Repeatable Battery For The Assessment Of Neuropsychological Status Performance Research Articles

34 Variability in RBANS Performance and Neurocognitive Impairment in Older Adults with Cognitive Concerns

Objective:Risk factors that contribute to brain pathology and cognitive decline among older adults include demographic factors (e.g., age, educational attainment), genetic factors, health factors, and depression (Plassman et al., 2010). Variability within an individual’s performance across cognitive tasks is referred to as dispersion (Hultsch et al., 2002), which appears sensitive to subtle cognitive impairments associated with neurodegenerative pathology in older adults (Bangen et al., 2019; Kälin et al., 2014). Thaler and colleagues (2015) found that dispersion across domains of the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) was a useful indicator of cognitive changes associated with cardiovascular disease and mortality. Also, research by Manning and colleagues (2021) found that elevated ratings of depression and anxiety in older adults was associated with greater dispersion across neuropsychological testing. The present study aimed to replicate findings that greater dispersion in neuropsychological performance is associated with impaired neurocognitive performance and greater self-reported depression among older adults who present for neuropsychological evaluation with cognitive concerns.Participants and Methods:Neuropsychological testing data was obtained from a university hospital. Chart reviews were conducted on 369 participants who met initial criteria (60 years or older with testing data from the RBANS Form A, Wechsler Test of Adult Reading, and Geriatric Depression Scale [GDS]). Retrospective analyses were conducted on a final sample of 293 participants from 60 to 94 years old (Mage = 74.41, SDage = 7.43; 179 females, 114 males). Diagnoses were used for group comparisons between cognitively intact individuals with subjective cognitive complaints (SCC, n = 49), persons with Mild Neurocognitive Disorder (mND, n =137), and persons with Major Neurocognitive Disorder (MND, n = 107).Results:As expected, results indicated that higher dispersion was related to lower Total RBANS Scores (r = -0.54, p < .001) and significant differences across diagnostic groupings (F(2, 289) = 29.19, p < 0.001; SCC, mND, MND) indicated that variability in performance was an indicator of greater neurocognitive impairment. Contrary to expectations, greater dispersion was very weakly associated with lower reported depressive symptomatology (r = -0.13, p = 0.03). A three-stage hierarchical linear regression was conducted with the RBANS Coefficient of Variation (CoV) as the dependent variable and three predictor variables (Age, Total RBANS, Total GDS). The regression analysis results indicated that age was not a significant predictor, but both Total RBANS and GDS Scores were. The most important predictor was Total RBANS Scores which uniquely explained 21% of the variation in dispersion.Conclusions:This study adds to the current literature regarding the clinical utility of dispersion in neuropsychological performance as an indicator of early and subtle neurocognitive impairment. Depressive symptom reporting was expected to help predict the degree of variability, but this factor was only weakly associated with the RBANS CoV.Limitations of this study include its retrospective use of archival data and the restricted range on some variables of interest. Further research is needed to examine the relative utility of different measures of dispersion and why increased cognitive performance variability is related to neurocognitive impairment and decline.

Using RBANS to characterize cognitive treatment response in autoimmune encephalopathy

IntroductionAutoimmune encephalopathy (AE) is an increasingly recognized cause of cognitive impairment. This study investigates the use of the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) to characterize treatment response of AE cognitive symptoms in ambulatory clinical practice. MethodsRetrospective evaluation of 29 consecutive patients treated for AE at the University of Cincinnati Memory Disorders Clinic. All patients underwent RBANS before treatment and 4–5 weeks after treatment. The Reliable Change index and clinically meaningful improvement method were used to determine if changes in RBANS performance were clinically significant. ResultsClinically meaningful improvement was seen in 20 out of 29 (69 %) subjects on one or more RBANS domains and in 13 patients (45 %) for the global RBANS index. Measured improvement on one or more cognitive domain scores showed excellent agreement with clinical impression of change. ConclusionThe RBANS provided an efficient and effective means to document cognitive outcomes and treatment response in AE. The brief administration time, availability of normative data, and alternate versions make the RBANS useful in clinical practice and in clinical research related to AE.

