BASE RATES OF LONGITUDINAL RBANS DISCREPANCIES AT ONE- AND TWO-YEAR INTERVALS IN COMMUNITY-DWELLING OLDER ADULTS

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BASE RATES OF LONGITUDINAL RBANSDISCREPANCIES AT ONE- AND TWO-YEARINTERVALS IN COMMUNITY-DWELLINGOLDER ADULTSDoyle E. Patton a b , Kevin Duff c , Mike R. Schoenberg d , JamesMold e , James G. Scott a & Russell L. Adams aa University at Oklahoma Health Sciences Center, Department ofPsychiatry & Behavioral Sciences , Oklahoma City, OK, USAb INTEGRIS Jim Thorpe Rehabilitation Center , Oklahoma City, OK,USAc University of Iowa, Department of Psychiatry , Iowa City, IA, USAd University Hospitals of Cleveland and Case Western ReserveUniversity School of Medicine, Department of Neurology , Cleveland,OH, USAe University at Oklahoma Health Sciences Center, Department ofFamily Medicine , Oklahoma City, OK, USAf Heller Psychology , Boca Raton, FL, USAPublished online: 16 Feb 2007.

To cite this article: Doyle E. Patton , Kevin Duff , Mike R. Schoenberg , James Mold , James G. Scott& Russell L. Adams (2005) BASE RATES OF LONGITUDINAL RBANS DISCREPANCIES AT ONE- AND TWO-YEAR INTERVALS IN COMMUNITY-DWELLING OLDER ADULTS, The Clinical Neuropsychologist, 19:1,27-44, DOI: 10.1080/13854040490888477

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BASE RATES OF LONGITUDINAL RBANSDISCREPANCIES AT ONE- AND TWO-YEARINTERVALS IN COMMUNITY-DWELLINGOLDER ADULTS

Doyle E. Patton1,2, Kevin Duff3, Mike R. Schoenberg4,James Mold5, James G. Scott1, and Russell L. Adams11University at Oklahoma Health Sciences Center, Department of Psychiatry &Behavioral Sciences, Oklahoma City, OK, USA, 2INTEGRIS Jim ThorpeRehabilitation Center, Oklahoma City, OK, USA, 3University of Iowa,Department of Psychiatry, Iowa City, IA, USA, 4University Hospitals ofCleveland and Case Western Reserve University School of Medicine,Department of Neurology, Cleveland, OH, USA, and 5University at OklahomaHealth Sciences Center, Department of Family Medicine, Oklahoma City, OK,USA and Heller Psychology, Boca Raton, FL, USA

Identification of clinically significant change in performance over time on neurocognitive

tests is an important aspect of neuropsychological evaluation; however, scant published

empirical data exists to guide the clinician in determining the significance of psychometric

change across clinically relevant retest intervals. The present study presents base rate data

of RBANS score discrepancies in a user-friendly manner based on the performances of

a large sample (n ¼ 283) of community-dwelling older adults. Data for 1- and 2-year retest

intervals are presented in a tabular form that can be used as a convenient reference. Base

rates of discrepancy scores were calculated and organized into three groups (i.e., below

average, average, and above average) with respect to the participants’ OKLAHOMA

age- and education-corrected RBANS Total Scale score (Duff, Patton, Schoenberg, Mold,

Scott, & Adams, 2003) at initial assessment, in an effort to reduce the influence of

regression to the mean and practice effects that is associated with varying levels of cognitive

ability (e.g., Rapport, Axelrod, Theisen, Brines, Kalechstein, & Ricker, 1997; Rapport,

Brines, Axelrod, & Theisen, 1997). These data may be helpful in clinical practice by assist-

ing the clinician in determining the clinical significance of score changes.

Identification and documentation of clinically significant change in objective neuro-cognitive functioning over time is a fundamental aspect of neuropsychological as-sessment. Documentation of progressive decline in neurocognitive functioning, forexample, is a crucial step in diagnosing such disorders as Alzheimer’s disease(AD) and other neurodegenerative dementing illnesses (Lezak, 1995). Indeed, aprogressive worsening of cognition is one of the core criteria for diagnosis of AD

Address correspondence to: Doyle E. Patton, Heller Psychology, 2200 NW Corporate Blvd, Suite

110, Boca Raton, FL, USA. Tel.: þ1-561-944-4565. Fax.: þ1-561-994-3552. E-mail: DPatton512@

yahoo.com.

Accepted for publication: July 5, 2004.

27

The Clinical Neuropsychologist, 19: 27–44, 2005

Copyright # Taylor and Francis Ltd.

ISSN: 1385-4046

DOI: 10.1080/13854040490888477

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according to guidelines put forth by the National Institute of Neurological and Com-municative Disorders and Stroke and the Alzheimer’s Disease and Related DisordersAssociation (NINCDS-ADRDA; McKhann et al., 1984) and Diagnostic and Stat-istical Manual of Mental Disorders (DSM-IV, American Psychiatric Association,1994). Identification of clinically significant change over time might prove parti-cularly useful in accurate early detection of dementia in cases where mild cognitiveimpairment (MCI; Petersen, 2003) is found. Specifically, individuals who are notedto have a progressive worsening of their condition, in addition to meeting suggestedcriteria for MCI (e.g., Petersen), could be considered to be at an elevated risk fordeveloping dementia. Other referral questions that stress the importance of notingclinical change over time include detecting mental changes associated with a surgicalprocedure (e.g., deep brain stimulator, temporal lobe resection), evaluating the ben-eficial impact of a medical intervention (e.g., anti-dementia drug therapies), andassessing recovery from acute and transitory neurological insult (e.g., ischemia, trau-matic brain injury).

Few studies have been published that offer guidance in determining meaning-fulness of score changes across multiple testing. Although several statistical formulashave been developed to assess clinically significant change in neuropsychological testperformance (Bruggemans, Van de Vijver, & Huysmans, 1997; Chelune, Naugle,Luders, Sedlak, & Awad, 1993; Jacobson & Traux, 1991; McSweeny, Naugle,Chelune, & Luders, 1993; Zegers & Hafkenscheid, 1994), their applicability is oftenlimited by the absence of appropriate and relevant data. For example, these changeformulas have generally been developed for use with specific patient groups, therebylimiting the ability to which they can be applied more generally.

One alternative to reliable change algorithms is the use of base rate data for dis-crepancy scores across a clinically meaningful period of time. In this paradigm, if a dis-crepancy between two scores (Time 1 and Time 2) exceeds a predetermined threshold(<10th percentile), this change in performance is interpreted to be clinically significant(Silverstein, 1981). Ivnik, Smith, Malec, Petersen, and Tangalos (1995) provided suchinformation on the long-term stability of the Mayo Cognitive Factor Scores (MCFS).In this study, the authors report base rate data regarding the frequency of psycho-metric change for variousMCFS scores in older adults across a four-year period. Ivnikand colleagues (i.e., Ivnik et al., 1999), also present data regarding the long-term stab-ility of cognitive test scores across multiple assessments, measured at clinically relevanttest–retest intervals of one to two years. These studies provide an alternative means toassess an individual’s change across multiple assessments on theMCFS. Clinicians canuse these findings to determine if a given discrepancy is clinically significant or if it fallswithin the bounds of normal fluctuations over time.

