Early Educational Experiences Contribute to Measurement Bias in Verbal Memory Assessment

Objective: Education is a crucial cognitive protective factor that often attenuates racial differences in neuropsychological test performance. This study applies a novel theory-driven psychometric approach (pervasive bias modeling) to examine how education and early life literacy simultaneously affect verbal memory ability and test measurement properties, potentially explaining group differences on verbal list learning tests (LLTs). Methods: Item-level responses from 2,047 cognitively unimpaired older adults who completed the Consortium to Establish a Registry for Alzheimer's Disease (CERAD) LLT were analyzed. The pervasive bias approach modeled years of education and childhood book access (at age 10) as factors that influence both individual memory ability and the relationship between word characteristics and test performance.Results: Educational attainment and childhood book access differed significantly between White and Black participants, with childhood books mediating 76% of racial differences in education. Significant measurement biases affecting item difficulty and discrimination were identified for race, education, and childhood books. Racial differences in memory performance were reduced by 45% when accounting for educational attainment bias and eliminated (95% reduction) when childhood book access was also included.Conclusions: Early life cognitive stimulation through education and book accessibility influences both later-life cognitive ability and the functioning of neuropsychological assessment measures. Formal education and literacy exposure create individual differences in word learning during LLTs that affect test reliability. These findings suggest that observed racial differences on verbal memory measures largely reflect discrepancies in education and early literacy opportunities, highlighting the importance of these factors in interpreting cognitive test performance and designing new measures.