recall II: 11.17 (3.76)
    • Recognition I: 15.1 (3.7)
    • Recognition II: 16.07 (2.95)

Construct Validity

Alzheimer’s Disease (AD): (Gil, 2001; n = 60 ; Age range: 68-90; Hebrew-speaking sample)

  • Significant differences (z=3.28, p<0.001) were obtained between the two groups (the healthy elderly control and the elderly suffering from AD) on the general awareness of the individuals’ subjective views of their memory status and of their resulting functional implications.
  • Self-efficacy differences between prediction and actual immediate recall (z-test) were found to be statistically significant (z= -1.94) between the two groups.
  • Self-efficacy differences between estimation and actual immediate recall (z-test) were found to be statistically significant (z= -2.4) between the two groups.

Brain Injury

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Test/Retest Reliability

Brain Injury: (Toglia,1993)

  • Excellent test-retest reliability (ICC = 0.85-0.95)

Internal Consistency

Acute Brain Injury: (Kizony, 2014; n = 16 ; Mean age=13.55 (3.29); Moderate or Severe ABI at least six months prior to participation in the study)

  • Adequate internal consistency (Cronbach’s alpha = .82)

Criterion Validity (Predictive/Concurrent)

Concurrent Validity

Brain Injury: (Toglia, 1993)

  • Excellent concurrent validity with the Rivermead Behavioral Memory Test (RBMT) with correlations ranging from 0.80 to 0.84.

Sensory Disorders

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Normative Data

Children with Cochlear Implants: (Engel-Yeger, 2010; n=40; Age 8-10 years)

  • Mean (SD) subscale scores for children with cochlear implants (n=20)
    • Memory
      • Immediate Recall : 9.75 (1.86)
      • Delayed Recall : 8.75 (1.97)
      • Recognition : 14.05 (1.35)
    • Meta-Memory
      • Performance Prediction: 15.65 (3.36)
      • Performance Estimation: 14.15 (3.70)
  • Mean (SD) subscale scores for children with normal hearing (n=20)
    • Memory
      • Immediate Recall : 13.10 (2.02)
      • Delayed Recall : 12.30 (2.34)
      • Recognition : 16.55 (1.23)
    • Meta-Memory
      • Performance Prediction: 13.35 (2.39)
      • Performance Estimation: 12.80 (2.56)

Internal Consistency

Children with Cochlear Implants: (Engel-Yeger, 2010)

  • High internal consistency (Cronbach's alphas= 0.82).

Criterion Validity (Predictive/Concurrent)

Concurrent Validity

Children with Cochlear Implants: (Engel-Yeger, 2010):

  • Excellent correlations between the CMS sub scales and the CMT memory tests for children with cochlear implants:
    • Immediate Recall (r = 0.505)
    • Delayed Recall (r = 0.68)
  • Excellent correlations between the CMS sub scales and the CMT memory tests for children with normal hearing:
    • Immediate Recall (r = 0.769)
    • Delayed Recall (r = 0.705)

Bibliography

Engel-Yeger, B., Durr, D. H., & Josman, N. (2011). Comparison of memory and meta-memory abilities of children with cochlear implant and normal hearing peers. Disability and Rehabilitation, 33(9), 770–777.

Gil, N., & Josman, N. (2001). Memory and metamemory performance in Alzheimer’s disease and healthy elderly: The Contextual Memory Test (CMT). Aging Clinical and Experimental Research, 13(4), 309.

Josman, N., Berney, T., & Jarus, T. (2000). Performance of children with and without traumatic brain injury on the contextual memory test (CMT). Physical & Occupational Therapy in Pediatrics, 19(3–4), 39–51.

Josman N, Hartman-Meir A. Cross-cultural assessment of the contextual Memory Test (CMT). Occup Ther Int 2010;7: 246–258.

Kizony R, Tau S, Bar O, Engel Yeger B. Comparing memory and meta-memory abilities between children with acquired brain injury and healthy peers. Res Dev Disabil. 2014 Jul;35(7):1666-73. doi: 10.1016/j.ridd.2014.03.041. Epub 2014 Apr 13. PMID: 24726285.

Liao, Wu, C., Liu, C.-H., Lin, S., Chiau, H.-Y., & Chen, C. (2020). Test-retest reliability and minimal detectable change of the Contextual Memory Test in older adults with and without mild cognitive impairment. PloS One, 15(7), e0236654–e0236654. https://doi.org/10.1371/journal.pone.0236654

OCTH 6260-spring- assessment rating form - health.utah.edu. Contextual Memory Test. https://health.utah.edu/sites/g/files/zrelqx131/files/files/migration/image/tca.pdf. 

Toglia JP. Contextual Memory Test. Tucson, AZ: Therapy Skill Builders; 1993.

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