Developing Cognition Endpoints for the CENTER-TBI Neuropsychological Test Battery

Jonas Stenberg, Justin E. Karr, Douglas P. Terry, Simen B. Saksvik, Anne Vik, Toril Skandsen, Noah D. Silverberg, Grant L. Iverson

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


Background: Measuring cognitive functioning is common in traumatic brain injury (TBI) research, but no universally accepted method for combining several neuropsychological test scores into composite, or summary, scores exists. This study examined several possible composite scores for the test battery used in the large-scale study Collaborative European NeuroTrauma Effectiveness Research in Traumatic Brain Injury (CENTER-TBI). Methods: Participants with mild traumatic brain injury (MTBI; n = 140), orthopedic trauma (n = 72), and healthy community controls (n = 70) from the Trondheim MTBI follow-up study completed the CENTER-TBI test battery at 2 weeks after injury, which includes both traditional paper-and-pencil tests and tests from the Cambridge Neuropsychological Test Automated Battery (CANTAB). Seven composite scores were calculated for the paper and pencil tests, the CANTAB tests, and all tests combined (i.e., 21 composites): the overall test battery mean (OTBM); global deficit score (GDS); neuropsychological deficit score-weighted (NDS-W); low score composite (LSC); and the number of scores ≤5th percentile, ≤16th percentile, or <50th percentile. Results: The OTBM and the number of scores <50th percentile composites had distributional characteristics approaching a normal distribution. The other composites were in general highly skewed and zero-inflated. When the MTBI group, the trauma control group, and the community control group were compared, effect sizes were negligible to small for all composites. Subgroups with vs. without loss of consciousness at the time of injury did not differ on the composite scores and neither did subgroups with complicated vs. uncomplicated MTBIs. Intercorrelations were high within the paper-and-pencil composites, the CANTAB composites, and the combined composites and lower between the paper-and-pencil composites and the CANTAB composites. Conclusion: None of the composites revealed significant differences between participants with MTBI and the two control groups. Some of the composite scores were highly correlated and may be redundant. Additional research on patients with moderate to severe TBIs is needed to determine which scores are most appropriate for TBI clinical trials.

Original languageEnglish
Article number670
JournalFrontiers in Neurology
StatePublished - Jul 17 2020

Bibliographical note

Funding Information:
Foundations for this work were funded in part by the U.S. Department of Defense as part of the TBI Endpoints Development Initiative with a grant entitled Development and Validation of a Cognition Endpoint for Traumatic Brain Injury Clinical Trials (subaward from W81XWH-14-2-0176). JS received funding from the Liaison Committee between the Central Norway Regional Health Authority (RHA) and the Norwegian University of Science and Technology (NTNU) (project number 90157700). Unrestricted philanthropic support was provided by the Spaulding Research Institute. JK acknowledges support from the Spaulding Research Institute Leadership Catalyst Fellowship. NS received salary support from the Michael Smith Foundation for Health Research (Health Professional Investigator Award).

Funding Information:
Conflict of Interest: GI serves as a scientific advisor for BioDirection, Inc., Sway Operations, LLC, and Highmark, Inc. He has a clinical and consulting practice in forensic neuropsychology, including expert testimony, involving individuals who have sustained mild TBIs. He has received research funding from several test publishing companies, including ImPACT Applications, Inc., CNS Vital Signs, and Psychological Assessment Resources (PAR, Inc.). He received royalties from one neuropsychological test (WCST-64; PAR, Inc.). He has received research funding as a principal investigator from the National Football League, and salary support as a collaborator from the Harvard Integrated Program to Protect and Improve the Health of National Football League Players Association Members. He acknowledges unrestricted philanthropic support from ImPACT Applications, Inc., the Heinz Family Foundation, and the Mooney-Reed Charitable Foundation.

Publisher Copyright:
© Copyright © 2020 Stenberg, Karr, Terry, Saksvik, Vik, Skandsen, Silverberg and Iverson.


  • brain concussion
  • brain injury
  • cognition
  • neuropsychology
  • psychometrics

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology


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