Intra-individual Cognitive Variability: An Examination of ANAM4 TBI-MIL Simple Reaction Time Data from Service Members with and without Mild Traumatic Brain Injury

AbstractObjectives:The Automated Neuropsychological Assessment Metrics 4 TBI-MIL (ANAM4) is a computerized cognitive test often used in post-concussion assessments with U.S. service members (SMs). Existing evidence, however, remains mixed regarding ANAM4’s ability to identify cognitive issues following mild traumatic brain injury (mTBI). Studies typically examine ANAM4 by comparing mean scores to baseline or normative scores. A more fine-grained approach involves examining inconsistency within an individual’s performance.Methods:Data from a sample of 231 were healthy control SMs and 100 SMs within 7 days of mTBI who took the ANAM4 were included in analyses. We examine each individual’s performance on a simple reaction time (SRT) subtest that is administered at the beginning (SRT1) and end (SRT2) of the ANAM4 battery, and calculate the standard deviation of difference scores by trial across administrations.Results:Multivariate analysis of variance and univariate analyses revealed group differences across all comparisons (p<.001) with pairwise comparisons revealing higher intra-individual variability and slower raw reaction time for the mTBI group compared with controls. Effect sizes were small though exceeded the recommended minimum practical effect size (ES>0.41).Conclusions:While inconsistencies in performance are often viewed as noise or test error, the results suggest intra-individual cognitive variability may be more sensitive than central tendency measures (i.e., comparison of means) in detecting changes in cognitive function in mTBI. Additionally, the findings highlight the utility of ANAM4’s repeating a subtest at two points in a battery to explore within-subject differences in performance. (JINS, 2017,23, 1–6)

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Intraindividual Cognitive Variability: An Examination of ANAM4 TBI-MIL Simple Reaction Time Data from Service Members with and without Mild Traumatic Brain Injury

Journal of the International Neuropsychological Society ◽

10.1017/s1355617717001187 ◽

2017 ◽

Vol 24 (2) ◽

pp. 156-162 ◽

Cited By ~ 8

Author(s):

Wesley R. Cole ◽

Emma Gregory ◽

Jacques P. Arrieux ◽

F. Jay Haran

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Reaction Time ◽

Mild Traumatic Brain Injury ◽

Simple Reaction Time ◽

Service Members ◽

Cognitive Test ◽

Simple Reaction ◽

Cognitive Variability ◽

Intraindividual Cognitive Variability

AbstractObjectives:The Automated Neuropsychological Assessment Metrics 4 TBI-MIL (ANAM4) is a computerized cognitive test often used in post-concussion assessments with U.S. service members (SMs). However, existing evidence remains mixed regarding ANAM4’s ability to identify cognitive issues following mild traumatic brain injury (mTBI). Studies typically examine ANAM4 using standardized scores and/ or comparisons to a baseline. A more fine-grained approach involves examining inconsistency within an individual’s performance (i.e., intraindividual variability).Methods:Data from 237 healthy control SMs and 105 SMs within seven days of mTBI who took the ANAM4 were included in analyses. Using each individual’s raw scores on a simple reaction time (RT) subtest (SRT1) that is repeated at the end of the battery (SRT2), we calculated mean raw RT and the intraindividual standard deviation (ISD) of trial-by-trial RT. Analyses investigated differences between groups in mean RT, RT variability (i.e., ISD), and change in ISD from SRT1 and SRT2.Results:Using regression residuals to control for demographic variables, analysis of variance, and pairwise comparisons revealed the control group had faster mean RT and smaller ISD compared to the mTBI group. Furthermore, the mTBI group had a significant increase in ISD from SRT1 to SRT2, with effect sizes exceeding the minimum practical effect for comparisons of ISD in SRT2 and change in ISD from SRT1 to SRT2.Conclusions:While inconsistencies in performance are often viewed as test error, the results suggest intraindividual cognitive variability may be more sensitive than traditional metrics in detecting changes in cognitive function after mTBI. Additionally, the findings highlight the utility of the ANAM4’s repeating a RT subtest at two points in the same session for exploring within-subject differences in performance variability. (JINS, 2018,24, 156–162)

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Intraindividual cognitive variability: An examination of ANAM4 TBI-MIL simple reaction time data from service members with and without mild traumatic brain injury – RETRACTION

Journal of the International Neuropsychological Society ◽

10.1017/s1355617717001199 ◽

2018 ◽

Vol 24 (2) ◽

pp. 212-212

Author(s):

Wesley R. Cole ◽

Emma Gregory ◽

Jacques P. Arrieux ◽

F. Jay Haran

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Reaction Time ◽

Mild Traumatic Brain Injury ◽

Simple Reaction Time ◽

Reaction Time Data ◽

Service Members ◽

Time Data ◽

Simple Reaction ◽

Intraindividual Cognitive Variability

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The Effect of Traumatic Brain Injury (TBI) on Cognitive Performance in a Sample of Active Duty U.S. Military Service Members

Military Medicine ◽

10.1093/milmed/usz202 ◽

2020 ◽

Vol 185 (Supplement_1) ◽

pp. 184-189

Author(s):

