Final Analysis of a Selected Test

Neuropsychological Assessment Battery (NAB)

Toni L. Hagen

Capela University

Introduction

When it comes to neuropsychology, concentration and memory issues are some of the most common complaints presented to the neuropsychologist, (Bowler, Rosemarie M. (2017).

Being able to utilize all these tests are very helpful in treatment and understanding of neuro issues but it is very important to use a test that is backed up with reliability or validity. NAB testing is going to be able to validity in cognitive changes with a variety of topics to test.

Neuropsychological Assessment Battery (NAB)

For this article it focuses on the study of validity of self-reported concentration and memory problems in individuals exposed to manganese (Mn). The individuals that were assessed for testing were mainly white, aged from 30-64. NAB testing is used in this article to address the neurotoxic effects of air-Mn in residents living near a ferromanganese (Bowler, Rosemarie M. (2017). Patients for this study completed a health questionnaire along with a psychiatric symptom inventory (Bowler, Rosemarie M. (2017). The questionnaire consisted of using (“Yes” or “No”) with individuals experiencing “difficulty concentrating” or “trouble remembering things”. This type of test is a 5-point scale system that addresses “how much the issue has bothered or distressed” the individual. With numbers of bivariate correlations examined, adjustments for multiple comparisons were made using the Benjamin-Hochberg false analysis to provide a more insignificant hypothesis test (Bowler, Rosemarie M. (2017). Strengths regarding this test include; strict exclusion criteria, administered by highly trained psychometricians, and restricted age range 30-64 years which minimizes the possibility of a bias selection (Bowler, Rosemarie M. (2017). Limitations of this study were found in the lack of personality measures to be able to measure long-term personality traits that help with results of their cognitive abilities (Bowler, Rosemarie M. (2017). Being able to understand these personalities better would be able to better determine depression and anxiety among cognitive impairment. There also had been no data collection between 2009 and 2011 that would have been helpful with test results when the collection started in 2011 (Bowler, Rosemarie M. (2017). Furthermore, this test concluded that alder individuals along with middle-aged people, appear to misunderstand their actual levels of cognitive dysfunction (Bowler, Rosemarie M. (2017).

NAB is also used in early detection of Alzheimer’s Disease (AD), which causes rapid decline in non-memory cognitive domains and later leads to deterioration of most or all aspects of cognitive functioning (Gavett, B. E., Ozonoff, A.L., Doktor, V., Palmisano, J., Nair, A. K., Green, R. C., Stern, R. A. (2010). NAB testing is used in order to catch this disease earlier so the individual can use therapeutic agents to help modify the disease course of AD (Gavett, B. E., Ozonoff, A.L., Doktor, V., Palmisano, J., Nair, A. K., Green, R. C., Stern, R. A. (2010). Individuals chosen for this study were taken from a longitudinal research registry on aging and dementia from the Boston University Alzheimer’s Disease Core Center (Gavett, B. E., Ozonoff, A.L., Doktor, V., Palmisano, J., Nair, A. K., Green, R. C., Stern, R. A. (2010). For this study people were divided into three different groups based off their NAB listing learning test performance (Gavett, B. E., Ozonoff, A.L., Doktor, V., Palmisano, J., Nair, A. K., Green, R. C., Stern, R. A. (2010). Age, sex, and education were demographically corrected with T-scores from the NAB were entered into the ordinal regression algorithm, which returns probability values for the suspected diagnoses of control, MCI, and AD (Gavett, B. E., Ozonoff, A.L., Doktor, V., Palmisano, J., Nair, A. K., Green, R. C., Stern, R. A. (2010). The three groups that were assigned had 167 participants in a controlled group, 58 in an MCI group, and 26 to an AD group. Time 0 is baseline which control group had 84%, MCI resulted at 50.1% and AD was 85.7% (Gavett, B. E., Ozonoff, A.L., Doktor, V., Palmisano, J., Nair, A. K., Green, R. C., Stern, R. A. (2010). Six types of variables were chosen; NAB measures episodes of memory, WAIS-R measures intelligence, Digit Symbol Coding to measure attention and processing speed, VOT measuring visuospatial functioning, and Trial Making Test-Part measuring executive functioning (Gavett, B. E., Ozonoff, A.L., Doktor, V., Palmisano, J., Nair, A. K., Green, R. C., Stern, R. A. (2010). These six variables were chosen due to the fact they provide a valid representation of each cognitive domain (Gavett, B. E., Ozonoff, A.L., Doktor, V., Palmisano, J., Nair, A. K., Green, R. C., Stern, R. A. (2010). Longitudinal regression models were used to differentiate the change of rate over three annual time points (Gavett, B. E., Ozonoff, A.L., Doktor, V., Palmisano, J., Nair, A. K., Green, R. C., Stern, R. A. (2010). During the process of reading this article, it doesn’t go into detail of why the NAB testing is more valid than others.

