Base rate comparison of suboptimal scores on the RBANS effort scale and effort index in Parkinson's disease.

OBJECTIVE: The effort index (EI) and the effort scale are commonly used embedded effort indicators on the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). This investigation examined the rates of suboptimal scores on the EI and effort scale in a Parkinson's disease (PD) sample. METHOD: One hundred and sixty-three participants who have been diagnosed with PD by a board-certified neurologist were included in the study. The base rate of suboptimal scores on the EI and effort scale was calculated for the entire group. RESULTS: On average, participants were 66.8 years of age (SD = 9.5) and had a mean education of 13.5 years (SD = 2.79). The mean Mini-Mental State Examination score was 27.0 (SD = 3.1). Overall, 8% of participants scored below the cut-off for optimal performance on the EI while 62.6% performed in the suboptimal range for the effort scale. CONCLUSION: The utility of the EI and the effort scale in PD populations warrants further examination. Additionally, results demonstrate the need for validation of embedded RBANS effort measures in various disease populations.

Improving the diagnostic accuracy of the RBANS in mild cognitive impairment with construct-consistent measures.

Research on the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) has suggested that it has somewhat limited sensitivity in the differentiation of patients with mild cognitive impairment (MCI) from patients with dementia and elderly patients with no neurologic or psychiatric diagnoses. This study sought to increase the diagnostic utility of the RBANS in differentiating between patients with Alzheimer's disease (AD), MCI, and no diagnosis (ND) with the addition of construct comparable neuropsychological test measures. Diagnostic utility was assessed by comparing patients diagnosed with MCI to patients diagnosed with AD as well as to the ND group. The following cognitive domains were investigated: short-term memory, retention and long-term memory, language, attention, visuoconstruction, and overall cognitive functioning. Stepwise logistic regressions found that in the comparisons between MCI and ND, the Step 2 addition of construct comparable neuropsychological measures provided a significant diagnostic increase in the short-term memory and overall cognitive functioning models. In the comparisons between MCI and AD, the Step 2 additions provided a significant diagnostic increase in the short-term memory, visuoconstruction, and overall cognitive functioning models. Results suggested that the inclusion of construct similar neuropsychological tests significantly increases the diagnostic accuracy of the RBANS when attempting to identify more subtle cognitive deficits inherent in MCI.

Longitudinal stability of RBANS profiles in a geriatric community-dwelling sample.

This investigation is an extension of a previous study that identified four neurocognitive RBANS groups via cluster analysis in a geriatric community-dwelling sample of 699 individuals who were at least 65 years of age. Groups were examined longitudinally over a 2-year interval to establish if they exhibited marked score changes over three assessment periods. Dropout rates, onset of medical pathology, and self-reported functioning were tracked at each evaluation. Results confirmed that cluster scores were generally stable over time although the Low Immediate Memory group's Immediate Memory index score regressed upward toward the mean by the third assessment. Of interest, individuals in the Below Average group had substantial dropout between the first and third assessments. Results are interpreted through a clinical framework to explore how RBANS cluster profiles may have predictive value in general neurocognitive functioning over the observed time period and be potentially influenced by general health factors.

RBANS cluster profiles in a geriatric community-dwelling sample.

Neuropsychological heterogeneity is prevalent in geriatric individuals and is due to a number of factors including the onset of neuropathology, increased risk of emotional complications, and normal cognitive changes associated with aging. In order to better characterize normal neurocognitive variability in this population, cluster analysis was used on a sample of 699 community-dwelling geriatric patients who completed The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). Three-, four-, five-, and six-cluster solutions were examined and based on a number of criteria, the four-cluster solution was selected for further analysis. Clusters were defined primarily by measures of immediate memory, delayed memory, and processing speed, and differed on self-reported measures of functioning. These findings provide insights on normal neuropsychological variation in community-dwelling geriatric individuals.

Brief report: the temporal stability of the Repeatable Battery for the Assessment of Neuropsychological Status Effort Index in geriatric samples.

The Effort Index (EI) of the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) was developed to identify inadequate effort. Although researchers have examined its validity, the reliability of the EI has not been evaluated. The current study examined the temporal stability of the EI across 1 year in two independent samples of older adults. One sample consisted of 445 cognitively intact older adults (mean age = 72.89; 59% having 12-15 years of education) and the second sample consisted of 51 individuals diagnosed with amnestic Mild Cognitive Impairment (mean age = 82.41; 41% having 12-15 years of education). For both samples, the EI was found to have low stability (Spearman's ρ = .32-.36). When participants were divided into those whose EI stayed stable or improved versus those whose EI worsened (i.e., declining effort) on retesting, it was observed that individuals with lower baseline RBANS Total scores tended to worsen on the EI across time. Overall, the findings suggest low temporal stability of the EI in two geriatric samples. In particular, individuals with poorer cognition at baseline could present with poorer effort across time. These findings also suggest the need to further examine the temporal stability of other effort measures.

