A computerized test battery sensitive to mild and severe brain injury.

OBJECTIVE Computerized neurocognitive testing (CNT) appears to be suited to measure relatively mild degrees of neurocognitive impairment in circumstances where speed, efficiency, and low cost are important. Computerized tests are used in the evaluation and management of patients who have had mild brain injuries; the objective is to determine if computerized testing is equally reliable and valid in the evaluation of patients who have had more severe brain injuries. DESIGN A cross-sectional, naturalistic study of brain injury patients compared with normal controls. SETTING An outpatient neuropsychiatry clinic. PARTICIPANTS 141 patients, aged 18-65 years, who had sustained traumatic brain injuries (TBIs): 13 patients with postconcussion syndrome; 15 who had recovered from mild brain injuries; 85 patients who had had severe brain injuries, but who had recovered, and were living independently; and 28 severe brain injury patients who were unable to live without assistance; compared with 145 normal controls. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES The CNS Vital Signs (CNS VS) battery is a PC-based system that includes tests of verbal and visual memory, psychomotor speed, complex attention, reaction time, and cognitive flexibility. RESULTS Performance on the CNS VS battery was related to severity of brain injury and degree of recovery. Tests of psychomotor speed and cognitive flexibility were the most relevant to TBI status. Patients who had recovered from mild brain injuries scored almost as well as normal controls. The Neurocognition Index (NCI), a summary score based on performance on all the tests in the battery, was 100 for normal controls and 98 for recovered mild brain injury patients. Postconcussive patients scored 82 on the MCI, and severe brain injury patients scored 66 on the NCI if they were living independently and 47 if they were not. CONCLUSIONS Computerized tests like CNS VS allow clinicians the advantage of precise neurocognitive measurement in the service of diagnosis and appropriate treatment. CNTs are never going to replace the flexibility or comprehensiveness of conventional neuropsychological testing, but they have a role to play in circumstances where a full test battery is not feasible, such as screening and serial assessment.