Neuropsychological Century - AzNSaz-ns.org/presentations/Sindelar.pdf · Neuropsychological Assessment in the 21 sstt Century The Meyers Neuropsychological Battery (MNB) Scott Sindelar,

Neuropsychological Neuropsychological

Assessment in the 21Assessment in the 21stst

Century Century The Meyers Neuropsychological The Meyers Neuropsychological

Battery (MNB)Battery (MNB)

Scott Sindelar, PhDScott Sindelar, PhD

[email protected]@QQSS.com

Outline for this sessionOutline for this session

�� Philosophy of MNBPhilosophy of MNB

�� Development of MNBDevelopment of MNB

�� Norms DevelopmentNorms Development

�� Sensitivity and SpecificitySensitivity and Specificity

�� Internal Validity ChecksInternal Validity Checks

�� LOC Dose ResponseLOC Dose Response

�� CT/MRI DataCT/MRI Data

�� ProfilesProfiles

�� The MNS ProgramThe MNS Program

Philosophy of MNBPhilosophy of MNB

�� MNB began as a longer battery of MNB began as a longer battery of tests. tests.

•• Using Discriminate Function: Selected Using Discriminate Function: Selected tests that were able to discriminate tests that were able to discriminate Normal vs TBI.Normal vs TBI.

•• Did original study years agoDid original study years ago

Philosophy of MNBPhilosophy of MNB

�� Goal was to find the best/shortest Goal was to find the best/shortest batterybattery

•• Sensitive to Brain InjurySensitive to Brain Injury

•• Commonly used Tests, that most NPs Commonly used Tests, that most NPs knowknow

•• Originally a 6 hour battery cut to 2.5 hrsOriginally a 6 hour battery cut to 2.5 hrs

•• Tests were selected not only for Tests were selected not only for sensitivity but also ease of sensitivity but also ease of administration and scoring (i.e., administration and scoring (i.e., Category vs. WCST)Category vs. WCST)

Testing Order for MNBTesting Order for MNB

�� Short WAISShort WAIS--III/IVIII/IV

�� Forced Choice (FC)Forced Choice (FC)

�� Rey Complex Figure (RCFT) Rey Complex Figure (RCFT) -- CopyCopy

�� Animal Naming Animal Naming

�� 3 minute recall of RCFT 3 minute recall of RCFT

�� COWACOWA

�� Dichotic ListeningDichotic Listening

�� North American Adult North American Adult Reading (NAART)Reading (NAART)

�� Sentence RepetitionSentence Repetition

�� 30 Minute Recall of RCFT30 Minute Recall of RCFT

�� Recognition Trial of RCFTRecognition Trial of RCFT

�� (Break offered)(Break offered)

�� AVLTAVLT

�� JOLJOL

�� Boston NamingBoston Naming

�� Finger TappingFinger Tapping

�� Finger LocalizationFinger Localization

�� Trails A & BTrails A & B

�� Token TestToken Test

�� AVLT 30 minute RecallAVLT 30 minute Recall

�� AVLT Recognition TrialAVLT Recognition Trial

�� Category TestCategory Test

Domains used by the MNBDomains used by the MNB

1. 1. Attention/Working Attention/Working Memory:Memory:

�� Digit SpanDigit Span

�� Forced ChoiceForced Choice

�� Animal NamingAnimal Naming

�� Sentence RepSentence Rep

�� AVLT 1AVLT 1

�� ArithmeticArithmetic

2. 2. Processing Processing Speed/Mental Speed/Mental FlexibilityFlexibility

�� Digit SymbolDigit Symbol

�� Dichotic BothDichotic Both

�� Trails ATrails A

�� Trails BTrails B


3. 3. Verbal Verbal ReasoningReasoning

�� SimilaritiesSimilarities

�� InformationInformation

�� COWACOWA

�� Dichotic LeftDichotic Left

�� Dichotic RightDichotic Right

�� Boston NamingBoston Naming

�� Token TestToken Test

4. 4. Visual Visual ReasoningReasoning

�� Picture CompletionPicture Completion

�� Block DesignBlock Design

�� JOLJOL

�� CategoryCategory

�� RCFT CopyRCFT Copy


5. 5. Verbal MemoryVerbal Memory

�� AVLT TotalAVLT Total

�� AVLT ImmediateAVLT Immediate

�� AVLT DelayedAVLT Delayed

�� AVLT RecognitionAVLT Recognition

6. 6. Visual MemoryVisual Memory

�� RCFT ImmediateRCFT Immediate

�� RCFT DelayedRCFT Delayed

�� RCFT Recognition RCFT Recognition


�� 7 & 8: 7 & 8: Motor and SensoryMotor and Sensory

•• Finger Tapping Dominant HandFinger Tapping Dominant Hand

•• Finger Tapping NonFinger Tapping Non--Dominant HandDominant Hand

•• Finger Localization Dominant HandFinger Localization Dominant Hand

•• Finger Localization NonFinger Localization Non--Dominant HandDominant Hand

WAISWAIS--III or WAISIII or WAIS--IVIV

�� Picture CompletionPicture Completion

�� Digit SymbolDigit Symbol

�� SimilaritiesSimilarities

�� Block DesignBlock Design

�� ArithmeticArithmetic

�� Digit SpanDigit Span

�� InformationInformation

•• Ward 7 Subtest (Pilgrim, Meyers, Ward 7 Subtest (Pilgrim, Meyers, Bayless, & Whetstone, 1999, Meyers Bayless, & Whetstone, 1999, Meyers 2013 in press) 2013 in press)

Domains AssessedDomains Assessed

1.1. Attention/Concentration/Working Attention/Concentration/Working MemoryMemory

2.2. Processing Speed and Mental Processing Speed and Mental FlexibilityFlexibility

3.3. Verbal Reasoning (Executive Verbal Reasoning (Executive ☺☺))4.4. Visual Reasoning (Executive Visual Reasoning (Executive ☺☺))

5.5. Verbal Memory and New Verbal Memory and New LLearningearning6.6. Visual Memory and New LearningVisual Memory and New Learning7.7. Dominant Motor and SensoryDominant Motor and Sensory8.8. NonNon--Dominant Motor and SensoryDominant Motor and Sensory

Domain ConsistencyDomain Consistency

�� NN = 936= 936

•• Passed all validity checksPassed all validity checks

•• No missing dataNo missing data

•• Not involved in litigationNot involved in litigation

�� Calculated Domain Calculated Domain M’sM’s

�� Regression used to predict Domain Regression used to predict Domain M’sM’s using all on other Domain using all on other Domain M’sM’s

Domain Means CorrelationsDomain Means Correlations

11 22 33 44 55 66

1 1 –– PremorbidPremorbid .76.76 .71.71 .62.62 .56.56 .79.79

2 2 -- OTBMOTBM .76.76 .98.98 .81.81 .82.82 .84.84

3 3 -- DTBMDTBM .71.71 .98.98 .77.77 .79.79 .78.78

4 4 -- AttentAttent/Work /Work MemMem .64.64 .81.81 .77.77 .64.64 .69.69

5 5 –– Pro Pro SpdSpd/Mental Flex/Mental Flex .62.62 .82.82 .79.79 .64.64 .72.72

6 6 -- Verbal ReasonVerbal Reason .79.79 .84.84 .78.78 .69.69 .72.72

7 7 -- Visual ReasonVisual Reason .68.68 .81.81 .81.81 .54.54 .64.64 .64.64

8 8 -- Verbal MemoryVerbal Memory .53.53 .77.77 .78.78 .68.68 .50.50 .54.54

9 9 -- Visual MemoryVisual Memory .54.54 .77.77 .80.80 .53.53 .55.55 .55.55

10 10 -- Dom Motor/SensoryDom Motor/Sensory .30.30 .54.54 .62.62 .37.37 .44.44 .36.36

11 11 -- NondNond Motor/SensoryMotor/Sensory .28.28 .53.53 .62.62 .31.31 .44.44 .30.30

�� All were Significant All were Significant pp < .001< .001

Domain Domain M’sM’s Correlations (cont.)Correlations (cont.)

