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C Thomas Gualtieri MDNorth Carolina Neuropsychiatry Clinics Neuropsychological testing is essential to the evaluation of patients with brain injury, but brain injuries do not always occur when neuropsychologists are nearby.

The sheer numbers of brain injuries, especially concussions, have inclined clinicians and policymakers towards the use of computerized neurocognitive testing CNT. Professional sports teams, university athletic programs and the armed forces of many nations have begun to use CNT as a way to manage the extraordinary number of people with brain injuries.

New technology in the service of improved care for more people, and at a drastically lower price, is something we should all be happy about. CNT has extraordinary potential in brain injury, just as it does in other fields. However, this new health technology was not born fully formed; it needs to be nurtured to attain its full potential.

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CNT began in the early s, with the old Commodore microcomputers. The technology was, for many years, quite obscure. Sophisticated testing batteries were used in occupational health and in aerospace and military medicine; then, later, in clinical trials for new drug development.

ImPact 1for example, is a CNT that was specifically developed for sports concussion, and is used by several professional teams. As that happens, however, we all would do well to remain cognizant of certain problems that are intrinsic to, and perhaps even unique to this new technology.

They are capable of calculating reaction times with millisecond accuracy, and can generate massive amounts of precise data.

The technology, however, can be a mixed blessing. Data can be misinterpreted or misused by poorly trained clinicians. Concussions in particular and brain injuries in general, are prevalent. So are other medical conditions associated with mild cognitive dysfunction: In all of these areas, CNT is the most practical way to evaluate the cognitive components of the condition.

This is not simply an academic matter. Cognitive dysfunction is an important predictor of medical morbidity, even in patients who do not have an overt cognitive disorder. The evaluation of cognitive impairment is simply too important to be left to the experts.

That was suitable for certain kinds of research but not for a clinical instrument. It has to do with the validity of a test.

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A test is not valid if scores do not improve with maturation and decline with ageing. If a test battery is sound, normal females should score higher on tests of verbal memory and normal males should score higher on tests of visual memory; males are faster at finger tapping and females are better at coding.

A normative database does not only give one an idea of where a particular subject stands with respect to norms, it assures you that the structure of the test is valid. This is one aspect of the discriminant validity of a test. Scores should improve when ADHD patients are treated with stimulants and they should go down if normal subjects are treated with scopolamine or benzodiazepines.

Patients with depression should perform better after they are treated. A CNT should also have concurrent validity — that is, it should generate results that are similar to established neuropsychological tests. The computer format is given to new ways of testing cognitive function, and many of the idiosyncratic test batteries are quite useful, at least in research.

For clinical purposes, however, it is better to choose a CNT that is comparable to tests that clinicians are familiar with. In clinical practice, obscurity is never a virtue. But test results do not, by themselves, constitute a medical diagnosis. But a sensitive test will also generate a high percentage of false positives.

In our clinics, every new patient is administered a comprehensive CNT. It is not uncommon to encounter patients with one or more cognitive domain score that is more than two standard deviations below the population mean.

Absent a clinically meaningful explanation, the best thing to do is to repeat the test at some later date, as the patient is seen in follow-up.3 Gualtieri, CT & Johnson, LG, Reliability and Validity of a Computerized Neurocognitive Test Battery, CNS Vital pfmlures.comes of Clinical Neuropsychology, 21, , These new, revolutionary programs will significantly improve your patients' binocular and perceptual vision skills, while putting minimal demands on your time even if you have not offered this valuable patient service before!

WE BELIEVE. You can improve the accuracy and speed of decision making - get virtual repetition in the digital world at a scale impossible to achieve in the physical world.

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