Cognitive performance scores for the pediatric automated neuropsychological assessment metrics in childhood-onset systemic lupus erythematosus

Objective To develop and initially validate a global cognitive performance score (CPS) for the Pediatric Automated Neuropsychological Assessment Metrics (PedANAM) to serve as a screening tool of cognition in childhood lupus. Methods Patients (n = 166) completed the 9 subtests of the PedANAM battery, each of which provides 3 principal performance parameters (accuracy, mean reaction time for correct responses, and throughput). Cognitive ability was measured by formal neurocognitive testing or estimated by the Pediatric Perceived Cognitive Function Questionnaire-43 to determine the presence or absence of neurocognitive dysfunction (NCD). A subset of the data was used to develop 4 candidate PedANAM-CPS indices with supervised or unsupervised statistical approaches: PedANAM-CPS_UWA, i.e., unweighted averages of the accuracy scores of all PedANAM subtests; PedANAM-CPS_PCA, i.e., accuracy scores of all PedANAM subtests weighted through principal components analysis; PedANAM-CPS_logit, i.e., algorithm derived from logistic models to estimate NCD status based on the accuracy scores of all of the PedANAM subtests; and PedANAM-CPS_multiscore, i.e., algorithm derived from logistic models to estimate NCD status based on select PedANAM performance parameters. PedANAM-CPS candidates were validated using the remaining data. Results PedANAM-CPS indices were moderately correlated with each other (|r| > 0.65). All of the PedANAM-CPS indices discriminated children by NCD status across data sets (P < 0.036). The PedANAM-CPS_multiscore had the highest area under the receiver operating characteristic curve (AUC) across all data sets for identifying NCD status (AUC >0.74), followed by the PedANAM-CPS_logit, the PedANAM-CPS_PCA, and the PedANAM-CPS_UWA, respectively. Conclusion Based on preliminary validation and considering ease of use, the PedANAM-CPS_multiscore and the PedANAM-CPS_PCA appear to be best suited as global measures of PedANAM performance.