Despite the pioneering work of Ivnik and colleagues, there remains an absenceof published base rate data for assessing change across time on neuropsychologicalmeasures other than the MCFS (Ivnik et al., 1995; Ivnik et al., 1999). Similarly, thereis scant literature on the impact of serial testing in cognitively intact older adults. Thepurpose of the present study was to provide base rate data on discrepancies betweenscores found with serial testing for the Repeatable Battery for the Assessment ofNeuropsychological Status (RBANS, Randolph, 1998). The data presented arebased on the performances of a large sample of community-dwelling older adultsfollowed for a two-year interval.

28 DOYLE E. PATTON ET AL.

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METHOD

Participants

Data for the present study represents a subsample of the Oklahoma Longi-tudinal Assessment of Health Outcomes in Mature Adults (OKLAHOMA) study,which is further described in Duff et al. (2003). Briefly, participants were recruitedfrom their primary care physicians who judged them to be cognitively intact and suit-able for participation in this longitudinal study. All participants completed aquestionnaire that inquired about demographic information, habits, medicalconditions, physical symptoms, functional status, and measures of health-relatedquality of life. These questionnaires were reviewed with a research nurse, who alsoobtained informed consent; checked vital signs, hearing, vision, gait, balance, andperipheral sensation=reflexes; and administered Form A of the RBANS. Sensorydeficits (e.g., macular degeneration) precluded some participants from completingsome subtests.

Of the 824 participants that were evaluated in the OKLAHOMA study, 106were eliminated from analyses due to a variety of self-reported comorbid medicalconditions that would be likely to negatively impact cognitive functioning (strokeor transient ischemic attack ¼ 52; head injury ¼ 33; concussion ¼ 19; seizures ¼ 12;12; Parkinson’s disease ¼ 5; brain hemorrhage ¼ 1; note that some of these parti-cipants reported more than one exclusionary condition). A final sample of 718 part-icipants remained.

For purposes of the present study, 283 participants who completed assess-ment on three occasions at one-year intervals (i.e., baseline, one-year followup,and two-year followup) were selected for further analyses. Demographic and medi-cal information for the participants included in the present study are displayed inTable 1.

Measure

The RBANS (Randolph, 1998) is a brief, individually administered testdesigned to assess attention, language, visuospatial=constructional abilities, and im-mediate and delayed memory. It consists of 12 subtests, which yield five Index scores(attention, language, visuospatial=constructional, immediate memory, and delayedmemory) and a Total Scale score. The normative information provided in the man-ual is based on 540 healthy, primarily Caucasian adults who ranged in age from 20 to89 years old. More recently, Duff et al. (2003) have provided expanded normativedata (n ¼ 718) that includes age and education corrections for use with older adultsages 65 to 94. The normative data provided by Duff et al. were utilized in the presentstudy. Scores utilizing the Duff et al. normative data are preceded with ‘‘OKLA-HOMA’’ to make this designation. All subtests were administered and scored asdefined in the manual, with the exception of the figure copy and figure recall, whichwere scored with a modified scoring criteria that was more liberal than the originalscoring criteria presented in the manual. Additional details about these modifiedscoring criteria are presented in Duff et al. In the present study, Form A of theRBANS was utilized at each assessment.

RBANS DISCREPANCY BASE RATES 29

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Data Analysis

Test–retest discrepancies between initial scores (T1) and retest scores at one-year (T2) and two-year (T3) intervals were calculated for each of the five Indexesand Total Scale scores. Base rate data for discrepancies at the one-year (i.e.,T2� T1 and T3� T2) and two-year (i.e., T3� T1) intervals were calculated. Specifi-cally, discrepancy scores were identified that were representative of specified percen-tiles for both score increases and score decreases over time.

Given that prior research has demonstrated that variability in test scores overtime is mediated by level of cognitive functioning, with higher cognitive functioningindividuals demonstrating more improvement (e.g., Rapport, Axelrod, et al., 1997;Rapport, Brines, et al., 1997), base rates of discrepancy scores were calculated andorganized with respect to participants’ OKLAHOMA age- and education-correctedRBANS Total Scale score at initial assessment. Specifically, base rates were orga-nized according to three groups. The first (below average) group was comprised of

Table 1 Demographic and Medical Information

Variable

n ¼ 283

Age: mean (SD) 72.51 (5.37)

Gender

Males 131

Females 152

Education

8th grade or less 4

Some high school 17

Completed high school 65

Some college 94

Completed college 36

Some graduate school 20

Completed graduate school 47

Race

African American 19

Hispanic=Latin American 3

Native American 5

White, Non-Hispanic 256

Retest Interval (days): mean (SD)

T1 to T2 378.0 (49.8)

T1 to T3 731.3 (63.7)

T2 to T3 352.5 (66.3)

Medical conditions (%)

Arthritis 61.5

Cancer 17.7

Depression 17.3

Diabetes 14.1

Heart disease 26.5

Hypertension 43.1

Note. Values represent frequencies unless otherwise specified. Age is in

years at time of first assessment and Retest Interval is in days. T1 ¼ testing

at Year 1; T2 ¼ testing at Year 2; T3 ¼ testing at Year 3. Medical condi-

tions ¼ percentage of sample reporting that condition.


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participants (n ¼ 50) who obtained an OKLAHOMA age- and education-correctedRBANS Total Scale score less than 90 at T1. The second ‘‘average’’ group (n ¼ 172)scored from 90 to 109 at T1. Finally, the ‘above average’ group (n ¼ 61) scored 110or greater at T1. The breakdown into these three groups was chosen due to a com-bination of the clinical appeal of this organization and compatibility with conven-tional classification schemes (e.g., as recommended by Wechsler, 1981), as well asthe fact that it was statistically supported. Specifically, a multivariate analysis ofvariance was conducted to determine the effect of the three groups on raw scorediscrepancies over a one-year period (i.e., T2� T1) for the 12 RBANS subtests. Sig-nificant differences were found among the three groups (Wilks’s K ¼ .83, F [24,538] ¼ 2.19, p < .001).

A split based on OKLAHOMA age-corrected and education-corrected TotalScale scores was also considered. While both models closely approximated normaldistributions (i.e., absolute value of skewness and kurtosis < 1 for both models),the age- and education-corrected model had a slightly better fit to the normal curve,with a better distribution of participants among the three groups as compared to theage-corrected model (i.e., the age-corrected model resulted in ns of 36, 140, and 107for the three groups, respectively). Therefore, the split based on OKLAHOMA age-and education-corrected Total Scale score at T1 was retained for the present study.

