Multivariate normative comparisons using an aggregated database.

In multivariate normative comparisons, a patient's profile of test scores is compared to those in a normative sample. Recently, it has been shown that these multivariate normative comparisons enhance the sensitivity of neuropsychological assessment. However, multivariate normative comparisons require multivariate normative data, which are often unavailable. In this paper, we show how a multivariate normative database can be constructed by combining healthy control group data from published neuropsychological studies. We show that three issues should be addressed to construct a multivariate normative database. First, the database may have a multilevel structure, with participants nested within studies. Second, not all tests are administered in every study, so many data may be missing. Third, a patient should be compared to controls of similar age, gender and educational background rather than to the entire normative sample. To address these issues, we propose a multilevel approach for multivariate normative comparisons that accounts for missing data and includes covariates for age, gender and educational background. Simulations show that this approach controls the number of false positives and has high sensitivity to detect genuine deviations from the norm. An empirical example is provided. Implications for other domains than neuropsychology are also discussed. To facilitate broader adoption of these methods, we provide code implementing the entire analysis in the open source software package R.