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Selection Bias Introduced by Neuropsychological Assessments

Published online by Cambridge University Press:  02 December 2014

Robert Olson ,
Maureen Parkinson  and
Michael McKenzie
Robert Olson*
Affiliation:
Vancouver Cancer Centre, Radiation Therapy Program, BC Cancer Agency Division of Radiation Oncology and Developmental Radiotherapeutics, University of British Columbia, Vancouver Harvard School of Public Health, Boston, MA, USA
Maureen Parkinson
Affiliation:
Fraser Valley Cancer Centre, Department of Patient and Family Counseling, BC Cancer Agency, Surrey, British Columbia, Canada
Michael McKenzie
Affiliation:
Vancouver Cancer Centre, Radiation Therapy Program, BC Cancer Agency Division of Radiation Oncology and Developmental Radiotherapeutics, University of British Columbia, Vancouver
*
600 West 10th Avenue, Vancouver, British Columbia, V5Z 4E6, Canada. E-mail: rolson2@bccancer.bc.ca.
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Abstract

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Objective:

Two prospective studies in patient with brain tumours were performed comparing the Mini Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA). The first assessed their feasibility and the second compared their diagnostic accuracy against a four-hour neuropsychological assessment (NPA). The introduction of the NPA decreased accrual and retention rates. We were therefore concerned regarding potential selection bias.

Methods:

Ninety-two patients were prospectively accrued and subsequently divided into three categories: a) no NPA required b) withdrew consent to NPA c) completed NPA. In order to quantify any potential bias introduced by the NPA, patient demographics and cognitive test scores were compared between the three groups.

Results:

There were significant differences in age (p<0.001), education (p=0.034), dexamethasone use (p=0.002), MMSE (p=0.005), and MoCA scores (p<0.001) across the different study groups. Furthermore, with increasing involvement of the NPA, patients' cognitive scores and educational status increased, while their age, dexamethasone use, and opioid use all decreased. Individuals who completed the NPA had higher MoCA scores than individuals who were not asked to complete the NPA (24.7 vs. 20.5; p < 0.001). In addition, this relationship held when restricting the analyses to individuals with brain metastases (p < 0.001).

Conclusions:

In this study, the lengthy NPA chosen introduced a statistically and clinically significant source of selection bias. These results highlight the importance of selecting brief and well tolerated assessments when possible. However, researchers are challenged by weighing the improved selection bias associated with brief assessments at the cost of reduced diagnostic accuracy.

Type
Research Article
Information
Canadian Journal of Neurological Sciences , Volume 37 , Issue 2 , March 2010 , pp. 264 - 268
Copyright
Copyright © The Canadian Journal of Neurological 2010

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