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Brief Test of Adult Cognition by Telephone: Normative Comparison in a Diverse Traumatic Brain Injury Model Systems
Angelle M Sander1, Shannon B Juengst, Robiann R Broomfield
1Author Affiliations: Brain Health and Rehabilitation Research Center, TIRR Memorial Herman, Houston, Texas (Drs Sander, Juengst, and Bako); Department of Psychiatry, Beth Israel Deaconess Medical Center/Harvard Medical School, Boston, Massachusetts (Dr Broomfield); Department of Physical Medicine and Rehabilitation, Wayne State University, Detroit, Michigan (Dr Hanks); Jefferson Moss Rehabilitation Research Institute, Elkins Park, Pennsylvania (Dr Hart); Mayo Clinic, Rochester, Minnesota (Dr Janssen); Kessler Foundation, East Hanover, New Jersey, and Department of Physical Medicine and Rehabilitation, Rutgers-New Jersey Medical School, Newark, NJ (Dr Lequerica); School of Data Science and Department of Psychology, University of Virginia, Charlottesville, Virginia and Mental Health Service, Central Virginia Veterans Affairs Health Care System, Richmond, Virginia (Dr Perrin); and Virginia Commonwealth University, Department of Rehabilitation Counseling, Richmond, Virginia (Dr Talley).
The Brief Test of Adult Cognition by Telephone (BTACT) may misclassify cognitive impairment in diverse traumatic brain injury (TBI) populations. Using demographically representative norms is crucial for accurate TBI outcome assessment.
Area of Science:
- Neuroscience
- Psychology
- Public Health
Background:
- Traumatic brain injury (TBI) can lead to cognitive impairments.
- Accurate assessment of cognitive function is vital for TBI rehabilitation and outcomes.
- Existing cognitive tests may have limitations in diverse populations.
Purpose of the Study:
- To investigate impairment rates on the Brief Test of Adult Cognition by Telephone (BTACT) domains and subtests.
- To examine these rates across different race/ethnicity, education levels, and primary languages.
- To assess cognitive impairment in individuals with moderate-to-severe TBI using the Traumatic Brain Injury Model Systems (TBIMS) national database.
Main Methods:
- Secondary analysis of the TBIMS national database involving 2,981 adults with TBI at 1-year follow-up.
- Standardized BTACT scores using US norms; cognitive impairment defined as scores ≤ -1.5 below normative means.
- Compared impairment rates across race/ethnicity, language (Spanish vs. English), and education using logistic regression, controlling for age, sex, and education.
Main Results:
- Black, Hispanic, and multiracial individuals showed higher BTACT impairment rates.
- Lower education (≤ eighth grade) correlated with increased impairment in recall and executive function.
- Spanish language administration revealed higher odds of executive functioning impairment; disparities persisted after adjustments.
Conclusions:
- Current BTACT normative data may disproportionately identify lower education, racial/ethnic minorities, and Spanish speakers as cognitively impaired.
- This can lead to misinterpretation of cognitive outcome disparities in TBI populations.
- There is a critical need for demographically representative normative data for accurate TBI assessment and interpretation.
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