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Empirical methods for assessing meaningful neuropsychological change following epilepsy surgery

Published online by Cambridge University Press:  26 February 2009

Stephen M. Sawrie ,
Gordon J. Chelune ,
Richard I. Naugle  and
Hans O. Lüders
Stephen M. Sawrie
Affiliation:
Section of Neuropsychology, Department of Psychiatry and Psychology, Cleveland Clinic Foundation, Cleveland, OH 44195 Department of Veterans Affairs Medical Center, Cleveland, OH 44106
Gordon J. Chelune
Affiliation:
Section of Neuropsychology, Department of Psychiatry and Psychology, Cleveland Clinic Foundation, Cleveland, OH 44195
Richard I. Naugle
Affiliation:
Section of Neuropsychology, Department of Psychiatry and Psychology, Cleveland Clinic Foundation, Cleveland, OH 44195
Hans O. Lüders
Affiliation:
Section of Epilepsy and Sleep Disorders, Department of Neurology, Cleveland Clinic Foundation, Cleveland, OH 44195
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Abstract

Traditional methods for assessing the neurocognitive effects of epilepsy surgery are confounded by practice effects, test-retest reliability issues, and regression to the mean. This study employs 2 methods for assessing individual change that allow direct comparison of changes across both individuals and test measures. Fifty-one medically intractable epilepsy patients completed a comprehensive neuropsychological battery twice, approximately 8 months apart, prior to any invasive monitoring or surgical intervention. First, a Reliable Change (RC) index score was computed for each test score to take into account the reliability of that measure, and a cutoff score was empirically derived to establish the limits of statistically reliable change. These indices were subsequently adjusted for expected practice effects. The second approach used a regression technique to establish “change norms” along a common metric that models both expected practice effects and regression to the mean. The RC index scores provide the clinician with a statistical means of determining whether a patient's retest performance is “significantly” changed from baseline. The regression norms for change allow the clinician to evaluate the magnitude of a given patient's change on 1 or more variables along a common metric that takes into account the reliability and stability of each test measure. Case data illustrate how these methods provide an empirically grounded means for evaluating neurocognitive outcomes following medical interventions such as epilepsy surgery. (JINS, 1996, 2, 556–564.)

Keywords

Temporal lobe epilepsyMemoryReliable changePractice effectsRegression to the mean
Type
Research Article
Information
Journal of the International Neuropsychological Society , Volume 2 , Issue 6 , November 1996 , pp. 556 - 564
Copyright
Copyright © The International Neuropsychological Society 1996

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