Average Impairment Rating Research Articles

A-195 Emotional Factors in Performance on Halstead-Reitan/Halstead-Russell Neuropsychological Tests

Abstract Objective Evaluate the relation between depression and performance on eight widely used tests: Revised Category Test, Trail Making Test, Part B Tactual Performance Test, TPT Memory, TPT Location, Aphasia Screening Test, Seashore Rhythm Test and Speech Perception Test. Method Participants: 116 women, 71 men referred for comprehensive neuropsychological evaluation in an outpatient memory disorders clinic as part of a broader neurodiagnostic workup for memory complaints and cognitive decline. Referral sources: neurologists (78%), primary care physicians (21%). Patients’ mean age: 59.0 (SD =13.8); education: 14.9 (SD = 2.6) years. They were screened from a larger sample (N = 214) for brain disorder or positive neurodiagnostic findings. All participants satisfied performance and symptom validity criteria. Diagnostically, 62% had mood disorders. Based on Scale D scores, 65 middle-range scorers were excluded and 122 patients were classified into High and Low Depressive Symptom groups (ns = 61). The two groups were no different on age, education, Average Impairment Rating or predicted level of intelligence (Test of Premorbid Function). Results On all eight of the neuropsychological tests, scores were compared across the two groups. There was no main effect (MANOVA) for group, F(8,98) = 1.56, p = .147. Univariate comparisons revealed a trend on TPT Location but no statistically significant effects of depression severity on any of these tests. Conclusion Results suggest that severity of depressive symptoms is unrelated to performance on these neuropsychological tests. In cooperative examinees, these tests are valid for assessing brain-based abilities independent of depressive symptom severity.

Determining neuropsychological cut scores for older, healthy adults.

Three age groups (20-31, 37-49, and 55-67 years) of healthy men and women were compared on tests from the Halstead-Reitan neuropsychological test battery. Age-cohort differences in performance were observed for every measure (except Finger Tapping) and for overall indices of cognitive functioning, the Average Impairment Rating (AIR) and the Halstead-Reitan Impairment Index (HR II). When traditional cut scores (developed with age-heterogeneous samples) were used, alarmingly high percentages of subjects in the oldest group were defined as brain damaged. These findings were not attributable to higher levels of psychometrically-assessed anxiety and depression in the older groups or for the impaired subjects. Slightly more conservative criteria (fewer diagnoses of brain impairment) were then employed. The first, AIR greater than or equal to 2.00, resulted in a low and more reasonable base rate of brain impairment for the oldest group. The second, AIR greater than 2.00, resulted in age-parity in incidence of brain impairment. The heuristic value of more conservative AIR scores was discussed as were possible uses in applied clinical research settings. The limitations of this approach were noted with regard to its exclusive focus on the problem of false positive diagnoses. It was emphasized that, from a neuropsychological diagnostic perspective, cut scores based on healthy aging samples must ultimately be tested in the context of traditional neuropsychological studies in which external validation with neurosurgical and neurological criteria is employed.

Using the Halstead–Reitan Battery to Diagnose Brain Damage: A Comparison of the Predictive Power of Traditional Techniques to Rohling’s Interpretive Method

The aim of this project was to validate an alternative global measure of neurocognitive impairment (Rohling Interpretive Method, or RIM) that could be generated from data gathered from a flexible battery approach. A critical step in this process is to establish the utility of the technique against current standards in the field. In this paper, we compared results from the Rohling Interpretive Method to those obtained from the General Neuropsychological Deficit Scale (GNDS; Reitan & Wolfson, 1988) and the Halstead–Russell Average Impairment Rating (AIR; Russell, Neuringer & Goldstein, 1970) on a large previously published sample of patients assessed with the Halstead–Reitan Battery (HRB). Findings support the use of the Rohling Interpretive Method in producing summary statistics similar in diagnostic sensitivity and specificity to the traditional HRB indices.

A consideration of neuropsychologically normal schizophrenia.

