Epub 2019 Sep 17. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Proper TOPF scoring procedures are presented. Cognitive strengths and weaknesses were identified for PBT patients. (, Evaluation of the accuracy of two regression-based methods for estimating premorbid IQ, Postscripts on premorbid ability estimation: Conceptual addenda and a few words on alternative and conditional approaches, Oklahoma premorbid intelligence estimation (OPIE): Utilization in clinical samples, Impaired National Adult Reading Test (NART) performance in traumatic brain injury, Estimation of WAISR premorbid intelligence: Current ability and demographic data used in a best-performance fashion, Clinical guide to the evidence-based assessment approach to diagnosis and treatment. Consistent with these findings were the large correlations between test performance and age, indicating that both the NART and WTAR tap crystallised knowledge (which typically improves across our sample age range) rather than fluid ability (which typically peaks in early adulthood and subsequently declines; Cattell, Citation1971). Can be used in forensic evaluations to evaluate suspected loss of cognitive functioning. [1] The number correct and time are combined into a ratio score using a Ratio Score Conversion Table included in government site. *p-value for omnibus test of group differences. Kirton JW, Soble JR, Marceaux JC, Messerly J, Bain KM, Webber TA, Fullen C, Alverson WA, McCoy KJM. Word pronunciation tests are the most commonly used hold test and have been used to estimate premorbid intelligence in a wide variety of clinical populations (Dwan, Ownsworth, Chambers, Walker, & Shum, 2015; Hanks et al., 2008; McGurn et al., 2004). In this study, we compare the precision of a range of approaches for estimating WAIS-IV full-scale IQ (FSIQ) and constituent indices and offer new combined methods that clinicians and researchers may wish to consider adopting in their work. Neuropsychological assessments are helpful in tracking changes that may affect daily functioning as cognitive impairment and dementia progress. In the present study, we examine the accuracy with which the NART and WTAR predict intelligence on the most recent revision of the Wechsler Adult Intelligence Scale (WAIS-IV), using a large sample of neurologically healthy participants (n=92). The WTAR was co-normed with the Wechsler Adult Intelligence scale, Third Edition (WAIS-III; Wechsler, 1997). Results WebTest of Premorbid Functioning Estimates amount of cognitive functioning lost due to brain injury. Analysis of participants WTAR-predicted IQ replicated these findings, with those with msevTBI improving from a predicted IQ of 88.7 (SD=14.7) to predicted IQ of 93.6 (SD=13.6), t(39)=2.97, p<.01, d=.47. It is a view-only digital file. The value of the NART and WTAR for estimating WAIS-IV index scores is more questionable, showing large correlations with the VCI and GAI but relatively modest correlations with WMI and PRI, suggesting that caution should be employed in drawing inferences about premorbid executive function and fluid ability. As expected, the msevTBI group had lower GOAT scores, t(78)=4.81, p<.001, than those with mTBI at baseline. Participants were initially assessed at 36 months post-injury and again 6 months later. Additionally, there was a positive correlation between the WTAR and change in these measures for those with msevTBI, providing additional evidence that the word-reading ability is influenced by cognitive recovery. Fifty-two participants with mild, moderate, or severe TBI were administered the ToPF and WAIS-IV between two weeks and 19 months post-injury. Bookshelf An official website of the United States government. Registered in England & Wales No. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide, This PDF is available to Subscribers Only. In Green, Melo, Christensen, Ngo, Monette and Bradbury's (2008) study, 24 patients with moderate-to-severe TBI were given the WTAR and a standard neuropsychological battery at 2 and 5 months post-injury. These tests should not be used to infer premorbid processing speed. Potential differences in demographic characteristics between control and TBI groups were analyzed using one-way analysis of variance (ANOVA; age, years of education) or Pearson's chi-square tests (gender, race). In contrast, participants with msevTBI performed significantly worse than controls on the WTAR both at baseline (p<.001, d=.99) and at 12 months post-injury (p<.01; d=.75), with a 11.25 and 8.15 raw point mean difference, respectively. Procedures were approved by the University ethics panel and followed the tenets of the Declaration of Helsinki. Since the NART (and NART-R) were published, similar tests of reading/vocabulary knowledge have also been proposed that provide predicted scores incorporating one or more demographic variables (the WTAR against WAIS-III and the TOPF against WAIS-IV). National Adult Reading Test (NART): For the assessment of premorbid intelligence in patients with dementia: Test manual. Wechsler Adult Intelligence Scale (4th ed.). The WTAR provides an accurate estimate of premorbid intellectual functioning in a variety of cognitively impaired populations (Wechsler, 2001). National Adult Reading Test (NART). Therefore, the low average WTAR score at baseline is presumably attributable to the effects of msevTBI. FOIA Correlations with PSI were comparatively poor, indicating that estimation of basic information processing speed should not be inferred on the basis of NART or WTAR scores. Reale-Caldwell A, Osborn KE, Soble JR, Kamper JE, Rum R, Schoenberg MR. Appl Neuropsychol Adult. Participants self-declared that they had no history of neurological or psychiatric disorder. Descriptive analyses, ttests, and chi-squared tests were utilized to identify and compare cognitive profiles. MeSH The current findings provide evidence for a dose-dependent effect of TBI on WTAR performance during the first year of recovery. However, such WAIS subtests may be more sensitive to neurological damage than standalone tests of word reading/knowledge, such as the NART and WTAR (Franzen et al.,Citation1997; Reynolds, Citation1997). Webintellectual functioning as their dependent variable, predicted by word reading task performance and demographics. Processing speed (PSI) has been excluded. A total of 135 participants (43 mild TBI [mTBI], 40 moderate/severe TBI [msevTBI], 52 healthy controls) were administered the WTAR at 1 and 12 months post-injury. There are a few limitations to the current study. Categories based on occupational status and education, for example, are arguably too coarse to provide an accurate premorbid IQ for a specific individual. We discuss and encourage the development of new methods for improving premorbid estimates of cognitive abilities in neurological patients. doi: 10.1093/arclin/acaa025. Although this mean change did not meet criteria for a clinically significant difference in testretest scores according to the Wechsler (2001) manual (>10.8 point difference), it should be noted that 23% individuals with msevTBI did meet this cutoff. HHS Vulnerability Disclosure, Help Results: 3, 53 The M-ACE consists of 5 items with a maximum score of 30. (Citation2002) provided evidence that the use of the NART is justified in patients with frontal lobe damage, Korsakoff syndrome, and mild or moderate stages of Alzheimers disease, and that this test outperforms demographic-derived estimates, with no additional benefit to be gained from a combination of the two methods. WebThe Test of Premorbid Functioning enables clinicians to estimate an individuals level of cognitive and memory functioning before the onset of injury or illness. Epub 2019 Sep 17. Steward: NINDS. Nevertheless, we observed considerable variability in correlations between NART/WTAR scores and individual WAIS-IV indices, which indicated particular usefulness in estimating more crystallised premorbid abilities (as represented by the verbal comprehension and general ability indices) relative to fluid abilities (working memory and perceptual reasoning indices). Although the relative utility and accuracy of these tests for many neurological conditions is unknown, Bright et al. Less commonly, Picture Completion (now a supplementary rather than core test) and Matrix Reasoning are also employed but will not be included here. This methodology has been used previously in TBI samples to provide evidence that word-reading tests are valid in the context of cognitive recovery (Green et al., 2008; Orme, Johnstone, Hanks, & Novack, 2004). Patients were excluded if they had received substance abuse treatment within 1 year of enrollment (per patient/family report) or had a preexisting diagnosed central nervous system disorder, developmental disorder, or severe psychiatric disorder. The independent ability of the ToPF/demographic score and the Verbal Comprehension Index (VCI) to predict WAIS-IV Full Scale IQ (FSIQ) was examined, as