77 88 99 1010 1111�� 1 1 -- PremorbidPremorbid .68.68 .53.53 .54.54 .30.30 .28 .28 �� 2 2 -- OTBMOTBM .81.81 .77.77 .77.77 .54.54 .53 .53 �� 3 3 -- DTBMDTBM .81.81 .78.78 .80.80 .62.62 .62 .62 �� 4 4 -- AttentAttent/Work /Work MemMem .54.54 .68.68 .53.53 .37.37 .31 .31 �� 5 5 -- ProcSpdProcSpd//MentMent Flex.64Flex.64 .50.50 .55.55 .44.44 .44.44�� 6 6 -- Verbal ReasoningVerbal Reasoning .64.64 .54.54 .55.55 .36.36 .30 .30 �� 7 7 -- Visual ReasoningVisual Reasoning .51.51 .70.70 .41.41 .45 .45 �� 8 8 -- Verbal MemoryVerbal Memory .51.51 .62.62 .34.34 .32 .32 �� 9 9 -- Visual MemoryVisual Memory .70.70 .62.62 .37.37 .40 .40 �� 10 10 -- Dom Motor/Dom Motor/SenSen .41.41 .34.34 .37.37 .53.53�� 11 11 -- NondNond Motor/Motor/SenSen .45.45 .32.32 .40.40 .53.53

�� All were Significant All were Significant pp < .001< .001

Domains Regression EquationsDomains Regression Equations

•• Attention & Working MemoryAttention & Working Memory

�� (Verbal Reasoning) * .315(Verbal Reasoning) * .315

�� (Verbal Memory) * .273(Verbal Memory) * .273

�� (Processing Speed) * .193(Processing Speed) * .193

�� Constant = 10.972Constant = 10.972


�� Processing Speed/ Mental FlexibilityProcessing Speed/ Mental Flexibility

•• Verbal Reasoning * .401Verbal Reasoning * .401

•• Visual Reasoning * .284Visual Reasoning * .284

•• Attention & Working Memory * .230Attention & Working Memory * .230

•• Constant = 2.434Constant = 2.434


�� Verbal ReasoningVerbal Reasoning

•• Processing Speed * .361Processing Speed * .361





�� Visual ReasoningVisual Reasoning

•• Visual Memory * .322Visual Memory * .322

•• Processing Speed/Mental Flexibility * Processing Speed/Mental Flexibility * .213.213

•• Verbal Reasoning * .208Verbal Reasoning * .208



�� Verbal Memory Verbal Memory


•• Visual Memory * .388Visual Memory * .388

•• Constant = Constant = --7.6157.615


�� Visual MemoryVisual Memory


•• Verbal Memory * .311Verbal Memory * .311

•• Processing Speed * .0909Processing Speed * .0909

•• Constant = Constant = --5.5175.517

RegressionRegression

Adjusted SEAdjusted SE

RR RR22 of the Estimateof the Estimate

�� AttentAttent/Working Memory/Working Memory .79.79 .63.63 4.884.88

�� Processing SpeedProcessing Speed .77.77 .60.60 5.315.31

�� Verbal ReasoningVerbal Reasoning .80.80 .64.64 5.045.04

�� Visual Reasoning Visual Reasoning .78.78 .61.61 4.884.88

�� Verbal MemoryVerbal Memory .75.75 .56.56 7.967.96

�� Visual MemoryVisual Memory .77.77 .59.59 7.117.11

�� Dominant MotorDominant Motor .56.56 .31.31 7.947.94

Core Battery of TestsCore Battery of Testsby publisherby publisher

�� AudiTechAudiTech (St Louis)(St Louis)•• Dichotic ListeningDichotic Listening

�� PsyPsy CorpCorp•• WAISWAIS--III/IV, MMPIIII/IV, MMPI--RFRF

�� Psychological Assessment Resources (PAR)Psychological Assessment Resources (PAR)•• RCFT, Boston Naming, JLO, Category, PAIRCFT, Boston Naming, JLO, Category, PAI

�� Public DomainPublic Domain•• Forced Choice, COWA, ANIMAL Naming, Sentence Forced Choice, COWA, ANIMAL Naming, Sentence Repetition, Token Test, Trails A/B, Finger Repetition, Token Test, Trails A/B, Finger Localization, 1min estimation, AVLTLocalization, 1min estimation, AVLT

�� ReitanReitan LabsLabs•• Finger TappingFinger Tapping•• Category TestCategory Test

AYOC/AYOPAYOC/AYOP

�� You can add 1000 of your own You can add 1000 of your own favorite tests to the Cognitive section favorite tests to the Cognitive section

�� ANDAND

�� 1000 tests to the Psychological 1000 tests to the Psychological sectionsection

�� The MNB is a core of tests, that has The MNB is a core of tests, that has the database comparison, and the database comparison, and Discriminant functions, and Discriminant functions, and NeuronetNeuronet

MNB Smoothed Normative DataMNB Smoothed Normative Data

�� In evaluating the norms, note there were In evaluating the norms, note there were variations in test norms, apparently due to variations in test norms, apparently due to age, & education. age, & education.

�� For example, AVLT norms For example, AVLT norms SpreenSpreen & Strauss & Strauss (1998)(1998)•• At Age = 30At Age = 30--39;39; M =M = 11.4 (11.4 (sdsd = 2.4) for Trial 6= 2.4) for Trial 6•• At Age = 40; At Age = 40; MM = 10.4 (= 10.4 (sdsd = 2.7) for Trial 6.= 2.7) for Trial 6.•• Therefore, pt. scoring 10 a day before bTherefore, pt. scoring 10 a day before b--day, after day, after bb--day, score (i.e. 10) would improve from 44T to day, score (i.e. 10) would improve from 44T to 48T, using linear norms.48T, using linear norms.

MNB Smoothed Normative DataMNB Smoothed Normative Data

�� Using Heaton et al. (1991) classification Using Heaton et al. (1991) classification system, pts’ score would improve from the system, pts’ score would improve from the Below AverageBelow Average to to AverageAverage just by just by becoming a day older.becoming a day older.•• A common problem with nonA common problem with non--smoothed smoothed normative data.normative data.

MNB Normative DataMNB Normative Data

�� Therefore, decided to smooth the norms. Therefore, decided to smooth the norms. �� Done by selecting all pts. from dataset who:Done by selecting all pts. from dataset who:

•• had a validity score of 0 or 1 (failures)had a validity score of 0 or 1 (failures)•• were age 15 years or olderwere age 15 years or older•• 15 yrs old used for the adult version of the Trail Making Test15 yrs old used for the adult version of the Trail Making Test

�� this was done to keep consistency. this was done to keep consistency.

�� The total sample size The total sample size N =N = 17271727�� Age: Age: MM = 45.7 yrs (= 45.7 yrs (sdsd = 20.7)= 20.7)�� Education: 12.3 yrs (Education: 12.3 yrs (sdsd = 2.7) year of education.= 2.7) year of education.�� Gender: 779 females; 948 malesGender: 779 females; 948 males�� Handedness: 1543 were RH and 184 were LH.Handedness: 1543 were RH and 184 were LH.�� Ethnic: 32 mixed; 22 African Ethnic: 32 mixed; 22 African AmericiansAmericians; 1617 white; 2 ; 1617 white; 2

Asian; 27 Native American; and 27 Hispanics.Asian; 27 Native American; and 27 Hispanics.


