Anderson Luke B, Jaroh Rebekah, Smith Hillary, Strong Carrie-Ann H, Donders Jacobus
a Psychology Service , Mary Free Bed Rehabilitation Hospital , Grand Rapids , MI , USA.
b Department of Psychology , Calvin College , Grand Rapids , MI , USA.
J Clin Exp Neuropsychol. 2017 Nov;39(9):890-899. doi: 10.1080/13803395.2016.1277513. Epub 2017 Jan 17.
The present study was composed of two parts examining the clinical utility of the Delis-Kaplan Executive Function System (D-KEFS) Verbal Fluency and Color-Word subtests in traumatic brain injury (TBI). In the first part, the performance of 128 outpatients with mild to severe TBI on the Verbal Fluency and Color-Word subtests was examined in relation to two primary indicators of TBI severity: length of coma and the presence of intracranial lesions on neuroimaging through regression analysis. After controlling for education, ethnicity, and complicating premorbid and comorbid factors, length of coma predicted performance on the Color-Word Inhibition/Switching subtest, whereas the presence of diffuse lesions was related to Verbal Fluency Category Switching performance. In the second part of this study, performance on the Category Switching and Inhibition/Switching subtests was compared between a group of 28 participants with moderate-to-severe TBI and demographically matched groups with mild-uncomplicated TBI (n = 28) and neurologically healthy control participants (n = 56). The moderate-to-severe TBI group performed significantly worse on both subtests than the mild-uncomplicated TBI and control groups, and the latter groups did not differ from each other on these subtests. Logistic regression analysis showed that the combined group classification accuracy of these subtests was 66.07%, with an area under the curve (AUC) of .70 and a likelihood ratio of 1.93. The findings provide modest support for the clinical utility of the Color-Word Inhibition/Switching subtest in the cognitive assessment of TBI, while also replicating prior research suggesting clinical utility of the Category Switching subtest in this population.
本研究由两部分组成，旨在检验德利斯-卡普兰执行功能系统（D-KEFS）言语流畅性和颜色-单词子测验在创伤性脑损伤（TBI）中的临床效用。在第一部分中，通过回归分析，研究了128例轻至重度TBI门诊患者在言语流畅性和颜色-单词子测验中的表现与TBI严重程度的两个主要指标的关系：昏迷时长和神经影像学上颅内病变的存在情况。在控制了教育程度、种族以及病前和共病的复杂因素后，昏迷时长可预测颜色-单词抑制/转换子测验的表现，而弥漫性病变的存在与言语流畅性类别转换表现相关。在本研究的第二部分中，比较了28例中度至重度TBI患者与人口统计学匹配的轻度无并发症TBI组（n = 28）和神经健康对照组（n = 56）在类别转换和抑制/转换子测验中的表现。中度至重度TBI组在这两个子测验中的表现均显著差于轻度无并发症TBI组和对照组，而后两组在这些子测验上没有差异。逻辑回归分析表明，这些子测验的联合组分类准确率为66.07%，曲线下面积（AUC）为0.70，似然比为1.93。这些发现为颜色-单词抑制/转换子测验在TBI认知评估中的临床效用提供了一定支持，同时也重复了先前的研究，表明类别转换子测验在该人群中具有临床效用。