A-125 Sex Moderates the Positive Effects of Sleep Schedule Consistency on Cognitive Function

Abstract Objective: Negative effects of reduced sleep duration and consistency on cognition are well-known. It is also well-known that both decline with age. While emerging research finds that sex interacts with sleep duration, less is known about whether sex interacts with sleep schedule consistency to predict cognitive performance. We hypothesized that reduced sleep consistency would negatively impact cognitive performance and that women would be less affected by inconsistent sleep based on suggested protective effects of brain organization in sleep-deprived women (Corsi-Carbrera et al., 2003). Methods: Participants (N = 77, 96.3% White) were selected from a parent study of community-dwelling older adults. Inclusion criteria: complete demographic data, Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) index scores, and self-reported sleep data. The sample was majority female and well-educated. Results: RBANS performance and sleep measures were within normal limits (see Table). There was a significant main effect of sleep consistency across all RBANS scores, controlling age, education, and sleep duration. There were significant main effects of sex on Immediate Memory, Attention, and Total score. Interactions between sleep consistency and sex were significant for Immediate Memory, Delayed Memory, and Total score. Conclusions: Sleep consistency is associated with better cognitive performance across domains. Women perform better than men globally and in domains of immediate memory and attention, regardless of consistency. Women who sleep consistently are most likely to exhibit better memory and global cognitive function. Findings extend sleep duration effects on cognitive function to variability and suggest consistency may benefit women more than men.

Predicting biomarkers in intact older adults and those with amnestic Mild Cognitive Impairment, and mild Alzheimer’s Disease using the Repeatable Battery for the Assessment of Neuropsychological Status

ABSTRACT Introduction: The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) has been associated, to varying degrees, with commonly used biomarkers of Alzheimer’s disease (AD). Given the ease of RBANS administration as a screening tool for clinical trials and other applications, a better understanding of how RBANS performance is associated with presence of APOE ε4 allele[s], cerebral amyloid burden, and hippocampal volume is warranted. Method: One hundred twenty-one older adults who were classified as intact, amnestic Mild Cognitive Impairment, or mild AD underwent cognitive assessment with the RBANS, genetic analysis, and quantitative brain imaging. APOE ε4 carrier status, 18F-Flutemetamol composite standardized uptake value ratio (SUVR), and hippocampal volume were each regressed on demographic variables and RBANS Total Scale score, Index scores, and subtest scores. Results: Lower RBANS Total Scale score or Delayed Memory Index (DMI) predicted the presence of APOE ε4 allele[s], higher cerebral amyloid burden, and lower hippocampal volumes. DMI was a slightly better predictor than Total Scale score for most AD biomarkers. No demographic variables consistently contributed to these models. Conclusions: The RBANS – DMI in particular – is sensitive to AD pathology. As such, it could be used as a predictive tool, particularly in clinical drug trials to enrich samples prior to less accessible AD biomarker investigation.

The Clinical Utility of the NAB Judgment Subtest Among Individuals Diagnosed With Schizophrenia Spectrum Disorder Within a Forensic Inpatient Setting.

Executive functioning (EF) has been identified as a significant predictor in determining competence to stand trial. Individuals deemed incompetent to stand trial are provided a limited time frame before conservatorship is considered, thus, treatment providers practicing within inpatient facilities have a responsibility to efficiently identify factors that may lead to prolonged hospitalizations, in order to avoid delays in a defendant's legal proceedings. Although previous studies have demonstrated the utility of the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) Total Index Score in predicting length of stay (LOS), the Neuropsychological Assessment Battery (NAB) Judgment subtest provides a measure of executive function, which is a domain not captured by the RBANS. The current study examined the relationship between both the RBANS and NAB Judgment performance as predictors of LOS among 63 individuals diagnosed with schizophrenia spectrum disorders undergoing competency restoration treatment. Additionally, sensitivity analyses were used to determine cutoff scores for individuals requiring additional competency services. Results indicated that the NAB Judgment subtest was more predictive of LOS than the RBANS Total Index Score. Additionally, a raw score of ≤9 on NAB Judgment was indicative of increased LOS. These results highlight the utility of the NAB Judgment subtest within a forensic inpatient setting.