were discrepancies between ToPF and WAIS-IV scores within and between participants. Extensive training in the administration and scoring of all tests was provided to three research assistants over several days by the lead author, and the testing sessions were closely monitored and supervised to ensure full compliance with the standardised administration and scoring procedures. They concluded that the WRAT Reading subtest underestimates premorbid functioning in those with more severe head injuries during the acute recovery period. The regression equations were as follows: Figure 3. Note: Values are meanSD or n (%).GCS = Glasgow Coma Scale; GOAT = Galveston Orientation and Amnesia Test; mTBI = mild traumatic brain injury; msevTBI = moderate-to-severe traumatic brain injury; NA = not applicable. Statistically, the tests provided equally precise predictions of WAIS-IV performance, with the strongest effects observed for FSIQ, GAI and VCI. eCollection 2022. WebMCCB scores were presented in four 2-year age cohorts as T-scores for each test and cognitive domain, and analyzed for effects of age and sex. However, there was a statistically significant interaction between time and group, F(2, 132)=4.31, p<.05, partial eta2=.061, on WTAR performance. WebThe Test of Premorbid Functioning Score Report can be generated with a maximum of four assessment records. B., et al. 2000 Feb;14(1):139-45. doi: 10.1076/1385-4046(200002)14:1;1-8;FT139. This was the case for equations incorporating NART, WTAR, and the sum of these test scores (Table 5). Linear correlation between National Adult Reading Test/Wechsler Test of Adult Reading (NART/WTAR) errors and Wechsler Adult Intelligence Scale Fourth Edition (WAIS-IV) full-scale IQ (FSIQ). Psychological Corporation] for WTAR, and combined counts from [Pearson (Citation2009). To determine the viability of using a straightforward best performance approach to estimating premorbid IQ, we assessed variability in performance across WAIS-IV subtests and indices in our neurologically healthy sample. By definition, psychometric intelligence predicts performance across all cognitive domains, but in practice such generalised inferences are likely to be problematic in many cases. 2021 Apr;28(3):994-1003. doi: 10.1177/1073191119887441. 2014 Sep;27(3):148-54. doi: 10.1097/WNN.0000000000000035. Windsor: NFER-Nelson. This approval level enables you to buy all our assessments. 2020 Jan;34(1):43-52. doi: 10.1037/neu0000569. WebTest of Pre-morbid Functioning Score Report Examinee Name Client D Date of Report 02-22-10 Test of Pre-morbid Functioning Score Summary Raw Score Standard Score Premorbidity refers to the state of functionality prior to the onset of a disease or illness. Although it is important to note that total citation counts will be biased towards longer established tests, they clearly demonstrate continued use of the NART and the WTAR, despite some indication that the TOPF is gaining popularity. To request a reprint or commercial or derivative permissions for this article, please click on the relevant link below. Weaker correlations were observed against WMI and PRI. Joseph AC, Lippa SM, McNally SM, Garcia KM, Leary JB, Dsurney J, Chan L. Appl Neuropsychol Adult. Bold values indicate significance at p < .05. The development of standardised tools such as the NART and WTAR has undoubtedly improved the ability to predict meaningful baseline levels of performance so that the impact of a neurological condition on cognition can be judged. Despite similar demographic profiles, participants with msevTBI performed significantly worse than controls on the WTAR at both time points. The published NART/NART-R manual provides estimates of WAIS or WAIS-R performance, and the WTAR presents WAIS-III estimates, all of which are now obsolete. WebName: Test of Premorbid Functioning - Raw score. All were British nationals, with English as the first language, and with normal/corrected-to-normal vision and hearing. Published by Oxford University Press. WAIS-IV, Wechsler Adult Intelligence Scale Fourth Edition. . We also consider an abbreviated form of the NART (mini-NART, McGrory, Austin, Shenkin, Starr, & Deary, Citation2015), developed in order to expedite the test and remove words that provide little additional predictive power. A proposed method to estimate premorbid intelligence utilizing group achievement measures from school records. NART, National Adult Reading Test; WTAR, Wechsler Test of Adult Reading; WAIS-IV, Wechsler