The brief repeatable battery of neuropsychological test (BRB-N) version B: update of Italian normative data

Background: Cognitive impairment affects up to 70% of people with multiple sclerosis (PwMS), mainly impacting memory, processing speed and attention. The Brief Repeatable Battery of Neuropsychological Tests (BRB-N) is widely used to monitor these deficits and has two parallel versions, A and B, to minimize practice effects. The Italian norms for version B have been published years ago and may not reflect current demographic trends. Objectives: To revise and update normative data for the BRB-N version B in the Italian population and to harmonize these procedures with those used for other neuropsychological batteries used in MS. Methods: We recruited 224 healthy subjects (94 males, 130 females; mean age = 43.34, standard deviation [SD] = 14.41, range: 19-86 years; mean education = 13.89, SD = 4.05, range = 5-23) from two centers (Milan, Florence). Each raw BRB-N version B score was transformed into a scaled-score metric, then regressed on centered age, centered age2, education, and sex. Results: No significant differences were found in age and sex distribution between centers (all p ≥ 0.87), whereas Milan subjects showed a higher education compared to Florence subjects (p < 0.001). Age and education emerged as consistent predictors across nearly all tests, while sex showed only limited influence. Regression analysis provided normative data to calculate demographically adjusted z scores for each BRB-N version B test. Despite differing sample size and composition, regression coefficients mirrored those from BRB-N version A updated normative data. Conclusions: These updated, regression-based norms for BRB-N version B align with other major MS neuropsychological batteries in Italy, improving cognitive assessment accuracy in clinical and research settings.