Symbol Digit Modalities

Test (SDMT)

Agenda
1.

What is the SDMT?

2.

Testing

3.

Results and Scoring

4.

Wrap it Up

What is the SDMT?

Purpose
Screening

tool for cognitive impairment in

children and adults
Screening

tool: should be utilized with another

assessment tool, cannot be single determinant of
cognitive impairment

Assesses

key neurocognitive functions including

attention, visual scanning, and processing speed

(Smith, 1973)

Population and Time

Population: cognitive impairment, brain damage, aphasia,

other educational difficulties

Validity determined with multiple populations including acute CVA, brain

trauma, Huntingtons Disease, Cushings Syndrome, Schizophrenia

Time: 5 minutes

Activity: conversion of meaningless geometric designs

into written and/or oral number responses

May be used with non-English speaking individuals

because numbers are universal
(Smith, 1973)

Review of Brain Function

Left brain: language and

calculation

Right brain: spatial reasoning

Corpus callosum: sends

information back and forth
between the two hemispheres

Substitution tests forces an

individual to utilize both
hemispheres of the brain

Cognitive Impairment

Cognitive impairment: difficulty remembering, learning new

information, concentrating, making decisions affecting everyday life

Age- greatest risk for cognitive impairment

Ranges from mild severe

Mild: may begin to notice change in cognitive functions, but still able to
function in everyday life

Severe: no longer able to live independently

(Centers for Disease Control, 2011)

Testing

Versions: Written & Oral

Written version given individually or in groups

Speech disorders (i.e. aphasia, dysarthria)

Oral version given individually

Motor challenges (i.e. CP, hemiparesis, Parkinsonism, Huntingtons)

Always complete the written test first, if score is more than 1

standard deviation below their appropriate age-sex norm should be
re-administered with oral SDMT to avoid unnecessary referrals

(Smith, 1973)

DEMONSTRATION

Results and Scoring

Scoring

Score: number of correct substitutions in each 90-secondinterval (excludes the first 10 practice boxes)

Total number of correct responses is found by separating the top

sheet upon which examinee has written his/her responses on
and counting the number of responses that correctly match the
number printed above each box on second sheet

i.e. 36/39- there were 39 responses total, 3 incorrect

Total score provides a measure of speed and accuracy of

symbol-digit substitutions

(Smith, 1973)

CONVERT THE SCORE

Standard Deviation

Mean
About
92%
within
1.5 s.d.
of mean

Standard deviation:
how spread out the
numbers are from
the mean

Interpretation of Adult Scores

Standardized completed with 1,307 normal adults ages 18-78

Low scores: scores approximately 1 standard deviation below

the mean for a particular age group

Moderately low scores: 1.5 standard deviations below the

mean for a particular age group

Very low scores: 2 standard deviations below the mean for a

particular age group

Scores that fall at or below -1.5 standard deviations from the

mean for a given age at a particular educational level are
indicative of possible cognitive impairment

i.e. 40 year old individual with college education, a written score of 37 or less would
suggest possible impairment

(Smith, 1973)

Low Score:

46 year old, 12 years or less

education, score of 38

(Smith, 1973)

Moderately Low Score:

46 year old, 12
years or less education, score of 33

(Smith, 1973)

Very Low Score:

46 year old, 12 years or less

education, score of 28

(Smith, 1973)

Standardization of Adult Norms

Adult norms obtained using two samples of 420 and 887 adult
volunteers (N=1,307)

Individuals with reported impairments excluded

Evenly distributed into six age groups (age groups on normative Table
3)

Divided by level of education

Age and education impacted score, gender did not therefore gender not
separated on normative table

(Smith, 1973)

Reliability

Degree to which a research instrument produces similar

results

Study of 80 adults used; mean age 34.8, mean education 16.2

Given both the written and oral version

Test-retest reliability: results are consistent over time

Giving a test on more than one occasion

Score of 1=perfectly correlated

0.9 and 0.8 = good reliability

0.8 test-retest reliability for written version

(Smith, 1973)

Validity

How accurate an instrument is at measuring what it is

trying to measure

SDMT shown to be an effective test of general cognitive

impairment

Written and oral version of SDMT delivered to individuals with

cognitive impairment, mean scores noticeably subnormal (i.e.
>2 s.d. away from appropriate age norm)

(Smith, 1973)

Validity: Acute CVA

Initial performance on SDMT by adults with acute CVA studied (Burkalnd &
Smith, 1967)

Written and oral SDMT scores examined for three classifications of adults;
independent, dependent, and deceased

Independent: recovered from CVA, able to function I

Dependent: required assistance with ADLs

Deceased: passed away prior to follow up

All mean scores fell at least 1.5 standard deviations below the mean for
the norm group, indicating cognitive impairment

Scores for dependent group remarkably lower than independent group

(Smith, 1973)

Literature Review; SDMT used with

MS
A one-year follow-up study of the Symbol Digit Modalities Test
(SDMT) and the Paced Auditory Serial Addition Test (PASAT) in
relapsing-remitting multiple sclerosis: an appraisal of comparative
longitudinal sensitivity

237 patients with RRMS and 57 controls underwent neuropsychological

assessment

Sensitivity to detect cognitive impairment for SDMT and PASAT-3 was

0.809 and 0.783

SDMT showed higher correlation values and higher sensitivity

SDMT is simpler to administer than PASAT-3

(Lpez-Gngora, Querol, & Escartnone, 2015)

Wrap it Up

Critique

Sample size per age range in normative table was equal,

however gender breakdown not reported

Lack of age and gender breakdowns in the literature limits value

of SDMT when assessing new cohorts against current normative
data

Questions

References
Centers for Disease Control. (2011). Cognitive Impairment: A Call for Action, Now!
Retrieved from
http://www.cdc.gov/aging/pdf/cognitive_impairment/cogimp_poilicy_final.pdf
Lpez-Gngora, M., Querol, L., and Escartnone, A. (2015). A one-year follow-up study of
the Symbol Digit Modalities Test (SDMT) and the Paced Auditory Serial Addition Test
(PASAT) in relapsing-remitting multiple sclerosis: an appraisal of comparative
longitudinal sensitivity. BMC Neurology, 15(1), 1-8 8p. doi:10.1186/s12883-015-0296-2
Smith, A. (1973). Symbol Digit Modalities Test [Manual]. Torrance, CA: Western
Psychological Services.