Neuropsychological deficits are considered by many to be core features of schizophrenia. However, about 20% of patients with schizophrenia appear to have normal neuropsychological function. This study investigates this subgroup by comparing a "neuropsychologically normal" schizophrenia group to a non-schizophrenic, non-brain damaged patient comparison (PC) sample, and to patients with definitive brain damage who performed normally on neuropsychological testing. All patients completed the Halstead-Reitan Neuropsychological Test Battery and were classified as neuropsychologically normal or impaired using the Average Impairment Rating (AIR). In a sample of 113 patients with schizophrenia, 19.5% were classified as neuropsychologically normal. The brain damaged neuropsychologically normal group (BD-NN) consisted of 14.3% of 124 subjects. These groups were compared with a patient non-schizophrenic, non-brain damaged group who were selected on the basis of having an Average Impairment Rating in the neuropsychologically normal range. The neuropsychologically normal schizophrenic group performed less well than the non-brain damaged, non-schizophrenic patient comparison group on a number of tests, indicating that patients in this group may not be completely neuropsychologically normal, and would be better characterized as "high-functioning" or near normal. The results are discussed in regard to possible neurobiological differences between neuropsychologically impaired and intact schizophrenic patients, and implications for course and outcome.

A partial cross-validation of a halstead-reitan battery malingering formula

Using the Halstead-Reitan Battery profiles of 796 people, a formula for the detection of malingering was partially cross-validated to assess the false positive rate. Subjects included normals, psychiatric cases, and persons with all major types of brain disorder. The formula incorrectly designated 32% of the sample as fakers (i.e., as false positives). Of the 120 head-trauma cases, 39 (32%) obtained Fake scores, whereas 81 (67%) were correctly assessed as not malingering. The correlation of the results of the formula and the severity of the profile (as measured by the Average Impairment Rating) was .67, p < .0001.

A 15-year longitudinal study of Halstead-Reitan neuropsychological test performance.

Using a two-stage growth curve analysis, change over time in performance on tests in the Halstead-Reitan Battery and Average Impairment Rating (AIR) was assessed for 53 individuals who varied in age and health status. In the first stage of the analysis, estimated slope and intercept values were calculated for each individual by regressing longitudinal data points on time. In the second stage, estimated slope and intercept values obtained in the first-stage analysis were regressed on age at entry into the study with statistical control for health status, education, occupation, and gender. Control for health status had an insignificant influence on magnitude of associations between age and test performance. Age-at-entry into the study was associated with statistically significant increasing change over time (poorer performance) for tests placing relatively heavy demands on speed of psychomotor performance and for AIR.

Using subtests of the Brain Age Quotient to screen for cognitive deficits among substance abusers.

The subtests of the Brain Age Quotient, a brief neuropsychological battery, were used to screen for cognitive impairment in a sample of 112 substance abusers. Each of the subtests was scored, using newly developed T scores corrected for age, education, and gender, for which a mean battery score of T less than 40 indicates general cognitive impairment. The chance-corrected agreement in finding cognitive dysfunction between this battery and the Average Impairment Rating T score from the Halstead-Reitan battery was adequate, kappa = .81. This result suggests that, for discerning global cognitive impairment, this relatively brief neurodiagnostic screening device may be an attractive alternative to the more time-consuming Halstead-Reitan battery.

USING SUBTESTS OF THE BRAIN AGE QUOTIENT TO SCREEN FOR COGNITIVE DEFICITS AMONG SUBSTANCE ABUSERS

The subtests of the Brain Age Quotient, a brief neuropsychological battery, were used to screen for cognitive impairment in a sample of 112 substance abusers. Each of the subtests was scored, using newly developed T scores corrected for age, education, and gender, for which a mean battery score of T < 40 indicates general cognitive impairment. The chance-corrected agreement in finding cognitive dysfunction between this battery and the Average Impairment Rating T score from the Halstead-Reitan battery was adequate, κ = .81. This result suggests that, for discerning global cognitive impairment, this relatively brief neurodiagnostic screening device may be an attractive alternative to the more time-consuming Halstead-Reitan battery.

