1. The Meyers Neuropsychological Battery (MNB)
John E. Meyers, Psy.D.
Center for Neuroscience, Orthopedics & Spine, Dakota Dunes, SD
Martin L. Rohling, Ph.D.
University of South Alabama, Mobile, AL

2. Table of Contents Philosophy of MNB Development of MNB
Norms Development
Sensitivity and Specificity
Internal Validity Checks
LOC Dose Response
CT/MRI Data
Profiles

3. Philosophy of MNB MNB began as a longer battery of tests.
Using Discriminate Function: Selected tests that were able to discriminate Normal vs TBI.
Did original study years ago

4. Philosophy of MNB Goal was to find the best/shortest battery
Sensitive to Brain Injury
Commonly used Tests, that most NPs know
Originally a 6 hour battery cut to hrs
Tests were selected not only for sensitivity but also ease of administration and scoring (i.e., Category vs. WCST)

5. Testing Order for MNB Short WAIS-III Forced Choice (FC)
Rey Complex Figure (RCFT) - Copy
Animal Naming
3 minute recall of RCFT
COWA
Dichotic Listening
North American Adult Reading (NART)
Sentence Repetition
30 Minute Recall of RCFT
Recognition Trial of RCFT
(Break offered)
AVLT
JOL
Boston Naming
Finger Tapping
Finger Localization
Trails A & B
Token Test
AVLT 30 minute Recall
AVLT Recognition Trial
Booklet Category Test

6. Individual Tests in The MSB
Picture Completion
Digit Symbol
Similarities
Block Design
Arithmetic
Digit Span
Information
Ward 7 Subtest (Pilgrim, Meyers, Bayless, & Whetstone, 1999)

7. The MNB database
Familiarize yourself with the database to be discussed.

8. MNB Database Description of large pt sample (N = 4050+)
Descriptive Statistics:
Min. Max. M SD
Age
Educ
Note: The individual with 0 yrs education from Mexico and had not completed a single year of education.

9. MNB Database Gender Female = 1816 (45%) Male = 2196 (55%) Handedness
Right = 3549 (89%) Left = 462 (11%)

10. MNB Database Ethnicity - Sample Sizes African American 82 (2%)
Mixed Racial (1%)
Caucasian (92%)
Asian (< 1%)
Native American (2%)
Hispanic (3%)

11. MNB Database
Lots of different diagnoses, as you would find in rehab hospital-based practice.

12. MNB Smoothed Normative Data
In evaluating the norms, note there were variations in test norms, apparently due to age, & education.
For example, AVLT norms Spreen & Strauss (1998)
At Age = 30-39; M = 11.4 (sd = 2.4) for Trial 6
At Age = 40; M = 10.4 (sd = 2.7) for Trial 6.
Therefore, pt. scoring 10 a day before b-day, after b-day, score (i.e. 10) would improve from 44T to 48T, using a linear.
Using Heaton et al. (1991) classification system, pts’ score would improve from the Below Average to Average just by becoming a day older.
A common problem with non-smoothed normative data.

13. MNB Normative Data Therefore, decided to smooth the norms.
Done by selecting all pts. from dataset who:
had a validity score of 0 or 1 (failures)
were age 15 years or older
15 yrs old used for the adult version of the Trail Making Test
this was done to keep consistency.
The total sample size N = 1727
Age: M = 45.7 yrs (sd = 20.7)
Education: yrs (sd = 2.7) year of education.
Gender: 779 females; 948 males
Handedness: were RH and 184 were LH.
Ethnic: 32 mixed; 22 African Americians; 1617 white; 2 Asian; 27 Native American; and 27 Hispanics.

14. MNB Normative Data
A Regression equation was then calculated using the raw score and the variables, age, education, gender, handedness, and race to predict the T score previously calculated using the standard normative data for the tests.

15. MNB Regression Norms Not only does process smooth the data
Also adds adjustments for age, education, gender, handedness, and ethnicity.
In Normals these variables may not always be significant. In injured group variables take on additional impact on test performance.

16. MNB Normative Data
Once the regression equations were calculated they were used
to calculate a Regression T score for each test
It was found that this procedure worked well for all test variables except Token Test (adult) due to excessive skew
For Token Test, percentile scores were calculated and converted to T score equivalents.

