TY - JOUR
T1 - Uncorrected versus demographically-corrected scores on the NIH toolbox cognition battery in persons with traumatic brain injury and stroke
AU - Nitsch, Kristian P.
AU - Casaletto, Kaitlin B.
AU - Carlozzi, Noelle E.
AU - Tulsky, David S.
AU - Heinemann, Allen W.
AU - Heaton, Robert K.
N1 - Funding Information:
This article extends previous research comparing demographically corrected and uncorrected scores from the National Institutes of Health Toolbox–Cognition Battery (NIHT-CB) with traumatic brain injury (TBI) and stroke populations, and demonstrates the increased construct validity of the NIHT-CB for classifying injury severity when using demographically corrected versus uncorrected fluid composite scores. This article highlights the importance of factoring out unwanted variance associated with patient demographic characteristics (e.g., age, education, gender, etc.) when interpreting the impact of acquired brain injury. In clinical practice, knowing when to use demographically corrected scores versus uncorrected scores is important for interpreting a patient’s performance on neuropsychological testing and can assist clinicians in treatment planning by providing a more accurate reflection of current cognitive functioning by removing test variance associated with demographic characteristics. This article demonstrates that NIHTB-CB crystallized composite scores may serve as a measure of premorbid functioning, as it was relatively resistant to the deleterious effects of acquired brain injury.
Publisher Copyright:
© 2017 American Psychological Association.
PY - 2017/11
Y1 - 2017/11
N2 - Objective: The association between demographic characteristics and neurocognitive performance is well established; however, clinicians may have difficulty selecting when to use uncorrected versus demographically corrected scores. We compared these score types in individuals with traumatic brain injury (TBI) and stroke, on the National Institutes of Health Toolbox-Cognition Battery (NIHTB-CB). Research Method: Adults with TBI and stroke were demographically matched to controls, and completed the NIHTB-CB. Published "corrected scores" are adjusted for age, education, sex, and race/ ethnicity; "uncorrected scores" were created using census data to represent the average adult in the U.S. population. Results: Effect sizes for the TBI and stroke groups versus controls were larger using corrected scores compared with uncorrected scores for the fluid composite (uncorrected to corrected effect sizes: TBI: d = 0.66, p < .001 to 0.83, p < .001; stroke d = 0.97, p < .001 to 1.10, p < .001). For the crystallized composite, effect sizes for the TBI and stroke groups versus controls were smaller and nonsignificant using corrected scores (uncorrected to corrected effect sizes: TBI d = 0.23, p = .03 to 0.20, p = .06; stroke d = 0.40, p < .001 to 0.17, p = .09). In the injury groups, demographic characteristics accounted for up to 33% of variance in uncorrected scores (p < .001), but <5% of variance in corrected scores (p > .06). Conclusions: Corrected scores were more sensitive to neurocognitive impairments in the brain-injured groups. Corrected scores have the advantage of controlling for variance associated with premorbid factors rather than changes in neurological functioning; are more helpful in characterizing acquired neurocognitive changes; and can aid in the interpretation of test performance.
AB - Objective: The association between demographic characteristics and neurocognitive performance is well established; however, clinicians may have difficulty selecting when to use uncorrected versus demographically corrected scores. We compared these score types in individuals with traumatic brain injury (TBI) and stroke, on the National Institutes of Health Toolbox-Cognition Battery (NIHTB-CB). Research Method: Adults with TBI and stroke were demographically matched to controls, and completed the NIHTB-CB. Published "corrected scores" are adjusted for age, education, sex, and race/ ethnicity; "uncorrected scores" were created using census data to represent the average adult in the U.S. population. Results: Effect sizes for the TBI and stroke groups versus controls were larger using corrected scores compared with uncorrected scores for the fluid composite (uncorrected to corrected effect sizes: TBI: d = 0.66, p < .001 to 0.83, p < .001; stroke d = 0.97, p < .001 to 1.10, p < .001). For the crystallized composite, effect sizes for the TBI and stroke groups versus controls were smaller and nonsignificant using corrected scores (uncorrected to corrected effect sizes: TBI d = 0.23, p = .03 to 0.20, p = .06; stroke d = 0.40, p < .001 to 0.17, p = .09). In the injury groups, demographic characteristics accounted for up to 33% of variance in uncorrected scores (p < .001), but <5% of variance in corrected scores (p > .06). Conclusions: Corrected scores were more sensitive to neurocognitive impairments in the brain-injured groups. Corrected scores have the advantage of controlling for variance associated with premorbid factors rather than changes in neurological functioning; are more helpful in characterizing acquired neurocognitive changes; and can aid in the interpretation of test performance.
KW - Cognition
KW - NIHTB-CB
KW - Statistical data analysis
KW - Stroke
KW - Traumatic brain injury
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U2 - 10.1037/rep0000122
DO - 10.1037/rep0000122
M3 - Article
C2 - 29265869
AN - SCOPUS:85038607566
VL - 62
SP - 485
EP - 495
JO - Rehabilitation Psychology
JF - Rehabilitation Psychology
SN - 0090-5550
IS - 4
ER -