Is Blood Pressure An Important Variable in Research on Aging and Neuropsychological Test Performance?

Regression analyses using Blood Pressure, Age, and the multiplicative effect of Blood Pressure and Age as predictors of performance (on selected tests from the Halstead-Reitan neuropsychological test battery) were done. Three hypotheses were tested with subjects ranging in age from 20 to 72 years of age: (1) blood pressure values predict neuropsychological test performance over a wide range of hypertensive and normotensive blood pressure values; (2) blood pressure predicts performance within the narrower range of normal and borderline values; (3) blood pressure X age interactions, when observed over this age and education range, are such that negative blood pressure effects on performance are larger for younger than older subjects. Regression analyses confirmed each of these hypotheses and indicated that strength of prediction was not reduced when participants free from hypertension-related complications and medication were tested. Blood pressure X age interactions were seen for Trailmaking-B Test and the Tactile Performance Test-Localization for the primary sample. However, only Blood Pressure main effects were observed for the Average Impairment Rating, the Categories Test, TPT-Memory and TPT-Localization when age, sex, and education were controlled. Implications of these findings for the role of blood pressure in aging research and for longitudinal studies with subjects free from the need for treatment with antihypertensive medications are discussed.

Recovery of memory after severe closed head injury: dissociations in recovery of memory parameters and predictors of outcome.

This study examined selective reminding and recognition memory performance of 21 severe closed-head injured patients tested within 6 months of regaining consciousness and then again after at least 1 year. Performances on selective reminding parameters were highly correlated and patients performed significantly worse at both testings than did hospitalized controls matched for age, education, and sex. Patients improved from testing 1 to testing 2 on only four of six memory variables. Average Impairment Rating at testing 1 was a marginally better predictor of memory performance at testing 2 than was length of coma. Results are discussed in terms of (a) utility of selective reminding parameters and predictors of outcome and (b) dissociations in recovery of memory parameters.

Effects of lateralized cerebral lesions on oral reading, reading comprehension, and spelling.

This study used the Peabody Individual Achievement Test (PIAT) to assess reading and spelling skills in a normal control group (n = 100) and in patients having cerebral damage in the left hemisphere (LH; n = 86) or right hemisphere (RH; n = 76). Relative to the normals, both brain-damaged groups were impaired on PIAT Reading Comprehension and Spelling. Only the LH group was impaired on PIAT Reading Recognition. PIAT performances were strongly related to extent of brain damage within the left hemisphere, but not within the right. Similarly, whereas reading and spelling deficits were associated with temporal- and occipital-lobe involvement in the LH group, presence or absence of specific lobe involvement was unrelated to PIAT performance in the RH group. Relationships also were assessed between PIAT performances and demographic variables and the Average Impairment Rating from the Halstead-Reitan Battery.

Clinical significance of cognitive performance by hypertensive patients.

Fifty-four subjects with uncomplicated essential hypertension and 54 normotensive subjects were compared with regard to a widely employed clinical index of cognitive dysfunction (the Average Impairment Rating) calculated from neuropsychological tests that discriminate between brain-damaged and neurologically normal persons. Hypertensive subjects exhibited lower mean scores on this index when education was ignored, but results were not the same for highly educated and less well educated groups. There were no differences between exceptionally well educated hypertensive and normotensive subjects, but in the less well educated group, hypertensive subjects performed more poorly than normotensive subjects. The percentages of hypertensive and normotensive subjects scoring in a cognitively impaired range on the Average Impairment Rating were low and did not differ for either education group. These data indicate the important role of subtle differences in education level with respect to positive or negative findings for studies comparing hypertensive and normotensive subjects and illustrate the important role of clinical neuropsychological indices of cognitive dysfunction when one wishes to make meaningful inferences regarding cerebral cortical function in hypertensive subjects.

Relative utility of three indices of neuropsychological impairment in a young, chronic schizophrenic population.

