The validity of neuropsychological assessment tools for the assessment of general and domain-specific cognitive functioning after an acquired brain injury

Accurate assessment and categorisation of cognitive impairment after an acquired brain injury is vital for the creation of targeted rehabilitation plans and the planning and provision of care. To be useful neuropsychological assessment tools must be able to predict patient outcomes and accurately classify the presence/absence of impairment.

Literature Review

The ability of domain-specific assessment tools used post-stroke, to predict later functional outcomes was reviewed. Tools assessing the domains of executive function, visuospatial perception/construction and visual memory were selected for review, due to previous evidence of their relationship with functional outcomes. It was concluded that all domains were predictive of a range of functional outcomes at many time-points post-stroke. Individual assessment tools showing evidence of predictive validity were identified for clinical use.

Empirical Report

This study assessed the diagnostic ability of the Short Parallel Assessments of Neuropsychological Status (SPANS) in acquired brain injury (ABI) samples. The ability of the SPANS to accurately distinguish between a sample of patients who had suffered an ABI and a sample of age and education matched healthy norms was investigated using five different clinical samples: ≤ 6-months post-ABI, ≥ 1-year post-ABI, high school educated, college/vocationally educated and university educated. The SPANS total score and individual indices had high diagnostic validity in the acute ABI sample, indicating it is a valid general and domain-specific screen in this setting. The /SPANS total score also had high diagnostic validity in the long-term ABI sample indicating it is a valid general cognitive screen in this setting. Scores for individual indices in this sample were mixed, this could be because of recovery of functioning in particular domains or a lack of sensitivity in subtests. Education level and time-since injury had a large impact on optimal cut-off scores, the implications for the use of ‘one- size-fits-all’ cut-offs is discussed.