Adult Intelligence Scale Fourth Edition. In addition, paired sample t-tests were used to assess for within-group effect of time for each group. Finally, future research should have a longer follow-up period to determine at what point word-reading ability stabilizes for individuals with msevTBI and if they ever reach the estimated IQ of healthy controls. The regression equations were as follows: NART predicted WAIS-IV FSIQ=.9775 NART error+126.41, WTAR predicted WAIS-IV FSIQ=1.2206 WTAR error+119.63. Knowledge of intelligence is essential for interpreting cognitive performance following traumatic brain injury (TBI). The raw score (total number correct) can be converted into two estimates of premorbid IQ. These findings support previous literature suggesting that the WTAR is a stable estimate of premorbid IQ following mild but not severe TBI (Mathias et al., 2007). Comparing the North American Adult Reading Test (NAART) and the Test of Premorbid Functioning (TOPF) to estimate premorbid Wechsler Adult Intelligence Scale - 4th edition FSIQ in a clinical sample with epilepsy. Kirton JW, Soble JR, Marceaux JC, Messerly J, Bain KM, Webber TA, Fullen C, Alverson WA, McCoy KJM. Unauthorized use of these marks is strictly prohibited. A revised and updated version of the Wechsler Test of Adult Reading, However, a higher percentage of Actual and Predicted scores were discrepant from FSIQ compared with the other three TOPF estimates, arguing against their use as independent premorbid estimates. An official website of the United States government. Published by Oxford University Press 2020. Bold values indicate significant single predictor models and stepwise multivariate models in which the fit is significantly improved. Ninety-two neurologically healthy adult participants were assessed on the full Wechsler Adult Intelligence Scale Fourth Edition (WAIS-IV; Wechsler, D. (2008). All TOPF scores were significantly correlated with WAIS-IV FSIQ scores (range r = 0.56-.73). Webpremorbid: [ pre-morbid ] occurring before the development of disease. Lezak (2012) suggests that Vocabulary and Information are the best/classic hold subtests. (, Orme, D. R., Johnstone, B., Hanks, R., & Novack, T. (, Triebel, K. L., Martin, R. C., Novack, T. A., Dreer, L., Turner, C., Pritchard, P. R., et al. Controls were excluded if they had been diagnosed with psychiatric disorders (except mild depression), substance abuse, or neurologic diseases. The current study assessed whether there was a dose-related relationship between injury severity and word-reading ability immediately after injury. For full access to this pdf, sign in to an existing account, or purchase an annual subscription. Inaccurate premorbid IQ estimates in those patients with moderate-to-severe TBI could lead clinicians to underestimate the level of actual cognitive decline due to TBI. Use of the TOPF as was designed is recommended. The British NART, WTAR and WAIS-IV were then administered (in that order) according to standardised instructions. 2021 Sep-Oct;28(5):535-543. doi: 10.1080/23279095.2019.1661247. The basic score on any test is the raw score, which is simply the Definition of mild traumatic brain injury, Is performance on the Wechsler test of adult reading affected by traumatic brain injury, Pronunciation of irregular words is preserved in dementia, validating pre-morbid IQ estimation, The WRAT-3 reading subtest as a measure of premorbid intelligence among persons with brain injury, Cognitive sequelae of traumatic brain injury, How robust is performance on the National Adult Reading Test following traumatic brain injury, Fluid and crystallized intelligence: Effects of diffuse brain damage on the WAIS, A compendium of neuropsychological tests: administration, norms, and commentary, Treatment consent capacity in patients with traumatic brain injury across a range of injury severity, WAIS-III Wechsler Adult Intelligence Scale. Despite the considerable limitations associated with all currently available methods, even the most experienced clinician would be constraining his or her ability to deliver optimal clinical management of a presenting neurological patient if estimation of premorbid ability was not attempted. Typically, school leaving age of 16 corresponds to level I, 18 to level II; levels III and IV included participants currently undertaking that level of study. Figure 1 provides an indication of comparative popularity of NART, WTAR and TOPF in research year-by-year. Figure 3 presents