Common results interpretation questions

If an individual’s scores are unusually low relative to their comparative group, is there cause for concern?

In cases in which a standard score and percentile are extremely low, or lower than expected given knowledge about the individual, a first step may be to discuss with the individual the conditions under which the assessment was completed, and then choose to reassess that individual to obtain additional data. In certain rare instances, the individual may have misunderstood the task instructions or may have been distracted during the assessment, but not enough to result in the task being flagged as potentially invalid. If the task results are consistently lower than expected, further investigation may be warranted.

Ultimately, it is up to the practitioner to evaluate all available sources of information to decide the appropriate course of action. This may include continued treatment of the individual within the practitioner’s area of expertise, reassessing the individual, or a referral to a neuropsychologist or neurologist. 

Is it normal for an individual to score high or normally on most tasks, but very poorly on one or two tasks?

It is normal to have a profile with some high scores and some low scores. Each task is designed to measure distinct cognitive abilities, and tasks within one cognitive domain (e.g., memory) are largely independent from tasks within other cognitive domains (e.g., verbal ability). Therefore, it is normal for individuals to exhibit strengths in one area of cognition, but weaknesses in another. In some cases, very low scores on a handful of tasks may indicate genuine weaknesses in one cognitive domain, and the areas of the brain associated with them. Examine patterns in the scores (e.g., was every low score a memory task?), and examine other information you may have collected to determine the appropriate next steps. In some cases, unusually low scores on a few tasks may simply be due to chance or other irrelevant factors. In these cases, you may choose to re-assess the individual to gather additional data and confirm the cognitive profile of the individual.

Is it possible for individuals to get low scores even if their true capabilities are normal or high?

Obtaining a surprisingly low score is possible, and can arise due to a number of factors, such as individuals being distracted, not understanding the task instructions, malingering (purposefully choosing wrong answers), or being unable to physically complete the assessment. In many of these rare occurrences, Creyos Health may indicate that the task result was likely invalid, but practitioners should still consider them when extremely low scores are obtained.

Is it possible for individuals to get high scores even if their true capabilities are normal or low?

Obtaining an artificially high score is highly unlikely, and only probable in cases where an individual is attempting to manipulate the results (e.g., using a pencil and paper to write down a sequence of digits in Digit Span). Taking the tests in this manner is detectable due to unusual patterns in the data, so in these cases, Creyos Health may indicate that the task result was likely invalid.

Why do assessment results sometimes fluctuate from one session to the next?

Variability in task results is completely normal, given that cognition naturally varies over time, and a wide variety of random and non-random factors can affect the final score on any neuropsychological task. Adjustment of scores (see Section B) reduces the effect of random factors (e.g., regression to the mean), but a measure of an individual’s cognition will change upon repeated task completions as result of practice effects, normal variation in performance, other random sources of error, and perhaps, meaningful change (e.g., deterioration resulting from a clinical condition). This is why the Meaningful Change Indicator is incorporated into Creyos Health. A positive indication suggests that the change in the individual's score is larger than what we would expect to happen due to chance. See Section D for more information about meaningful change.

If a meaningful change is not indicated, does that mean cognition has stayed the same?

Not necessarily. The statistical analysis for meaningful change indicates when a variation in a task result is unlikely if chance alone is operating. It does not follow that a lack of significance means there is not meaningful change. Practically, this means that Creyos Health reports are best interpreted as indicating when a change in a task result is unusual. If a result is not unusual, it is not definitive evidence that everything is normal, and small changes may be interpretable in the context of information specific to an individual’s history or treatment.

How are the age ranges used for population comparisons determined?

Age ranges were chosen based on two objectives: i) Minimizing significant differences in average performance within age ranges; and ii) Ensuring a large sample size data for that age range (and gender) to accurately compare the individual’s score to the database.