RESULTS

Descriptive information on RBANS performances at T1, T2, and T3 is pre-sented in Table 2. Base rate data for discrepancies over one- and two-year intervalsare presented in Tables 3 through 5, organized by OKLAHOMA age- and edu-cation-corrected RBANS Total Scale score at T1. Base rates from three sourcesare presented in the tables, including: (a) OKLAHOMA age-corrected Index scores,

Table 2 Descriptive Statistics for RBANS (Form A) OKLAHOMA Scores

Measure Year 1 Year 2 Year 3

n ¼ 283 283 283

Age-Corrected Index Scores Mean (SD)

Immediate memory 105.4 (14.5) 103.7 (13.2) 106.0 (14.2)

Visuospatial=constructional 92.8 (14.2) 84.7 (10.9) 97.2 (14.5)

Language 105.9 (13.8) 104.7 (13.9) 105.2 (14.4)

Attention 106.1 (13.7) 105.6 (13.1) 105.9 (14.4)

Delayed memory 100.8 (14.2) 98.9 (12.7) 105.0 (14.4)

Total Scale 101.1 (14.0) 97.6 (12.4) 103.9 (14.3)

Age- and Education-Corrected Index Scores Mean (SD)

Immediate memory 104.4 (14.8) 102.9 (13.5) 105.4 (14.8)

Visuospatial=constructional 90.2 (12.2) 83.8 (10.1) 93.7 (12.1)

Language 91.7 (8.4) 90.9 (8.5) 91.5 (9.2)

Attention 105.3 (14.0) 104.5 (13.5) 105.1 (14.9)

Delayed memory 97.0 (11.8) 95.2 (11.6) 100.3 (12.5)

Total Scale 95.4 (12.6) 92.4 (11.3) 97.9 (13.2)

Note. Index scores are age-corrected or age- and education-corrected scores based on the OKLA-

HOMA normative studies (Duff et al., 2003).


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(b) OKLAHOMA age- and education-corrected Index scores, and (c) age-correctedIndex scores based on the original RBANS normative data (Randolph, 1998).

DISCUSSION

The present study provides base rate information regarding discrepancies inRBANS scores across time in a large sample of community-dwelling older adults.These data may be used to help confirm or refute the presence of clinically significantchange in a patient’s performance at one- and two-year intervals with repeated test-ing. The data reveal that relatively large differences across time are common in manyinstances. For example, Table 4 reveals that for individuals in the average group (i.e.,RBANS OKLAHOMA age- and education-corrected Total Scale score between 90and 109 at T1), a 6-point decline (i.e., T2� T1 ¼ �6.0) for the OKLAHOMA age-and education-corrected Delayed Memory Index occurred in 20% of the cases over aone-year period. For the same group, a 8-point decline (i.e., T2� T1 ¼ �8.4)occured in 20% of the cases for OKLAHOMA age- and education-corrected Visuo-spatial=Construction Index obtained over the one-year period. Other examplesabound and the presented data offer the clinician the opportunity to avoid someof the pitfalls associated with overreliance on clinical judgment to the exclusion ofactuarial methods (Dawes, Faust, & Meehl, 1989; Tracey, & Rounds, 1999).

Discrepancies found between Indexes with the OKLAHOMA age correctionswere largely comparable to the discrepancies found when Indexes were calculatedbased on age-corrections from the original RBANS normative data (Randolph,1998). The largest differences occurred between the different discrepancy sets inthe Visuospatial=Construction Index, which is not surprising given the OKLA-HOMA normative data likely accounts for scoring changes in the figure copy subtestmore than the original normative data. Mild discrepancies between normative setsalso occur with respect to the Delayed Memory Index.

In addition, difference in the performance of the data sets emerge when initialability level is considered. For example, in the high average group (i.e., Time 1 TotalScore > 110), the base rate of declines in the Total Score across the first year (i.e.,Time 1 to Time 2) was quite different between the age-corrected norms from themanual and the age-corrected norms from Duff et al. (2003), particularly at theextremes. Based on Randolph’s norms, a decline of 23 Index points (i.e., approxi-mately 1.5 SDs) falls� 1st percentile. A similar decline falls between the 2nd and5th percentile using Duff et al.’s norms. Given that a decline of 23 points (i.e.,approximately 1.5 SDs below the mean) should correspond to approximately the6th percentile, the data appear to be somewhat more compatible with Duff et al.’snorms compared to the RBANS manual norms. Although there are likely numerousexamples throughout these tables that support one group of norms in favor of theother, it is clear that clinicians or researchers who utilize these values should inspectthem carefully before deciding which set to apply for their individual client orresearch participant.

The data presented also illustrate some psychometric principles inherent toserial testing, despite attempts to minimize their influence. Specifically, regressionto the mean and=or practice effects were apparent, particularly for individuals inthe above average group. For example, consider the OKLAHOMA age-corrected


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Table

3Frequencies

(CumulativePercentages)ofDiscrepancies

BetweenRBANS(Form

A)Age-

andAge&

Education-C

orrectedIndex

Scoresat1-and2-year

Intervals:Age-

&EducationCorrectedTotalScale

Score

atTim

e1<

90(n

¼50)

CumulativePercentages

Declinein

ScoresOver

Tim

eIncrease

inScoresOver

Tim

e

�1%

2%

5%

10%

20%

50%

20%

10%

5%

2%

�1%

TotalScale

Age-Corrected(O

KLAHOMA)a

1-yearInterval(T2–T

1)�17.0

�17.0

�14.4

�7.7

�1.8

5.0

9.0

12.8

15.9

18.0

18.0


1)�22.0

�21.9

�17.9

�10.9

�4.6

4.5

12.0

16.0

18.4

22.0

22.0


2)�10.0

�10.0

�10.0

�9.0

�6.8

0.0

6.0

8.0

9.9

13.9

14.0

Age-

&Education-C

orrecteda


1)�16.0

�15.9

�12.0

�6.7

�2.8

3.0

10.0

12.8

16.9

20.0

20.0


1)�21.0

�20.9

�16.4

�10.9

�4.8

3.5

10.0

14.8

19.3

23.0

23.0


2)�12.0

�12.0

�9.9

�8.0

�6.8

0.0

4.0

8.0

9.5

16.9

17.0

Age-Corrected(R

andolph,1998)

b

1-yearInterval(T2–T1)