�� A Regression equation was then A Regression equation was then calculated using the raw score and calculated using the raw score and the variables, age, education, the variables, age, education, gender, handedness, and race to gender, handedness, and race to predict the T score previously predict the T score previously calculated using the standard calculated using the standard normative data for the tests. normative data for the tests.

MNB Regression NormsMNB Regression Norms

�� Not only does process smooth the Not only does process smooth the datadata

�� Also adds adjustments for age, Also adds adjustments for age, education, gender, handedness, and education, gender, handedness, and ethnicity.ethnicity.

�� In Normals these variables may not In Normals these variables may not always be significant. In injured always be significant. In injured groups, variables take on additional groups, variables take on additional impact on test performance.impact on test performance.


�� Once the regression equations were Once the regression equations were calculated they were usedcalculated they were used•• to calculate a Regression T score for to calculate a Regression T score for each testeach test

�� It was found that this procedure It was found that this procedure worked well for all test variables worked well for all test variables except Token Test (adult) due to except Token Test (adult) due to excessive skewexcessive skew•• For Token Test, percentile scores were For Token Test, percentile scores were calculated and converted to T score calculated and converted to T score equivalents. equivalents.


�� With Regression Equations, with a raw score 10 With Regression Equations, with a raw score 10 on AVLT Imm. Recallon AVLT Imm. Recall•• In the example used, would change the data (for person In the example used, would change the data (for person tested 1 day before b’day), at age 39tested 1 day before b’day), at age 39

•• T Score equivalent would be 45T; a day after her b’day T Score equivalent would be 45T; a day after her b’day 45T. 45T.

�� Using the regression equation normative data, Using the regression equation normative data, comparisons can be more reliable made over comparisons can be more reliable made over time. The individual subtests for the WAIStime. The individual subtests for the WAIS--III or III or WISCWISC--III were not subjected to the Regression III were not subjected to the Regression Equation method as only the Scale Scores were Equation method as only the Scale Scores were coded in the database, not raw scores. Therefore, coded in the database, not raw scores. Therefore, the scores for these tests are based on normative the scores for these tests are based on normative data from the test manuals. data from the test manuals.


AdultsAdults

�� ScaleScale RR R2 R2 SignificanceSignificance Paired Samples t TestPaired Samples t Test�� Trails ATrails A .902.902 .814.814 .000.000 .000 (1363), .000 (1363), pp=1.00=1.00�� Trails BTrails B .873.873 .762.762 .000.000 --.088 (1354), .088 (1354), pp=.930=.930�� JudgmentJudgment .946.946 .894.894 .000.000 --.099 (1263), .099 (1263), pp=.921=.921�� Finger Tapping DHFinger Tapping DH .961.961 .924.924 .000.000 --.079 (1599), .079 (1599), pp=.937=.937�� Finger Tapping NDHFinger Tapping NDH .952.952 .906.906 .000.000 .029 (1577),.029 (1577),pp=.977=.977�� Finger Localization DHFinger Localization DH .874.874 .764.764 .000.000 .027 (1201), .027 (1201), pp=.979=.979�� Finger Localization NDHFinger Localization NDH .801.801 .641.641 .000.000 --.017 (1196), .017 (1196), pp=.987=.987�� *Token Test*Token Test .486.486 .236.236 .000.000 .008 (1534),.008 (1534),pp=.993=.993�� Sentence RepetitionSentence Repetition .957.957 .915.915 .000.000 .040 (1253),.040 (1253),pp=.968=.968�� Controlled Oral Word AssociationControlled Oral Word Association .977.977 .955.955 .000.000 --.022 (1487),.022 (1487),pp=.982=.982�� Animal NamingAnimal Naming .976.976 .953.953 .000.000 .099 (1366), .099 (1366), pp=.921=.921�� Boston NamingBoston Naming .902.902 .814.814 .000.000 72.900 (1312), 72.900 (1312), pp=.000=.000�� Dichotic Listening LeftDichotic Listening Left .887.887 .787.787 .000.000 --3.994 (1198), 3.994 (1198), pp=.000=.000�� Dichotic Listening RightDichotic Listening Right .891.891 .794.794 .000.000 --2.460 (1198), 2.460 (1198), pp=.014=.014�� Dichotic Listening BothDichotic Listening Both .921.921 .849.849 .000.000 --2.920 (1198), 2.920 (1198), pp=004=004


AdultsAdults

�� Forced ChoiceForced Choice .992.992 .984.984 .000.000 --1.065 (1131), 1.065 (1131), pp=.287=.287�� AVLT 1AVLT 1 .939.939 .883.883 .000.000 .034 (1470), .034 (1470), pp=.973=.973�� AVLT 2AVLT 2 .949.949 .901.901 .000.000 .076 (1470), .076 (1470), pp=.940=.940�� AVLT 3AVLT 3 .959.959 .920.920 .000.000 --.178 (1470), .178 (1470), pp=.859=.859�� AVLT 4AVLT 4 .939.939 .882.882 .000.000 --.024 (1469), .024 (1469), pp=.981=.981�� AVLT 5AVLT 5 .934.934 .872.872 .000.000 --.008 (1469),.008 (1469),pp=.993=.993�� AVLT TotalAVLT Total .941.941 .886.886 .000.000 .064 (1470), .064 (1470), pp=.949=.949�� AVLT AVLT DistractorDistractor .933.933 .871.871 .000.000 .057 (1467), .057 (1467), pp=.955=.955�� AVLT ImmediateAVLT Immediate .957.957 .915.915 .000.000 .103 (1468), .103 (1468), pp=.918=.918�� AVLT DelayedAVLT Delayed .957.957 .915.915 .000.000 --.071 (1470), .071 (1470), pp=943=943�� AVLT RecognitionAVLT Recognition .892.892 .796.796 .000.000 --.015 (1470), .015 (1470), pp=.988=.988�� CFT TimeCFT Time .927.927 .859.859 .000.000 --.075 (1657), .075 (1657), pp=.941=.941�� CFT CopyCFT Copy .879.879 .773.773 .000.000 --.053 (1660), .053 (1660), pp=.958=.958�� CFT ImmediateCFT Immediate .964.964 .930.930 .000.000 --.077 (1658), .077 (1658), pp=.938=.938�� CFT DelayedCFT Delayed .966.966 .934.934 .000.000 --.068 (1659), .068 (1659), pp=.946=.946�� CFT False PositiveCFT False Positive .811.811 .657.657 .000.000 --.027 (1657), .027 (1657), pp=.979=.979�� CFT False NegativeCFT False Negative .993.993 .985.985 .000.000 --.056 (1657), .056 (1657), pp=.956=.956�� CFT RecognitionCFT Recognition .938.938 .879.879 .000.000 .005 (1658), .005 (1658), pp=.996=.996�� Booklet Category (Victoria Version)Booklet Category (Victoria Version) .883.883 .780.780 .000.000 .024 (1290), .024 (1290), pp=981=981�� * Because of the * Because of the skewednessskewedness of the data percentile scores were computed and transformed to T Scores for this test.of the data percentile scores were computed and transformed to T Scores for this test.

