How to Administer the Hopkins Verbal Learning Test-Revised (HVLT-R)
The HVLT-R is administered by reading a 12-word list (from 3 semantic categories) aloud three times with immediate free recall after each trial, followed by a 20-minute delay filled with other tasks, then testing delayed free recall and finally recognition memory using 24 words (12 targets plus 12 distractors). 1
Test Structure and Administration Protocol
Materials Needed
- One of six alternate forms (each containing 12 words from 3 semantic categories)
- Quiet testing environment
- 20-25 minutes total administration time
- Intercurrent tasks for the delay period
Step-by-Step Administration
Learning Trials (Trials 1-3):
- Read the 12-word list aloud to the patient at a steady pace
- Immediately after reading, ask the patient to recall as many words as possible in any order
- Record the number of words recalled correctly
- Repeat this exact procedure two more times (total of 3 learning trials)
- Do NOT tell the patient they will be tested again later 2
Delay Period (20 minutes):
- Fill this time with non-memory tasks (e.g., other cognitive tests, conversation)
- Do not allow rehearsal of the word list 2
Delayed Recall (Trial 4):
- After the 20-minute delay, ask the patient to recall as many words from the original list as possible
- No re-presentation of the list occurs
- Record the number of words recalled
Recognition Trial:
- Immediately after delayed recall, read a list of 24 words aloud
- 12 are from the original list (targets)
- 12 are new words (distractors)
- Ask the patient to identify which words were on the original list
- Record correct identifications and false positives 2
Key Scoring Parameters
Direct scores to calculate:
- Trial 1 score (immediate recall)
- Total Recall score (sum of Trials 1-3)
- Delayed Recall score (Trial 4)
- Recognition Discrimination Index (true positives minus false positives)
Performance interpretation:
- Compare scores to age and education-adjusted normative data
- Cognitive impairment typically indicated by scores 1-1.5 standard deviations below normative means 3
- The test reveals learning rate over trials, maximum acquisition, and retention over delay 3
Clinical Advantages and Limitations
Strengths recognized by guidelines:
- Multiple alternate forms allow repeated testing without practice effects 1
- Brief administration time (approximately 10-15 minutes) 1
- Widely used in clinical trials 1
- Assesses both immediate and delayed recall to determine retention 3
- Good test-retest reliability (0.537-0.818 for most parameters) 4
Important limitations to recognize:
- Does NOT include an interference list 1
- Does NOT include cued recall conditions 1
- These features are available in the California Verbal Learning Test-II (CVLT-2), which may be preferred when more detailed assessment of learning strategies is needed 1
Common Pitfalls to Avoid
- Do not provide cues or hints during free recall trials
- Do not allow the patient to know about the delayed recall in advance
- Ensure the 20-minute delay is filled with non-memory tasks to prevent rehearsal
- Use age and education-adjusted norms, as both significantly affect performance 5, 6
- Consider sex differences, which can affect some variables (Trial 1, Total Recall, Discrimination Index) 5
- Recognize that the test requires trained administration—either by a psychometrician or clinical research associate under neuropsychologist supervision 7
When to Use HVLT-R
The HVLT-R is particularly appropriate for:
- Longitudinal follow-up of memory disorders (due to multiple alternate forms) 2
- Screening for dementia (87% sensitivity, 98% specificity using Total Recall cutoff of 14.5) 8
- Identifying MCI patients at risk for progression to Alzheimer's dementia 3
- Clinical trials requiring repeated memory assessment 1
- Situations requiring brief but comprehensive verbal memory assessment 7