scatterplots relating NART error to index scores. and transmitted securely. In our sample, the ToPF/demographic predicted FSIQ underestimated intelligence in a substantial portion of our participants (31%), particularly in those with high average to superior intelligence. PMC Our results are also consistent with other TBI studies, which used hold measures comparable to the WTAR, such as the National Adult Reading Test (NART) and the Reading subtest from the Wide Range Achievement Test (WRAT). Table 4 provides correlations of these test scores with WAIS-IV FSIQ, constituent indices and core subtest scaled scores. Would you like email updates of new search results? These include best performance (Lezak, Citation1995), hold/no-hold (Wechsler, Citation1958), demographics (e.g., Barona, Reynolds, & Chastain, Citation1984; Crawford & Allan, Citation1997), reading ability (e.g., Nelson, Citation1982; Nelson & Willison, Citation1991; Wechsler, Citation2001), and combinations thereof (e.g., Crawford, Nelson, Blackmore, Cochrane, & Allan, Citation1990; Vanderploeg, Schinka, & Axelrod, Citation1996). Figure 2. The significance level for all analyses was p<.05. Did you know that with a free Taylor & Francis Online account you can gain access to the following benefits? Get instructions and help on ordering online or from our product catalog. . (, Oxford University Press is a department of the University of Oxford. Would you like email updates of new search results? Results indicated a main effect of group, F(2, 132)=10.23, p<.001, partial eta2=.134, but not of time, F(1, 132)=1.49, p=.23, partial eta2=.011, on raw WTAR score. The ToPF/demographic predicted FSIQ accounted for a significant proportion of variability in actual FSIQ, above and beyond that accounted for by education or time since injury. 2020 Jan;34(1):43-52. doi: 10.1037/neu0000569. Mixed ANOVAs were used to determine whether healthy controls, patients with mTBI, and patients with msevTBI performed differently on the WTAR, TMT, and CVLT-II Trials 15 Total between baseline and 1 year following injury. Please visit our International Contacts Page to find where you can order from. National Library of Medicine One such word pronunciation task is the Wechsler Test of Adult Reading (WTAR; Wechsler, 2001). The authors thank the following contributors: Sandra Caldwell, MA (UAB Department of Physical Medicine and Rehabilitation, data collection); UAB Neuropsychology Laboratory Staff (data collection); Pat R. Pritchard, MD (UAB Department of Surgery, referring study participants), and Sarah Nafziger, MD (UAB Department of Emergency Medicine, referring study participants). measure of premorbid intelligence. In addition to the WTAR, all participants were administered a standardized battery of neuropsychological tests. Data were collected from all participants in one session. NART, National Adult Reading Test; WTAR, Wechsler Test of Adult Reading; WAIS-IV Wechsler Adult Intelligence Scale Fourth Edition. Occupation information unavailable for 14 participants; education data lists maximum qualification obtained (or in progress). Furthermore, we assess whether a combination of NART/WTAR and demographic information improves predictive accuracy and compare NART/WTAR performance against the WAIS-IV embedded hold tests as measures of WAIS-IV FSIQ. Additionally, WTAR-estimated intelligence was similar to that predicted by the Crawford and Allan (1997) demographic equation. Typically, the clinician infers general premorbid ability on the basis of the one or two best WAIS-IV subtest scores, but given the considerable variability among the subtests observed in healthy populations, it is acknowledged that this approach is likely to significantly overestimate premorbid ability (Franzen et al., Citation1997; Griffin, Mindt, Rankin, Ritchie, & Scott, Citation2002; Mortensen, Gade, & Reinisch, Citation1991; Reynolds, Citation1997). ToPF and WAIS-IV scores did not differ by injury severity. Performance on the WTAR was also compared with neuropsychological measures known to be sensitive to the effects of head injury in order to assess the stability of word reading relative to other cognitive domains likely to display improvement during the post-acute phase. The UAB Institutional Review Board approved the study procedures. An observed difference between expected performance and actual performance may indicate loss of functioning or there may be some other reason for lower test scores. The Test of