Patrick Kristina E, Shields Allison N, Dustin Holly A, Patel Anup D, McNally Kelly
Department of Neuropsychology, Nationwide Children's Hospital, Columbus, Ohio, USA.
Department of Neurosciences, Seattle Children's Hospital, Seattle, Washington, USA.
Epilepsia. 2025 Aug;66(8):2916-2929. doi: 10.1111/epi.18421. Epub 2025 Apr 26.
This study aimed to evaluate the effectiveness of current neuropsychology referral methods for children with epilepsy and develop data-informed recommendations for use of performance-based cognitive screening measures to improve these processes.
Children with epilepsy who had been referred to neuropsychology (n = 51) or had never been referred (n = 34) completed four brief tablet-based screening tests from the National Institutes of Health Toolbox Cognition Battery along with a comprehensive neuropsychological test battery. Demographics, medical information, and parent questionnaires were gathered.
Mean performance on the neuropsychological test battery was worse in the referral group (p = .008, d = .52), but percentage of patients who presented with cognitive impairment (at least two scores 1.5 SD below the mean) did not differ. Demographics did not predict performance on the comprehensive neurocognitive battery (p = .46, = .06). Medical variables added some predictive value (p = .004, = .25). Parent questionnaires added minimal value (p = .066, = .05) beyond the previous variables. Performance on the cognitive screening battery added significant predictive value (p < .001, = .31) above demographics, medical variables, and parent questionnaires, explaining 31% additional variance in performance on the comprehensive neuropsychological battery. Stepwise analysis suggested that only three screening tests, totaling 15 min of administration time, were necessary. A cutoff score of .70 SD below the mean on any of those screening tests had high sensitivity (.90) while maintaining specificity > .50. A cutoff score of 1 SD below the mean provided better balance of sensitivity (.74) and specificity (.70).
Brief and easy to administer performance-based cognitive screening may add value and reduce bias when making decisions about neuropsychology referrals for children with epilepsy. An ideal clinical model could include neuropsychology consultation with chart review, clinical interview, questionnaires, and brief cognitive screening to inform referrals for more comprehensive evaluation. In settings where this is not possible, cognitive screening may be a useful and minimally resource-intensive method for informing referral decisions.
本研究旨在评估当前针对癫痫儿童的神经心理学转诊方法的有效性，并基于数据提出关于使用基于表现的认知筛查措施以改进这些流程的建议。
已被转诊至神经心理学科室的癫痫儿童（n = 51）或从未被转诊过的癫痫儿童（n = 34）完成了美国国立卫生研究院工具箱认知电池中的四项简短的基于平板电脑的筛查测试，以及一套全面的神经心理学测试。收集了人口统计学信息、医学信息和家长问卷。
转诊组在神经心理学测试中的平均表现更差（p = .008，d = .52），但出现认知障碍（至少两项分数低于平均值1.5个标准差）的患者百分比没有差异。人口统计学信息无法预测在全面神经认知测试中的表现（p = .46， = .06）。医学变量增加了一些预测价值（p = .004， = .25）。家长问卷在先前变量之外增加的价值极小（p = .066， = .05）。认知筛查测试的表现比人口统计学信息、医学变量和家长问卷增加了显著的预测价值（p < .001， = .31），解释了全面神经心理学测试表现中额外31%的方差。逐步分析表明，只需三项筛查测试，总计15分钟的施测时间即可。在这些筛查测试中，任何一项测试分数低于平均值0.7个标准差的临界值具有高灵敏度（.90），同时保持特异性 > .50。低于平均值1个标准差的临界值在灵敏度（.74）和特异性（.70）之间提供了更好的平衡。
简短且易于实施的基于表现的认知筛查在为癫痫儿童做出神经心理学转诊决策时可能会增加价值并减少偏差。一个理想的临床模型可以包括神经心理学咨询，同时进行病历审查、临床访谈、问卷和简短的认知筛查，以为更全面的评估提供转诊依据。在无法做到这一点的情况下，认知筛查可能是一种有用且资源消耗最少的方法，可为转诊决策提供信息。
