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Eur J Cardiothorac Surg 2006;29:82-88
© 2006 Elsevier Science NL
a Research Concentration in Biological and Medical Sciences, School of Life Sciences, Queensland University of Technology, Brisbane, Australia
b Discipline of General Practice, School of Medicine, University of Queensland, Brisbane, Australia
c Department of Psychology and Neuropsychology, The Prince Charles Hospital, Brisbane, Australia
d Department of Haematology, The Prince Charles Hospital, Brisbane, Australia
e Department of Perfusion Services, Main Operating Theatres, The Prince Charles Hospital, Rode Road, Brisbane Q4032, Australia
Received 29 March 2005; received in revised form 31 August 2005; accepted 7 October 2005.
* Corresponding author. Tel.: +61 7 3350 8705; fax: +61 7 3350 8659. (Email: p.raymond{at}optusnet.com.au).
Objective: This paper compares four techniques used to assess change in neuropsychological test scores before and after coronary artery bypass graft surgery (CABG), and includes a rationale for the classification of a patient as overall impaired. Methods: A total of 55 patients were tested before and after surgery on the MicroCog neuropsychological test battery. A matched control group underwent the same testing regime to generate test–retest reliabilities and practice effects. Two techniques designed to assess statistical change were used: the Reliable Change Index (RCI), modified for practice, and the Standardised Regression-based (SRB) technique. These were compared against two fixed cutoff techniques (standard deviation and 20% change methods). Results: The incidence of decline across test scores varied markedly depending on which technique was used to describe change. The SRB method identified more patients as declined on most measures. In comparison, the two fixed cutoff techniques displayed relatively reduced sensitivity in the detection of change. Conclusions: Overall change in an individual can be described provided the investigators choose a rational cutoff based on likely spread of scores due to chance. A cutoff value of 
20% of test scores used provided acceptable probability based on the number of tests commonly encountered. Investigators must also choose a test battery that minimises shared variance among test scores.
Key Words: Cardiopulmonary bypass • Neurocognitive deficits • Brain • Cerebral complications
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