MNB Data ChildrenMNB Data Children

�� Child Regression Equation Child Regression Equation RR R2 R2 SignificanceSignificancePaired Samples t Paired Samples t TestTest

�� Trails ATrails A .765.765 .585.585 .000.000 .001(99),p=1.000.001(99),p=1.000�� Trails BTrails B .839.839 .704.704 .000.000 --.050(99),p=.960.050(99),p=.960�� Judgment of LineJudgment of Line .944.944 .891.891 .000.000 .072(96),p=.942.072(96),p=.942�� Finger Tapping DomFinger Tapping Dom .913.913 .833.833 .000.000 .017(106),p=.986.017(106),p=.986�� Finger Tapping NonDomFinger Tapping NonDom .916.916 .840.840 .000.000 --.016(106),p=.987.016(106),p=.987�� Finger Localization DomFinger Localization Dom .953.953 .908.908 .000.000 .109 (95), p=.914.109 (95), p=.914�� Finger Localization NonDomFinger Localization NonDom .895.895 .801.801 .000.000 .136 (95), p=.892.136 (95), p=.892�� Token TestToken Test .847.847 .718.718 .000.000 .229 (106), p=.819.229 (106), p=.819�� Sentence RepetitionSentence Repetition .956.956 .914.914 .000.000 .088 (105), p=.930.088 (105), p=.930�� Controlled Oral Word AssociatControlled Oral Word Associat .930.930 .865.865 .000 ..000 .--1.515 (109), p=.1331.515 (109), p=.133�� Animal NamingAnimal Naming .953.953 .908.908 .000.000 .113 (100), p=.910.113 (100), p=.910�� Boston NamingBoston Naming .855.855 .731.731 .000.000 --.986 (105), p=326.986 (105), p=326�� Dichotic Listening LeftDichotic Listening Left .946.946 .894.894 .000.000 --.748 (99), p=.457.748 (99), p=.457�� Dichotic Listening RightDichotic Listening Right .862.862 .743.743 .000.000 --.538 (99), p=.592.538 (99), p=.592�� Dichotic Listening BothDichotic Listening Both .937.937 .878.878 .000.000 --.052 (99), p=.959.052 (99), p=.959

MNB Data ChildrenMNB Data Children

�� Forced ChoiceForced Choice .996.996 .992.992 .000.000 --3.089 (94), p=.0033.089 (94), p=.003�� AVLT 1AVLT 1 .996.996 .991.991 .000.000 .183 (111), p=.855.183 (111), p=.855�� AVLT 2AVLT 2 .998.998 .996.996 .000.000 --.457 (111), p=.648.457 (111), p=.648�� AVLT 3AVLT 3 .995.995 .990.990 .000.000 --.295 (111), p=.768.295 (111), p=.768�� AVLT 4AVLT 4 .998.998 .995.995 .000.000 .483 (111), p=.630.483 (111), p=.630�� AVLT 5AVLT 5 .919.919 .845.845 .000.000 --.022 (111), p=.983.022 (111), p=.983�� AVLT TotalAVLT Total .932.932 .869.869 .000.000 .047 (111), p=.963.047 (111), p=.963�� AVLT DistractorAVLT Distractor .903.903 .816.816 .000.000 .066 (111),p=.948.066 (111),p=.948�� AVLT ImmediateAVLT Immediate .903.903 .815.815 .000.000 .097 (111),p=.923.097 (111),p=.923�� AVLT Delayed AVLT Delayed .959.959 .919.919 .000.000 .143 (111),p=.887.143 (111),p=.887�� AVLT RecognitionAVLT Recognition .868.868 .755.755 .000.000 --.041 (111),p=.968.041 (111),p=.968�� CFT TimeCFT Time .868.868 .754.754 .000.000 .067 (111),p=.947.067 (111),p=.947�� CFT CopyCFT Copy .866.866 .750.750 .000.000 .000 (111),p=1.000.000 (111),p=1.000�� CFT ImmediateCFT Immediate .897.897 .805.805 .000.000 .015 (111),p=.988.015 (111),p=.988�� CFT Delayed CFT Delayed .970.970 .941.941 .000.000 --.028 (111),p=.977.028 (111),p=.977�� CFT False PositiveCFT False Positive .886.886 .784.784 .000.000 --.766 (111),p=.446.766 (111),p=.446�� CFT False NegativesCFT False Negatives .997.997 .995.995 .000.000 .303 (111),p=.762.303 (111),p=.762�� CFT RecognitionCFT Recognition .955.955 .913.913 .000.000 .000 (111),p=1.000.000 (111),p=1.000�� Booklet Category Booklet Category .620.620 .384.384 .000.000 .000 (92),p=1.000.000 (92),p=1.000

MNB RecapMNB Recap

�� Step 1. Took battery of well known NP Step 1. Took battery of well known NP Tests Tests

•• Tests with which most clinicians would be Tests with which most clinicians would be familiarfamiliar

•• Tests selected based on utility, ease of Tests selected based on utility, ease of scoring, and to assess wide array of scoring, and to assess wide array of cognitive functionscognitive functions

�� This battery is the result several preliminary This battery is the result several preliminary batteriesbatteries

MNB Recap ContinuedMNB Recap Continued

�� Step 2. Large database of pts. Step 2. Large database of pts. collectedcollected

�� Step 3. Examined results for need to Step 3. Examined results for need to smoothsmooth

�� Step 4. Data smoothed across Step 4. Data smoothed across batterybattery

•• ages ranged from 6 ages ranged from 6 –– 99 years old99 years old

•• Separate norms for 6 Separate norms for 6 -- 14 and 15 14 and 15 -- 9999

•• Adjust for age, Adjust for age, eded, gender, ethnicity & , gender, ethnicity & handedhanded

MNB Recap ContinuedMNB Recap Continued

�� Step 4. Recalculate database with Step 4. Recalculate database with new norms (Step 3)new norms (Step 3)

�� Now onto Step 5Now onto Step 5

•• Is this battery of tests valid?Is this battery of tests valid?

MNB MNB Step 5: Is this battery valid?Step 5: Is this battery valid?

�� Need to examine Reliability/Validity Need to examine Reliability/Validity MSBMSB

•• Meyers, J. E., & Rohling, M. L. (2004). Meyers, J. E., & Rohling, M. L. (2004). Validation of the Meyers Short Battery Validation of the Meyers Short Battery on Mild TBI patients. on Mild TBI patients. Archives of Clinical Archives of Clinical Neuropsychology, 19Neuropsychology, 19, 637, 637--651.651.

�� Study included 4 GroupsStudy included 4 Groups

Validity of MNBValidity of MNB

30 Medical Controls (Group 1)30 Medical Controls (Group 1)

•• in hospital for non CNS problem (i.e. in hospital for non CNS problem (i.e. ingrown toe nails)ingrown toe nails)

�� All community dwellingAll community dwelling

�� No No HxHx of LD, DD, Substance abuse, of LD, DD, Substance abuse, TBI, or Mental Health problem, or TBI, or Mental Health problem, or anything that would disqualify as anything that would disqualify as Normal.Normal.

Validity of MNB:Validity of MNB:30 Medical Controls (cont.)30 Medical Controls (cont.)

