Skip to main content
British Journal of Sports Medicine logoLink to British Journal of Sports Medicine
. 2004 Jun;38(3):273–278. doi: 10.1136/bjsm.2003.000293

Statistical procedures for determining the extent of cognitive change following concussion

A Collie 1, P Maruff 1, M Makdissi 1, M McStephen 1, D Darby 1, P McCrory 1
PMCID: PMC1724830  PMID: 15155425

Abstract

Neuropsychological (NP) testing is now often used to help to determine if the cognitive function of a concussed athlete has declined. The NP test score after concussion is compared with the baseline test score. Many clinicians simply subtract one from the other and make a clinical decision about the significance or otherwise of the resulting "difference score". Such techniques are inadequate, as they fail to account for the many factors that may confound interpretation of serially acquired cognitive test scores. This is a review of a number of alternative approaches used in other areas of medicine for differentiating "true" changes from changes caused by these confounding factors. A case example is used to illustrate the effect that the statistical approach may have on clinical decision making.

Full Text

The Full Text of this article is available as a PDF (81.4 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Benedict R. H., Zgaljardic D. J. Practice effects during repeated administrations of memory tests with and without alternate forms. J Clin Exp Neuropsychol. 1998 Jun;20(3):339–352. doi: 10.1076/jcen.20.3.339.822. [DOI] [PubMed] [Google Scholar]
  2. Bruggemans E. F., Van de Vijver F. J., Huysmans H. A. Assessment of cognitive deterioration in individual patients following cardiac surgery: correcting for measurement error and practice effects. J Clin Exp Neuropsychol. 1997 Aug;19(4):543–559. doi: 10.1080/01688639708403743. [DOI] [PubMed] [Google Scholar]
  3. Butler R. J. Neuropsychological investigation of amateur boxers. Br J Sports Med. 1994 Sep;28(3):187–190. doi: 10.1136/bjsm.28.3.187. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Catron D. W., Thompson C. C. Test-retest gains in WAIS scores after four retest intervals. J Clin Psychol. 1979 Apr;35(2):352–357. doi: 10.1002/1097-4679(197904)35:2<352::aid-jclp2270350226>3.0.co;2-2. [DOI] [PubMed] [Google Scholar]
  5. Collie A., Darby D., Maruff P. Computerised cognitive assessment of athletes with sports related head injury. Br J Sports Med. 2001 Oct;35(5):297–302. doi: 10.1136/bjsm.35.5.297. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Collie Alexander, Maruff Paul, Darby David G., McStephen Michael. The effects of practice on the cognitive test performance of neurologically normal individuals assessed at brief test-retest intervals. J Int Neuropsychol Soc. 2003 Mar;9(3):419–428. doi: 10.1017/S1355617703930074. [DOI] [PubMed] [Google Scholar]
  7. Collie Alexander, Maruff Paul, Makdissi Michael, McCrory Paul, McStephen Michael, Darby David. CogSport: reliability and correlation with conventional cognitive tests used in postconcussion medical evaluations. Clin J Sport Med. 2003 Jan;13(1):28–32. doi: 10.1097/00042752-200301000-00006. [DOI] [PubMed] [Google Scholar]
  8. Collins M. W., Grindel S. H., Lovell M. R., Dede D. E., Moser D. J., Phalin B. R., Nogle S., Wasik M., Cordry D., Daugherty K. M. Relationship between concussion and neuropsychological performance in college football players. JAMA. 1999 Sep 8;282(10):964–970. doi: 10.1001/jama.282.10.964. [DOI] [PubMed] [Google Scholar]
  9. Erlanger David, Saliba Ethan, Barth Jeffrey, Almquist Jon, Webright William, Freeman Jason. Monitoring Resolution of Postconcussion Symptoms in Athletes: Preliminary Results of a Web-Based Neuropsychological Test Protocol. J Athl Train. 2001 Sep;36(3):280–287. [PMC free article] [PubMed] [Google Scholar]