Intersubtest discrepancies on the RBANS: results from the OKLAHOMA study.

The present study provides supplemental data for the Repeatable Battery for the Assessment of Neuropsychological Status (Randolph, 1998) by reporting base rate data on discrepancies between subtests of this measure. These discrepancies are organized by general level of ability and include both age and education corrections. The data come from the Oklahoma Longitudinal Assessment of Health Outcomes in Mature Adults study and include cognitive performances of 718 community-dwelling older adults. These findings offer the possibility of increased sensitivity at detecting clinically significant differences that might not be identified when relying on base rate data from a greater age range. Similarly, these data highlight the mediating effects of the global level of cognitive functioning on discrepancy scores.

The RBANS Effort Index: base rates in geriatric samples.

The Effort Index (EI) of the RBANS was developed to assist clinicians in discriminating patients who demonstrate good effort from those with poor effort. However, there are concerns that older adults might be unfairly penalized by this index, which uses uncorrected raw scores. Using five independent samples of geriatric patients with a broad range of cognitive functioning (e.g., cognitively intact, nursing home residents, probable Alzheimer's disease), base rates of failure on the EI were calculated. In cognitively intact and mildly impaired samples, few older individuals were classified as demonstrating poor effort (e.g., 3% in cognitively intact). However, in the more severely impaired geriatric patients, over one third had EI scores that fell above suggested cutoff scores (e.g., 37% in nursing home residents, 33% in probable Alzheimer's disease). In the cognitively intact sample, older and less educated patients were more likely to have scores suggestive of poor effort. Education effects were observed in three of the four clinical samples. Overall cognitive functioning was significantly correlated with EI scores, with poorer cognition being associated with greater suspicion of low effort. The current results suggest that age, education, and level of cognitive functioning should be taken into consideration when interpreting EI results and that significant caution is warranted when examining EI scores in elders suspected of having dementia.

Gender differences on the Repeatable Battery for the Assessment of Neuropsychological Status subtests in older adults: baseline and retest data.

Gender differences have been widely reported across a range of cognitive ability tasks, and these differences appear to persist across the lifespan into later adulthood. The current study assessed the influence of gender on the subtests of the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) in a large cohort (n = 718) of older adult primary care patients. Males (n = 300) were compared to females (n = 418) on the 12 subtests of the RBANS, after controlling for age and education. Significant differences were found on 9 of the subtests. Therefore, gender corrected normative data were calculated, which also control for age and education. Test-retest data were also examined in a subset of this sample (n = 446) that was reevaluated at 1 year. Males and females were comparable on 1-year practice effects. By controlling for additional systematic bias in RBANS scores (e.g., gender effects), these findings allow clinicians and researchers to better match patients and participants when using this screening battery.

Normative data on and psychometric properties of Verbal and Visual Indexes of the RBANS in older adults.

The original structure of the RBANS includes five Indexes; however, recent factor analyses support a two-factor solution (Duff et al., 2006; Wilde, 2006). Unfortunately, normative and psychometric data do not currently exist on these two new Indexes. Building on prior work, the current study provides age- and education-corrected normative data to calculate the factor-derived Verbal and Visual RBANS Indexes (Duff et al., 2006) in a large cohort (n = 718) of older adult primary care patients. Psychometric data (e.g., discrepancy scores, internal consistency, retest reliability) on these new Indexes are also presented. These data might allow clinicians and researchers to better assess laterality effects of brain dysfunction when using the RBANS, although clinical validation is needed.

Premorbid intellect and current RBANS performance: discrepancy scores in three geriatric samples.

Assessing cognitive change during a single visit requires the comparison of estimated premorbid abilities and current neuropsychological functioning. As newer instruments are developed to measure current cognitive functioning, their relationships with premorbid estimates need to be evaluated. The current study examined the clinical utility of discrepancy scores between an estimate of premorbid intellect derived from demographic variables (i.e., Barona) and the Total score on the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) in three geriatric samples. A large community-dwelling "control" sample and two clinical samples were examined. As expected, there was little difference between estimated premorbid intellect and current RBANS Total Scale scores in the community-dwelling sample, while estimated premorbid intellect obtained from the two clinical samples significantly differed from obtained RBANS Total scores. Similar findings were observed on Discrepancy scores for the five Indexes of RBANS. The current findings, along with normative data on these discrepancy scores, can provide additional confidence for clinicians and researchers who need to determine cognitive decline when using these screening measures of neuropsychological status.

Retention rates on RBANS memory subtests in elderly adults.