The complete Halstead-Reitan Neuropsychological Test Battery and the Wechsler Adult Intelligence Scale were administered to 20 young, male, chronic schizophrenics. Three commonly used indices of neuropsychological impairment were calculated and compared. Although all three indices were similar in separating computerized axial tomography normal from abnormal patients, statistical significance was achieved only with the Halstead Impairment Index. Thus, the easier-to-obtain Halstead Impairment Index appears to be at least as good as, and possibly better than, the more-difficult-to-obtain indices of Percent of Ratings within the Impaired Range and the Average Impairment Rating. Reasons for these findings are discussed.

An evaluation of the Digit Symbol component of the Russell, Neuringer, and Goldstein Average Impairment Rating.

An evaluation of the Digit Symbol component of the Russell, Neuringer, and Goldstein Average Impairment Rating.

An evaluation of the digit symbol component of the Russell, Neuringer, and Goldstein Average Impairment Rating.

An evaluation of the digit symbol component of the Russell, Neuringer, and Goldstein Average Impairment Rating.

Mental status outcomes following carotid endarterectomy: a six-month analysis.

Fifty-one male and two female patients were divided into the following three groups: (a) patients with symptomatic carotid artery disease who received carotid endarterectomies, (b) patients with symptomatic carotid artery disease who either declined or were not candidates for carotid endarterectomies, and (c) patients who received a surgical procedure unrelated to cerebral functioning. The three groups were not significantly different in terms of age or educational level. The subjects were examined using the WAIS, Wechsler Memory Scale, Halstead-Reitan Neuropsychological Battery, Sickness Impact Profile, and Profile of Mood States. The assessments were conducted presurgery and repeated at a 6 month follow-up. The results of two-way analyses of variance revealed a significant trials effect for a majority of the variables, including the average impairment rating and the full scale WAIS IQ. However, significant group x trials interactions were not found for either the neuropsychological measures or the quality of life indices. The results did not support the conclusion of improved mental status or increased psychosocial well-being in patients who received carotid endarterectomies.

Personality dysfunction and lateralized deficits in cerebral functions as measured by the MMPI and Reitan-Halstead Battery.

Previous research using the MMPI has failed to show personality differences between right and left hemispheric brain-damaged patients. The purposes of the present study were, first to determine whether lateralized deficits in cortical functioning as measured by neuropsychological testing are systematically associated with neurotic-psychotic distinctions on the MMPI. Secondly, we wished to determine the strength of predictive association in the relationship between lateralized functional deficits and personality organization. A localization key (Russell, et al., 1972) was applied to the "Reitan-Battery" test results for 94 patients who were referred for neuropsychological testing. Based on this approach, 15 pairs of patients were selected who were "left" or "right" hemispheric dysfunctional in terms of test performance. Pairs were matched for age and "average impairment rating" (Russell, et al., 1972). Their MMPIs were also designated "neurotic" or "psychotic" using the Goldberg Psychotic Index (Goldberg, 1972). The results suggest that patients with deficits in left hemisphere functions tend to score in the psychotic range and patients with deficits in right hemispheric functions tend to score in the neurotic range of the MMPI Goldberg Index. In this set of data there was a 38% reduction in error of predicting neurotic-psychotic category but knowing whether the patient was left or right hemispheric dysfunctional in terms of neuropsychological tests.

Statistical and normative studies of the Halstead Neuropsychological Test Battery relevant to a neuropsychiatric hospital setting.

A series of studies was performed with the general aim of evaluating the usefulness of the Halstead Neuropsychological Test Battery with a neuropsychiatric population. Factor analysis of the battery showed that it measured language, perceptual, complex problem-solving, and motor skills. Utilizing stepwise discriminant analysis the battery discriminated between brain-damaged and non-brain-damaged Ss at a statistically significant level. However, a simpler index, the Average Impairment Rating, did as well in terms of percentage of correct classifications. Also, through the use of stepwise multiple discriminant analysis, the battery discriminated among Ss with lateralized, diffuse and no brain damage at statistically significant levels, with the exception that it could not discriminate between Ss with right-hemisphere lesions and those with diffuse lesions.