17. MNB Normative Data
With Regression Equations, with a raw score 10 on AVLT Imm. Recall
In the example used, would change the data (for person tested 1 day before b’day), at age 39
T Score equivalent would be 45T; a day after her b’day 45T.
Using the regression equation normative data, comparisons can be more reliable made over time. The individual subtests for the WAIS-III or WISC-III were not subjected to the Regression Equation method as only the Scale Scores were coded in the database, not raw scores. Therefore, the scores for these tests are based on normative data from the test manuals.

18. MNB Normative Data Scale R R2 Significance Paired Samples t Test
Trails A (1363), p=1.00
Trails B (1354), p=.930
Judgment (1263), p=.921
Finger Tapping DH (1599), p=.937
Finger Tapping NDH (1577),p=.977
Finger Localization DH (1201), p=.979
Finger Localization NDH (1196), p=.987
*Token Test (1534),p=.993
Sentence Repetition (1253),p=.968
Controlled Oral Word Association (1487),p=.982
Animal Naming (1366), p=.921
Boston Naming (1312), p=.000
Dichotic Listening Left (1198), p=.000
Dichotic Listening Right (1198), p=.014
Dichotic Listening Both (1198), p=004

19. MNB Normative Data Forced Choice .992 .984 .000 -1.065 (1131), p=.287
AVLT (1470), p=.973
AVLT (1470), p=.940
AVLT (1470), p=.859
AVLT (1469), p=.981
AVLT (1469),p=.993
AVLT Total (1470), p=.949
AVLT Distractor (1467), p=.955
AVLT Immediate (1468), p=.918
AVLT Delayed (1470), p=943
AVLT Recognition (1470), p=.988
CFT Time (1657), p=.941
CFT Copy (1660), p=.958
CFT Immediate (1658), p=.938
CFT Delayed (1659), p=.946
CFT False Positive (1657), p=.979
CFT False Negative (1657), p=.956
CFT Recognition (1658), p=.996
Booklet Category (Victoria Version) (1290), p=981
* Because of the skewedness of the data percentile scores were computed and transformed to T Scores for this test.

20. MNB Data Children
Child Regression Equation R R2 Significance Paired Samples t Test
Trails A (99),p=1.000
Trails B (99),p=.960
Judgment of Line (96),p=.942
Finger Tapping Dom (106),p=.986
Finger Tapping NonDom (106),p=.987
Finger Localization Dom (95), p=.914
Finger Localization NonDom (95), p=.892
Token Test (106), p=.819
Sentence Repetition (105), p=.930
Controlled Oral Word Association (109), p=.133
Animal Naming (100), p=.910
Boston Naming (105), p=326
Dichotic Listening Left (99), p=.457
Dichotic Listening Right (99), p=.592
Dichotic Listening Both (99), p=.959

21. MNB Data Children Forced Choice .996 .992 .000 -3.089 (94), p=.003
AVLT (111), p=.855
AVLT (111), p=.648
AVLT (111), p=.768
AVLT (111), p=.630
AVLT (111), p=.983
AVLT Total (111), p=.963
AVLT Distractor (111),p=.948
AVLT Immediate (111),p=.923
AVLT Delayed (111),p=.887
AVLT Recognition (111),p=.968
CFT Time (111),p=.947
CFT Copy (111),p=1.000
CFT Immediate (111),p=.988
CFT Delayed (111),p=.977
CFT False Positive (111),p=.446
CFT False Negatives (111),p=.762
CFT Recognition (111),p=1.000
Booklet Category (92),p=1.000

22. MNB Regression Equations
Adult
Test Age Ed Sex Hand Race Raw Constant
Trails A
Trails B
JOL
FT Dominant
FT NonDom
F Loc Dom
F Loc NonD
Sentence Rep
COWA
Animal
Boston
Dichotic Left
Dichotic Right
Dichotic Both

23. MNB Regression Equations
Forced Choice
AVLT
AVLT
AVLT
AVLT
AVLT
AVLT Total
AVLT Distractor
AVLT Recall
AVLT Delay
AVLT Recognition
CFT Time
CFT Copy
CFT Immediate
CFT Delayed
CFT FP
CFT FN
CFT Recognition
Booklet Category

24. Norms for the Token Test
Adult Token Test
Raw T score
163 67
162 55
161 50
160 47
159 46
158 45
157 41
156 39
155 38
154 37
153 34
152 29
151 25
150 20
149 15
148 10
147 5
<=146 1

25. MNB Children’s Norms CHILD Regression Equation Variables
Test Age Ed Sex Hand Race Raw Constant
Trails A
Trails B
JOL
Finger T Dom
Finger T Non
Finger Loc D
Finger Loc N
Token Test
Sentence Rep
COWA
Animal
Boston
Dichotic L
Dichotic R
Dichotic B