�� Mean Age: 38.6 yrs (Mean Age: 38.6 yrs (sd sd = 18.9)= 18.9)

�� Mean Educ: 13.4 yrs (Mean Educ: 13.4 yrs (sd sd = 3.19) = 3.19)

�� Gender: 15 females; 15 malesGender: 15 females; 15 males

�� Handedness: 29 were RH; 1 was LH Handedness: 29 were RH; 1 was LH

�� Ethnicity: 29 white; 1 Native Ethnicity: 29 white; 1 Native AmericanAmerican


Depressed Group (Group 2) Depressed Group (Group 2) �� 41 patients41 patients�� All on SSRIAll on SSRI�� Mean Age: 46.0 yrs (Mean Age: 46.0 yrs (sdsd = 15.0)= 15.0)�� Mean Education: 13.5 yrs (Mean Education: 13.5 yrs (sdsd = 2.7)= 2.7)�� Gender: 20 females; 21 malesGender: 20 females; 21 males�� Handedness: 38 were RH; 3 were LHHandedness: 38 were RH; 3 were LH�� Ethnicity: 1 mixed race; 40 white Ethnicity: 1 mixed race; 40 white �� 29 completed MMPI29 completed MMPI--2 with 2 with MM scores as followsscores as follows

•• L = 52.1 (L = 52.1 (sdsd=11.4), F = 60.5 (=11.4), F = 60.5 (sdsd=11.7), K = 50.2 (=11.7), K = 50.2 (sdsd=10.2)=10.2)•• 1 = 63.8 (1 = 63.8 (sdsd = 12.8)= 12.8)•• 2 = 70.8 (2 = 70.8 (sdsd =14.5)=14.5)•• 3 = 66.7 (3 = 66.7 (sdsd = 16.0)= 16.0)

Validity of MNB Validity of MNB

Chronic Pain (Group 3) Chronic Pain (Group 3)

�� 32 pts who were being treated as 32 pts who were being treated as outptoutpt. . for chronic pain. for chronic pain.

�� None involved in litigation at time of None involved in litigation at time of assessmentassessment•• None had previous litigation histories None had previous litigation histories

�� Pts. were injured in nonPts. were injured in non--workwork--related related injuries or were injured on their own injuries or were injured on their own farms, or had chosen not to pursue farms, or had chosen not to pursue Workman’s compensation and were being Workman’s compensation and were being treated at an outpatient pain clinic. treated at an outpatient pain clinic.

Validity of the MNBValidity of the MNBChronic Pain Group ContinuedChronic Pain Group Continued

Mean Age: 40.7 yrs (Mean Age: 40.7 yrs (sdsd = 14.2) = 14.2)

Mean Education: 13.4 yrs (Mean Education: 13.4 yrs (sdsd = 2.1)= 2.1)

Gender: 20 females and 12 malesGender: 20 females and 12 males

Handedness: 29 were RH; 3 were LHHandedness: 29 were RH; 3 were LH

Ethnicity: 31 white; 1 Native AmericanEthnicity: 31 white; 1 Native American

Validity of MNBValidity of MNBGroup 4: history of TBIGroup 4: history of TBI�� 59 pts. 59 pts. �� All pts. seen at local hospital and All pts. seen at local hospital and rehab unitrehab unit

�� All pts. had identified LOC 20 min. or All pts. had identified LOC 20 min. or lessless•• other data (i.e., GCS or PTA) not often other data (i.e., GCS or PTA) not often recordedrecorded

•• however, LOC data available for all pts.however, LOC data available for all pts.

�� LOC defined as “Time to Follow LOC defined as “Time to Follow Commands”Commands”•• (e.g., (e.g., DikmenDikmen et al., 1995; et al., 1995; VolbrechtVolbrecht et al., et al., 2000)2000)


TBI group, continuedTBI group, continued

�� Mean Age: 36.9 yrs (Mean Age: 36.9 yrs (sdsd = 15.1)= 15.1)

�� Mean Education: 12.6 yrs (Mean Education: 12.6 yrs (sdsd = 2.1) = 2.1)

�� Time Post Injury: 7.6 mo. (Time Post Injury: 7.6 mo. (sdsd = 10.0) = 10.0)

�� Gender: 14 females; 43 malesGender: 14 females; 43 males

�� Handedness: 51 were RH; 6 were LHHandedness: 51 were RH; 6 were LH

�� Ethnicity: 2 mixed; 1 Hispanic; 54 whiteEthnicity: 2 mixed; 1 Hispanic; 54 white

Validity of MSBValidity of MSB

�� Test scores obtained for each of the study groupsTest scores obtained for each of the study groups��

�� NormalNormal ChronicChronic MildMild�� ControlsControls Depressed PainDepressed Pain TBITBI�� NAART FSIQNAART FSIQ MeanMean 108.03108.03 105.03105.03 103.71103.71 98.4598.45�� nn 2929 4040 3131 5151�� SDSD 8.348.34 8.578.57 8.038.03 6.026.02�� Barona et. Barona et. MeanMean 105.63105.63 105.61105.61 106.25106.25 103.74103.74�� al FSIQal FSIQ nn 3030 4141 3232 5757�� SDSD 7.077.07 7.127.12 6.576.57 6.216.21�� WAIS VIQWAIS VIQ MeanMean 104.97104.97 103.15103.15 102.28102.28 92.4592.45�� nn 3030 4141 3232 5656�� SDSD 9.369.36 12.8612.86 11.1711.17 9.879.87�� WAIS PIQWAIS PIQ MeanMean 107.93107.93 100.22100.22 107.59107.59 96.8096.80�� nn 3030 4141 3232 5555�� SDSD 11.5511.55 13.2413.24 13.0413.04 10.5010.50�� WAIS FIQWAIS FIQ MeanMean 106.53106.53 101.56101.56 105.19105.19 94.1894.18�� nn 3030 4141 3232 5555�� SDSD 8.438.43 11.0411.04 10.7810.78 9.159.15


�� Validity assessed using a Validity assessed using a discriminant function analysis discriminant function analysis comparing Noncomparing Non--TBI pts. with the TBI TBI pts. with the TBI pts. pts.

�� Resulted: 96% correct classification Resulted: 96% correct classification raterate

•• 99% specificity99% specificity

•• 90% sensitivity90% sensitivity

Reliability of MNBReliability of MNB

�� Reflecting a general clinical sample, Reflecting a general clinical sample,

�� 63 persons with mixed diagnoses assessed 63 persons with mixed diagnoses assessed more than once, with the first testing at more than once, with the first testing at least 6 mo. post injury least 6 mo. post injury

�� Some in litigation, but all passed validity Some in litigation, but all passed validity checkschecks

�� Group descriptiveGroup descriptive

�� Age: Mean = 38.4 yrs (Age: Mean = 38.4 yrs (sdsd = 22.8)= 22.8)

�� Education: Mean = 12.2 yrs (Education: Mean = 12.2 yrs (sdsd = 2.9) = 2.9)

Test ReTest Re--test Reliabilitytest Reliability

�� 1st Test: Post Injury 21.6 mo. (1st Test: Post Injury 21.6 mo. (sdsd = = 22.8) 22.8)

�� ReRe--test: Post Injury 40.7 mo. (test: Post Injury 40.7 mo. (sdsd = = 33.2) 33.2)

�� Time Time btwnbtwn Sessions: 19.1 mo. (Sessions: 19.1 mo. (sdsd = = 16.6)16.6)

•• range 2 to 91 mo., median 13 mo.range 2 to 91 mo., median 13 mo.

�� Reliability Reliability rr = .86 = .86

TBI vs. StrokeTBI vs. Stroke

�� VolbrechtVolbrecht and Meyers (2000) were and Meyers (2000) were able to somewhat identify different able to somewhat identify different levels of TBI injury severity from levels of TBI injury severity from stroke patients with stroke patients with correct correct classification rate of 71.6%. classification rate of 71.6%.

�� The majority of the misclassifications The majority of the misclassifications were in discriminating severely were in discriminating severely injured individuals from severe injured individuals from severe stroke patients.stroke patients.

LOC and OTBMLOC and OTBM

�� RohlingRohling, Meyers, and Millis (2003) found , Meyers, and Millis (2003) found that the length of loss of consciousness that the length of loss of consciousness (LOC) (LOC) for traumatic brain injured (TBI) for traumatic brain injured (TBI) patients was related to the level of expected patients was related to the level of expected cognitive impairment as measured by the cognitive impairment as measured by the overall test battery mean overall test battery mean (OTBM). (OTBM).