Posttraumatic Stress Disorder-Associated Cognitive Deficits on the Repeatable Battery for the Assessment of Neuropsychological Status in a Veteran Population.

Posttraumatic stress disorder (PTSD) is a frequent problem of veterans receiving care and is often associated with cognitive deficits. The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) is a well-validated cognitive screening measure often used in the US Department of Veterans Affairs (VA), particularly in neurorehabilitation settings. However, the influence of PTSD on RBANS performance is unclear, particularly within a heterogeneous VA outpatient population in which PTSD and traumatic brain injury (TBI) may not be the primary focus of care. Participants included 153 veterans with complex deployment-related health problems, including a diagnosis of PTSD (n = 98) and a history of TBI (n = 92). All veterans completed a targeted cognitive battery that included the Wechsler Test of Adult Reading, the Wechsler Adults Intelligence Scale, measure assessing processing speed, attention, and cognitive flexibility, and RBANS. A diagnosis of PTSD was associated with worse performance on the Story Recall subtest of the RBANS, but not on any other cognitive measures. A diagnosis of mild TBI, or co-occurring PTSD and TBI did not predict cognitive performance on any measures. The RBANS best captured cognitive deficits associated with PTSD compared with a history of mild TBI or co-occurring mild TBI and PTSD. These findings may provide insight into the interpretation and attribution of cognitive deficits in the veteran population.

Type I Chiari malformation, RBANS performance, and brain morphology: Connecting the dots on cognition and macrolevel brain structure.

Idiopathic descent of cerebellar tonsils into the cervical spine in Chiari malformation Type I (CMI) is typically associated with occipital headache. Accumulating evidence from experimental studies suggests cognitive effects of CMI. The aim of the current study was to examine the relationship between cognition and CMI using a battery of standardized neuropsychological and symptom inventory instruments. Eighteen untreated adults with CMI, and 18 gender, age, and education matched healthy controls completed the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), and standardized measures of pain, mood, and disability. Morphometric measurements of key neural and osseous elements were also obtained from structural brain magnetic resonance images, for correlation with symptom outcomes. CMI patients exhibited deficits in RBANS attention, immediate memory, delayed memory, and total score. After controlling for pain and associated affective disturbance, the significant group effect for RBANS attention remained. CMI patients also presented seven morphometric differences comprising the cerebellum and posterior cranial fossa compartment that differed from healthy controls, some of which were associated with self-reported pain and disability. Notably, group differences in tonsillar position were associated with self-reported pain, disability, and delayed memory. Adult CMI is associated with domain-specific cognitive change, detectable using a standard clinical instrument. The extent of cognitive impairment is independent of pain or affective symptomatology and may be related to the key pathognomonic feature of the condition. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Relationship between 18F-Flutemetamol uptake and RBANS performance in non-demented community-dwelling older adults

Objective: The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) has been used extensively for clinical care and in research for patients with mild cognitive impairment and Alzheimer’s disease (AD); however, relatively few studies have evaluated the relationship between RBANS performance and AD imaging biomarkers. The purpose of the current study was to evaluate the association between a relatively new amyloid positron emission tomography imaging biomarker and performance on the RBANS. Methods: Twenty-seven nondemented community-dwelling adults over the age of 65 underwent 18F-Flutemetamol amyloid– positron emission tomography imaging, along with cognitive testing using the RBANS and select behavioral measures. Partial correlation coefficients were used to identify relationships between the imaging and behavioral markers. Results: After controlling for age and education, amyloid deposition and RBANS Indexes of Immediate Memory, Delayed Memory, and Total Scale score were significantly correlated (p’s < .001, r’s = −.73 to −.77, d’s = 2.13–2.39), with greater amyloid burden being associated with lower RBANS scores. The Delayed Memory Index was particularly highly associated with 18F-Flutemetamol binding (r2 = .59, p < .001, d = 2.39). Neither 18F-Flutemetamol binding nor RBANS performance was significantly correlated with levels of depression, subjective cognitive difficulties, or premorbid intellect. Conclusions: Because of the limited use of amyloid imaging in clinical settings due to high cost and lack of reimbursement, these findings suggest that in particular RBANS Delayed Memory Index may be a cost-efficient tool to identify early signs of AD pathology, and its use may enlighten clinical decision-making regarding potential progression to dementia due to AD.