�19.0

�18.9

�12.8

�7.0

�2.8

3.5

11.6

14.9

17.9

20.0

20.0


1)�29.0

�28.8

�19.9

�7.9

�4.0

4.0

11.8

17.6

23.9

26.0

26.0


2)�15.0

�15.0

�12.9

�11.0

�9.0

�1.0

6.8

10.9

13.9

20.9

21.0

Immediate

Mem

ory

Index

Age-Corrected(O

KLAHOMA)a


1)�17.0

�17.0

�17.0

�11.6

�4.8

4.0

11.0

16.7

18.9

26.9

27.0


1)�30.0

�29.7

�15.5

�12.6

�7.0

3.5

13.6

17.9

23.5

26.9

27.0


2)�15.0

�15.0

�13.0

�10.8

�8.0

0.0

7.6

10.8

15.4

18.0

18.0

Age-

&Education-C

orrecteda


1)�18.0

�18.0

�17.5

�8.9

�4.8

3.5

12.0

17.0

21.3

29.9

30.0


1)�27.0

�26.8

�15.5

�13.9

�7.8

4.5

14.0

17.9

21.9

29.9

30.0


2)�17.0

�17.0

�13.4

�11.9

�8.0

0.0

7.8

12.8

15.4

19.9

20.0

Age-Corrected(R

andolph,1998)

b


1)�28.0

�28.0

�25.9

�10.8

�3.8

5.0

15.4

21.0

29.4

39.8

40.0


1)�37.0

�36.8

�22.3

�13.7

�7.4

5.5

18.8

22.9

28.2

39.8

40.0


2)�29.0

�28.9

�17.0

�12.0

�9.0

0.0

9.8

17.5

21.8

25.0

25.0

(continued)

33

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Table

3(C

ontinued)


Declinein

ScoresOver

Tim

eIncrease

inScoresOver

Tim

e

�1%

2%

5%

10%

20%

50%

20%

10%

5%

2%

�1%

Visuospatial=ConstructionalIndex

Age-Corrected(O

KLAHOMA)a


1)�34.0

�33.8

�20.9

�16.9

�7.0

1.5

10.0

16.7

29.1

36.9

37.0


1)�35.0

�34.9

�28.9

�19.8

�15.0

0.0

10.0

18.9

21.8

49.5

50.0


2)�33.0

�32.8

�21.3

�16.8

�14.8

�4.0

7.8

13.9

22.3

32.8

33.0

Age-

&Education-C

orrecteda


1)�29.0

�28.9

�21.8

�12.7

�5.8

0.0

9.8

18.7

24.0

26.9

27.0


1)�26.0

�26.0

�23.5

�18.8

�13.8

0.0

12.4

16.9

20.9

39.6

40.0


2)�26.0

�25.9

�18.8

�17.0

�13.8

�6.0

8.0

11.9

19.9

23.9

24.0

Age-Corrected(R

andolph,1998)

b


1)�40.0

�39.8

�26.2

�13.0

�9.0

3.0

12.0

21.8

34.5

39.9

40.0


1)�34.0

�34.0

�31.5

�26.5

�18.8

0.0

15.8

21.0

28.4

52.5

53.0


2)�31.0

�31.0

�28.8

�22.0

�18.0

�6.0

10.2

16.0

21.8

30.9

31.0

Language

Index

Age-Corrected(O

KLAHOMA)a


1)�31.0

�30.9

�23.1

�16.9

�9.0

�0.5

9.8

24.3

32.8

43.8

44.0


1)�28.0

�27.8

�17.4

�11.8

�9.0

0.0

12.6

20.8

29.3

45.8

46.0


2)�25.0

�24.9

�19.9

�13.9

�9.8

3.0

11.8

15.9

21.5

32.8

33.0

Age-

&Education-C

orrecteda


1)�19.0

�18.9

�14.4

�8.0

�6.0

0.0

6.0

11.8

17.8

22.9

23.0


1)�14.0

�13.9

�11.0

�8.0

�4.0

0.0

7.8

12.0

18.3

30.8

31.0


2)�11.0

�11.0

�10.0

�6.0

�4.0

0.0

6.0

12.7

15.9

20.9

21.0

Age-Corrected(R

andolph,1998)

b


1)�32.0

�31.7

�16.3

�10.7

�6.0

0.0

8.6

14.9

27.8

31.0

31.0


1)�28.0

�27.7

�13.5

�10.8

�8.0

0.0

6.8

16.8

21.4

31.8

32.0


2)�28.0

�27.8

�16.7

�8.9

�7.0

0.0

6.8

11.9

20.7

27.9

28.0

34

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AttentionIndex

Age-Corrected(O

KLAHOMA)a


1)�14.0

�13.9

�10.5

�6.9

�3.8

3.0

8.0

14.8

17.5

18.0

18.0


1)�21.0

�21.0

�18.3

�11.0

�5.6

3.0

10.8

15.0

21.0

24.9

25.0


2)�20.0

�20.0

�17.5

�15.6

�7.0

0.0

7.0

9.8

13.5

16.9

17.0

Age-

&Education-C

orrecteda


1)�14.0

�14.0

�11.9

�9.9

�4.0

3.0

7.8

14.0

14.5

20.9

21.0


1)�24.0

�23.9

�17.2

�12.8

�6.6

3.0

13.4

17.0

22.0

24.0

24.0


2)�18.0

�18.0

�17.5

�10.9

�7.0

0.0

8.0

11.0

14.0

16.9

17.0

Age-Corrected(R

andolph,1998)b


1)�19.0

�18.9

�10.4

�6.0

�6.0

3.0

12.0

15.0

18.0

21.9

22.0


1)�22.0

�22.0

�18.3

�13.7

�3.8

3.0

14.4

18.0

21.5

24.0

24.0


2)�22.0

�22.0

�18.8

�11.9

�8.4

0.0

6.0

11.8

13.4

17.9

18.0

Delayed

Mem

ory

Index

Age-Corrected(O

KLAHOMA)a


1)�19.0

�18.8

�9.5

�6.0

�4.8

4.0

11.8

16.9

24.5

32.9

33.0


1)�19.0

�19.0

�15.9

�9.9

�3.6

7.0

13.8

16.0

26.3

33.9

34.0


2)�14.0

�14.0

�13.0

�8.9

�4.8

0.5

6.8

9.8

12.5

13.0

13.0

Age-

&Education-C

orrecteda


1)�62.0

�61.0

�9.5

�6.0

�4.0

3.5

8.8

13.9

20.3

28.9

29.0


1)�19.0

�19.0

�15.4

�9.0

�2.8

4.5

11.8

14.0

18.4

28.8

29.0


2)�13.0

�13.0

�11.5

�6.9

�4.0

0.5

6.0

9.0

12.4

42.4

43.0

Age-Corrected(R

andolph,1998)

b


1)�38.0

�37.7

�20.5

�16.0

�8.8

3.5

13.8

23.3

25.9

33.9

34.0


1)�38.0

�37.8

�22.5

�16.9

�10.6

3.5

17.8

23.9

26.0

37.8

38.0


2)�28.0

�28.0

�23.7

�18.1

�5.8

0.0

14.4

17.0

19.0

24.9

25.0

Note.T1¼

testingatyear1score;T2¼


testingatyear3score.In

determiningwhichTab

leto

use,calculate

theTlage-

&education-

correctedTotalScalescore

basedonDuff,et

al.(2003)

norm

ativedata.Forscores<90use

Tab

le3;forscoresfrom

90to

109,use

Tab

le4;andforscores�110,use

Table

5.

aAge-correctedIndex

discrepancy

scoresdesignated‘‘(O

KLAHOMA)’’andage-

&education-correctedIndex

discrepancy

scoresare

basedontheOKLAHOMA

norm

ativestudies(D

uffet

al.,2003).

bAge-correctedIndex

discrepancy

scoresdesignated‘‘(R

andolph,1998)’’are

basedontheoriginalRBANSnorm

ativedata.