�� Results were nearly identical to those Results were nearly identical to those presented by presented by DikmenDikmen, , MachamerMachamer, Winn, & , Winn, & TemkinTemkin (1995) using an expanded Halstead (1995) using an expanded Halstead ReitanReitan Battery. Battery. •• Core Battery of tests was same sensitivity Core Battery of tests was same sensitivity as longer Expanded HRBas longer Expanded HRB

Internal Validity ChecksInternal Validity Checks

�� Meyers, J. E., & Meyers, J. E., & VolbrechtVolbrecht, M. E. , M. E. (2003). A Validation of Multiple (2003). A Validation of Multiple Malingering Detection Methods in a Malingering Detection Methods in a Large Clinical Sample, Large Clinical Sample, Archives of Archives of Clinical Neuropsychology, 18Clinical Neuropsychology, 18, 261, 261--276.276.

�� Other publications Other publications

Internal Validity Check Internal Validity Check (0%FP Rate cutoff)(0%FP Rate cutoff)

�� Test/MethodTest/Method CutoffCutoff�� RCFT: MEPRCFT: MEP <= 3 (1= <= 3 (1= AttentAttent, ,

2=Encode, 3=Store, 4= Retrieve)2=Encode, 3=Store, 4= Retrieve)�� Reliable DigitsReliable Digits <= 7<= 7�� Forced ChoiceForced Choice <= 10<= 10�� JOLJOL <= 12<= 12�� Token TestToken Test <= 150<= 150�� Dichotic Listening BothDichotic Listening Both <= 9<= 9�� Sentence RepetitionSentence Repetition <= 9<= 9�� AVLTAVLT--RecognitionRecognition <= 9<= 9�� FTFT--Estimated FTEstimated FT <= <= --1010�� * Others are being worked on* Others are being worked on


�� A total of 796 participants in the A total of 796 participants in the study, ages ranged from 16 yrs to 86 study, ages ranged from 16 yrs to 86 yrs, with education ranging from 5 yrs, with education ranging from 5 yrs to 23 yrs.yrs to 23 yrs.


�� 15 Groups15 Groups

•• NonNon--litigant groupslitigant groups

•• Litigant groupsLitigant groups

Internal Validity CheckInternal Validity Check

�� This method showed 83% sensitivity This method showed 83% sensitivity and 100% specificity. Also, there was and 100% specificity. Also, there was a a 0% false positive rate0% false positive rate. .

Validity / Malingering of Validity / Malingering of

Neuropsychological TestsNeuropsychological Tests�� 9 validity checks used (Combination of studies)9 validity checks used (Combination of studies)

�� Meyers, J. E. & Meyers, J. E. & VolbrechtVolbrecht, M. E. (2003). A Validation of Multiple Malingering Detection , M. E. (2003). A Validation of Multiple Malingering Detection Methods in a Large Clinical Sample, Methods in a Large Clinical Sample, Archives of Clinical Neuropsychology, Archives of Clinical Neuropsychology, 1818, 3, 261, 3, 261--276.276.

�� Meyers, J. E., & Meyers, J. E., & DiepDiep, A. (2000). Assessment of malingering in chronic pain patients , A. (2000). Assessment of malingering in chronic pain patients using neuropsychological tests. using neuropsychological tests. Applied Neuropsychology, 7Applied Neuropsychology, 7, 133, 133--139.139.

�� Meyers, J. E., & Meyers, J. E., & VolbrechtVolbrecht, M. (1999). Detection of malingerers using the Rey , M. (1999). Detection of malingerers using the Rey Complex Figure and Recognition Trial. Complex Figure and Recognition Trial. Applied Neuropsychology, 6Applied Neuropsychology, 6, 4, 201, 4, 201--207.207.

�� Meyers, J. E., Meyers, J. E., GalinskyGalinsky, A., & , A., & VolbrechtVolbrecht, M. (1999). Malingering and mild brain , M. (1999). Malingering and mild brain injury: injury: How low is too low. How low is too low. Applied Neuropsychology, 6Applied Neuropsychology, 6, 208, 208--216.216.

�� Meyers, J. E., & Meyers, J. E., & VolbrechtVolbrecht, M. (1998). Validation of reliable digits for detection of , M. (1998). Validation of reliable digits for detection of malingering. malingering. Assessment, 5Assessment, 5, 301, 301--305.305.

�� Meyers, J. E., & Morrison, A. L., & Miller, J. C. (2001). How low is too low revisited: Meyers, J. E., & Morrison, A. L., & Miller, J. C. (2001). How low is too low revisited: Sentence repetition and AVLT Recognition in the detection of malingering. Sentence repetition and AVLT Recognition in the detection of malingering. (Submitted to Applied Neuropsychology).(Submitted to Applied Neuropsychology).

�� Meyers, J. E., & Meyers, J. E., & VolbrechtVolbrecht, M. E. (2001). A validation of multiple malingering , M. E. (2001). A validation of multiple malingering detection detection methods in a large clinical sample. (under review at methods in a large clinical sample. (under review at Archives of Archives of Clinical Clinical NeuropsychologyNeuropsychology))

Validity checks for Validity checks for

Neuropsychological testsNeuropsychological tests

< 1hr

LOC

1hr

<24

LOC

1-8

days

LOC

9

days+

LOC

Pain

Frequency of failing validity checks for NON LITIGATING Groups

8

7

6

5

4

3

2

1 7 3 8 7 5 1 1

0 49 7 21 4 33 24 31

No

rmals

Validity checks for Validity checks for

Neuropsychological testsNeuropsychological tests

Frequency of failing validity checks for LITIGATING groups

9 0 0 0 2

8 3 0 1 2

7 0 0 0 4

6 2 1 1 1

5 4 0 2 3

4 1 0 3 1

3 5 1 7 4

2 2 1 3 0

1 16 6 16 4

0 49 10 31 0

<1hr

LOC

> 1 hr

LOC

Pain Malingering Actors

1.1. DikmenDikmen et al., (1995) administered HRB to a et al., (1995) administered HRB to a sample of TBI patients. Similar patients from sample of TBI patients. Similar patients from MNB.MNB.a)a) First, determine if a doseFirst, determine if a dose--response TBI severity & response TBI severity &

deficitsdeficits

b)b) Second, are Second, are DikmenDikmen et al. results et al. results generalizablegeneralizable to other to other TBI samples?TBI samples?

2.2. Analyses of the Meyers sample replicated Analyses of the Meyers sample replicated DikmenDikmen..a)a) A doseA dose--response relationship between LOC & response relationship between LOC &

impairment found using effect sizes for impairment found using effect sizes for DikmenDikmen sample, sample, as well as using regressionas well as using regression--based normative Tbased normative T--scores scores for Meyers sample.for Meyers sample.

3.3. Both samples highly correlated with one anotherBoth samples highly correlated with one another..a)a) Mean scores for the six LOCMean scores for the six LOC--severity groups for two severity groups for two

samples resulted in a correlation coefficient samples resulted in a correlation coefficient rr = .97= .97, , pp< .0001.< .0001.

TBI Dose ResponseTBI Dose Response

TBI Dose Response TBI Dose Response

Table 1

Injury severity using effect sizes (Hedges’ g) for Dikmen’s sample.

Severity Group n Mean SD Min. Median Max.

