Halstead-Reitan Neuropsychological Test Battery Research Articles

Descriptive Halstead-Reitan study of nonimpact mild traumatic brain injury

ABSTRACTPatients subjected to severe acceleration forces in motor vehicle accidents that met criteria for uncomplicated mild traumatic brain injury (mTBI) in the absence of direct impact to the head were examined neuropsychologically using the Halstead-Reitan Neuropsychological Test Battery. The subjects were litigants and/or insurance claimants for whom there was psychometric evidence of acceptable test effort. The purpose of the study was to provide descriptive neuropsychological data for this particular clinical population. Individual test results were interpreted using inferential methods of level of performance, pathognomonic signs, score patterns, and right-left performance differences. These interpretive strategies yielded group data from which frequencies and percentages of atypical neuropsychological characteristics were calculated. The most salient clinical characteristics involved atypical right-left performance relationships on simple and more complex tests of motor function. Clinical data provided support for the possibility that a minority of nonimpact litigants or insurance claimants that sustain uncomplicated mTBI experience persistent diminishment in some neuropsychological abilities.

Comparability of the Computerized Halstead Category Test with the Original Version

The Halstead Category Test-Computer Version (HCT-CV) was developed with the goal of adapting the HCT to the computer while maintaining all essential features of the original test. We compared the HCT-CV results from clinical neuropsychological evaluations of 25 patients who were matched on a pairwise basis with 25 patients previously tested with the original version. Matching was done on age, education, and diagnosis. Results of group comparisons showed that the HCT-CV performed comparably with the original version, with mean score differences of <2 points. Correlations with the other subtests from the Halstead-Reitan Neuropsychological Test Battery were also found to be comparable. Results suggest that the HCT-CV can be considered a satisfactory and comparable version of the HCT, while providing advantages in terms of ease of use and portability.

Cognitive and psychiatric issues in juvenile myoclonic epilepsy

Objective. Difficulties in the area of executive functions, social adjustment and behavior are observed in patients with JME and stressed to frontal lobe involvement in this electro-clinical syndrome. The contribution of extra-frontal structures to cognition in JME is also challenged. Methods. We prospectively analyzed clinical and diagnostic data and prognosis of 83 JME patients (36 male, 47 female) aged 16 to 31.5 years (mean 21.4), with mean seizure onset of 13.3 years (range 8.5–18.7). Cognitive functions are assessed by the Halstead–Reitan Neuropsychological Test Battery for adolescents and younger adults. Retest was done for mean 5 years after the initial test. Patients with JME were compared with 35 healthy controls, sex-, ageand education-matched, and comparable subjects. Results. Complete seizure control was achieved in 63 (75.9%) patients mainly with valproate (54 patients). Pseudo-resistant seizures occurred in 89.6%, while JME was refractory in14.5% patients. Seizure and drug freedom was noted in 12% patients. No cognitive dysfunctions were disclosed in 31 (37.3%) patients. No clear and significant association between test-results and epilepsy-related parameters, including type of antiepileptic drug, level of seizure control and JME duration. Patients diagnosed with JME scored significantly below controls on frontal tasks (Wisconsin test-perseverations, TMT-B, Stroop test, verbal categorical and phonemic fluency tests). No intellectual decline was stated over clinical follow-up. Poor performance was found not only on tests measuring frontal functions (attention, executive functions, working memory, mental flexibility, concept formation and planning) but also on tasks assessing delayed verbal and visual learning and naming. Psychiatric disorders were noted in 38 (45.8%) patients. High rates of anxiety, phobias and somatization disorders (25.3%) and mood disorders (18.1%) were seen in patients with JME. Depression associated with personality disorder prevailed. Only 22.9% patients are employed. Conclusions. Juvenile myoclonic epilepsy may be a non-uniform condition. Different still elusive mechanisms could underlie the clinically observed differences in prognosis, cognitive and psychological functioning.

Influence of comorbid depression on quality of life in patients with epilepsy

Objective. The purpose of this study was to assess symptoms of depression and to define its influence on quality of life (QOL) in patients with epilepsy.

Level of Performance Accuracy for Core Halstead-Reitan Measures by Pooling Normal Controls from Published Studies: Comparison with Existing Norms in a Clinical Sample

The Halstead-Reitan Neuropsychological Test Battery offers a multifaceted, empirically supported interpretive framework for neuropsychological assessment founded upon raw scores referenced to a brain-damaged sample. Complementary approaches have used T scores from normal samples often composed of community volunteers or medical patients, augmented by regression. By pooling normal controls of all types from published studies, a sample large enough for stratification of core Halstead-Reitan measures by age and education was obtained (206 studies, N1 = 17,980). Comparisons based on T scores with two published normative systems in an outpatient sample produced a continuum: liberal norms for medical patients, intermediate pooled values from many types of subjects, and stringent norms for community volunteers. Features recommending clinical application of pooled norms include enhanced accuracy in clinical situations precluding a full battery, few empty cells or inversions for nonelderly subjects, and a screening application based upon a very large Trail Making Test sample (Trails B: n > 14,000).