35

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Table 4 Frequencies (Cumulative Percentages) of Discrepancies Between RBANS (Form A) Age- and

Age & Education-Corrected Index Scores at 1- and 2-year Intervals: Age- & Education-Corrected Total

Scale Score at Time 1 ¼ 90 to 109 (n ¼ 172)

Cumulative Percentages

Decline in Scores Over Time Increase in Scores Over Time

�1% 2% 5% 10% 20% 50% 20% 10% 5% 2% �1%

Total Scale

Age-Corrected (OKLAHOMA)a

1-year Interval (T2–T1) �21.5 �18.2 �12.0 �9.0 �6.0 0.0 7.0 10.0 12.0 16.1 18.1

2-year Interval (T3–T1) �21.0 �16.5 �14.0 �8.7 �5.0 0.5 8.0 12.7 18.0 22.5 25.9

1-year Interval (T3–T2) �20.3 �15.5 �10.4 �8.0 �5.0 1.0 8.0 12.0 16.0 20.5 24.0

Age- & Education-Correcteda

1-year Interval (T2–T1) �19.6 �14.5 �10.0 �8.0 �6.0 0.0 6.0 9.0 11.0 13.5 16.6

2-year Interval (T3–T1) �17.0 �15.5 �12.0 �8.0 �5.0 1.0 7.4 12.0 15.4 19.5 24.5

1-year Interval (T3–T2) �18.1 �16.5 �10.4 �8.0 �4.0 0.5 7.0 11.0 15.0 19.1 22.8

Age-Corrected (Randolph,

1998)b

1-year Interval (T2–T1) �20.3 �16.5 �14.0 �12.0 �8.0 0.0 8.4 12.7 16.0 20.0 21.4

2-year Interval (T3–T1) �17.5 �16.0 �13.0 �11.0 �5.4 1.0 9.4 13.7 21.0 27.5 28.3

1-year Interval (T3–T2) �24.6 �17.0 �12.0 �8.0 �5.0 1.0 8.0 13.0 16.0 19.5 21.3

Immediate Memory Index


1-year Interval (T2–T1) �29.3 �27.0 �19.4 �15.0 �9.8 0.0 6.0 11.7 15.0 20.5 21.0

2-year Interval (T3–T1) �33.3 �26.5 �18.0 �13.4 �9.0 0.0 11.4 18.0 22.1 27.0 33.0

1-year Interval (T3–T2) �21.5 �19.6 �12.0 �11.0 �6.0 3.0 11.4 15.0 19.4 24.0 30.9


1-year Interval (T2–T1) �28.0 �28.0 �20.0 �17.0 �11.0 0.0 8.0 12.0 14.4 19.1 20.3

2-year Interval (T3–T1) �30.2 �27.5 �18.7 �14.0 �9.0 0.0 13.0 18.0 25.0 29.1 35.9

1-year Interval (T3–T2) �22.8 �21.0 �12.0 �11.0 �5.4 4.0 12.0 16.0 20.0 26.1 33.5


1998)b

1-year Interval (T2–T1) �40.4 �32.3 �25.0 �18.7 �13.0 0.0 9.0 16.7 21.4 25.5 27.0

2-year Interval (T3–T1) �41.3 �34.1 �22.7 �15.7 �9.0 3.0 15.0 20.0 27.0 34.6 40.6

1-year Interval (T3–T2) �25.5 �22.0 �17.0 �12.0 �6.4 6.0 14.0 19.7 22.4 29.5 37.1

Visuospatial=Constructional Index


1-year Interval (T2–T1) �34.1 �28.2 �23.7 �18.0 �11.0 0.0 12.0 18.0 22.0 29.6 33.5

2-year Interval (T3–T1) �43.0 �35.2 �22.7 �19.0 �13.0 0.0 8.0 13.0 21.0 25.0 36.8

1-year Interval (T3–T2) �37.3 �32.7 �25.0 �19.0 �10.4 0.0 7.0 12.0 20.1 27.7 30.0


1-year Interval (T2–T1) �27.1 �25.1 �16.4 �12.0 �8.4 0.0 7.4 13.7 16.4 22.6 27.8

2-year Interval (T3–T1) �33.0 �25.6 �18.0 �15.7 �10.4 0.0 6.0 11.0 14.4 20.5 26.4

1-year Interval (T3–T2) �31.2 �26.5 �20.4 �14.0 �9.0 0.0 6.0 11.0 14.4 18.0 18.8


1998)b

1-year Interval (T2–T1) �33.4 �28.2 �21.4 �18.4 �12.0 0.0 14.4 20.0 24.0 31.7 39.2

2-year Interval (T3–T1) �47.0 �31.0 �24.4 �19.0 �14.4 0.0 10.0 18.0 22.0 29.0 36.9

1-year Interval (T3–T2) �42.2 �33.1 �26.7 �22.4 �13.0 0.0 8.0 14.7 19.0 25.1 29.5

Language Index


1-year Interval (T2–T1) �31.5 �30.0 �22.4 �16.7 �11.0 0.0 9.4 13.0 16.7 24.7 31.7

(continued)


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Table 4 (Continued )

Cumulative Percentages

Decline in Scores Over Time Increase in Scores Over Time

�1% 2% 5% 10% 20% 50% 20% 10% 5% 2% �1%

2-year Interval (T3–T1) �35.5 �29.5 �25.0 �14.0 �10.0 0.0 10.0 14.0 17.7 29.5 36.1

1-year Interval (T3–T2) �34.0 �29.6 �20.4 �14.0 �10.4 0.0 10.0 16.7 21.0 27.5 28.3