Group 1: TFC < 1 hr 161 -.02 (.13) -.26 -.02 .20

Group 2: TFC = 1-23 hrs 100 -.22 (.14) -.47 -.23 -.03

Group 3: TFC = 1-6 days 52 -.45 (.22) -.94 -.42 -.09

Group 4: TFC = 7-13 days 37 -.68 (.27) -1.21 -.66 -.15

Group 5: TFC = 14-28 days 32 -1.33 (.26) -1.67 -1.26 -.89

Group 6: TFC > 28 days 53 -2.31 (.41) -2.88 -2.24 -.85

Entire Sample 435 -.82 (.80) -2.88 -.56 .20

Table 2

Severity of injury information for the Meyers’ sample.

Grp 1

(n = 138)

Grp 2

(n = 52)

Grp 3

(n = 47)

Grp 4

(n = 19)

Grp 5

(n = 14)

Grp 6

(n = 21)

All Pts.

(N = 291) H p

LOC (days) 274.6 < .0001

Mean .01 .17 2.5 9.0 17.3 44.6 5.4

Median .01 .09 2.0 8.0 16.0 30.0 .02

(sd) (.004) (.18) (1.5) (1.9) (3.7) (21.8) (14.4)

PTA (days) 143.8 < .0001

Mean 3.9 9.1 17.3 36.7 44.0 97.3 18.2

Median 1.0 5.0 7.0 28.0 30.0 90.0 4.0

(sd) (8.6) (10.9) (26.3) (55.1) (34.5) (74.0) (40.7)

Mo. since TBI 61.2 < .0001

Mean 13.1 10.7 26.4 37.2 81.3 126.5 32.6

Median 4.0 3.0 6.0 10.0 21.0 65.5 3.0

(sd) (28.5) (18.8) (66.5) (71.1) (121.4) (136.3) (79.4)

Table 3

Injury severity using T scores for Meyers’ sample.

Severity Group n M sd Minimum Median Maximum

Group 1: LOC < 1 hr 138 44.3 (5.0) 31.8 44.9 54.6

Group 2: LOC = 1-23 hrs 52 41.3 (5.7) 30.7 42.0 52.4

Group 3: LOC = 1-6 days 47 40.0 (6.6) 28.3 39.4 49.7

Group 4: LOC = 7-13 days 19 36.5 (7.1) 24.2 38.4 48.5

Group 5: LOC = 14-28 days 14 33.7 (5.3) 22.6 34.5 42.3

Group 6: LOC > 28 days 21 30.3 (8.6) 10.6 31.2 40.7

Entire Sample 291 41.1 (7.2) 10.6 42.3 54.6

Table 4

Comparison between mean OTBM-T for Meyers’ sample and estimated OTBM-T for Dikmen sample,

excluding the most severely impaired group.

Severity Group Meyers Sample Dikmen Sample

Group 1: LOC < 1 hr 44.3 44.1

Group 2: LOC = 1-23 hrs 41.3 42.1

Group 3: LOC = 1-6 days 40.0 39.8

Group 4: LOC = 7-13 days 36.5 37.5

Group 5: LOC = 14-28 days 33.7 31.0

Sample mean of six groups (sd) 39.2 (4.1) 38.9 (5.1)

Correlation Coefficient a .99 .96

Slope of regression line (95% CI) -2.6 (+ .6) -3.1 (+ 1.6)

Intercept of regression line 47.0 (+ 2.0) 48.1 (+ 5.3)

F i g u r e 2

O v e r a l l T e s t B a t t e r y M e a n ( O T B M ) u s i n g T - s c o r e s f r o m t h e M e y e r s s a m p l e .

1 0

1 5

2 0

2 5

3 0

3 5

4 0

4 5

5 0

5 5

6 0

G r o u p 1

< 1 h r

G r o u p 2

1 - 2 3 h r s

G r o u p 3

1 - 6 d a y s

G r o u p 4

7 - 1 3 d a y s

G r o u p 5

1 4 - 2 8 d a y s

G r o u p 6

> 2 8 d a y s

S e v e r i t y o f T B I b a s e d o n L O C

Ove

rall

Te

st

Ba

tte

ry M

ea

n-T

M in y = - 3 .5 x + 3 6 . 4

M a x y = - 2 .1 x + 5 6 . 2

9 0 % ile y = - 2 .2 x + 5 3 .5

7 5 % ile y = - 2 .3 x + 5 0 .4

5 0 % ile y = - 2 .6 x + 4 7 .6

2 5 % ile y = - 3 .1 x + 4 4 .6

1 0 % ile y = - 3 .7 x + 4 2 .2

CT/MRI DataCT/MRI Data

�� Participant Demographic InformationParticipant Demographic Information

•• Variable Sample Sizes (Variable Sample Sizes (NN = 124)= 124)

•• GenderGender

�� MaleMale 8282

�� FemaleFemale 4242

•• EthnicityEthnicity

�� CaucasianCaucasian 119119

�� OtherOther 55

CT/MRICT/MRI

�� Diagnostic Groups Sample SizeDiagnostic Groups Sample Size

�� MVA/TBIMVA/TBI 4747

�� Blow to HeadBlow to Head 3232

�� LCVALCVA 2424

�� RCVARCVA 2121

CT/MRICT/MRI

1.1. All were Right Handed.All were Right Handed.

2.2. All were followed by Dr. Meyers through All were followed by Dr. Meyers through hospitalization and rehabilitation.hospitalization and rehabilitation.

3.3. None were involved in litigation.None were involved in litigation.

4.4. All passed internal validity checks.All passed internal validity checks.

CT/MRICT/MRI

�� CT/MRI LocationCT/MRI Location

�� Left FrontalLeft Frontal 5959

�� Left ParietalLeft Parietal 3737

�� Left TemporalLeft Temporal 3434

�� Left OccipitalLeft Occipital 66

�� Right FrontalRight Frontal 4040

�� Right ParietalRight Parietal 4242

�� Right TemporalRight Temporal 3131

�� Right OccipitalRight Occipital 33

CT/MRICT/MRI

�� All were given MNBAll were given MNB

�� CT/MRI data coded for injury CT/MRI data coded for injury reported on MRI/CT at the time of reported on MRI/CT at the time of injuryinjury

•• Present = 1Present = 1

•• Absent = 0Absent = 0

•• Some had injury in more than one placeSome had injury in more than one place

Meyers and Meyers and RohlingRohling (2009) found an (2009) found an 84 % concordance with CT/MRI data. 84 % concordance with CT/MRI data.

CT/MRICT/MRI

�� NP tests generally behaved as NP tests generally behaved as expectedexpected

�� A more “Systemic” or “Domain” like A more “Systemic” or “Domain” like approach better at explaining resultsapproach better at explaining results

�� Construct of “FrontalConstruct of “Frontal--Executive Executive Function” not supported. Function” not supported.

Comparison DatabaseComparison Database

�� Current Database Current Database 8000+8000+

�� Can be used to compare your Can be used to compare your patient’s performance to a reference patient’s performance to a reference group(s)group(s)

�� DicriminantDicriminant functionsfunctions

Profile MatchingProfile Matching

�� Look at the shape of the pattern, not Look at the shape of the pattern, not necessarily the level of scores.necessarily the level of scores.

�� Similar conditions have similar Similar conditions have similar patternspatterns

�� This helps the clinician to This helps the clinician to “Hypothesis Test” for the DX.“Hypothesis Test” for the DX.

PatternsPatterns

�� Similar injuries have similar patternsSimilar injuries have similar patterns

�� 2 examples2 examples

•• TBI different levels of injuryTBI different levels of injury

•• Hypoxia Hypoxia –– Carbon Monoxide Carbon Monoxide

Commonality of Reduced O2Commonality of Reduced O2

DiscriminantDiscriminant FunctionsFunctions

�� Individual Individual discriminantdiscriminant functions can functions can also help clinician to hypothesis testalso help clinician to hypothesis test

�� If it is TBI should generally match If it is TBI should generally match TBI groups.TBI groups.

