Age-related differences and reliability on computerized and paper-and-pencil neurocognitive assessment batteries

Neurocognitive testing is a recommended component in a concussion assessment. Clinicians should be aware of age and practice effects on these measures to ensure appropriate understanding of results.

To assess age and practice effects on computerized and paper-and-pencil neurocognitive testing batteries in collegiate and high school athletes.

Cohort study.

Classroom and laboratory.

Participants consisted of 20 collegiate student-athletes (age = 20.00 ± 0.79 years) and 20 high school student-athletes (age = 16.00 ± 0.86 years).

Hopkins Verbal Learning Test scores, Brief Visual-Spatial Memory Test scores, Trail Making Test B total time, Symbol Digit Modalities Test score, Stroop Test total score, and 5 composite scores from the Immediate Post-Concussion Assessment and Cognitive Testing (ImPACT) served as outcome measures. Mixed-model analyses of variance were used to examine each measure.

Collegiate student-athletes performed better than high school student-athletes on ImPACT processing speed composite score (F(1,38) = 5.03, P = .031) at all time points. No other age effects were observed. The Trail Making Test B total time (F(2,66) = 73.432, P < .001), Stroop Test total score (F(2,76) = 96.85, P = < .001) and ImPACT processing speed composite score (F(2,76) = 5.81, P = .005) improved in test sessions 2 and 3 compared with test session 1. Intraclass correlation coefficient calculations demonstrated values ranging from 0.12 to 0.72.

An athlete's neurocognitive performance may vary across sessions. It is important for clinicians to know the reliability and precision of these tests in order to properly interpret test scores.