The Effects of Alcoholism Comorbidity on Neurocognitive Function Following Traumatic Brain Injury

Alcoholism and traumatic brain injury (TBI) often produce neuropsychological deficits. However, the extent and manner by which these factors interact is unclear. In this study, it was hypothesized that alcoholism would have compounding cognitive effects in individuals with TBI and alcoholism. Participants were divided into three groups, including a patient comparison (PC) group and groups with TBI with or without alcoholism histories. Participants were administered the Wechsler Adult Intelligence Scale-Revised and major components of the Halstead-Reitan Neuropsychological Test Battery. Comparing the groups on test performance, the TBI groups performed significantly worse than the PC group but did not significantly differ from each other. Thus, the effects of TBI on cognitive function overshadow preexisting deficits from the alcoholism.

Use of the Binomial Distribution to Predict Impairment: Application in a Nonclinical Sample

A mathematical model based on the binomial theory was developed to illustrate when abnormal score variations occur by chance in a multitest battery (Ingraham & Aiken, 1996). It has been successfully used as a comparison for obtained test scores in clinical samples, but not in nonclinical samples. In the current study, this model has been applied to demographically corrected scores on the Halstead-Reitan Neuropsychological Test Battery, obtained from a sample of 94 nonclinical college students. Results found that 15% of the sample had impairments suggested by the Halstead Impairment Index, using criteria established by Reitan and Wolfson (1993). In addition, one-half of the sample obtained impaired scores on one or two tests. These results were compared to that predicted by the binomial model and found to be consistent. The model therefore serves as a useful resource for clinicians considering the probability of impaired test performance.

Neuropsychological Assessment of Adult Offenders

ABSTRACT This report is primarily concerned with reporting on the normative results obtained on a large sample of serious adult offenders. An expanded Halstead-Reitan Neuropsychological Test Battery was administered to 584 adult offenders (OF), 132 normal controls (NC), and 494 acute psychiatric patients (PP). Subjects were between 18 and 44 years of age. Descriptive statistics for all neuropsychological measures are reported. Impairment analyses indicate substantial neuropsychological impairment in the OF and PP groups, especially on measures of executive function and verbal capacities. The neuropsychology of the prefrontal cortex and of Attentional Deficit Hyperactivity Disorder and Conduct Disorder is reviewed. This review, in the context of the present findings, supports a working hypothesis that the executive deficits and behavioral disinhibition of offenders represent heterotypic continuities of brain dysfunction among some children with disruptive behavior disorders. Implications for research, the potential of neuropsychology for offenders, and the early identification and remediation of high-risk children are discussed.

Screening for neuropsychological impairment using Reitan and Wolfson's preliminary neuropsychological test battery

This study examined the utility of a screening battery developed by Reitan & Wolfson, 2006 for predicting neuropsychological impairment on the Halstead–Reitan neuropsychological test battery for adults. Using archival neuropsychological data from 69 litigants seen in a private practice setting, the Pearson correlation between the General Neuropsychological Deficit Scale (GNDS) score and the total Neuropsychological Deficit Scale (NDS) score from the screening battery (SBNDS) was .82. ROC curve analysis determined that the AUC was .88. Using a cutoff score of 9, as recommended by Reitan and Wolfson, the screening battery had excellent specificity but only fair sensitivity for identifying individuals with neuropsychological impairment on the Halstead–Reitan battery. Using a cutoff score of 8, the sensitivity and specificity of the screening battery was comparable to the findings of Reitan and Wolfson. The findings from this study indicate the optimal cutoff score for the screening battery may vary with different populations. The positive predictive power (PPP) and negative predictive power (NPP) were calculated for various base rates for cut scores with both sensitivity and specificity of greater than .600, and this information is provided.