Susac syndrome is a rare condition that hits that encephalopathy, branch retinal artery occlusion, and sensorineural hearing loss (Barritt, Andrew W. (01/02/2019). The study was conducted on a male 21 years of age that showed severe encephalopathy and later showed more of Susac symptoms (Barritt, Andrew W. (01/02/2019). The man started presenting with worsening symptoms; confusion, anxiety, panic attacks, migrainous headaches, and collapses (Barritt, Andrew W. (01/02/2019). Routine exams were done and responses to simple questions slow and sometimes nonsensical, wasn’t able to complete a three-stage command, and focus on person and place were poor (Barritt, Andrew W. (01/02/2019). Routine blood draws were done to check CBC levels to tumor markers and anti-neuronal antibodies along with MR brain imaging to tract abnormalities (Barritt, Andrew W. (01/02/2019). NAB testing was conducted prior to giving the man an immunosuppressive regimen with six intravenous cyclophosphamide infusions 3 weekly intervals (Barritt, Andrew W. (01/02/2019). Mycophenolate mofetil was given along with other treatment regimens, the steroid therapy was weaned down to none over a 6-month time frame (Barritt, Andrew W. (01/02/2019). To monitor systems, the patient was admitted to 6-month stay at a rehabilitation center, along with outpatient occupational therapy. After 12 months patient showed improvement to levels of functioning, enabling the patient to be able to return to the university (Barritt, Andrew W. (01/02/2019). During that time cognitive screening was conducted, results of ACE-R score of 54/100 and using NAB testing. NAB and RBANS showed almost the same results overall scores of 60 and 61(Barritt, Andrew W. (01/02/2019). Results showed patient was deficit in language, attention, delayed recall, and visuospatial processing, following these results additional testing was done and showed impaired verbal fluency and cognitive flexibility (Barritt, Andrew W. (01/02/2019). The patient had a follow up two years later and showed improved results; baseline scores are in parentheses (Barritt, Andrew W. (01/02/2019).

Reflecting on the data given, the assessment was over-inclusive with the focus to collect data for a rare condition which there is minimal neuropsychological data (Barritt, Andrew W. (01/02/2019). NAB and RBANS showed very similar scores at baseline and total scores at follow-up. Both these tests are able to diagnose an overall level of cognitive impairment but the nature of NAB makes it easier to understand deficit and interpreting the context of intellectual ability (Barritt, Andrew W. (01/02/2019).

NAB was developed by Consortium to Establish a Registry for Alzheimer’s disease to assess cognitive deficits in Alzheimer’s disease (AD), Luck, Tobias (2018). The NAB test focuses on change in memory, language, praxis and general intellectual status along with being able to examine deficits throughout the course of the disease (Luck, Tobias (2018). Starting from a baseline, data was collected from 10,000 random German-speaking individuals ranging in age from 40-79. All participants went through verbal fluency test, and animals and trail making test, individuals 60+ years were administered the NAB testing (Luck, Tobias (2018). Testing focused on verbal fluency test-animals, mini-mental state examination, word list learning, word list recall, word list recognition, constructional praxis copying, constructional praxis recall, trail making test and verbal fluency test (Luck, Tobias (2018). NAB test was taken in order to collect data on a group of individuals and using all that data for information. Including the other tests, has improved the overall information provided and researchers are able to understand/collect more data. A table is shown with NAB results, (Luck, Tobias (2018).

Results have shown that age, sex, and education need to be measured to have an accurate interpretation of dementia-free adult’s cognitive performance (Luck, Tobias (2018). It is difficult to compare NAB values with already available reference values. This is due to the fact that reference values are categorized differently across studies. NAB results are reliant on inclusion and exclusion criteria for the selection of calculating the reference values. Exclusion data was different compared to other research data, NAB testing is more sensitive because it is stricter being able to have more accurate results (Luck, Tobias (2018).

Conclusion

Reviewing different articles, using NAB testing is very beneficial when studying cognitive functioning and following the effects Alzheimer’s disease. NAB testing made it easier to track the deficits within individuals and thus being able to minimize symptoms and slow down deterioration. NAB testing consists of six modules, a screening module and five domain specific modules: attention, language, memory, spatial and executive forms. Having multiple domains to use allows NAB testing to be more flexible with testing and allowing for more detailed results.

References