Identification of memory impairment is important for neuropsychological diagnostic and research applications, and retention rates on verbal and visual memory tests can provide useful information when characterizing a variety of neurological and psychiatric disorders. Although the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) is becoming a popular screening battery for cognitive functions, normative data on retention rates are not available. The retention rates of verbal and visual material were evaluated in a sample of clinical patients (n = 109) compared to a healthy control group (n = 718). Individual subtest retention rates were converted to age-corrected scaled scores based on the cumulative distribution of raw scores obtained by an elderly community-dwelling sample. Compared with the healthy normative sample, the percent retention found for the clinical group was significantly lower on all 3 RBANS memory subtests. These preliminary data suggest that retention rates of the RBANS memory subtests may add to the clinical utility of this test as a neuropsychological diagnostic and research tool.

Cognitive outcome in pediatric brain tumor survivors: delayed attention deficit at long-term follow-up.

BACKGROUND: Treatment of childhood brain tumors has often been associated with long-term cognitive morbidity in children. Our previous research identified age at diagnosis, polytherapy and brain radiation dose as treatment factors affecting neuropsychological outcome most strongly in children with cancer 1. Our current goal was to measure the change across different cognitive functions. PROCEDURE: This study examined the cognitive outcome over repeat testing in a heterogeneous sample of 18 children with brain tumors. Tumor types included medulloblastoma and glioma. ANOVA's for repeated measures were used to evaluate the changes in cognitive domains across follow-up evaluations. RESULTS: Consistent with previous findings, the most deleterious effects were seen on IQ indices of non verbal cognitive ability, visual perceptual skills and information processing speed. Analyses reveal that the attentional factor, Freedom from Distractibility, is the only IQ index that declines over subsequent testing. The statistical decline was attributable to a significant decline on the arithmetic subtest, as well as a non-significant trend for the auditory attention span subtest. CONCLUSIONS: This study reveals that while most indices remained stable over repeat testing, auditory attention and concentration skills decline. Long-term outcome is discussed in light of the high prevalence of attention and mathematic difficulties reported in these children and the need for preventive and remedial approaches.

Predicting cognitive change across 3 years in community-dwelling elders.

The determination of clinically significant cognitive change across time is an important issue in neuropsychology, and repeated assessments are common with older adults. Regression-based prediction formulas, which use initial test performance and demographic variables to predict follow-up test performance, have been utilized with patient and healthy control samples. Comparisons between predicted and observed follow-up performances can assist clinicians in determining the significance of change in the individual patient. In the current study, multiple regression-based prediction equations for the five Indexes and Total Score of the RBANS were developed for a sample of 146 community-dwelling older adults across a 2-year interval. These algorithms were then validated on a separate elderly sample (n = 145). Minimal differences were present between Observed and Predicted follow-up scores in the validation sample, suggesting that the prediction formulas are clinically useful for practitioners who assess older adults. A case example is presented that illustrates how the algorithms can be used clinically.

Normative and retest data on the RBANS cortical/subcortical index in older adults.

Several neuropsychological disorders have been classified as having either "cortical" or "subcortical" profiles; however, little information is available about the frequency of these profiles in the normal population or their stability on retesting. Therefore, the current study calculated the cortical/subcortical profile index from the Repeatable Battery for the Assessment of Neuropsychological Status in a large cohort (n = 793) of older adult primary care patients. The frequency of these profiles was examined, as was their stability across 1- and 2-year periods. Cortical profiles were quite common in this sample, with 37% having 10 or more points on this index. Stability of these index scores across 1 and 2 years was moderate (r = .58-.61). Although the utility of this index needs to be investigated in clinical samples, practitioners should use caution when interpreting these types of indicator as pathognomonic for the presence of disease.

Modified scoring criteria for the RBANS figures.

Visual construction and memory tasks are routinely used in neuropsychological assessment, but their subjective scoring criteria can negatively affect the reliability of these instruments. The current study examined the standard scoring criteria for the Figure Copy and Recall subtests of the RBANS and compared them to a modified set of scoring criteria in two samples. In both a large community dwelling sample of older adults and in a mixed clinical sample, the original scoring criteria consistently led to lower scores than the modified criteria. Inter-rater reliability was high for the modified scoring criteria, and no age effects were found with the modified scoring criteria. In both samples, the modified scoring criteria led to Figure Copy scores that more closely approximated other performances on the RBANS compared to the standard criteria, whereas both scoring systems led to plausible Figure Recall scores. Despite these results, the present study cannot identify one scoring criterion as the "better," but only points out the significant differences between them. Such differences can have important clinical implications, and practitioners and researchers who utilize the RBANS with patient samples should be cautious when interpreting low scores on Figure Copy and Recall if the standard criteria are used.

Examining the repeatable battery for the assessment of neuropsychological status: factor analytic studies in an elderly sample.

