Screening for neuropsychological impairment using Reitan and Wolfson's preliminary neuropsychological test battery (original) (raw)
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Archives of Clinical Neuropsychology, 2017
The American Medical Association Current Procedural Panel developed a new billing code making behavioral health screening a reimbursable healthcare service. The use of computerized testing as a means for cognitive screening and brief cognitive testing is increasing at a rapid rate. The purpose of this education paper is to provide information to clinicians, healthcare administrators, and policy developers about the purpose, strengths, and limitations of cognitive screening tests versus comprehensive neuropsychological evaluations. Screening tests are generally brief and narrow in scope, they can be administered during a routine clinical visit, and they can be helpful for identifying individuals in need of more comprehensive assessment. Some screening tests can also be helpful for monitoring treatment outcomes. Comprehensive neuropsychological assessments are multidimensional in nature and used for purposes such as identifying primary and secondary diagnoses, determining the nature and severity of a person's cognitive difficulties, determining functional limitations, and planning treatment and rehabilitation. Cognitive screening tests are expected to play an increasingly important role in identifying individuals with cognitive impairment and in determining which individuals should be referred for further neuropsychological assessment. However, limitations of existing cognitive screening tests are present and cognitive screening tests should not be used as a replacement for comprehensive neuropsychological testing.
Archives of Clinical Neuropsychology, 2011
Neuropsychologists frequently rely on a battery of neuropsychological tests which are normally distributed to determine impaired functioning. The statistical likelihood of Type I error in clinical decision-making is in part determined by the base rate of normative individuals obtaining atypical performance on neuropsychological tests. Base rates are most accurately obtained by co-normed measures, but this is rarely accomplished in neuropsychological testing. Several statistical methods have been proposed to estimate base rates for tests that are not co-normed. This study compared two statistical approaches (binomial and Monte Carlo models) used to estimate the base rates for flexible test batteries. The two approaches were compared against empirically derived base rates for a multitest co-normed battery of cognitive measures. Estimates were compared across a variety of conditions including age and different a levels (N ¼ 3,356). Monte Carlo R 2 estimates ranged from .980 to .997 across five different age groups, indicating a good fit. In contrast, the binomial model fit estimates ranged from 0.387 to 0.646. Results confirm that the binomial model is insufficient for estimating base rates because it does not take into account correlations among measures in a multitest battery. Although the Monte Carlo model produced more accurate results, minor biases occurred that are likely due to skewess and kurtosis of test variables. Implications for future research and applied practice are discussed.
The Clinical Neuropsychologist, 2013
The Automated Neuropsychological Assessment Metrics (ANAM) is a computerized neuropsychological assessment battery that has demonstrated utility in a variety of clinical populations including multiple sclerosis, systemic lupus erythematosus, Parkinson's disease, acquired brain injury, migraine headaches, and Alzheimer's disease. This study utilized selected tests from the ANAM General Neuropsychological Screening Battery (ANAM GNS), a newly defined subset of tests from the broader ANAM library designed for general clinical assessment of cognition. ANAM GNS is an expansion of the ANAM Core battery which has been utilized in a military setting. The efficacy of the ANAM GNS was explored in a mixed clinical sample relative to well-established, traditional neuropsychological measure, the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). It was hypothesized that scores from the ANAM GNS would accurately predict participants as either impaired (n = 30) or normal (n = 113). Participants were grouped a priori based on RBANS Total Index scores with impairment defined as scores 15th percentile. Logistic regression analysis was conducted to evaluate the classification accuracy of the ANAM GNS. The predictor variables were the Throughput scores from seven selected ANAM GNS subtests. The full model significantly predicted impairment status, sensitivity was 81% and specificity was 89.1%. Overall classification rate was 87.9% and the Odds Ratio for the overall model was 34.65. Positive predictive value was 56.7% and negative predictive value was 96.4%. This study represents the first clinical data on the ANAM GNS, and documents that it has good concurrent and predictive validity with a well-established neuropsychological measure.