Premorbid Functioning (TOPF; Pearson, Citation2009; Wechsler, Citation2011), proposed as a replacement for the WTAR, has been standardised against WAIS-IV, but has not been widely adopted to date (at least for research purposes). Significant mixed ANOVA interactions were followed with univariate ANOVA at both baseline and 12 months to test between-group effects. Windsor: NFER-Nelson.) Healthy adult controls (n=52) were recruited through local advertisements and selected to match participants with TBI on demographic variables of age, sex, ethnicity, and education. Overall, there was a greater range in WTAR scores among participants with msevTBI compared with those with milder head injury and healthy controls. By closing this message, you are consenting to our use of cookies. Such variability in neurologically healthy participants renders estimation of premorbid IQ using a straightforward best performance approach problematic, and likely to produce markedly inflated predicted scores. NART consistently produced higher WAIS-IV estimates than WTAR for a given level of performance, with the level of disparity increasing as a function of error. Purpose. All levels of occupation and education were represented. The https:// ensures that you are connecting to the Their group reported stable performance on the WTAR despite consistent improvement on other cognitive measures known to be sensitive to the effects of head injury. Predicted General Ability Index (GAI)=.9656 NART errors+126.5Predicted Verbal Comprehension Index (VCI)=1.0745 NART errors+126.81Perceptual Reasoning Index (PRI)=.6242 NART errors+120.18Working Memory Index (WMI)=.7901 NART errors+120.53, Predicted General Ability Index (GAI)=1.2025 WTAR errors+119.77Predicted Verbal Comprehension Index (VCI)=1.4411 WTAR errors+120.25Perceptual Reasoning Index (PRI)=.6931 WTAR errors+115.06Working Memory Index (WMI)=.9579 WTAR errors+114.78. An opportunity sample of 100 neurologically healthy adults (mean age 40 years; range 18 to 70; SD 16.78) were recruited primarily from university campuses in Cambridge and London, local retail environments and via social media, of which eight participants failed to complete one or more tests and were excluded from all analyses. Hsieh et al (2014) identified two cutoffs: 1) 25/30 has both high sensitivity and specificity and 2) 21/30 is almost A comparison of these means in our sample revealed a 22.62 point discrepancy (mean lowest=95.27; highest=117.89). and transmitted securely. However, given that all three groups had similar demographic profiles and that those with msevTBI experienced improvement over time, there is no reason to suspect that the msevTBI group was less intelligent than other groups prior to injury. The unadjusted premorbid IQ is based on published tables developed through regression with TOPF alone as a predictor of IQ. Notes: All scores are age-corrected standard scores based on normative data in the test manuals (except the MMSE, which is raw score). All participants were recruited and tested between 2013 and 2016, in a UK university setting. In this cross-sectional study, post-9/11 veterans (N = 233, 84.12% male) completed the TOPF, the Wechsler Adult Intelligence Scale-Fourth Edition (WAIS-IV), and performance validity measures. Data for the 23 items comprising the mini-NART (McGrory et al., Citation2015) were extracted to provide an overall score on this abbreviated version of the test. All rights reserved. Permission is granted subject to the terms of the License under which the work was published. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Future studies including a higher number of severity groups will help to elucidate at what point on the TBI severity spectrum reading ability tests begin underestimating premorbid intelligence. WebEstimates of premorbid intelligence obtained from the TOPF and WRAT-4 READ have a strong linear relationship, but systematically generate inconsistent estimates in a neurodegenerative disease clinical sample and should not be used interchangeably. Similarly, a comparison of participants mean lowest subtest scaled score (7.85) against their highest subtest scaled score (14.77) revealed a mean difference of 6.92 scaled points. Additionally, scores on the VCI and PRI subtests contribute to a General Ability Index (GAI), typically employed in cases in which disproportionate working memory and/or processing speed difficulties complicate the interpretation of FSIQ (Wechsler, Citation2008).