Valerie J Rice ◽

Paul J Schroeder ◽

Daniel N Cassenti ◽

Gary L Boykin

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Reaction Time ◽

Cognitive Performance ◽

Military Service ◽

Simple Reaction Time ◽

Active Duty ◽

Service Members ◽

Simple Reaction ◽

Mathematical Processing

Abstract Introduction Traumatic brain injury (TBI) is considered a signature injury from the fighting in Iraq and Afghanistan. Since the year 2000, over 370,000 U.S. active duty service members have been diagnosed with TBI. Although prior research has shown that even mild forms of TBI are associated with impaired cognitive performance, it is not clear which facets of cognition (computation, memory, reasoning, etc.) are impacted by injury. Method In the present study, we compared active duty military volunteers (n = 88) with and without TBI on six measures of cognition using the Automated Neuropsychological Assessment Metric software. Results Healthy volunteers exhibited significantly faster response times on the matching-to-sample, mathematical processing, and second round of simple reaction time tasks and had higher throughput scores on the mathematical processing and the second round of the simple reaction time tasks (P < 0.05). Conclusion In this population, cognitive impairments associated with TBI influenced performance requiring working memory and basic neural processing (speed/efficiency).

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Investigating the Effect of Fatigue and Psychological Distress on Information Processing Speed in the Postacute Period After Mild Traumatic Brain Injury in Premorbidly Healthy Adults

Archives of Clinical Neuropsychology ◽

10.1093/arclin/acaa123 ◽

2021 ◽

Author(s):

Jacqueline F I Anderson ◽

Emily Cockle

Keyword(s):

Traumatic Brain Injury ◽

Psychological Distress ◽

Brain Injury ◽

Reaction Time ◽

Cognitive Load ◽

Mild Traumatic Brain Injury ◽

Processing Speed ◽

Simple Reaction Time ◽

Psychological Status ◽

Healthy Individuals

Abstract Impairments in processing speed under conditions of increasing cognitive load have been reported in individuals with mild traumatic brain injury (mTBI). In other conditions that are also associated with white matter disruption, both psychological distress and fatigue have been shown to underlie this impairment. Objective: the current study aimed to investigate whether slowing of processing abilities under conditions of greater cognitive load is independent of fatigue and psychological status in premorbidly healthy individuals with subacute mTBI. Method: using a prospective observational design, we examined 84 individuals with mTBI approximately 8 weeks after injury and 47 healthy control (HC) participants. They were assessed with the Symbol Digit Modality Test, an n-back task and a rate of gain of information choice reaction time task that conforms to Hick’s law. Participants were also assessed with measures of fatigue and psychological status. Results: as expected, findings revealed no group differences on simple reaction time tasks, but as task complexity increased, the mTBI group performed more slowly than the HC group. This group difference occurred independently of fatigue and psychological distress levels and was associated with a moderate effect size. Conclusions: during the subacute period after mTBI, premorbidly healthy individuals demonstrate impairment in their ability to rapidly process information as the cognitive load of the task increases beyond simple reaction time requirements. Examination of whether these changes affect resumption of premorbid roles is warranted.

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Assessment of Cognitive-Communicative Disorders of Mild Traumatic Brain Injury Sustained in Combat

Perspectives on Neurophysiology and Neurogenic Speech and Language Disorders ◽

10.1044/nnsld19.2.47 ◽

2009 ◽

Vol 19 (2) ◽

pp. 47-57 ◽

Cited By ~ 10

Author(s):

Christine Parrish ◽

Carole Roth ◽

Brooke Roberts ◽

Gail Davie

Keyword(s):

Traumatic Brain Injury ◽

Brain Injury ◽

Mild Traumatic Brain Injury ◽

Psychological Health ◽

Communication Disorders ◽

Service Members ◽

Patient Questionnaire ◽

Speech Language Pathologists ◽

Test Protocol ◽

Communication Deficits

Abstract Background: Mild traumatic brain injury (mTBI) is recognized as the signature injury of the current conflicts in Iraq and Afghanistan, yet there remains limited understanding of the persisting cognitive deficits of mTBI sustained in combat. Speech-language pathologists (SLPs) have traditionally been responsible for evaluating and treating the cognitive-communication disorders following severe brain injuries. The evaluation instruments historically used are insensitive to the subtle deficits found in individuals with mTBI. Objectives: Based on the limited literature and clinical evidence describing traditional and current tests for measuring cognitive-communication deficits (CCD) of TBI, the strengths and weaknesses of the instruments are discussed relative to their use with mTBI. It is necessary to understand the nature and severity of CCD associated with mTBI for treatment planning and goal setting. Yet, the complexity of mTBI sustained in combat, which often co-occurs with PTSD and other psychological health and physiological issues, creates a clinical challenge for speech-language pathologists worldwide. The purpose of the paper is to explore methods for substantiating the nature and severity of CCD described by service members returning from combat. Methods: To better understand the nature of the functional cognitive-communication deficits described by service members returning from combat, a patient questionnaire and a test protocol were designed and administered to over 200 patients. Preliminary impressions are described addressing the nature of the deficits and the challenges faced in differentiating the etiologies of the CCD. Conclusions: Speech-language pathologists are challenged with evaluating, diagnosing, and treating the cognitive-communication deficits of mTBI resulting from combat-related injuries. Assessments that are sensitive to the functional deficits of mTBI are recommended. An interdisciplinary rehabilitation model is essential for differentially diagnosing the consequences of mTBI, PTSD, and other psychological and physical health concerns.

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