A Meta-Analysis of the Relative Sensitivity of Neuropsychological Screening Tests
The National Institute of Mental Health recently formed a committee of experts which published a proposal for a lengthy neuropsychological test battery judged most apt to detect diffuse brain damage while covering a wide range of cognitive abilities. The purposes of the present study were (1) to assemble empirical evidence of the existence of statistically significantly sensitive screening tests across an equivalently wide range of functional domains, and (2) to present this evidence systematically, in such a manner as to help clinicians sdect subsets of screening tests manifesting greatest sensitivity to diffuse brain damage. It was found that in certain functional domains (speed of processing, problem solving, executive functions), marked differences in sensitivity occured. Brief tests just as sensitive as time-consuming tests were also identified. The reader is cautioned about possible extraneous sources of the differences obtained (test and group selection bias, test reliability, test difficulty, procedural effects, Type I error). Nevertheless, it was concluded that a brief highly sensitive and functionally wide-ranging neuro-psychological test battery for screening cases of putative diffuse brain dysfunction can be assembled.
The Journal of neuropsychiatry and clinical neurosciences, 1997
A 1994 survey by the Research Committee of the American Neuropsychiatric Association revealed that 58% of respondents employed formal assessment of cognitive status; the Mini-Mental State Examination (MMSE) and neuropsychological testing were the commonest techniques. Literature review on common cognitive screening instruments found that the MMSE has widespread popularity, ease of use, and a large body of research demonstrating its sensitivity to common neuropsychiatric disorders. The Committee recommends that clinicians who employ the MMSE 1) use it as a minimum screening for cognitive dysfunction; 2) employ age- and education-normative corrections; and 3) supplement it with specific measures of spatial functions, delayed memory, and executive abilities. The Modified MMSE and the Neurobehavioral Cognitive Status Examination also show promise as screening tools.
The Clinical Neuropsychologist, 2019
Objective: While the Neuropsychological Assessment Battery, Screening Module (S-NAB) is a commonly used cognitive screening measure, no composite embedded performance validity test (PVT) formula has yet been described within it. This study sought to empirically derive PVT formulas within the S-NAB using an analog simulation paradigm. Method: Seventy-two university students (M age ¼ 18.92) were randomly assigned to either an Asymptomatic (AS) or simulated mild traumatic brain injury (S-mTBI) group and were administered a neuropsychological test battery that included the S-NAB and standalone and embedded PVTs. The AS group was instructed to perform optimally, and the S-mTBI group received symptom and test coaching to help simulate mTBI-related impairment. Both groups received warnings regarding the presence of PVTs throughout the test battery. Results: Groups showed significant differences (all ps < .001) on all S-NAB domain scores and PVTs. In the S-NAB, the Attention (S-ATT) and Executive Function (S-EXE) domains showed the largest effect sizes (Cohen's ds ¼ 2.02 and 1.79, respectively). Seven raw scores from S-ATT and S-EXE subtests were entered as predictor variables in a direct logistic regression (LR). The model accurately classified 90.3% of cases. Two PVT formulas were described: (1) an exponentiated equation from LR results and (2) an arithmetic formula using four individually meaningful variables. Both formulas demonstrated outstanding discriminability between groups (AUCs ¼ .96-.97) and yielded good classification statistics compared to other PVTs. Conclusions: This study is the first to describe composite, embedded PVT formulas within the S-NAB. Implications, limitations, and appropriate future directions of inquiry are discussed.