Depression and performance on the Repeatable Battery for the Assessment of Neuropsychological Status

ABSTRACTThere is strong evidence that depression is associated with neuropsychological deficits across multiple domains. However, research on this topic has spanned a variety of measures with different psychometric properties and normative samples, which prevents drawing definitive conclusions about the pattern of neuropsychological deficiencies. The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) is a brief neurocognitive battery that is routinely used in clinical settings and provides co-normed measures of attention, language, memory, and visuospatial/constructional skills. The present study examined the association between depression and RBANS performance in a sample of 66 18–65 year-old adults who completed a neuropsychological evaluation at an outpatient clinic. Results indicated that depressed participants, relative to controls, demonstrated poorer performance in immediate and delayed memory, attention, and visuospatial/constructional abilities, and the four domains were diminished to a similar degree. These results were replicated using a continuous measure of depression symptoms. In addition, the association between depression and delayed memory was at least partially due to current psychotropic medication. The present study suggests that the RBANS is sensitive to the neuropsychological deficits typically found in depression, such that mild to moderate depression in adult outpatients is associated with comparable deficits in attention, memory, and visuospatial/constructional abilities.

Cognition and Competency Restoration: Using the RBANS to Predict Length of Stay for Patients Deemed Incompetent to Stand Trial

Intact cognition is a foundational component of one’s ability to be competent to stand trial. Given the cost of assessing and treating incompetence, it is recommended that clinicians develop efficient methods to identify individuals who are most likely to require intensive competence-related treatment interventions. This study sought to ascertain whether a brief cognitive screening instrument, the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), could predict the length of stay required to restore trial competency among 288 forensic psychiatric inpatients undergoing competency restoration treatment. Results indicated that incompetent defendants who were older or demonstrated poorer overall RBANS performance required longer hospitalizations to be deemed restored to trial competence. Interestingly, incompetent defendants scoring in the 51–60 range on the RBANS Total Scale Index were almost three times more likely to require hospitalization beyond the average length of stay. Findings support the use of the RBANS to identify individuals early in the treatment process who may require and benefit from intensive restoration treatment.

Normative data for the repeatable battery for the assessment of neuropsychological status in elderly Chinese.

Asia will experience a surge in dementia prevalence within the next 20-40 years, but there is a dearth of well-normed neuropsychological tests that could assist with dementia diagnosis. Here, we report normative data for the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) in Elderly ethnic Chinese Singaporeans aged 55-91 years of age. A total of 1,165 male and female community-dwelling, cognitively normal elderly Chinese persons in Singapore, with varying levels of education and range of languages, were tested with the RBANS version A. The effects of age, education, language and gender on RBANS performance were examined. Negative effects of increased age and positive effects of education on the RBANS subtests, Index and Total Scale scores were found suggesting differential associations between age-related cognitive decline and education that vary according to the specific cognitive ability measured. The findings indicate that unique cultural and educational profile of elderly Chinese should be considered when applying the RBANS in this population.

The Effect of Moderate to Heavy Alcohol Consumption on Neuropsychological Performance as Measured by the Repeatable Battery for the Assessment of Neuropsychological Status