26. MNB Children’s Norms
Forced Choice
AVLT
AVLT
AVLT
AVLT
AVLT
AVLT Total
AVLT Distractor
AVLT Recall
AVLT Delay
AVLT Recognition
CFT Time
CFT Copy
CFT Immediate
CFT Delayed
CFT FP
CFT FN
CFT Recognition
Booklet Category

27. MNB Recap Step 1. Took battery of well known NP Tests
Tests with which most clinicians would be familiar
Tests selected based on utility, ease of scoring, and to assess wide array of cognitive functions
This battery is the result several preliminary batteries

28. MNB Recap Continued Step 2. Large database of pts. collected
Step 3. Examined results for need smooth
Step 4. Data smoothed across battery
ages ranged from 6 – 99 years old
Separate norms for and
Adjust for age, ed, gender, ethnicity & handed

29. MNB Recap Continued
Step 4. Recalculate database with new norms (Step 3)
Now on the Step 5
Is this battery of tests valid?

30. MNB Step 5: Is this battery valid?
Need to examine Reliability/Validity MSB
Meyers, J. E., & Rohling, M. L. (2004). Validation of the Meyers Short Battery on Mild TBI patients. Archives of Clinical Neuropsychology, 19,
Study included 4 Groups

31. Validity of MNB 30 Medical Controls (Group 1) All community dwelling
in hospital for non CNS problem (i.e. ingrown toe nails)
All community dwelling
No Hx of LD, DD, Substance abuse, TBI, or Mental Health problem, or anything that would disqualify as Normal.

32. Validity of MNB: 30 Medical Controls (cont.)
Mean Age: 38.6 yrs (sd = 18.9)
Mean Educ: 13.4 yrs (sd = 3.19)
Gender: 15 females; 15 males
Handedness: 29 were RH; 1 was LH
Ethnicity: 29 white; 1 Native American

33. Validity of MNB Depressed Group (Group 2) 41 patients All on SSRI
Mean Age: 46.0 yrs (sd = 15.0)
Mean Education: 13.5 yrs (sd = 2.7)
Gender: 20 females; 21 males
Handedness: 38 were RH; 3 were LH
Ethnicity: 1 mixed race; 40 white
29 completed MMPI-2 with M scores as follows
L = 52.1 (sd=11.4), F = 60.5 (sd=11.7), K = 50.2 (sd=10.2)
1 = 63.8 (sd = 12.8)
2 = 70.8 (sd =14.5)
3 = 66.7 (sd = 16.0)

34. Validity of MNB
Chronic Pain (Group 3) comprised of 32 pts who were being treated as outpt. for chronic pain.
None involved in litigation at time of assessment
None had previous litigation histories
Pts. were injured in non-work-related injuries or were injured on their own farms, or had chosen not to pursue Workman’s compensation and were being treated at an outpatient pain clinic.

35. Validity of the MNB Chronic Pain Group Continued
Mean Age: 40.7 yrs (sd = 14.2)
Mean Education: 13.4 yrs (sd = 2.1)
Gender: 20 females and 12 males
Handedness: 29 were RH; 3 were LH
Ethnicity: 31 white; 1 Native American

36. Validity of MNB Group 4: 59 pts. history of TBI
All pts. seen at local hospital and rehab unit
followed by the senior author (JEM)
All pts. had identified LOC 20 min. or less
other data (i.e., GCS or PTA) not often recorded
however, LOC data available for all pts.
LOC defined as “Time to Follow Commands”
(e.g., Dikmen et al., 1995; Volbrecht et al., 2000)

37. Validity of MNB Mean Age: 36.9 yrs (sd = 15.1)
Mean Education: 12.6 yrs (sd = 2.1)
Time Post Injury: 7.6 mo. (sd = 10.0)
Gender: 14 females; 43 males
Handedness: 51 were RH; 6 were LH
Ethnicity: 2 mixed; 1 Hispanic; 54 white

38. Validity of MSB Test scores obtained for each of the study groups
Normal Chronic Mild
Controls Depressed Pain TBI
NART FSIQ Mean n SD
Barona et. al FSIQ Mean n SD
WAIS VIQ Mean n SD
WAIS PIQ Mean n SD
WAIS FIQ Mean SD

39. Validity of MNB
Validity assessed using a discriminant function analysis comparing Non-TBI pts. with the TBI pts.
Resulted: 96% correct classification rate
99% specificity
90% sensitivity

