title: Prospective, Head-to-Head Study of Three Computerized Neurocognitive Assessment Tools (CNTs): Reliability and Validity for the Assessment of Sport-Related Concussion.
abstract: Limited data exist comparing the performance of computerized neurocognitive tests (CNTs) for assessing sport-related concussion. We evaluated the reliability and validity of three CNTs-ANAM, Axon Sports/Cogstate Sport, and ImPACT-in a common sample. High school and collegiate athletes completed two CNTs each at baseline. Concussed (n=165) and matched non-injured control (n=166) subjects repeated testing within 24 hr and at 8, 15, and 45 days post-injury. Roughly a quarter of each CNT's indices had stability coefficients (M=198 day interval) over .70. Group differences in performance were mostly moderate to large at 24 hr and small by day 8. The sensitivity of reliable change indices (RCIs) was best at 24 hr (67.8%, 60.3%, and 47.6% with one or more significant RCIs for ImPACT, Axon, and ANAM, respectively) but diminished to near the false positive rates thereafter. Across time, the CNTs' sensitivities were highest in those athletes who became asymptomatic within 1 day before neurocognitive testing but was similar to the tests' false positive rates when including athletes who became asymptomatic several days earlier. Test-retest reliability was similar among these three CNTs and below optimal standards for clinical use on many subtests. Analyses of group effect sizes, discrimination, and sensitivity and specificity suggested that the CNTs may add incrementally (beyond symptom scores) to the identification of clinical impairment within 24 hr of injury or within a short time period after symptom resolution but do not add significant value over symptom assessment later. The rapid clinical recovery course from concussion and modest stability probably jointly contribute to limited signal detection capabilities of neurocognitive tests outside a brief post-injury window. (JINS, 2016, 22, 24-37).
authors.affiliation: 1Medical College of Wisconsin,Milwaukee,Wisconsin.
authors.forename: Lindsay D
authors.initials: LD
authors.lastname: Nelson
authors.affiliation: 1Medical College of Wisconsin,Milwaukee,Wisconsin.
authors.forename: Ashley A
authors.initials: AA
authors.lastname: LaRoche
authors.affiliation: 1Medical College of Wisconsin,Milwaukee,Wisconsin.
authors.forename: Adam Y
authors.initials: AY
authors.lastname: Pfaller
authors.affiliation: 1Medical College of Wisconsin,Milwaukee,Wisconsin.
authors.forename: E Brooke
authors.initials: EB
authors.lastname: Lerner
authors.affiliation: 1Medical College of Wisconsin,Milwaukee,Wisconsin.
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Hammeke
authors.affiliation: 3Loyola University Medical School,Maywood,Illinois.
authors.forename: Christopher
authors.initials: C
authors.lastname: Randolph
authors.affiliation: 4New York University School of Medicine,New York,New York.
authors.forename: William B
authors.initials: WB
authors.lastname: Barr
authors.affiliation: 5University of North Carolina at Chapel Hill,Chapel Hill,NC.
authors.forename: Kevin
authors.initials: K
authors.lastname: Guskiewicz
authors.affiliation: 1Medical College of Wisconsin,Milwaukee,Wisconsin.
authors.forename: Michael A
authors.initials: MA
authors.lastname: McCrea
mesh_terms: D000293:Adolescent; D000704:Analysis of Variance; D001265:Athletic Injuries / Q000150:complications; D001924:Brain Concussion / Q000175:diagnosis* / Q000209:etiology; D003072:Cognition Disorders / Q000175:diagnosis* / Q000209:etiology; D003936:Diagnosis, Computer-Assisted / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D009483:Neuropsychological Tests; D012372:ROC Curve; D011930:Reaction Time / Q000502:physiology; D015203:Reproducibility of Results; D015599:Trauma Severity Indices; D055815:Young Adult
keywords: ANAM; Axon Sports; Computerized testing; Concussion; ImPACT; Sport