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Neuropsychology review
Dec, 2023;33 (4): 675-692.

Psychometric Properties of Computerized Cognitive Tools and Standard Neuropsychological Tests Used to Assess Sport Concussion: A Systematic Review.

Kristin Wilmoth, Benjamin L Brett, Natalie A Emmert, Carolyn M Cook, Jeffrey Schaffert, Todd Caze, Thomas Kotsonis, Margaret Cusick, Gary Solomon, Jacob E Resch, C Munro Cullum, Lindsay D Nelson, Michael McCrea
Author Information
  1. Kristin Wilmoth: Departments of Psychiatry and Physical Medicine & Rehabilitation, UT Southwestern Medical Center, 5323 Harry Hines Blvd., Dallas, TX, 75390-9055, USA. Kristin.Wilmoth@UTSouthwestern.edu. ORCID
  2. Benjamin L Brett: Departments of Neurosurgery and Neurology, Medical College of Wisconsin, Milwaukee, WI, USA.
  3. Natalie A Emmert: Department of Neurology, University at Buffalo, State University of New York, Buffalo, NY, USA.
  4. Carolyn M Cook: Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, USA.
  5. Jeffrey Schaffert: Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, USA.
  6. Todd Caze: Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, USA.
  7. Thomas Kotsonis: Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, USA.
  8. Margaret Cusick: Department of Neurology, Medical College of Wisconsin, Milwaukee, WI, USA.
  9. Gary Solomon: Player Health and Safety Department, National Football League and Department of Neurosurgery, Vanderbilt University School of Medicine, Nashville, TN, USA.
  10. Jacob E Resch: Department of Kinesiology, University of Virginia, Charlottesville, VA, USA.
  11. C Munro Cullum: Departments of Psychiatry, Neurology, and Neurological Surgery, UT Southwestern Medical Center, Dallas, TX, USA.
  12. Lindsay D Nelson: Departments of Neurosurgery and Neurology, Medical College of Wisconsin, Milwaukee, WI, USA.
  13. Michael McCrea: Departments of Neurosurgery and Neurology, Medical College of Wisconsin, Milwaukee, WI, USA.
PMID: 36040610 DOI: 10.1007/s11065-022-09553-4

Abstract

Athletic programs are more frequently turning to computerized cognitive tools in order to increase efficiencies in concussion assessment. However, assessment using a traditional neuropsychological test battery may provide a more comprehensive and individualized evaluation. Our goal was to inform sport clinicians of the best practices for concussion assessment through a systematic literature review describing the psychometric properties of standard neuropsychological tests and computerized tools. We conducted our search in relevant databases including Ovid Medline, Web of Science, PsycINFO, and Scopus. Journal articles were included if they evaluated psychometric properties (e.g., reliability, sensitivity) of a cognitive assessment within pure athlete samples (up to 30 days post-injury). Searches yielded 4,758 unique results. Ultimately, 103 articles met inclusion criteria, all of which focused on adolescent or young adult participants. Test-retest reliability estimates ranged from .14 to .93 for computerized tools and .02 to .95 for standard neuropsychological tests, with strongest correlations on processing speed tasks for both modalities, although processing speed tasks were most susceptible to practice effects. Reliability was improved with a 2-factor model (processing speed and memory) and by aggregating multiple baseline exams, yet remained below acceptable limits for some studies. Sensitivity to decreased cognitive performance within 72 h of injury ranged from 45%-93% for computerized tools and 18%-80% for standard neuropsychological test batteries. The method for classifying cognitive decline (normative comparison, reliable change indices, regression-based methods) affected sensitivity estimates. Combining computerized tools and standard neuropsychological tests with the strongest psychometric performance provides the greatest value in clinical assessment. To this end, future studies should evaluate the efficacy of hybrid test batteries comprised of top-performing measures from both modalities.

Keywords

Computerized neurocognitive tests Neuropsychological assessment Reliability Sensitivity Sport concussion Validity

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MeSH Term

Adolescent
Young Adult
Humans
Athletic Injuries
Reproducibility of Results
Psychometrics
Brain Concussion
Neuropsychological Tests
Sports
Cognition
Systematic Review Journal Article Review

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