40. Reliability of MNB Reflecting a general clinical sample,
63 persons with mixed diagnoses assessed more than once, with the first testing at least 6 mo. post injury
Some in litigation, but all passed validity checks
Group descriptive
Age: Mean = 38.4 yrs (sd = 22.8)
Education: Mean = 12.2 yrs (sd = 2.9)

41. Test Re-test Reliability
1st Test: Post Injury 21.6 mo. (sd = 22.8)
Re-test: Post Injury 40.7 mo. (sd = 33.2)
Time btwn Sessions: 19.1 mo. (sd = 16.6)
range 2 to 91 mo., median 13 mo.
Reliability r = .86

42. Internal Validity Checks
Meyers, J. E., & Volbrecht, M. E. (2003). A Validation of Multiple Malingering Detection Methods in a Large Clinical Sample, Archives of Clinical Neuropsychology, 18,
Other publications

43. Internal Validity Check (0%FP Rate cutoff)
Test/Method Cutoff
RCFT: MEP <= (1= Attent, 2=Encode, =Store, 4= Retrieve)
Reliable Digits <= 6
Forced Choice <= 10
JOL <= 12
Token Test <= 150
Dichotic Listening Both <= 9
Sentence Repetition <= 9
AVLT-Recognition <= 9
FT-Estimated FT <= -10

44. Internal Validity Checks
A total of 796 participants in the study, ages ranged from 16 yrs to 86 yrs, with education ranging from 5 yrs to 23 yrs.

45. Internal Validity Checks
15 Groups
Non-litigant groups
Litigant groups

46. Internal Validity Check
This method showed 83% sensitivity and 100% specificity. Also, there was a 0% false positive rate.

47. Validity of Neuropsychological Tests
9 validity checks used (Combination of studies)
Meyers, J. E. & Volbrecht, M. E. (2003). A Validation of Multiple Malingering Detection Methods in a Large Clinical Sample, Archives of Clinical Neuropsychology, 18, 3,
Meyers, J. E., & Diep, A. (2000). Assessment of malingering in chronic pain patients using neuropsychological tests. Applied Neuropsychology, 7,
Meyers, J. E., & Volbrecht, M. (1999). Detection of malingerers using the Rey Complex Figure and Recognition Trial. Applied Neuropsychology, 6, 4,
Meyers, J. E., Galinsky, A., & Volbrecht, M. (1999). Malingering and mild brain injury: How low is too low. Applied Neuropsychology, 6,
Meyers, J. E., & Volbrecht, M. (1998). Validation of reliable digits for detection of malingering. Assessment, 5,
Meyers, J. E., & Morrison, A. L., & Miller, J. C. (2001). How low is too low revisited: Sentence repetition and AVLT Recognition in the detection of malingering. (Submitted to Applied Neuropsychology).
Meyers, J. E., & Volbrecht, M. E. (2001). A validation of multiple malingering detection methods in a large clinical sample. (under review at Archives of Clinical Neuropsychology)

48. Validity checks for Neuropsychological tests
Frequency of failing validity checks for NON LITIGATING Groups 8 7 6 5 4 3 2
< 1hr LOC
1hr <24 LOC
1-8 days LOC
9 days+ LOC
Pain
Normals
Depression

49. Validity checks for Neuropsychological tests
Frequency of failing validity checks for LITIGATING groups
<1hr LOC
> 1 hr LOC
Pain
Malingering Actors

50. TBI Dose Response - Dr. Rohling

54. Dikmen et al. (1995) Patients
TBI Dose Response
Dikmen et al. (1995) Patients

56. TBI Dose Response - Dr. Rohling
Dikmen et al., (1995) administered HRB to a sample of TBI patients. Similar patients from 2nd author (JEM).
First, determine if a dose-response TBI severity & deficits
Second, are Dikmen et al. results generalizable to other TBI samples?
Analyses of the Meyers sample replicated Dikmen.
A dose-response relationship between LOC & impairment found using effect sizes for Dikmen sample, as well as using regression-based normative T-scores for Meyers sample.
Both samples highly correlated with one another.
Mean scores for the six LOC-severity groups for two samples resulted in a correlation coefficient r = .97, p <

57. CT/MRI Data Participant Demographic Information
Variable Sample Sizes (N = 124)
Gender
Male
Female 42
Ethnicity
Caucasian 119
Other

58. CT/MRI Diagnostic Groups Sample Size MVA/TBI 47 Blow to Head 32
LCVA 24
RCVA 21

59. CT/MRI All were Right Handed.
All were followed by Dr. Meyers through hospitalization and rehabilitation.
None were involved in litigation.
All passed internal validity checks.

