Stenberg Jonas, Karr Justin E, Karlsen Rune H, Skandsen Toril, Silverberg Noah D, Iverson Grant L
Department of Neuromedicine and Movement Science, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
Department of Neurosurgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway.
Front Neurol. 2020 Oct 20;11:541533. doi: 10.3389/fneur.2020.541533. eCollection 2020.
Seven candidate cognition composite scores have been developed and evaluated as part of a research program designed to validate a cognition endpoint for traumatic brain injury (TBI) research and clinical trials, but these composites have yet to be examined longitudinally. This study examined test-retest reliability and methods for determining reliable change for these seven candidate composite scores, using the neuropsychological test battery from the Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI). Participants (18-59 years-old) with mild TBI ( = 124), orthopedic trauma without head injury ( = 67), and healthy community controls ( = 63) from the Trondheim MTBI follow-up study completed the CENTER-TBI neuropsychological test battery at 2 weeks and 3 months after injury. The battery included both traditional paper-and-pencil tests and computerized tests from the Cambridge Neuropsychological Test Automated Battery (CANTAB). Seven composite scores were calculated for the paper-and-pencil tests, the CANTAB tests, and all tests combined (i.e., 21 composites in total on each assessment): the overall test battery mean (OTBM); global deficit score (GDS); neuropsychological deficit score-weighted (NDS-W); low score composite (LSC); and the number of scores ≤5th percentile, ≤16th percentile, or <50th percentile. The OTBM was calculated by averaging scores for all tests. The other composite scores were deficit-based scores, assigning different weights to low scores. All composites revealed better cognitive performance at the 3-month assessment compared to the 2-week assessment and the magnitude of improvement was similar across groups. Differences, in terms of effect sizes, were largest on the OTBMs. In the combined composites, the test-retest correlation was highest for the OTBM (Spearman's = 0.87, in the community control group) and lowest for the number of scores ≤5th percentile ( = 0.41). The high test-retest reliability of the OTBM appears to favor its use in TBI research; however, future studies are needed to examine these candidate composite scores in participants with more severe TBIs and cognitive deficits and the association of the composites with functional outcomes.
作为一项旨在验证创伤性脑损伤（TBI）研究和临床试验认知终点的研究项目的一部分，已经开发并评估了七个候选认知综合评分，但这些综合评分尚未进行纵向研究。本研究使用欧洲创伤性脑损伤协作神经创伤有效性研究（CENTER-TBI）的神经心理测试组合，检验了这七个候选综合评分的重测信度以及确定可靠变化的方法。来自特隆赫姆轻度创伤性脑损伤随访研究的参与者（18 - 59岁），包括轻度TBI患者（n = 124）、无头部损伤的骨科创伤患者（n = 67）和健康社区对照者（n = 63），在受伤后2周和3个月完成了CENTER-TBI神经心理测试组合。该组合包括传统的纸笔测试和来自剑桥神经心理测试自动组合（CANTAB）的计算机化测试。针对纸笔测试、CANTAB测试以及所有测试的组合计算了七个综合评分（即每次评估总共21个综合评分）：整体测试组合均值（OTBM）；整体缺陷评分（GDS）；神经心理缺陷评分加权（NDS-W）；低分综合评分（LSC）；以及得分≤第5百分位数、≤第16百分位数或<第50百分位数的数量。OTBM通过对所有测试的得分求平均值来计算。其他综合评分是基于缺陷的评分，对低分赋予不同权重。与2周评估相比，所有综合评分在3个月评估时均显示出更好的认知表现，且各组的改善幅度相似。就效应大小而言，OTBM的差异最大。在综合综合评分中，OTBM的重测相关性最高（在社区对照组中，Spearman's ρ = 0.87），得分≤第5百分位数的数量的重测相关性最低（ρ = 0.41）。OTBM的高重测信度似乎有利于其在TBI研究中的应用；然而，未来需要在更严重的TBI和认知缺陷参与者中研究这些候选综合评分，以及综合评分与功能结局的关联。