Excessive alcohol use is associated with damage to the structure and function of the brain and impairment of cognition and behavior. Traditional test batteries used to assess cognitive performance in alcoholics are extensive and costly, limiting their use across various clinical and research settings. The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) is a relatively new instrument that attempts to overcome some of these limitations. As yet the individual effect of moderate to heavy alcohol consumption on RBANS performance has not been examined. The primary aim of this study was to explore and quantify differences in performance between controls and drinkers on the RBANS and to examine the influence of age, gender, and alcohol use patterns on test performance. Data from a subset of "Using Our Brains" (UoB) donors (n = 28) still actively drinking and meeting criteria for moderate to heavy alcohol use (30 to 80 g of ethanol per day) (Harper, 1988) and 28 matched controls (age, education, and premorbid Intelligence Quotient) were compared. Participants in the alcohol group performed below the healthy control group on the visuospatial and immediate memory index, and also on the RBANS total score p < 0.001 and showed a greater decline in RBANS scores from estimated cross-sectional premorbid levels. There was a positive association between alcohol ingestion in the preceding 12 months and the language index p < 0.03 and the semantic fluency subtest (p < 0.03). Age was negatively associated with story memory (p < 0.02), coding (p < 0.001), list recognition (p < 0.01), story recall (p < 0.03), and figure recall (p < 0.02). Our results suggest that the RBANS is able to detect and characterize differences in verbal fluency, visuospatial skills, components of declarative memory, and psychomotor speed between healthy controls and moderate to heavy active alcohol users. Executive functions, commonly affected by alcoholism and not included in the RBANS, require assessment with additional measures.

Battery for assessment of neuropsychological status (RBANS) in schizophrenia: a pilot study in the Spanish population.

The aims of this study were to research the following issues in a Spanish population of patients with schizophrenia. (a) The sensitivity and reliability of the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) to detect cognitive impairment in schizophrenia. (b) The convergent validity of RBANS on a larger battery of neuropsychological tests sensitive to the cognition disorders typically observed in schizophrenia. (c) The correlates of poor performance in RBANS with clinical features and illness severity. Thirty schizophrenia patients, 30 non-psychotic patients and 30 healthy participants were assessed using RBANS (form A). We administered a battery of neuropsychological tests and four scales to evaluate patient's clinical status. Schizophrenia patients and non-psychotic patients performed significantly worse than healthy controls on RBANS, and schizophrenia patients performed slightly worse than non-psychiatric controls, but this difference was not significant. Good inter-test reliability and concurrent validity were found. Only a moderate correlation between RBANS performance and illness severity was observed. RBANS revealed coherence in identifying cognitive impairment in schizophrenia patients of a different cultural background, and it is shown to be a sensitive, valid and easy-to-perform tool for the neuropsychological assessment of Spanish patients with schizophrenia.

Premorbid Intellect and Current RBANS Performance: Discrepancy Scores in Three Geriatric Samples

Assessing cognitive change during a single visit requires the comparison of estimated premorbid abilities and current neuropsychological functioning. As newer instruments are developed to measure current cognitive functioning, their relationships with premorbid estimates need to be evaluated. The current study examined the clinical utility of discrepancy scores between an estimate of premorbid intellect derived from demographic variables (i.e., Barona) and the Total score on the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) in three geriatric samples. A large community-dwelling “control” sample and two clinical samples were examined. As expected, there was little difference between estimated premorbid intellect and current RBANS Total Scale scores in the community-dwelling sample, while estimated premorbid intellect obtained from the two clinical samples significantly differed from obtained RBANS Total scores. Similar findings were observed on Discrepancy scores for the five Indexes of RBANS. The current findings, along with normative data on these discrepancy scores, can provide additional confidence for clinicians and researchers who need to determine cognitive decline when using these screening measures of neuropsychological status.

Repeatable Battery for the Assessment of Neuropsychological Status (RBANS): Preliminary Australian normative data

The aim of the present study was to establish demographically adjusted normative data for the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) in an Australian context. RBANS data from 172 healthy Australian community dwelling adults enrolled in the “Using our Brains” (UoB) Brain Tissue Donor program between April 2002 and September 2005 were included in this study. The present study group differed from the original North American normative sample on all 12 subtests and five RBANS indices. Education and to a lesser degree age were related to RBANS performance. The present study provides complementary RBANS normative data for clinicians and researchers when interpreting RBANS results for Australian individuals closely matching those reported in this study.

RBANS Performance: Influences of Sex and Education

A sample of 278 men and 353 elderly women who resided in the community received the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) as part of a study of health in mature adult Oklahomans. Females attained significantly higher scores on the Immediate and Delayed Memory and the Language Indexes. Males performed better on the Visuospatial/Construction Index, but there was no sex difference on the Attention or Total Indexes. Differences related to sex were modest (2–6 Index points), but combined with the larger effects of education could lead to an adjustment of up to 11 Index points.