UBC scoring guidelines for WORLD reversal
(My thanks to Dr Lynn Beattie, Medical Director of Clinic for Alzheimer Disease and
Related Disorders, UBC Hospital, Vancouver, British Columbia, Canada for
permission to publish)
PLEASE: Read instructions carefully to ensure that the patient understands what
the question is asking.
Create 5 spaces to correspond to the proper placement of one of the letters of WORLD.
The best way to handle the WORLD question is to write each letter the patient says
into the spaces. One letter placed in either the absolute correct position
or the relative correct position equals 1 point.
1. In the case of errors in the given five letters:
Ex: D L O R W
Here, the only problem is that the patient switched the O and the R. In short, one
reversal of letters results in 4 points.
This brings up an important point: when looking at positions of letters, use the
letters in absolute correct position (here, D, L, W) as points of reference
(i.e. find them first, then look at the rest of the letters). The absolute
correct position of O means that it occupies the 4th space from the
left. Here, O is not in its absolute correct position.
The relative correct position of O means that it lies either after
the R or before the W, but not in the correct space (4th from the
left). If we choose to look at O first, the O lies before the R,
but it is in relative correct position because it remains before the W. If
we choose the R to look at first, then R is in relative correct position
as it remains after the L, and O is in the wrong place. Either way,
the answer shows 3 letters in the absolute correct position and 1 letter
in the relative correct position.
Ex: D R L O W
Here, the same issue is at work, D, O and W are in the absolute
correct position, but the R and the L are reversed. The R is
normally after the L but before the O. If we choose to look at R
first then, R remains before the O and is in the relative correct position
and it is the L that is out of place. If we choose to look at the L
first, it remains after the D and it is the R that is in the wrong
place. Either way, there are 3 letters in the absolute correct position and
1 letter in the relative correct position. This answer merits 4 points (it
is another letter reversal).
Ex: D L D R W
Essentially, ignore the repeated D. This example is similar to the one above,
except with the absence of the O, the R is now in the relative correct
position. The patient is awarded 4 points.
2. In the case of too few letters:
Award a point for each letter that appears in a correct position. (NB: pay close
attention to the relative correct position, as too few letters shifts the
letters out of their absolute correct positions ).
Ex: D R O W _
Here, the patient merely missed the L so they are awarded 4 points. R
is in the relative correct position as it appears in front of the O
. 4 points can be awarded.
Ex: D O W _ _
Ex: D R W _ _
Here, 2 letters are in the relative correct position and the D is
in its absolute correct position so 3 points can be awarded. The absence
of letters not only shifts the absolute correct position but it also changes the
relative correct position. Use D as the reference: The R and the O
now occupy a relative correct position as they lie between the D
(which remains in its absolute correct position) and the W (shifted out of
its absolute correct position).
Ex: D W L _ _
Here, only one letter is in the relative correct position: the W.
The L needs to be in between the other two letters in order to be correct.
W is in the relative correct position because it appears behind D,
which occupies its absolute correct position. The patient is awarded 2 points.
3. In the case of too many letters: (i.e. six or
subtract one point per letter of excess. (This situation is not scored by the WORLD Reversal Score Tool above.)
Ex: D L R O W L
Here, the patient gave an extra letter but they got the backward spelling correct,
so their score would be 4 points, one point for each correct letter in the correct
place and a deduction of 1 point for the extra letter. In the case of an excess
of two letters, subtract two points.
Ex: D R O L W D L
Here, again there are too many letters, but the backward spelling is incorrect.
Essentially, L is in the wrong place but, the first D, the R, the O, and the
W are in the correct place. D, and W are in the absolute correct
position (1st and 5th from the left), and R and O lie
in between the D and W (reference points), so they are in the relative
correct position ( L is out of place). The extra D and L account for
deductions, so the score here is 2.