Digit symbol substitution test (DSST) is a neuropsychological test sensitive to brain damage, dementia, age and depression. The test is not sensitive to the location of brain-damage (except for damage comprising part of the visual field).[1] It consists of (e.g. nine) digit-symbol pairs (e.g. 1/-, 2/┴, ... 7/Λ, 8/X, 9/=) followed by a list of digits.[2][3][4] Under each digit the subject should write down the corresponding symbol as fast as possible. The number of correct symbols within the allowed time (e.g. 90 or 120 sec) is measured.
The DSST contained in the Wechsler Adult Intelligence Scale is called 'Digit Symbol' (WAIS-R), 'Digit-Symbol-Coding' (WAIS-III), or most recently, 'Coding' (WAIS-IV). Based on The Boston Process Approach to assessment, in order to examine the role of memory in Digit-Symbol-Coding performance, WAIS-III (but not WAIS-IV[5]) contains an optional implicit learning test: after the Digit Symbol-Coding test paired and free recall of the symbols is assessed.[6][7][8][9]
The National Health and Nutrition Examination Survey (NHANES) administered the DSST to over three thousand participants 60 years and older in 2011–2014. Trained interviewers administered the test at the end of a face-to-face private interview in an examination center and two interviewers independently scored the test. An extensive analysis of these data has been published.[10] Scores (mean, 25th percentile, 75th percentile) declined with age: 60-69y: 57, 46, 68; 70-79y: 48, 38, 68; 80+y: 40, 29, 49.
^Lezak, M.D.; Howieson, D.B. & Loring, D.W. (2004). Neuropsychological assessment. New York: Oxford University Press. pp. 368–370. ISBN 978-0-19-511121-7.
^Chris Adam; Neil Craton (2002). "Concussions: A Head-On Approach" (PDF). The Canadian Journal of Diagnosis: 101–115.
^"Concussions-Craton.pdf" (PDF). Archived from the original (PDF) on 2011-07-06. {{cite journal}}: Cite journal requires |journal= (help)
^Brukner, P.; Khan, K. & Kron, J. (2004). The encyclopedia of exercise, sport and health. Crows Nest, N.S.W.: Allen & Unwin. p. 109. ISBN 1-74114-058-7.
^Lichtenberger, E.O.; Kaufman, A.S. (2009). Essentials of WAIS-IV assessment. Essentials of Psychological Assessment. Hoboken, N.J.: Wiley. p. 27. ISBN 978-0-471-73846-6. LCCN 2009015529.
^Ryan, J.J. & Lopez, S.J. (2001). "Wechsler adult intelligence scale-III". In W.I. Dorfman & M. Hersen (eds.). Understanding psychological assessment. Perspectives on individual differences. New York: Kluwer Academic/Plenum Publishers. p. 23. ISBN 978-0-306-46268-9.
^Milberg, W.P.; Hebben, N. & Kaplan, E. (2009). "The Boston Process Approach to Neuropsychological Assessment". In I. Grant & K.M. Adams (eds.). Neuropsychological assessment of neuropsychiatric and neuromedical disorders (3rd ed.). Oxford: Oxford University Press. p. 49. ISBN 978-0-19-537854-2.
^Golden, C.J.; Espe-Pfeifer, P. & Wachsler-Felder, J. (2000). Neuropsychological interpretation of objective psychological tests. Critical issues in neuropsychology. New York: Kluwer Academic/Plenum. p. 125. ISBN 978-0-306-46224-5.
^Lezak, M.D.; Howieson, D.B. & Loring, D.W. (2004). Neuropsychological assessment. New York: Oxford University Press. p. 472. ISBN 978-0-19-511121-7.
^Brody, D.J.; Kramarow, E.A.; Taylor, C.A.; McGuire, L.C. (1 Sep 2019). "Cognitive Performance in Adults Aged 60 and Over: National Health and Nutrition Examination Survey, 2011-2014". Natl Health Stat Report (126). CDC/National Center for Health Statistics: 1–23. PMID 31751207.
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