Screening for neuropsychological impairment in children using Reitan and Wolfson's preliminary neuropsychological test battery

This study examined the efficacy of two screening batteries developed by Reitan and Wolfson [Reitan, R. M., & Wolfson, D. (2006). Issues in neuropsychology: Where have we succeeded? Where have we failed? What are the clinical and forensic implications? Presented at the 26th annual conference of the National Academy of Neuropsychology] for predicting neuropsychological impairment on the Halstead–Reitan Neuropsychological Test Battery for Older Children (ages 9–14) and the Reitan–Indiana Neuropsychological Test Battery (ages 5–8). Sixty-eight subjects were selected from archival data collected from cases in a private practice setting. Using Reitan and Wolfson's recommended screening battery neuropsychological deficit scale score (SBNDS) cut-off of 16/17 correctly classified 82.5% of older children as normal or impaired according to total GNDS scores. The screening battery for young children ( n = 28) resulted in 100% correct classification using Reitan and Wolfson's recommended SBNDS cut-off of 22/23.

Serial Testing of Older Children as a Basis for Recommending Comprehensive Neuropsychological Evaluation

The aim of this study was to develop a short screening battery that would predict whether older children would show significant impairment on comprehensive neuropsychological testing. The screening battery was subdivided into two phases. Phase 1 was intended as a broad catchment effort; Phase 2 was designed to be a more detailed and selective procedure. Administration of the full set of screening tests requires about 45 minutes. Their predictive validity was assessed using the Neuropsychological Deficit Scale (NDS), which summarizes results in the entire Halstead-Reitan Neuropsychological Test Battery for Older Children. Cutoff scores and guidelines for interpretation of the screening tests were developed, and the results were substantially correct in identifying children who performed normally versus children who were impaired on the testing and therefore required comprehensive testing to evaluate their neuropsychological status and deficits.

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.

Psychological Disturbance, Incomplete Effort, and Compensation-Seeking Status as Predictors of Neuropsychological Test Performance in Head Injury

Indices from the Minnesota Multiphasic Personality Inventory-2 (MMPI-2; Butcher, Dahlstrom, Graham, Tellegen, & Kaemmer, 1989) representing cognitive and emotional disturbance as well as incomplete effort on the Recognition Memory Test (RMT; Warrington, 1984) were examined as predictors of performance on the Halstead-Reitan Neuropsychological Test Battery (HRB; Reitan & Wolfson, 1993). In the current study, which included a large sample (N = 369) of patients referred for neuropsychological (NP) evaluation after presumptive head injury, MMPI-2 measures of psychological disturbance accounted for as much as 25% of the variance in HRB test scores, resulting in a moderate overall effect size (median Adj. R2 = .16; R = .40). When demographic variables, head injury severity, and compensation-seeking status were entered in previous steps, incomplete effort as defined by chance performance on the RMT accounted for between 2% and 13% of the variance in HRB test scores, with modest overall effect size (median R2 Δ = .07; R = .26) in multiple regression equations. Additionally, when MMPI-2 indices of psychological disturbance were included in the last step, they accounted for 2% to 11% of additional variance, retaining a modest overall effect (median R2 Δ = .03; R = .17). Compensation-seeking status and injury severity as measured by duration of post-traumatic amnesia were, at best, modestly related to NP test performance. Findings confirm the reliable relationship between test performance and psychological disturbance as well as incomplete effort when assessing dysfunction following head injury. In contrast to previous studies, incomplete effort was unrelated to compensation-seeking status.

Clinical and Forensic Issues Regarding Age, Education, and the Validity of Neuropsychological Test Results

Abstract This paper reviews procedures and reports of adjustments of raw scores from the Halstead-Reitan Neuropsychological Test Battery for Adults using the method proposed by Heaton, Grant, and Matthews (1991). Arguments and findings both supporting and criticizing the HGM transformations are reviewed. From a psychometric viewpoint, the conclusion is reached that the HGM method, which is based only on a neurologically-normal group, transforms raw scores into scaled scores that tend to fall in the normal range, especially for braindamaged persons. Although this question is not yet adequately researched, the effect may stem principally from adjustments made for persons with less education and older age. The consequent result of the adjustments, in this case, would be to produce normal scores for tests that were designed, developed, and validated as measures of brain impairment-defeating the very purpose of the tests as neuropsychological measures. If the transformation process, based on age and education,...

