title: Evidence for added value of baseline testing in computer-based cognitive assessment.
abstract: BACKGROUND
  Large-scale baseline cognitive assessment for individuals at risk for concussion is a common part of the protocol for concussion-surveillance programs, particularly in sports. Baseline cognitive testing is also being conducted in US military service members before deployment. Recently, the incremental validity of large-scale baseline cognitive assessment has been questioned.
  
  
  OBJECTIVE
  To examine the added value of baseline cognitive testing in computer-based neuropsychological assessment by comparing 2 methods of classifying atypical performance in a presumed healthy sample.
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  Military base.
  
  
  METHODS
  Military service members who took the Automated Neuropsychological Assessment Matrix (ANAM) before and after deployment (n = 8002).
  
  
  METHODS
  Rates of atypical performance in this healthy, active-duty sample were determined first by comparing postdeployment scores with a military normative database and then with each individual's personal baseline performance using a reliable change index.
  
  
  RESULTS
  Overall rates of atypical performance were comparable across these 2 methods. However, these methods were highly discordant in terms of which individuals were classified as atypical. When norm-referenced methods were used, 2.6% of individuals classified as normal actually demonstrated declines from baseline. Further, 65.7% of individuals classified as atypical using norm-referenced scores showed no change from baseline (ie, potential false-positive findings).
  
  
  CONCLUSIONS
  Knowing an individual's baseline performance is important for minimizing potential false-positive errors and reducing the risks and stresses of misdiagnosis.
authors.affiliation: Cognitive Science Research Center, University of Oklahoma, 3200 Marshall Avenue, Suite 260, Norman, OK 73072, USA. tresa@ou.edu
authors.forename: Tresa M
authors.initials: TM
authors.lastname: Roebuck-Spencer
authors.forename: Andrea S
authors.initials: AS
authors.lastname: Vincent
authors.forename: Robert E
authors.initials: RE
authors.lastname: Schlegel
authors.forename: Kirby
authors.initials: K
authors.lastname: Gilliland
mesh_terms: D003072:Cognition Disorders / Q000175:diagnosis*; D003430:Cross-Sectional Studies; D003936:Diagnosis, Computer-Assisted; D006801:Humans; D008889:Military Personnel; D009483:Neuropsychological Tests; D012016:Reference Values