  10. Heaton R. K., Temkin N., Dikmen S., Avitable N., Taylor M. J., Marcotte T. D., Grant I. Detecting change: A comparison of three neuropsychological methods, using normal and clinical samples. Arch Clin Neuropsychol. 2001 Jan;16(1):75–91. [PubMed] [Google Scholar]
  11. Hinton-Bayre A. D., Geffen G. M., Geffen L. B., McFarland K. A., Friis P. Concussion in contact sports: reliable change indices of impairment and recovery. J Clin Exp Neuropsychol. 1999 Feb;21(1):70–86. doi: 10.1076/jcen.21.1.70.945. [DOI] [PubMed] [Google Scholar]
  12. Jacobson N. S., Truax P. Clinical significance: a statistical approach to defining meaningful change in psychotherapy research. J Consult Clin Psychol. 1991 Feb;59(1):12–19. doi: 10.1037//0022-006x.59.1.12. [DOI] [PubMed] [Google Scholar]
  13. Johnston K. M., McCrory P., Mohtadi N. G., Meeuwisse W. Evidence-Based review of sport-related concussion: clinical science. Clin J Sport Med. 2001 Jul;11(3):150–159. doi: 10.1097/00042752-200107000-00005. [DOI] [PubMed] [Google Scholar]
  14. Kneebone A. C., Andrew M. J., Baker R. A., Knight J. L. Neuropsychologic changes after coronary artery bypass grafting: use of reliable change indices. Ann Thorac Surg. 1998 May;65(5):1320–1325. doi: 10.1016/s0003-4975(98)00158-1. [DOI] [PubMed] [Google Scholar]
  15. Lovell M. R., Collins M. W. Neuropsychological assessment of the college football player. J Head Trauma Rehabil. 1998 Apr;13(2):9–26. doi: 10.1097/00001199-199804000-00004. [DOI] [PubMed] [Google Scholar]
  16. Maassen G. H. Principles of defining reliable change indices. J Clin Exp Neuropsychol. 2000 Oct;22(5):622–632. doi: 10.1076/1380-3395(200010)22:5;1-9;FT622. [DOI] [PubMed] [Google Scholar]
  17. Macciocchi S. N., Barth J. T., Alves W., Rimel R. W., Jane J. A. Neuropsychological functioning and recovery after mild head injury in collegiate athletes. Neurosurgery. 1996 Sep;39(3):510–514. [PubMed] [Google Scholar]
  18. Maddocks D., Saling M. Neuropsychological deficits following concussion. Brain Inj. 1996 Feb;10(2):99–103. doi: 10.1080/026990596124584. [DOI] [PubMed] [Google Scholar]
  19. Makdissi M., Collie A., Maruff P., Darby D. G., Bush A., McCrory P., Bennell K. Computerised cognitive assessment of concussed Australian Rules footballers. Br J Sports Med. 2001 Oct;35(5):354–360. doi: 10.1136/bjsm.35.5.354. [DOI] [PMC free article] [PubMed] [Google Scholar]
  20. Matarazzo J. D., Herman D. O. Base rate data for the WAIS-R: test-retest stability and VIQ-PIQ differences. J Clin Neuropsychol. 1984 Nov;6(4):351–366. doi: 10.1080/01688638408401227. [DOI] [PubMed] [Google Scholar]
  21. Matser J. T., Kessels A. G., Jordan B. D., Lezak M. D., Troost J. Chronic traumatic brain injury in professional soccer players. Neurology. 1998 Sep;51(3):791–796. doi: 10.1212/wnl.51.3.791. [DOI] [PubMed] [Google Scholar]
  22. Mitrushina M., Satz P. Effect of repeated administration of a neuropsychological battery in the elderly. J Clin Psychol. 1991 Nov;47(6):790–801. doi: 10.1002/1097-4679(199111)47:6<790::aid-jclp2270470610>3.0.co;2-c. [DOI] [PubMed] [Google Scholar]
  23. Temkin N. R., Heaton R. K., Grant I., Dikmen S. S. Detecting significant change in neuropsychological test performance: a comparison of four models. J Int Neuropsychol Soc. 1999 May;5(4):357–369. doi: 10.1017/s1355617799544068. [DOI] [PubMed] [Google Scholar]
  24. Thurman D. J., Branche C. M., Sniezek J. E. The epidemiology of sports-related traumatic brain injuries in the United States: recent developments. J Head Trauma Rehabil. 1998 Apr;13(2):1–8. doi: 10.1097/00001199-199804000-00003. [DOI] [PubMed] [Google Scholar]

Articles from British Journal of Sports Medicine are provided here courtesy of BMJ Publishing Group

RESOURCES