Response to the article on baseline neuropsychological testing: throwing away clinical gold with the statistical bathwater.

摘要

In a recent article, Randolph (6) has challenged the utility of neurocognitive screening as part of the sports concussion management process. As a matter of some concern, I wish to draw attention to flaws in the fundamental underpinnings of his critique from a conceptual perspective along two broad parameters, as follows.Principles of Modern Clinical Neuropsychology A "straw man" argument provides the core framework of Randolph's article, in that it is "baseline testing" that is delineated repeatedly as the chief mechanism to come under attack. All challenges are phrased in the form of what it is that baseline testing can contribute to the process, as though this exists as an entity in its own right. However, at no point to my knowledge has any developer or user of neurocognitive screening in the sports concussion arena claimed that baseline testing in itself is of any value for any purpose whatsoever. Rather, the value of baseline testing lies in its availability for comparative purposes with subsequent follow-up testing, all of which need to be contextualized further in the overall clinical evaluation process (5). The ability to have access to baseline (i.e., premorbid) neurocognitive levels for postmorbid neuropsychological evaluation is an indisputable aid to psychometric evaluation in general, and to argue otherwise for sports concussion cannot be supported, especially given the potentially "silent" brain changes that typically occur within that context (7).