O'Connell Megan E, Tuokko Holly, Voll Stacey, Simard Martine, Griffith Lauren E, Taler Vanessa, Wolfson Christina, Kirkland Susan, Raina Parminder
a Department of Psychology , University of Saskatchewan , Saskatoon , Canada.
b Institute on Aging & Lifelong Health, University of Victoria , Victoria , Canada.
Clin Neuropsychol. 2017 Aug-Oct;31(6-7):1188-1203. doi: 10.1080/13854046.2017.1349931. Epub 2017 Jul 5.
We detail a new approach to the creation of normative data for neuropsychological tests. The traditional approach to normative data creation is to make demographic adjustments based on observations of correlations between single neuropsychological tests and selected demographic variables. We argue, however, that this does not describe the implications for clinical practice, such as increased likelihood of misclassification of cognitive impairment, nor does it elucidate the impact on decision-making with a neuropsychological battery.
We propose base rate analyses; specifically, differential base rates of impaired scores between theoretical and actual base rates as the basis for decisions to create demographic adjustments within normative data. Differential base rates empirically describe the potential clinical implications of failing to create an appropriate normative group. We demonstrate this approach with data from a short telephone-administered neuropsychological battery given to a large, neurologically healthy sample aged 45-85 years old. We explored whether adjustments for age and medical conditions were warranted based on differential base rates of spuriously impaired scores.
Theoretical base rates underestimated the frequency of impaired scores in older adults and overestimated the frequency of impaired scores in younger adults, providing an evidence base for the creation of age-corrected normative data. In contrast, the number of medical conditions (numerous cardiovascular, hormonal, and metabolic conditions) was not related to differential base rates of impaired scores. Despite a small correlation between number of medical conditions and each neuropsychological variable, normative adjustments for number of medical conditions does not appear warranted. Implications for creation of normative data are discussed.
我们详细阐述了一种为神经心理学测试创建常模数据的新方法。创建常模数据的传统方法是基于对单个神经心理学测试与选定人口统计学变量之间相关性的观察进行人口统计学调整。然而，我们认为，这并未描述对临床实践的影响，例如认知障碍误分类可能性增加，也未阐明对神经心理成套测验决策的影响。
我们提出基础率分析；具体而言，理论基础率与实际基础率之间受损分数的差异基础率作为在常模数据内进行人口统计学调整决策的依据。差异基础率从经验上描述了未能创建适当常模组的潜在临床影响。我们用来自一个简短电话神经心理成套测验的数据对这一方法进行了演示，该测验施测于一个年龄在45至85岁之间的大型神经健康样本。我们根据虚假受损分数的差异基础率探讨了是否有必要对年龄和医疗状况进行调整。
理论基础率低估了老年人受损分数的频率，高估了年轻人受损分数的频率，为创建年龄校正常模数据提供了证据基础。相比之下，医疗状况的数量（众多心血管、激素和代谢状况）与受损分数的差异基础率无关。尽管医疗状况数量与每个神经心理学变量之间存在小的相关性，但对医疗状况数量进行常模调整似乎没有必要。文中讨论了对创建常模数据的启示。