Luria-nebraska neuropsychological battery: High rates of false positives for geriatirc subjects
Current Psychology, 1992
This study examined false positive rates obtained for two normal adult age groups, using three different methods for interpreting performances on the Luria-Nebraska Neuropsychological Battery (LNNB). Among normal subjects ages 18 to 30 and ages 65 to 85, false positive rates were found to range from 3.9% to 7.7% for younger subjects and 13.5% to 32.7% for older subjects. Significant differences were found between the proportion of false positives in each age group on each method of interpretation. A lack of agreement was found between the three different methods of interpretation concerning which subjects should be classified as impaired. Further analysis was performed by dividing older subjects into two groups, ages 65 to 70 and over 70. False positive rates for subjects over age 70 were found to range from 20.7% to 41.4%. Significant differences were also found between the proportion of false positives in each of these two groups. Golden, Purisch, and Hammeke (1978) developed the Luria-Nebraska Neuropsychological Battery (LNBB), a neuropsychological battery based on the test materials and work of Aleksandr Luria. They borrowed and adapted Luria's qualitative assessment methods to accommodate the quantitative emphasis of American neuropsychology. Subsequent work by Golden, Moses, Graber, and Berg (1981) resuited in an objective system for interpreting performance profiles obtained on the LNNB. Using a step-wise regression on the performance scores of 60 normal subjects, an equation was developed to derive the expected level of performance on the battery for a subject, given his or her age and level of education. The equation [58.8 + (.214) (age)-(1.47) (years of education)] was determined to yield a T-score at which a nonimpaired subject was expected to perform. An impaired performance was defined as a score which was one standard deviation, or ten T-score points, above the score expected, given the subject's age and level of education. Golden et al., termed the level above which a performance is considered impaired the critical level, obtained by using the equation [68.8 + (.214) (age)-(1.47) (years of education)]. By using the critical level equation, Golden et al. (1981) asserted that the LNNB could be used as an accurate indicator of brain impairment across all adult ages and
Constructing a Composite Score for the Seoul Neuropsychological Screening Battery-Core
Dementia and Neurocognitive Disorders
Background and Purpose The brief version of the Seoul Neuropsychological Screening Battery (SNSB), the SNSB-Core (SNSB-C), has been developed. Although each subtest score of the SNSB-C provides information on different features of broad cognitive functioning or impairment, a composite score is needed to identify the severity of global cognitive impairment. We aimed to develop and validate a composite score of the SNSB-C that would provide a normative-based summary score of global cognitive functioning, especially for differentiating patients with cognitive impairment from normal elderly. Methods A normative sample of 1067 elderly was used to develop a composite score of SNSB-C. The composite score was corrected for the effects of age, years of education, and sex by the regression method. Patients with Alzheimer's disease (n=41), vascular dementia (n=40), amnestic mild cognitive impairment (MCI) (n=73), vascular MCI (n=41), and Parkinson's disease with MCI (n=41) were differentiated from a normal sample (n=70) by the uncorrected and corrected composite scores using receiver operating characteristic (ROC) curve analysis. Results Confirmatory factor analysis showed that the composite score equal weight to each standardized cognitive domain of SNSB-C is appropriate for indexing overall cognitive functioning. The corrected and uncorrected composite scores yielded a satisfactory size of the area under the ROC curve comparable to the Mini Mental State Examination (MMSE). Conclusions The composite scores of SNSB-C, especially the corrected score, provide an index of overall cognitive functioning, and they can be used as an alternative to MMSE for screening patients with cognitive impairment.
Evidence of the validity of a novel version of the computerized cognitive screening battery CompCog
Dementia & Neuropsychologia, 2021
Although the availability of the computer-based assessment has increased over the years, neuropsychology has not carried out a significant paradigm shift since the personal computer’s popularization in the 1980s. To keep up with the technological advances of healthcare and neuroscience in general, more efforts must be made in the field of clinical neuropsychology to develop and validate new and more technology-based instruments, especially considering new variables and paradigms when compared to paper and pencil tests. Objective: This study’s objective was to produce concurrent validity evidence of the novel version of the computerized cognitive screening battery CompCog. Methods: Participants performed a traditional paper and pencil neuropsychological testing session and another session where CompCog was administrated. The data of a total of 50 young adult college students were used in the analyses. Results: Results have shown moderate and strong correlations between CompCog’s task...