60. CT/MRI CT/MRI Location Left Frontal 59 Left Parietal 37
Left Temporal 34
Left Occipital 6
Right Frontal 40
Right Parietal 42
Right Temporal 31
Right Occipital 3

61. CT/MRI All were given MNB
CT/MRI data coded for injury reported on MRI/CT at the time of injury
Present = 1
Absent = 0

64. CT/MRI Independent Sample 1-tailed t-test on each lobe
On CT/MRI report
Present = 1
Absent = 0

65. CT/MRI Data

66. Brain Regions Involved in the Performance of WAIS-III Arithmetic

67. Brain Regions Involved in the Performance of the Boston Naming Test

68. Brain Regions Involved in the Performance of the Rey-CFT Copy

69. Brain Regions Involved in the Performance of the AVLT Total Score

70. CT/MRI NP tests generally behaved as expected
A more “Systemic” or “Domain” like approach better at explaining results
Construct of “Executive Function” not supported.

71. Domains used by the MNB Attention/Working Memory: Digit Span
Forced Choice
Animal Naming
Sentence Rep
AVLT 1
Processing Speed/Mental Flexibility:
Digit Symbol
Dichotic Both
Trails A
Trails B

72. Domains used by the MNB Visual Reasoning Picture Completion
Verbal Reasoning
Similarities
Arithmetic
Information
COWA
Dichotic Left
Dichotic Right
Boston Naming
Token Test
Visual Reasoning
Picture Completion
Block Design
JOL
Category
RCFT Copy

73. Domains used by the MNB Verbal Memory AVLT Total AVLT Immediate
AVLT Delayed
AVLT Recognition
Visual Memory
RCFT Immediate
RCFT Delayed
RCFT Recognition

74. Domains used by the MNB Motor and Sensory Finger Tapping Dominant Hand
Finger Tapping Non-Dominant Hand
Finger Localization Dominant Hand
Finger Localization Non-Dominant Hand

79. Commonality of Reduced O2

80. Domain Consistency N = 936 Calculated Domain M’s
Passed all validity checks
No missing data
Not involved in litigation
Calculated Domain M’s
Regression used to predict Domain M’s using all on other Domain M’s

81. Domain Means Correlations
1 – Premorbid
2 - OTBM
3 - DTBM
4 - Attent/Work Mem
5 – Pro Spd/Mental Flex
6 - Verbal Reason
7 - Visual Reason
8 - Verbal Memory
9 - Visual Memory
10 - Dom Motor/Sensory
11 - Nond Motor/Sensory
All were Significant p < .001

82. Domain M’s Correlations (cont.)
1 - Premorbid
2 - OTBM
3 - DTBM
4 - Attent/Work Mem
5 - ProcSpd/Ment Flex
6 - Verbal Reasoning
7 - Visual Reasoning
8 - Verbal Memory
9 - Visual Memory
10 - Dom Motor/Sen
11 - Nond Motor/Sen
All were Significant p < .001

83. Domains Regression Equations
Attention & Working Memory
(Verbal Reasoning) * .315
(Verbal Memory) * .273
(Processing Speed) * .193
Constant =

84. Domains Regression Equations
Processing Speed/ Mental Flexibility
Verbal Reasoning * .401
Visual Reasoning * .284
Attention & Working Memory * .230
Constant = 2.434

85. Domains Regression Equations
Verbal Reasoning
Processing Speed * .361
Attention & Working Memory * .354
Visual Reasoning * .243
Constant = 2.5

86. Domains Regression Equations
Visual Reasoning
Visual Memory * .322
Processing Speed/Mental Flexibility * .213
Verbal Reasoning * .208
Constant =

87. Domains Regression Equations
Verbal Memory
Attention & Working Memory * .738
Visual Memory * .388
Constant =

88. Domains Regression Equations
Visual Memory
Visual Reasoning * .698
Verbal Memory * .311
Processing Speed * .0909
Constant =

89. Regression Adjusted SE R R2 of the Estimate
Attent/Working Memory
Processing Speed
Verbal Reasoning
Visual Reasoning
Verbal Memory
Visual Memory

90. Review Took a battery of well known tests Developed Norms
Identified Validity, Reliability, Sensitivity and Specificity.
Internal Validity Checks and Internal Consistency