1-year Interval (T2–T1) �22.0 �18.5 �13.4 �9.7 �6.0 0.0 4.0 6.0 11.4 15.1 16.5

2-year Interval (T3–T1) �18.4 �14.0 �12.0 �8.7 �6.0 0.0 4.0 7.0 14.0 20.5 24.5

1-year Interval (T3–T2) �20.8 �18.5 �12.0 �8.0 �4.4 0.0 6.0 11.0 14.0 20.0 22.3


1998)b

1-year Interval (T2–T1) �24.0 �21.0 �14.4 �11.0 �7.0 0.0 7.0 9.0 16.0 20.5 25.9

2-year Interval (T3–T1) �25.3 �22.6 �14.7 �9.7 �6.0 0.0 8.0 12.0 18.0 24.2 29.5

1-year Interval (T3–T2) �36.2 �23.2 �14.0 �10.4 �7.0 0.0 7.0 12.0 16.0 21.0 24.6

Attention Index


1-year Interval (T2–T1) �23.4 �20.5 �14.7 �11.0 �7.0 0.0 7.0 11.0 14.0 20.5 22.8

2-year Interval (T3–T1) �19.3 �16.1 �14.0 �13.0 �9.0 0.0 7.0 11.0 17.0 20.1 24.0

1-year Interval (T3–T2) �21.0 �16.6 �14.0 �10.0 �6.4 0.0 9.0 14.0 17.0 23.2 26.3


1-year Interval (T2–T1) �25.8 �23.6 �15.4 �11.7 �8.0 0.0 7.4 11.0 14.0 21.0 22.5

2-year Interval (T3–T1) �18.5 �17.5 �14.4 �14.0 �10.0 0.0 8.0 13.1 18.0 20.5 25.8

1 -year Interval (T3–T2) �21.6 �17.5 �14.0 �11.0 �7.0 0.0 10.0 14.0 18.4 25.0 28.8


1998)b

1-year Interval (T2–T1) �18.3 �15.0 �15.0 �13.0 �9.0 0.0 9.0 15.0 21.0 23.1 27.0

2-year Interval (T3–T1) �21.8 �18.0 �15.0 �12.0 �9.0 3.0 10.0 15.0 19.0 24.5 28.1

1-year Interval (T3–T2) �21.8 �18.5 �15.0 �12.0 �6.0 0.0 9.0 14.4 19.0 22.5 25.5

Delayed Memory Index


1-year Interval (T2–T1) �25.0 �19.0 �16.4 �11.0 �6.0 1.0 10.0 13.7 17.0 23.0 25.5

2-year Interval (T3–T1) �20.3 �19.0 �14.4 �9.7 �4.0 4.0 12.0 15.0 18.7 23.0 26.2

1-year Interval (T3–T2) �20.8 �17.5 �15.4 �11.0 �5.0 2.0 10.4 14.0 17.4 22.5 25.5


1-year Interval (T2–T1) �20.5 �16.1 �14.4 �10.0 �6.0 1.0 8.0 11.0 14.0 19.1 20.3

2-year Interval (T3–T1) �19.4 �15.5 �11.7 �8.0 �4.0 3.0 10.0 13.0 16.0 20.7 24.1

1-year Interval (T3–T2) �19.4 �14.5 �12.0 �9.0 �5.0 1.5 9.0 13.0 16.0 20.5 24.1


1998)b

1-year Interval (T2–T1) �29.0 �26.5 �21.4 �16.0 �9.0 2.5 10.0 18.1 21.0 23.5 28.5

2-year Interval (T3–T1) �26.3 �22.2 �19.0 �11.7 �4.0 3.5 13.0 20.0 24.0 29.0 32.8

1-year Interval (T3–T2) �29.8 �24.6 �16.0 �11.4 �6.4 2.5 13.0 17.0 22.4 26.5 28.8

Note. T1 ¼ testing at year 1 score; T2 ¼ testing at year 2 score; T3 ¼ testing at year 3 score. In deter-

mining which Table to use, calculate the Tl age- & education-corrected Total Scale score based on Duff

et al. (2003) normative data. For scores <90 use Table 3; for scores from 90 to 109, use Table 4; and

for scores �110, use Table 5.aAge-corrected Index discrepancy scores designated ‘‘(OKLAHOMA)’’ and age- & education-corrected

Index discrepancy scores are based on the OKLAHOMA normative studies (Duff et al., 2003).bAge-corrected Index discrepancy scores designated ‘‘(Randolph, 1998)’’ are based on the original

RBANS normative data.


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Total Scale scores illustrated in Figure 1. For the entire group, there was a very slightdecrease in scores from T1 to T2 (i.e., 0.3 points) followed by a very slight increasefrom T2 to T3 (i.e., 0.8 points). Upon closer investigation, it is revealed that much ofthe change appears to be due to changes in the scores at the extremes (i.e. in theabove average groups) and likely represents regression to the mean. Specifically,the below average group demonstrated a 312 point improvement from T1 to T2, whilethe above average group demonstrated a 4-point decline over the same period. Incontrast, the average group demonstrates virtually no change (i.e., 0.1 point declineon average) during that period. It is also likely that other factors related to serialassessments (e.g., ceiling effects, actual stability of the test, theoretical stability ofthe measured trait) are moderating longitudinal performances in all three groups.

Despite the influence of these moderating variables, the current findingsremain quite useful in allowing clinicians to determine, within a certain degree ofprobability, whether an observed discrepancy is significant above and beyond theinfluence of the aforementioned phenomena. That is, the presented base rates includea combination of ‘‘true change’’ and ‘‘error change,’’ with the latter moderatorsbeing ‘‘built-in’’ to the present base rates. Unfortunately, the present data do notallow for these two sources of variability to be separated, nor do they allow for finerdifferentiation of the ‘‘error change.’’

A brief case example may help illustrate how the present base rate data may beused. Consider the case of a 69-year-old patient with 12 years of education who isreferred by her neurologist for an evaluation. Her daughter states that the patienthas shown signs of mild cognitive decline since her husband passed away two yearsago, but that her condition does not seem to have worsened much over the past yearor so. Laboratory findings are reportedly negative to date and a recent MRI wasread as ‘‘mild cortical atrophy not inconsistent with age.’’ In her medical records,the results from a prior evaluation, conducted a year earlier, include RBANS data.You decide to repeat the RBANS as part of your current evaluation and convert all

Figure 1 RBANS (FormA)OKLAHOMAage-corrected total scores across time. T1 ¼ testing at year 1 score;

T2 ¼ testing at year 2 score; T3 ¼ testing at year 3 score. Below ¼ ‘‘below average’’ group; Average ¼‘‘average’’ group; Above ¼ ‘‘above average’’ group; Combined ¼ the total sample. Index scores are based

on age- and education-corrections derived from the OAKLAHOMA normative studies (Duff, et al., 2003).


