Doyle E. Patton

Age- and Education-Corrected Independent Normative Data for the RBANS in a Community Dwelling Elderly Sample

The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS, Randolph, 1998) is likely to become a popular screening instrument for measuring cognitive functioning, particularly in elderly patients. As such, the present study attempted to extend the original normative data by reporting on RBANS performances in a group of 718 community dwelling older adults. Participants were recruited from an outpatient primary care setting, and were assessed for demographic, medical status, functional status, and quality of life information. Utilizing four empirically supported overlapping midpoint age ranges, individual subtest raw scores were converted to age-corrected scaled scores based on their position within a cumulative frequency distribution. These age-corrected scaled scores were also converted into education-corrected scaled scores using the same methodology across four education levels. Independent Index and Total scores were also calculated based on the data from this large elderly sample. These data may considerably advance the clinical utility of the RBANS by allowing clinicians to interpret individual subtests and make direct comparisons between subtests. Practitioners and researchers who elect to use the current normative data are encouraged to consider the similarities and differences between the present sample and their individual patients or research participants.

Test-Retest Stability and Practice Effects of the RBANS in a Community Dwelling Elderly Sample

Repeated neuropsychological assessments are common with older adults, and the determination of true neurocognitive change is important for diagnostic assessment. Several statistical formulas are available to assist in this determination, but they rely on access to test-retest stability coefficients and practice effect values. The current study presents data on these psychometric properties of the RBANS in a large community dwelling elderly sample. Across a one-year retest interval, stability coefficients ranged from .58 to .83 for the Index scores, and from .51 to .83 for the subtest scores. Practice effects were largely absent, with most performances slightly decreasing at retest. These psychometric properties are contrasted with those reported in the RBANS manual, and possible reasons for these differences are discussed. A case example is provided that demonstrates the use of the current findings in conjunction with existing change formulas.

Performance of Cognitively Normal African Americans on the RBANS in Community Dwelling Older Adults

Recent research suggests that cognitively normal African Americans are more likely to be misdiagnosed as impaired compared to Caucasians due to lower neuropsychological test scores (e.g., Manly et al., 1998). Given this, the present study sought to determine whether such racial discrepancies exist on the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS). Performances of 50 cognitively normal older African Americans on the RBANS were compared to those of 50 Caucasians matched on age, education, and gender. The African Americans scored significantly lower on 10 of 12 subtests, 3 of 5 Index scores, and the Total Scale score. Results underscored the utility of demographically appropriate norms when serving minority clients. Given that there remains a paucity of normative data for minority groups, RBANS normative data for older African Americans are provided. Although preliminary, it is hoped that data presented will offer the practitioner assistance with clinical diagnosis and decision-making in a manner that will help minimize diagnostic errors.

Modified Scoring Criteria for the RBANS Figures

Visual construction and memory tasks are routinely used in neuropsychological assessment, but their subjective scoring criteria can negatively affect the reliability of these instruments. The current study examined the standard scoring criteria for the Figure Copy and Recall subtests of the RBANS and compared them to a modified set of scoring criteria in two samples. In both a large community dwelling sample of older adults and in a mixed clinical sample, the original scoring criteria consistently led to lower scores than the modified criteria. Inter-rater reliability was high for the modified scoring criteria, and no age effects were found with the modified scoring criteria. In both samples, the modified scoring criteria led to Figure Copy scores that more closely approximated other performances on the RBANS compared to the standard criteria, whereas both scoring systems led to plausible Figure Recall scores. Despite these results, the present study cannot identify one scoring criterion as the “better,” but only points out the significant differences between them. Such differences can have important clinical implications, and practitioners and researchers who utilize the RBANS with patient samples should be cautious when interpreting low scores on Figure Copy and Recall if the standard criteria are used.

Predicting change with the RBANS in a community dwelling elderly sample.

Repeated neuropsychological assessments are common with older adults, and the determination of clinically significant change across time is an important issue. Regression-based prediction formulas have been utilized with other patient and healthy control samples to predict follow-up test performance based on initial performance and demographic variables. Comparisons between predicted and observed follow-up performances can assist clinicians in determining the significance of change in the individual patient. In the current study, multiple regression-based prediction equations for the 5 Indexes and Total Score of the RBANS were developed for a sample of 223 community dwelling older adults. These algorithms were then validated on a separate elderly sample (N = 222). Minimal differences were present between observed and predicted follow-up scores in the validation sample, suggesting that the prediction formulas are clinically useful for practitioners who assess older adults. A case example is presented that illustrates how the algorithms can be used clinically.

Base rates of longitudinal RBANS discrepancies at one- and two-year intervals in community-dwelling older adults.

ABSTRACT 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 = 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 assisting the clinician in determining the clinical significance of score changes.

Predicting cognitive change across 3 years in community-dwelling elders

The determination of clinically significant cognitive change across time is an important issue in neuropsychology, and repeated assessments are common with older adults. Regression-based prediction formulas, which use initial test performance and demographic variables to predict follow-up test performance, have been utilized with patient and healthy control samples. Comparisons between predicted and observed follow-up performances can assist clinicians in determining the significance of change in the individual patient. In the current study, multiple regression-based prediction equations for the five Indexes and Total Score of the RBANS were developed for a sample of 146 community-dwelling older adults across a 2-year interval. These algorithms were then validated on a separate elderly sample (n = 145). Minimal differences were present between Observed and Predicted follow-up scores in the validation sample, suggesting that the prediction formulas are clinically useful for practitioners who assess older adults. A case example is presented that illustrates how the algorithms can be used clinically.

Intersubtest Discrepancies on the RBANS: Results from the OKLAHOMA Study

The present study provides supplemental data for the Repeatable Battery for the Assessment of Neuropsychological Status (Randolph, 1998) by reporting base rate data on discrepancies between subtests of this measure. These discrepancies are organized by general level of ability and include both age and education corrections. The data come from the Oklahoma Longitudinal Assessment of Health Outcomes in Mature Adults study and include cognitive performances of 718 community-dwelling older adults. These findings offer the possibility of increased sensitivity at detecting clinically significant differences that might not be identified when relying on base rate data from a greater age range. Similarly, these data highlight the mediating effects of the global level of cognitive functioning on discrepancy scores.