Relationship Between Neuropsychological and Emotional Functioning in Severe Chronic Alcoholism

Previous studies of patients with severe chronic alcoholism have shown a high prevalence of emotional distress such as anxiety and depression, and neuropsychological impairments such as executive deficits, but few have examined the relationship between these disorders. We addressed this issue in 51 abstinent patients with histories of severe chronic alcoholism utilizing the Minnesota Multiphasic Personality Inventory (MMPI) and the Halstead–Reitan Neuropsychological Test Battery (HRNTB). Applying factor analysis to the MMPI clinical and validity scales, we derived four dimensions accounting for 78% of the available variance. We found that Factor 1, which loaded on most clinical scales of the MMPI, was significantly correlated (p <.01) with performance on the Halstead Category Test (HCT), a measure of executive functioning. Further, group analysis with MANOVA using HCT (impaired and nonimpaired) as the independent variable revealed a significant main effect for Factor 1 (p <.004), which was maintained and strengthened when age and education were controlled as covariates (p <.001). The results suggest a relationship between emotional distress and executive functioning as measured by the HCT, reflecting differing facets of frontal lobe dysfunction common to cognitive and affective domains in patients with severe chronic alcoholism.

Construct dependence of the Halstead-Reitan neuropsychological test battery on response time : Gurmal Rattan (Indiana University of Pennsylvania), Raymond S. Dean, (Ball State University, Muncie, IN, and Indiana University School of Medicine), Wyma E.Fischer (Neuropsychology Laboratory, Ball State University), and Arlene I. Rattan (Neuropsychology Laboratory, Ball State University)

Construct dependence of the Halstead-Reitan neuropsychological test battery on response time : Gurmal Rattan (Indiana University of Pennsylvania), Raymond S. Dean, (Ball State University, Muncie, IN, and Indiana University School of Medicine), Wyma E.Fischer (Neuropsychology Laboratory, Ball State University), and Arlene I. Rattan (Neuropsychology Laboratory, Ball State University)

Neuropsychological Assessment in Clinical Practice: A Guide to Test Interpretation and Integration

Back to table of contents Previous article Next article Book Forum: NeuropsychiatryFull AccessNeuropsychological Assessment in Clinical Practice: A Guide to Test Interpretation and IntegrationMANFRED SPITZER, M.D., PH.D., MANFRED SPITZERSearch for more papers by this author, M.D., PH.D., Ulm, GermanyPublished Online:1 Mar 2002https://doi.org/10.1176/appi.ajp.159.3.502AboutSectionsView EPUB ToolsAdd to favoritesDownload CitationsTrack Citations ShareShare onFacebookTwitterLinked InEmail As stated in the preface, this book tries to provide a comprehensive guide to neuropsychology—and so it does! It is divided into four parts. General insights into neuropsychology and neurological syndromes are provided and the terminology behind neurological assessments are explained in the first part. This is accomplished by presentations of short and prototypical clinical descriptions of paradigmatic disorders. These descriptions are taken from the points of view of different clinical settings, such as a neurological hospital, a rehabilitation unit, a psychiatric practice, and a judicial context. These sample cases start with a short history, present results of neuropsychological assessments, and explain test results in relation to the patients’ medical condition and history. Therapeutic conclusions and a prognosis are derived from this information. In essence, the first section of the book emphasizes the importance of thorough history-taking and delivers concise insights into important neurological syndromes in which neuropsychological issues are particularly relevant.The second part is centered around the description of the four major neuropsychological assessment batteries, namely, the Wechsler Intelligence Scale, the Wechsler Memory Scale, the Halstead-Reitan Neuropsychological Test Battery, and the Luria Nebraska Neuropsychological Battery. The history and the development of each battery, including its subtests, are discussed, and practical instructions on how to administer and evaluate test results, how to use norms, and how to calculate correction factors for age and education are provided.The third part examines in depth the assessment and evaluation of functional domains. It provides a comprehensive overview of tests with respect to important higher cognitive functions, such as attention, visuoconstructive abilities, executive function, and emotional processes. Starting with the neuroanatomical background, this section of the book also presents patients’ sample test results and provides normative data.The fourth part is devoted to the integration of test results, treatment, and therapy planning. It culminates in a manual on how to report the neuropsychological results taken during clinical neuropsychological assessment. As in the previous chapters, this is done by presenting exemplary reports on patients.The book is extremely readable and filled with illustrative stories. Readers who have not yet invested much time in the study of neuropsychology will not have problems following the author. Groth-Marnat does a very good job in catching the readers’ attention and keeping it. This book is not only for the neuropsychological novice, however. It provides the clinical practitioner with what is needed to update and deepen his or her understanding of the field.If you are looking for a thorough introduction into neuropsychological assessment, test interpretation, and integration of neuropsychological test results, this book is well worth adding to your library. It may not be the right book if you are looking for a fast, in-depth reference in daily clinical routine, or if you are looking for a quick reference on the variety of neuropsychological tests. However, if you want a practitioner’s guide to practical test interpretation and integration, the book is definitely a very good choice.Edited by Gary Groth-Marnat. New York, John Wiley & Sons, 2000, 672 pp., $89.95. FiguresReferencesCited byDetailsCited byNone Volume 159Issue 3 March 2002Pages 502-502 Metrics History Published online 1 March 2002 Published in print 1 March 2002