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Table

5Frequencies

(Cumulative

Percentages)ofDiscrepancies

BetweenRBANS(Form

A)Age-

andAge&

Education-C

orrectedIndex

Scoresat1-and2-year

Intervals:Age-

&Education-C

orrectedTotalScale

Score

atTim

e1�110(n

¼61)


Declinein

ScoresOver

Tim

eIncrease

inScoresOver

Tim

e

�1%

2%

5%

10%

20%

50%

20%

10%

5%

2%

�1%

TotalScale

Age-Corrected(O

KLAHOMA)a


1)

�25.0

�24.0

�17.8

�14.4

�9.0

�6.0

4.0

6.0

8.0

14.0

15.0


1)

�16.0

�15.8

�13.9

�12.8

�11.0

�4.0

2.0

4.8

6.9

14.0

14.0


2)

�15.0

�14.3

�11.0

�9.8

�8.0

0.0

7.6

9.8

13.0

20.6

22.0

Age-

&Education-C

orrecteda


1)

�20.0

�19.0

�16.0

�14.0

�10.6

�5.0

2.0

7.8

9.8

15.0

16.0


1)

�19.0

�18.0

�12.9

�11.0

�10.0

�4.0

2.0

5.8

8.8

12.8

13.0


2)

�18.0

�17.3

�12.8

�9.0

�8.0

0.0

7.6

10.8

14.8

15.0

15.0

Age-Corrected(R

andolph,1998)

b


1)

�23.0

�22.3

�19.9

�16.0

�11.6

�3.0

3.6

7.0

13.0

22.0

22.0


1)

�21.0

�21.0

�19.9

�13.8

�10.6

�4.0

6.0

9.8

12.8

26.4

30.0


2)

�15.0

�14.8

�13.9

�11.8

�7.0

�1.0

8.6

14.8

21.3

36.1

39.0

Immediate

Mem

ory

Index

Age-Corrected(O

KLAHOMA)a


1)

�32.0

�30.8

�25.9

�21.0

�18.6

�4.0

4.0

11.4

15.9

21.0

22.0


1)

�24.0

�23.5

�21.6

�17.0

�11.6

�3.0

7.6

11.8

17.7

20.3

21.0


2)

�21.0

�20.3

�17.8

�15.0

�9.0

3.0

12.0

18.0

21.0

22.5

23.0

Age-

&Education-C

orrecteda


1)

�30.0

�29.5

�28.0

�22.0

�17.0

�5.0

4.6

10.8

17.8

22.8

24.0


1)

�26.0

�25.5

�21.7

�17.6

�12.0

0.0

7.6

13.0

17.8

21.0

22.0


2)

�21.0

�20.3

�16.9

�16.0

�7.2

3.0

13.6

18.0

20.7

24.0

24.0

Age-Corrected(R

andolph,1998)

b


1)

�35.0

�34.0

�23.9

�23.0

�15.0

�6.0

6.0

14.8

17.0

23.0

24.0


1)

�27.0

�27.0

�25.6

�17.0

�9.0

0.0

9.6

17.0

20.0

25.3

26.0


2)

�24.0

�22.8

�16.9

�12.0

�8.0

3.0

15.2

19.6

25.9

32.0

33.0

(continued)

39

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Table

5(C

ontinued)


Declinein

ScoresOver

Tim

eIncrease

inScoresOver

Tim

e

�1%

2%

5%

10%

20%

50%

20%

10%

5%

2%

�1%

Visuospatial=ConstructionalIndex

Age-Corrected(O

KLAHOMA)a


1)

�30.0

�29.5

�25.0

�24.8

�13.0

0.0

11.2

17.8

23.8

28.8

30.0


1)

�33.0

�33.0

�30.7

�25.0

�15.0

0.0

10.6

13.0

18.6

23.6

25.0


2)

�33.0

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40

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Note.Tl¼



testingatyear3score.In

determiningwhichTab

leto

use,calculate

theTlage-

&education-

correctedTotalScalescore

basedonDuff,et

al.(2003)norm

ativedata.Forscores<90use

Tab

le3;forscoresfrom

90to

109,use

Table4;andforscores�1

10,use

Tab

le5.

aAge-correctedIndex

discrepancy

scoresdesignated‘‘(O

KLAHOMA)’’andage-

&education-correctedIndex

discrepancy

scoresare

basedontheOKLAHOMA

norm

ativestudies(D

uffet

al.,2003).

bAge-correctedIndex

discrepancy

scoresdesignated‘‘(R

andolph,1998)’’are

basedontheoriginalRBANSnorm

ativedata.

41

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scores (old and new) to the OKLAHOMA age- and education-corrected RBANSIndex scores, which are presented in Table 6. On the basis of base rate data providedin Table 4 (given the OKLAHOMA age- and education-corrected Total Scale scoreof 90 at Time 1), it can be concluded that the patient has experienced clinicallysignificant declines in both immediate and delayed memory (i.e., occurs inapproximately�10% of cases), with a suspicion of decline in language functioningthat warrants follow-up investigation.

A few cautions regarding the use of the data presented are in order. First, of the718 original participants that were assessed at Year 1, only 283 participants com-pleted assessment on three occasions at one-year intervals (i.e., baseline, one-yearfollowup, and two-year followup). That is, approximately 39% of the originalsample returned for follow-up evaluation for both Years 2 and 3. Post hoc ana-lyses revealed that, when compared with both OKLAHOMA age-corrected andOKLAHOMA age- and education-corrected RBANS Index scores, participantswho were tested on all three occasions obtained higher scores at baseline assessmentthan participants tested fewer than three times for all Indexes and the Total Scalescore (i.e., p < .01 for all comparisons). It was also found that educational attain-ment was significantly higher for the participants tested three times compared tothose who were assessed less than three times (p < .01). These findings are consistentwith previous studies (e.g., Ivnik et al., 1999), suggesting a relationship between edu-cation and willingness to participate in longitudinal research, and have implicationsfor the use of the current data.

Second, the reader is reminded that these base rate data were derived from alarge sample of community-dwelling older adults, and their applicability for asses-sing clinical change in patients with known disorders requires empirical investi-gation. That is, the complex interaction of change over time, regression to themean, and practice effects embodied in this data set may differ from that inherentto individuals with known neurological and=or psychiatric conditions. While infer-ences may be made regarding a patient’s change compared to a relatively healthy co-hort, inferences regarding the meaningfulness of changes relative to other patientswith the same condition would be more tenuous pending further research. Similarly,while inferences might be made regarding improvement in neurocognitive function-ing (e.g., due to recovery from neurological insult and=or beneficial effects of

Table 6 Case Example of a 69-year-old with 12 years of education & an OKLAHOMA Age- and

Education-Corrected Total Score ¼ 90 at Initial Assessment

Measure Year l Year 2 Discrepancy Frequency

Age- & Education-Corrected Index Scores

Immediate Memory 104 86 �18 5–10%

Visuospatial=Constructional 104 99 �5 20–50%

Language 90 84 �6 20%

Attention 108 108 0 50%

Delayed Memory 76 65 �11 5–10%

Total Scale 90 77 �13 2–5%

Note. Index scores are age- & education-corrected scores based on the OKLAHOMA normative studies

(Duff et al., 2003).


