Justin E Karr1, Mauricio A Garcia-Barrera1, James A Holdnack2, Grant L Iverson3. 1. Department of Psychology, University of Victoria, Victoria, British Columbia, Canada V8W 2Y2. 2. Clinical Assessment, Pearson, Bear, DE 19701, USA. 3. Department of Physical Medicine and Rehabilitation, Harvard Medical School; Spaulding Rehabilitation Hospital; MassGeneral Hospital for Children Sports Concussion Program & Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Boston, MA 02129, USA.
Abstract
OBJECTIVE: Executive function consists of multiple cognitive processes that operate as an interactive system to produce volitional goal-oriented behavior, governed in large part by frontal microstructural and physiological networks. Identification of deficits in executive function in those with neurological or psychiatric conditions can be difficult because the normal variation in executive function test scores, in healthy adults when multiple tests are used, is largely unknown. This study addresses that gap in the literature by examining the prevalence of low scores on a brief battery of executive function tests. METHOD: The sample consisted of 1,050 healthy individuals (ages 16-89) from the standardization sample for the Delis-Kaplan Executive Function System (D-KEFS). Seven individual test scores from the Trail Making Test, Color-Word Interference Test, and Verbal Fluency Test were analyzed. RESULTS: Low test scores, as defined by commonly used clinical cut-offs (i.e., ≤25th, 16th, 9th, 5th, and 2nd percentiles), occurred commonly among the adult portion of the D-KEFS normative sample (e.g., 62.8% of the sample had one or more scores ≤16th percentile, 36.1% had one or more scores ≤5th percentile), and the prevalence of low scores increased with lower intelligence and fewer years of education. CONCLUSIONS: The multivariate base rates (BR) in this article allow clinicians to understand the normal frequency of low scores in the general population. By use of these BRs, clinicians and researchers can improve the accuracy with which they identify executive dysfunction in clinical groups, such as those with traumatic brain injury or neurodegenerative diseases.
OBJECTIVE: Executive function consists of multiple cognitive processes that operate as an interactive system to produce volitional goal-oriented behavior, governed in large part by frontal microstructural and physiological networks. Identification of deficits in executive function in those with neurological or psychiatric conditions can be difficult because the normal variation in executive function test scores, in healthy adults when multiple tests are used, is largely unknown. This study addresses that gap in the literature by examining the prevalence of low scores on a brief battery of executive function tests. METHOD: The sample consisted of 1,050 healthy individuals (ages 16-89) from the standardization sample for the Delis-Kaplan Executive Function System (D-KEFS). Seven individual test scores from the Trail Making Test, Color-Word Interference Test, and Verbal Fluency Test were analyzed. RESULTS: Low test scores, as defined by commonly used clinical cut-offs (i.e., ≤25th, 16th, 9th, 5th, and 2nd percentiles), occurred commonly among the adult portion of the D-KEFS normative sample (e.g., 62.8% of the sample had one or more scores ≤16th percentile, 36.1% had one or more scores ≤5th percentile), and the prevalence of low scores increased with lower intelligence and fewer years of education. CONCLUSIONS: The multivariate base rates (BR) in this article allow clinicians to understand the normal frequency of low scores in the general population. By use of these BRs, clinicians and researchers can improve the accuracy with which they identify executive dysfunction in clinical groups, such as those with traumatic brain injury or neurodegenerative diseases.
Authors: Christina van der Feltz-Cornelis; Sally Brabyn; Jonathan Ratcliff; Danielle Varley; Victoria Allgar; Simon Gilbody; Chris Clarke; Dimitris Lagos Journal: Brain Behav Immun Health Date: 2021-02-24
Authors: Jonas Stenberg; Justin E Karr; Rune H Karlsen; Toril Skandsen; Noah D Silverberg; Grant L Iverson Journal: Front Neurol Date: 2020-10-20 Impact factor: 4.003