�� Normal VS TBINormal VS TBI

�� Depressed VS TBIDepressed VS TBI

�� PTSD VS TBIPTSD VS TBI

�� Etc. Etc.

NeuronetNeuronet

�� Can help clinician to decide what Can help clinician to decide what pattern is more similar to patient’s pattern is more similar to patient’s datadata

�� Objectively matchesObjectively matches

�� Must assume patient’s data is one of Must assume patient’s data is one of the comparison groupsthe comparison groups

�� We will discuss more about We will discuss more about NeuronetNeuroneta little later. a little later.

Demographic DescriptionDemographic Description

NeuronetNeuronetGroup Right

HandedLeft Handed

Caucasian

Not Caucasian

Female Male

Normal s

32 4 31 5 13 23

TBI 392 57 423 26 164 285

Depressed

122 10 123 9 83 49

Anxiety 82 8 89 1 50 40

PCS 37 3 38 2 9 31

PTSD 23 4 24 1 11 16

Malingering/Invalid

51 9 56 4 21 39

CombinedCombined

�� Had to combine Had to combine

•• DepressionDepression

•• AnxietyAnxiety

•• PCS PCS

•• Normal Controls Normal Controls

�� Into a single group as Into a single group as NeuronetNeuronetidentified these groups as similar and identified these groups as similar and not able to be discriminated.not able to be discriminated.

�� Not an unusual findingNot an unusual finding

NeuronetNeuronet ResultsResults

�� “Neural networks are often the tools of “Neural networks are often the tools of choice when predictive accuracy is choice when predictive accuracy is required.” required.”

�� While in most cases, 20 algorithms for While in most cases, 20 algorithms for comparison are sufficient, we examined 200 comparison are sufficient, we examined 200 for this analysis and selected the best one. for this analysis and selected the best one.

�� Further neural network analyses were Further neural network analyses were performed, with one million algorithms performed, with one million algorithms compared, but none improved on the best compared, but none improved on the best of the batch of 200 previously mentioned.of the batch of 200 previously mentioned.

�� Summary of what they didSummary of what they did

•• Data setData set

•• NeuronetNeuronet analysisanalysis

�� 80% of cases randomly selected80% of cases randomly selected--produced produced the algorithmthe algorithm

�� 20 % of case form first validation20 % of case form first validation-- 94% 94% correct classification overallcorrect classification overall

Demographics of SoldiersDemographics of Soldiers

�� Mean Mean

•• Age 29.3 (Age 29.3 (++6.87) years6.87) years

•• Ed 12.36 (Ed 12.36 (++1.4) years1.4) years

�� 92 Right Handed, 8 Left handed92 Right Handed, 8 Left handed

�� 5 Female, 95 Male5 Female, 95 Male

�� Ethnicity: AA =13,Ca=63, Asian=5, Ethnicity: AA =13,Ca=63, Asian=5, HispHisp=14, Pacific Islander=5=14, Pacific Islander=5

Diagnoses ClassifiedDiagnoses Classified

Classification by Neuronet

Clinician Diagnosis TBI PTSD Malingering (Normal, Anx, Dep, PCS)

TBI 30 2

PTSD 1 19

Malingering 10

(Normal,Anx,Dep,PCS)

4 3 31

ConclusionsConclusions

�� Using standard MNB interpretation Using standard MNB interpretation system we are consistent 90% of the system we are consistent 90% of the timetime

OrOr

�� The The neuronetneuronet is 90% accurate is 90% accurate compared to clinician, in a military compared to clinician, in a military populationpopulation

ConclusionConclusion

�� The neural network produced The neural network produced accuracies of over 90% in this trial.accuracies of over 90% in this trial.

�� Two other trials on the Two other trials on the neuronetneuronet with with new subjects produced accuracies of new subjects produced accuracies of 90% or better90% or better

�� Overall, this test appears to have Overall, this test appears to have been a successbeen a success

MNB InterpretationMNB Interpretation

�� Hypothesis testHypothesis test

•• If it is a TBI what else should it match If it is a TBI what else should it match to? to?

�� Should match other TBI patternsShould match other TBI patterns

•• Does pt’s data make sense given Does pt’s data make sense given reported injury.reported injury.

�� Consider Dose ArticleConsider Dose Article

•• PatternPattern tells you what the problem is.tells you what the problem is.

InterpretationInterpretation

�� Pattern tells you what it is.Pattern tells you what it is.

�� OTBM tells you how bad it is.OTBM tells you how bad it is.

�� Domain scores tell you what Domain scores tell you what functional difficulties patient will functional difficulties patient will have.have.

�� Individual tests tell you what rehab Individual tests tell you what rehab tasks would be helpful. tasks would be helpful.

ReviewReview

�� Took a battery of well known testsTook a battery of well known tests

�� Developed Smoothed NormsDeveloped Smoothed Norms

�� Identified Validity, Reliability, Identified Validity, Reliability, Sensitivity and Specificity.Sensitivity and Specificity.

�� Internal Validity Checks and Internal Internal Validity Checks and Internal ConsistencyConsistency

�� Used pattern matching to help make Used pattern matching to help make DX. DX.

�� Then developed Then developed NeuronetNeuronet

SummarySummary

�� We have discussed:We have discussed:

•• Make up of MNBMake up of MNB

�� Norms/ test selection etcNorms/ test selection etc

�� PVTsPVTs

�� Validity and Reliability of MNB test etc.Validity and Reliability of MNB test etc.

•• Interpretative Method Interpretative Method

�� PatternsPatterns

�� DiscriminantDiscriminant functionsfunctions

�� RIM MatrixRIM Matrix

�� NeuronetNeuronet analysis (new)analysis (new)

Rim MatrixRim Matrix

RohlingRohling Interpretive MethodInterpretive Method

D1

Slide 98

D1 Effect and power tell me if I've done enough testing on that domain. Effect size of .3 and more is good effect size; we want power to

be lower than .74.

Effect tells me that the testing shows that I have tested enough, that the range level is accurate.

Cohen says .2 effect size is sufficient.Doc, 6/15/2012

Workings of the MNBWorkings of the MNB

Basic Information TabBasic Information Tab

Wechsler TabWechsler Tab

MNB TabMNB Tab

Rating Forms TabRating Forms Tab

MMPIMMPI--A /MMPIA /MMPI--RF (raw)RF (raw)

MMPIMMPI--22

Summary TabSummary Tab

Graph CompareGraph Compare

Overlays TabOverlays Tab

Report TabReport Tab

Pain TabPain Tab

Advanced Info TabAdvanced Info Tab

AYOCAYOC

PremorbidPremorbid TabTab

Specialty Tests TabSpecialty Tests Tab

Performance Validity TabPerformance Validity Tab

AYOPAYOP

Alternate Summary TabAlternate Summary Tab

Import/ExportImport/Export

T Score CalculatorT Score Calculator

Full GraphFull Graph

TablesTables

Performance ValidityPerformance Validity

Edit Working FilesEdit Working Files

PVM FrequenciesPVM Frequencies

Rule OutsRule Outs

MenuMenu

�� ModeMode

�� HelpHelp

•• Do general update at least monthlyDo general update at least monthly

QuestionsQuestions

��??

Documents

Neuropsychological Century - AzNSaz-ns.org/presentations/Sindelar.pdf · Neuropsychological Assessment in the 21 sstt Century The Meyers Neuropsychological Battery (MNB) Scott Sindelar,