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medication=treatment), such inferences should be made tentatively. Further researchon individuals with well-characterized neurological and=or psychiatric conditions isneeded.

Third, it is important to note that discrepancy data for the two-year intervalincludes interim testing at one year and may not be appropriate for use in caseswherein there are deviations from this. Similarly, data for one-year discrepanciesinvolving T3 minus T2 calculations are predicated on the fact that testing hadoccurred at T1, and therefore should only be used when evaluating cases where simi-lar serial testing has occurred. In support of this is the fact that post hoc analysesshowed that the correlation between OKLAHOMA age-corrected Total Scale scoresat T1 and T3 (i.e., r ¼ 0.76) is rather dramatically reduced when the influence ofscores at T2 are partialled out (i.e., r ¼ 0.31). That is, there is a reduction fromapproximately 58% explained variance to 10%.

Fourth, the data presented are intended to be used adjunctively in clinicaldecision-making, wherein all relevant variables are taken into account. Indeed,neuropsychological assessment is a complex process that extends far beyond mereinterpretation of test scores and requires thoughtful consideration of an indivi-dual’s medical, autobiographical, cognitive, behavioral, emotional, and personalitydata that contribute to the clinical picture. As such, the determination of clinicallysignificant neurocognitive change should not be based solely on discrepancy scores.

Despite the limitations of the current study, the observed findings provide clin-icians with a series of user-friendly tables that allow assessment of the clinical signifi-cance of psychometric change across time in older adults on the RBANS. Althoughdiscrepancy scores might be less sophisticated than other alternatives (e.g.,Reliable Change Index, Jacobson & Truax, 1991; regression-based formulas, Duff,Schoenberg, Patton, Mold, Scott, & Adams, in press), the current results considermany clinically relevant variables (e.g., one- or two-year retest intervals, varyinglevels of overall neurocognitive functioning) and provide base rate data for arelatively large sample. Application of the present data in independent samples,including in neurologically and=or psychiatrically impaired individuals, wouldfurther extend the utility of these data.

REFERENCES

American Psychiatric Association (1994). Diagnostic and statistical manual of mental disorders(4th ed.). Washington, DC: Author.

Bruggemans, E. F., Van de Vijver, F. J. R., & Huysmans, H. A. (1997). Assessment of cog-nitive deterioration in individual patients following cardiac surgery: Correcting formeasurement error and practice effects. Journal of Clinical and Experimental Neuropsy-chology, 19, 543–559.

Chelune, G. J., Naugle, R. I., Luders, H., Sedlak, J., & Awad, I. A. (1993). Individual changeafter epilepsy surgery: Practice effects and base-rate information. Neuropsychology, 7,41–52.

Dawes, R. M., Faust, D., & Meehl, P. E. (1989). Clinical and actuarial judgment. Science, 243,1668–1674.

Duff, K., Patton, D., Schoenberg, M. R., Mold, J., Scott, J. G., & Adams, R. L. (2003). Age-and education-corrected independent normative data for the RBANS in a communitydwelling elderly sample. The Clinical Neuropsychologist, 17(3), 351–366.


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ded

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Duff, K., Schoenberg, M. R., Patton, D., Mold, J., Scott, J. G., & Adams, R. L. (2004). Pre-dicting change with the RBANS in a community dwelling elderly sample. Journal of theInternational Neuropsychological Society 10(6), 828–834.

Ivnik, R. J., Smith, G. E., Lucas, J. A., Petersen, R. C., Boeve, B. F., Kokmen, E., et al.(1999). Testing normal older people three or four times at 1- to 2-year intervals: Definingnormal variance. Neuropsychology, 13(1), 121–127.

Ivnik, R. J., Smith, G. E., Malec, J. F., Petersen, R. C., & Tangalos, E. G. (1995). Long-termstability and intercorrelations of cognitive abilities in older persons. Psychological Assess-ment, 7(2), 155–161.

Jacobson, N. S. & Truax, P. (1991). Clinical significance: A statistical approach to definingmeaningful change in psychotherapy research. Journal of Consulting and Clinical Psy-chology, 59, 12–19.

Lezak, M. D. (1995). Neuropsychological assessment (3rd ed.). New York: Oxford.McSweeny, A. J., Naugle, R. I., Chelune, G. J., & Luders, H. (1993). ‘‘T scores for change’’:

An illustration of a regression approach to depicting change in clinical neuropsychology.The Clinical Neuropsychologist, 7, 300–312.

McKhann, G., Drachman, D., Folstein, M., Katzman, R., Price, D., & Stadlan, E.M. (1984).Clinical diagnosis of Alzheimer’s disease: Report of the NINCDS-ADRA WorkGroup under the auspices of Department of Health and Human Services Task Forceon Alzheimer’s Disease. Neurology, 34, 939–944.

Petersen, R. C. (Ed.). (2003). Mild cognitive impairment: Aging to Alzheimer’s disease.New York: Oxford University Press.

Randolph, C. (1998). Repeatable Battery for the Assessment of Neuropsychological StatusManual. San Antonio, TX: The Psychological Corporation.

Rapport, L. J., Axelrod, B. N., Theisen, M. E., Brines, B., Kalechstein, A. D., & Ricker, J. H.(1997). Relationship of IQ to verbal learning and memory: Test and retest. Journal ofClinical and Experimental Neuropsychology, 19, 655–666.

Rapport, L. J., Brines, B., Axelrod, B. N., & Theisen, M. E. (1997). Full scale IQ as mediatorof practice effects: The rich get richer. The Clinical Neuropsychologist, 11, 375–380.

Silverstein, A. B. (1981). Reliability and abnormality of test score differences. Journal of Clini-cal Psychology, 37(2), 392–394.

Tracey, J. T. & Rounds, J. (1999). Inference and attribution errors in test interpretation. Pp.113–131 in R. K. Goodyear & J. W. Lichtenberg, (Eds.), Test interpretation: Integratingscience and practice. Boston: Allyn & Bacon.

Wechsler, D. (1981). Examiner’s manual: Wechsler Adult Intelligence Scale-Revised. New York:The Psychological Corporation.

Zegers, F. E. & Hafkenscheid, A. (1994). The Ultimate Reliable Change Index: An alternativeto the Hageman & Arrindell approach. (Heymans Bulletins HB-94-1154-EX). Groningen,The Netherlands: University of Groningen.


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Documents

BASE RATES OF LONGITUDINAL RBANS DISCREPANCIES AT ONE- AND TWO-YEAR INTERVALS IN COMMUNITY-DWELLING OLDER ADULTS