Efficacy of L-Carnitine in Reducing Hyperammonaemia and Improving Neuropsychological Test Performance in Patients with Hepatic Cirrhosis

To determine the efficacy of L-carnitine in reducing hyperammonaemia and improving neuropsychological performance in patients with hepatic cirrhosis and subclinical hepatic encephalopathy (SHE). Randomised, parallel group, controlled trial. The study enrolled 31 patients with hepatic cirrhosis resulting from hepatitis C and/or hepatitis B, alcohol abuse and other causes. Patients randomised to active treatment, received oral L-carnitine 6 g/day in two divided doses for 4 weeks. Diagnosis of SHE was based on psychometric tests (subtests of the Wechsler Adult Intelligence Scale-Revised and the Halstead-Reitan Neuropsychological Test Battery) carried out at beginning and end of study. Serum ammonia levels were measured before treatment and weekly thereafter. A total of 27 patients completed the study. Sixteen patients received L-carnitine and 11 served as controls (no treatment). L-carnitine caused rapid and significant reductions in ammonia levels, sustained over the 4-week treatment period (mean reductions 60.1 and 1.4 (μmol/L in the treated and control groups, respectively). Normal ammonia levels were attained in 14 of 16 patients receiving L-carnitine. Based on psychometric test results, seven patients (43.7%) in the L-carnitine group and five (45.5%) in the control group had SHE at baseline. L-carnitine treatment for 4 weeks caused a net overall improvement in psychometric test results compared with controls. No clinically significant adverse events were reported and all patients receiving L-carnitine reported subjective improvements in their condition. RESULTS of this preliminary study indicate that L-carnitine reduces hyperammonaemia and improves the clinical symptoms of SHE in patients with hepatic cirrhosis.

Serum Dioxin and Cognitive Functioning among Veterans of Operation Ranch Hand

We used the Halstead–Reitan neuropsychological test battery, the Wechsler adult intelligence scale-revised, the Wechsler memory scale, and the wide range achievement test to assess cognitive functioning among Air Force veterans exposed to Agent Orange and its contaminant, 2,3,7,8-tetrachlorodibenzo- p-dioxin (dioxin), during the Vietnam war. The index subjects were veterans of Operation Ranch Hand (N = 937), the unit responsible for aerial herbicide spraying in Vietnam from 1962 to 1971. A comparison group of other Air Force veterans (N = 1052), who served in Southeast Asia during the same period but were not involved with spraying herbicides served as referents. Cognitive functioning was assessed in 1982, and dioxin levels were measured in 1987 and 1992. We assigned each Ranch Hand veteran to the background, low, or high dioxin exposure category on the basis of a measurement of dioxin body burden. Although we found no global effect of dioxin exposure on cognitive functioning, we did find that several measures of memory functioning were decreased among veterans with the highest dioxin exposure. These results became more distinct when we restricted the analysis to enlisted personnel, the subgroup with the highest dioxin levels. An analysis based on dioxin quintiles in the combined cohort produced consistent results, with veterans in the fifth quintile exhibiting reduced verbal memory function. Although statistically significant, these differences were relatively small and of uncertain clinical significance.

Age and Neuropsychological Status Following Exposure to Violent Nonimpact Acceleration Forces in MVAs

ABSTRACT Performance on the Halstead-ReitanNeuropsychological Test Battery (HRB) was analyzed for 33 ind viduals, aged 20 to 69, who had been subjected to violent aceeleration forces in motor vehicle accidents . Age was considered as a continuous variable and correlated with single and compos ite HRB measures. With the one exception of the Left Neuropsychological Deficit Scale (NDS) score, agere lated de cline was consistently demonstrated by com positeHRB scores (i.e., Gen eralNDS, Right NDS, Level of Performance NDS, Pathognomonic SignNDS, Pattern NDS, Right-Left Differ enceNDS, and Halstead Impairment Index). In contrast, most single non-composite HRB measures did not refleet a substantive relation ship between age andperformance. Single-score exceptions were the Total Time, Memory and Local ization measures of the Tactual Perfor mance Test (TPT), Category Test scores, and left auditory suppression. Most significant correlations represented linear relationships, but non-lin earrelation ships with age were found for the Total and Localization scores of the TPT. In general, composite measures rather than single scores of the HRB appear to be sensitive to the effects of age invietims of nonimpact aceeleration forces.