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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).
Objective:
To investigate impairment rates on the Brief Test of Adult Cognition by Telephone (BTACT) domains and subtests by race/ethnicity, education, and primary language for individuals with moderate-to-severe traumatic brain injury (TBI) in the Traumatic Brain Injury Model Systems (TBIMS) national database.
Setting:
Secondary analysis of the TBIMS national database.
Participants:
A total of 2,981 adults with complicated-mild-to-severe TBI who completed all BTACT subtests at 1-year follow-up (Mage = 41.0 years; 27.1% Female; Meducation = 13.6 years; 63.5% White).
Design:
Cross-sectional observational study.
Main Measures:
Brief Test of Adult Cognition by Telephone domain and subtest scores were standardized using combined Midlife Development in the US norms. Cognitive impairment was defined as scores ≤ -1.5 below the normative means. Impairment rates were compared across race/ethnicity, language of administration (Spanish versus English), and education. Logistic regression models evaluated the contribution of race/ethnicity, education, and language to impairment after controlling for variables that the normative data are stratified on (age, education, sex).
Results:
Participants who identified as Black, Hispanic, or multiracial were more likely to be classified as cognitively impaired on the BTACT domain scores and subtests. Individuals with ≤eighth grade education had higher impairment rates on recall and executive function measures. Spanish-language administration revealed increased odds of impairment on executive functioning tasks. Racial/ethnicity disparities in impairment persisted after adjustment for age, sex, and years of education.
Conclusions:
Findings indicate that BTACT normative data disproportionately classify those with lower education, racial/ethnic minority, and Spanish speakers as cognitively impaired. This can result in misinterpretation of disparities in cognitive outcomes and highlight the need for demographically representative normative data. Appropriate norms are critical for accurate assessment of cognitive outcomes and for the valid interpretation of the trajectories in diverse TBI populations.
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