A-10 Influence of Different Normative Reference Standards among Cognitively Normal Former NFL Players

Abstract

Abstract Purpose: Demographic adjustments (e.g., age, sex, race/ethnicity) to neuropsychological tests can assist clinical interpretation and avoid false-positive diagnoses of cognitive impairment. The issue of “race” as a criterion for normative adjustment has been highlighted in recent cases among former NFL players. We examined the impact of different normative reference comparisons on neuropsychological scores among cognitively normal Black and White NFL retirees. Methods: Cognitively normal Black (n = 20) and White (n = 20) retirees were age- and education-matched. Measures of attention (Digit Span), processing speed (Coding, TMTA), memory (ROCFT, CVLT), language (FAS, Animals, BNT), and executive function (TMTB) were examined. Independent samples t-tests (using p < 0.01) were conducted between raw and normative scores of Black and White retirees that adjusted for 1) age/education (Mitrushina); 2) age/education/sex (NACC); and 3) age/education/sex/race (Heaton, MOANS/MOAANS). An additional ANCOVA evaluated group differences controlling for baseline estimated IQ. Results: Raw scores differed between groups on TMTB, Coding, and BNT. Mitrushina normative data showed differences on TMTB (p = 0.007) and BNT (p < 0.001). NACC normative data showed differences on the BNT (p < 0.001). ANCOVA (controlling for IQ) of raw scores between groups differed on the BNT (p = 0.002). Heaton and MOANS/MOAANS normative scores did not reveal differences between groups on any test. Conclusions: As expected, the use of different neuropsychological norms influences findings across different sociodemographic groups to various degrees, depending on the test. The underlying contributors to group differences using “race” as a proxy need to be disentangled and understood. Cautious use of demographically-adjusted norms as interpretive guidelines is warranted until these factors are identified.