Brain Impairment

Clinical Practice: Current Opinion

How Do You Know Whether Your Patient Is Getting Better (or Worse)? A User's Guide

Michael Perdicesa1 c1

a1 Department of Neurology, Royal North Shore Hospital University of Sydney, Australia.


It is important to know when improvement or deterioration in cognitive function occurs. Until fairly recently neuropsychologists have made these judgments clinically, with little resort to empirical methods. In addition to the issue of whether a change in performance is reliable, there is also the consideration of whether it is clinically significant. This article briefly discusses these concepts, reviews the most common methods for determining reliability in change in test scores, considers their use in the broader clinical context, and illustrates their application with reference to an actual database.


c1 Address for correspondence: Michael Perdices PhD, Department of Neurology, Royal North Shore Hospital, St Leonards NSW 2065. E-mail