OBJECTIVE: The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), a recently developed cognitive assessment instrument, has been shown to be useful with a variety of neuropsychiatric conditions, but its factor structure has not been examined. METHOD: Using 824 community-dwelling elders, the RBANS was examined with confirmatory and exploratory factor analyses. RESULTS: The existing structure of the RBANS was not supported; however, a two-factor solution was. CONCLUSIONS: Clinicians and researchers using the RBANS should be cautious when interpreting this measure with its existing structure.

Test performance and classification statistics for the Rey Auditory Verbal Learning Test in selected clinical samples.

The Rey Auditory Verbal Learning Test [RAVLT; Rey, A. (1941). L'examen psychologique dans les cas d'encéphalopathie traumatique. Archives de Psychologie, 28, 21] is a commonly used neuropsychological measure that assesses verbal learning and memory. Normative data have been compiled [Schmidt, M. (1996). Rey Auditory and Verbal Learning Test: A handbook. Los Angeles, CA: Western Psychological Services]. When assessing an individual suspected of neurological dysfunction, useful comparisons include the extent that the patient deviates from healthy peers and also how closely the subject's performance matches those with known brain injury. This study provides the means and S.D.'s of 392 individuals with documented neurological dysfunction [closed head TBI (n=68), neoplasms (n=57), stroke (n=47), Dementia of the Alzheimer's type (n=158), and presurgical epilepsy left seizure focus (n=28), presurgical epilepsy right seizure focus (n=34)] and 122 patients with no known neurological dysfunction and psychiatric complaints. Patients were stratified into three age groups, 16-35, 36-59, and 60-88. Data were provided for trials I-V, List B, immediate recall, 30-min delayed recall, and recognition. Classification characteristics of the RAVLT using [Schmidt, M. (1996). Rey Auditory and Verbal Learning Test: A handbook. Los Angeles, CA: Western Psychological Services] meta-norms found the RAVLT to best distinguish patients suspected of Alzheimer's disease from the psychiatric comparison group.

Prediction errors of the Oklahoma Premorbid Intelligence Estimate-3 (OPIE-3) stratified by 13 age groups.

The Oklahoma Premorbid Intelligence Estimate-3 (OPIE-3) combines Wechsler Adult Intelligence Scale-3rd edition (WAIS-III) subtest raw scores (vocabulary, information, matrix reasoning, and picture completion) and demographic data (i.e., age, education, gender, ethnicity, and region) to predict FSIQ scores. Differences between OPIE-3 estimated FSIQ scores and actual FSIQ scores were compared across 13 age groups in a random sample (N=1201) of the WAIS-III standardization sample. There were mean differences in estimated FSIQ between age groups (P<.01). There was a trend that the OPIE-3 algorithms underestimated FSIQ for individuals 16-17 (2.7 points) and 80-89 years old (3.5 points). However, the differences in estimation errors were small and the percentage of individuals misclassified by more than 10 FSIQ points by age group was similar across groups. The OPIE-3(2ST), OPIE-3MR, and OPIE-3VOC yielded robust estimates of FSIQ across age groups in a neurologically intact sample. Limitations, particularly with individuals aged 16-17 and 85-89 years, are discussed.

Clinical validation of the General Ability Index--Estimate (GAI-E): estimating premorbid GAI.

The clinical utility of the General Ability Index--Estimate (GAI-E; Lange, Schoenberg, Chelune, Scott, & Adams, 2005) for estimating premorbid GAI scores was investigated using the WAIS-III standardization clinical trials sample (The Psychological Corporation, 1997). The GAI-E algorithms combine Vocabulary, Information, Matrix Reasoning, and Picture Completion subtest raw scores with demographic variables to predict GAI. Ten GAI-E algorithms were developed combining demographic variables with single subtest scaled scores and with two subtests. Estimated GAI are presented for participants diagnosed with dementia (n = 50), traumatic brain injury (n = 20), Huntington's disease (n = 15), Korsakoff's disease (n = 12), chronic alcohol abuse (n = 32), temporal lobectomy (n = 17), and schizophrenia (n = 44). In addition, a small sample of participants without dementia and diagnosed with depression (n = 32) was used as a clinical comparison group. The GAI-E algorithms provided estimates of GAI that closely approximated scores expected for a healthy adult population. The greatest differences between estimated GAI and obtained GAI were observed for the single subtest GAI-E algorithms using the Vocabulary, Information, and Matrix Reasoning subtests. Based on these data, recommendations for the use of the GAI-E algorithms are presented.

RBANS index discrepancies: base rates for older adults.

The present study expands upon the data available in the manual of the Repeatable Battery for the Assessment of Neuropsychological Status, by providing base rate data on Index discrepancies that are organized by general level of ability and include both age and education corrections. The data presented are based on the performances of a sample of 718 community dwelling older adults. These findings offer the possibility of increased sensitivity at detecting clinically significant differences that might not be identified when relying on base rate data from a greater age range. Similarly, these data highlight the mediating effects of the global level of cognitive functioning on discrepancy scores.