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Utility of the Neuropsychological Assessment Battery in detecting cognitive impairment after unilateral stroke

Published online by Cambridge University Press:  01 July 2010

NIKKI H. STRICKER
Affiliation:
Psychology Service, Boston VA Healthcare System, Boston, Massachusetts Department of Psychiatry, Boston University School of Medicine, Boston, Massachusetts
JOSHUA M. TYBUR
Affiliation:
Department of Psychology, University of New Mexico, Albuquerque, New Mexico
JOSEPH R. SADEK
Affiliation:
Behavioral Healthcare Line, New Mexico VA Healthcare System, Albuquerque, New Mexico Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque, New Mexico
KATHLEEN Y. HAALAND
Affiliation:
Department of Psychiatry, University of New Mexico School of Medicine, Albuquerque, New Mexico Research Service, New Mexico VA Healthcare System, Albuquerque, New Mexico Department of Neurology, University of New Mexico School of Medicine, Albuquerque, New Mexico
Corresponding
E-mail address:

Abstract

This study evaluated the clinical utility of the Neuropsychological Assessment Battery (NAB) in a stroke sample by examining the NAB’s ability to differentiate a chronic stroke group with radiologically confirmed unilateral damage (n = 42) and a demographically matched healthy control (HC) group (n = 36). The stroke group performed more poorly than the control group across NAB Total score and all five Domain scores. Receiver operator curves (ROC) were derived and area under the curve (AUC) showed moderate diagnostic effectiveness (AUC .70 to .90) for NAB Total score, all five Domain scores, a motor composite, and a Global Deficit Score (GDS) that has been shown to closely approximate clinical ratings of neuropsychological impairment. The NAB Total, GDS, and motor composite had comparable clinical utility, whereas the Attention and Executive domain scores demonstrated better classification utility compared with the Memory domain. Because 90.5% of our stroke sample had middle cerebral artery territory strokes, the comparison of motor and cognitive classification utility may be biased. However, follow-up analyses showed that the NAB accounted for additional variance even when motor composite was included in the model. Sensitivity, specificity, and odds ratios at various clinical cutoffs are provided. These results suggest that the NAB is a useful clinical tool for detection of cognitive deficits in individuals with chronic unilateral stroke, although lenient clinical cutoffs appear warranted to maximize sensitivity. (JINS, 2010, 16, 813–821.)

Type
Research Articles
Copyright
Copyright © The International Neuropsychological Society 2010

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