Concordance validity of PVTs in a sample of veterans referred for mild TBI.

Concordance validity of commonly used performance validity tests (PVTs) was assessed in a sample of Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn (OEF/OIF/OND) veterans referred to an mTBI screening clinic in a south-eastern Veterans Affairs hospital. Veteran service members (total n = 184) completed the Rey-15, Repeatable Battery of the Assessment for Neuropsychological Status Effort Index (RBANS EI), and Reliable Digit Span (RDS) from the Wechsler Intelligence Scales. Kappa coefficients and percentage of agreement were established to determine the level of concordance between the three measures. PVT failure rate ranged from 7.4% of the sample (Rey-15) to 26.1% (RBANS EI Liberal). The highest concordance was found between the Rey 15 and RBANS EI "highly suspicious" cut-off, with the lowest agreement noted between all PVTs and the RBANS EI "liberal" cut-score. All concordance coefficients fell within the fair to moderate levels. Overall, the observed agreement between the explored measures was generally consistent with or greater than other studies of PVT concordance. Given the rates of concordance, the current results continue to suggest that PVTs are likely to measure a construct separate from the typical cognitive domains.

History of neuropsychological study of sport-related concussion.

Although the medical literature has a long history of description and comment on concussion, the occurrence of concussion within the context of sports other than boxing was not judged to be problematic until the 1980s. Neuropsychological assessment played a critical and integral role in identifying the cognitive sequelae of concussion and mapping out the short- and long-term vagaries in recovery. This paper captures that history and expands upon current applications of neuropsychological assessment in the diagnosis and management of sport-related concussion.

Normative values of major SCAT2 and SCAT3 components for a college athlete population.

The Sports Concussion Assessment Tool-2 (SCAT2) is a posttrauma evaluative screener for concussion. Although a revised version (SCAT3) recently was released, the SCAT2 continues in use. Moreover, there have been no reports of normative values with college athletes with the SCAT2 or SCAT3. Similar to the SCAT3, the SCAT2 includes a 22-item self-report symptom scale, the Standardized Assessment of Concussion (SAC), and a hard surface-only version of the Balance Error Scoring System (BESS). The SCAT3 does not employ a total score and adds an optional gait component. The purpose of this study was to develop normative values for collegiate athletes on the SCAT2 and its subparts with respect to sex, collision risk by sport, and concussion history. In preseason, 477 college athletes (332 male, 145 female) completed the SCAT2. The average total score was 91.08 (SD = 5.60). The average number of symptoms endorsed was 1.75. Average SAC and BESS scores were 27.17 (SD = 2.01) and 25.64 (SD = 4.07), respectively. Little or no difference was found in total and component scores due to sex, sport type, or concussion history. When baseline measurement is lacking, these data provide a good benchmark for interpreting SCAT2 and SCAT3 performance.

Sport and team differences on baseline measures of sport-related concussion.

CONTEXT: With the advent of the National Collegiate Athletic Association's (NCAA's) mandating the presence and practice of concussion-management plans in collegiate athletic programs, institutions will consider potential approaches for concussion management, including both baseline and normative comparison approaches. OBJECTIVE: To examine sport and team differences in baseline performance on a computer-based neurocognitive measure and 2 standard sideline measures of cognition and balance and to determine the potential effect of premorbid factors sex and height on baseline performance. DESIGN: Cross-sectional study. SETTING: University laboratory. PATIENTS OR OTHER PARTICIPANTS: A total of 437 NCAA Division II student-athletes (males = 273, females = 164; age = 19.61 ± 1.64 years, height = 69.89 ± 4.04 inches [177.52 ± 10.26 cm]) were recruited during mandatory preseason testing conducted in a concussion-management program. MAIN OUTCOME MEASURE(S): The computerized Concussion Resolution Index (CRI), the Standardized Assessment of Concussion (Form A; SAC), and the Balance Error Scoring System (BESS). RESULTS: Players on the men's basketball team tended to perform worse on the baseline measures, whereas soccer players tended to perform better. We found a difference in total BESS scores between these sports (P = .002). We saw a difference between sports on the hard-surface portion of the BESS (F6,347 = 3.33, P = .003, ηp(2) = 0.05). No sport, team, or sex differences were found with SAC scores (P > .05). We noted differences between sports and teams in the CRI indices, with basketball, particularly the men's team, performing worse than soccer (P < .001) and softball/baseball (P = .03). When sex and height were considered as possible sources of variation in BESS and CRI team or sport differences, height was a covariate for the team (F1,385 = 5.109, P = .02, ηp(2) = 0.013) and sport (F1,326 = 11.212, P = .001, ηp(2) = 0.033) analyses, but the interaction of sex and sport on CRI indices was not significant in any test (P > .05). CONCLUSIONS: Given that differences in neurocognitive functioning and performance among sports and teams exist, the comparison of posttraumatic and baseline assessment may lead to more accurate diagnoses of concussion and safer return-to-participation decision making than the use of normative comparisons.

Some observations about two versions of mental status examinations: implications for screening dementia patients in nursing homes.

Qualitative analysis of item content conducted on two versions of mental status examinations indicated that the Modified Mini-Mental State examination is a more pragmatic screening device to use not only for early detection of dementia but also as a basis for developing individualized care planning objectives for managing cognitive impairment of residents with dementia in nursing homes.