Construct validity of the NIH toolbox cognitive domains: A comparison with conventional neuropsychological assessments

Utility of the NIH Toolbox Cognition Battery in middle to older aged adults with longstanding type 1 diabetes: The DCCT/EDIC study

Objective: Adults with type 1 diabetes (T1D) face an increased risk for cognitive decline and dementia. Diabetes-related and vascular risk factors have been linked to cognitive decline using detailed neuropsychological testing; however, it is unclear if cognitive screening batteries can detect cognitive changes associated with aging in T1D. Method: 1,049 participants with T1D (median age 59 years; range 43-74) from the Diabetes Control and Complications Trial (DCCT), and the follow-up Epidemiology of Diabetes Interventions and Complications (EDIC) study, completed the NIH Toolbox Cognition Battery (NIHTB-C) and Montreal Cognitive Assessment (MoCA). Neuropsychological assessments, depression, glycated hemoglobin levels (HbA1c), severe hypoglycemia, T1D complications, and vascular risk factors were assessed repeatedly over 32 years to determine associations with current NIHTB-C performance. Available cognitive data was clinically adjudicated to determine cognitive impairment status. Results: NIHTB-C scores had moderate associations (r = 0.36-0.53) with concurrently administered neuropsychological tests. In multivariate models, prior severe hypoglycemic episodes, depression symptoms, nephropathy, lower BMI, and higher HbA1c and LDL cholesterol were associated with poorer NIHTB-C Fluid Cognition Composite scores. The NIHTB-C adequately detected adjudicated cognitive impairment (Area Under the Curve = 0.86; optimal cut score ≤90). The MoCA performed similarly (Area Under the Curve = 0.83; optimal cut score ≤25). Conclusions: The NIHTB-C is sensitive to the cognitive effects of diabetes-related and vascular risk factors, correlated with neuropsychological testing, and accurately detects adjudicated cognitive impairment. These data support its use as a screening test in middle to older aged adults with T1D to determine if referral for detailed neuropsychological assessment is needed.

Neurocognition and its predictors in a linguistically and culturally diverse cohort of people with HIV

Objective: HIV/AIDS disproportionately affects Black and Latino people in the United States, yet there is a lack of research on predictors of neurocognitive outcomes in these groups. We examined neurocognitive performance and its key predictors across White, Black, and Latino people with HIV (PWH). Method: Participants included 586 PWH of White, Black, and Latino (English- and Spanish-speaking) background. Neurocognition was assessed via demographically-adjusted Fluid Cognition Composite T-scores from the NIH-Toolbox cognition battery, and individual tests comprising this composite. Predictors examined included sociodemographic and HIV disease characteristics, and medical, psychiatric and substance comorbidities. Results: Compared to White PWH, English-speaking Latino PWH had lower T-scores on the Fluid Cognition Composite, as well as Flanker Inhibition and Picture Sequence Memory tests. While there were no other significant group differences on Fluid Cognition, both Latino PWH language groups performed worse than Black PWH on Flanker Inhibition, and Black PWH performed worse than White PWH on List Sorting. Separate multivariable linear regression models by ethnic/racial/language group showed that significant correlates of worse Fluid Cognition included depressive symptoms among White PWH; hepatitis C co-infection among Black PWH; hypertension among English-speaking Latino PWH; and higher estimated duration of HIV disease and depressive symptoms in Spanish-speaking Latino PWH. Conclusions: Findings suggest worse neurocognition among English-speaking Latino PWH compared to Whites. Predictors of neurocognitive function among PWH differ across ethnic/racial and language groups. Consideration of these HIV disease characteristics and comorbidities may be valuable in developing targeted culturally-relevant interventions aimed at ameliorating neurocognitive dysfunction among diverse PWH.

Construct validation of NIH Toolbox Cognition Battery premorbid cognitive functioning scores in Black and White older Americans with and without mild cognitive impairment

OBJECTIVE

Valid estimates of premorbid cognitive functioning (PMIQ) are crucial for the assessment of older adults at risk for Alzheimer's disease. We investigated the relationship between the NIH Toolbox-Cognition Battery's (NIHTB-CB) Oral Reading Recognition (ORR) subtest and Wechsler Test of Adult Reading scores (WTAR, convergent validity). We also compared ORR to NIHTB-CB Flanker scores, where null relationships were expected (discriminant validity).

METHODS

The WTAR and NIHTB-CB were administered to 130 cognitively normal (CN) and 113 participants with mild cognitive impairment (MCI). Participants were community-dwelling, older Black and White adults, ages 55-88 years. Data analysis used uncorrected standard scores and Bayesian bivariate correlations. Supplemental materials include intraclass correlations.

RESULTS

ORR and WTAR scores were strongly positively associated, while ORR and Flanker scores were unrelated. This pattern held when restricting analyses to the two cognitive status groups, the two racial groups, and the four race-by-diagnosis subgroups.

CONCLUSION

The findings demonstrate convergent and discriminant validity and support NIHTB-CB ORR scores as valid estimates of scores on a PMIQ measure in older Black and White adults with and without MCI.

Evidence for a Compensatory Relationship between Left- and Right-Lateralized Brain Networks

The two hemispheres of the human brain are functionally asymmetric. At the network level, the language network exhibits left-hemisphere lateralization. While this asymmetry is widely replicated, the extent to which other functional networks demonstrate lateralization remains a subject of Investigation. Additionally, it is unknown how the lateralization of one functional network may affect the lateralization of other networks within individuals. We quantified lateralization for each of 17 networks by computing the relative surface area on the left and right cerebral hemispheres. After examining the ecological, convergent, and external validity and test-retest reliability of this surface area-based measure of lateralization, we addressed two hypotheses across multiple datasets (Human Connectome Project = 553, Human Connectome Project-Development = 343, Natural Scenes Dataset = 8). First, we hypothesized that networks associated with language, visuospatial attention, and executive control would show the greatest lateralization. Second, we hypothesized that relationships between lateralized networks would follow a dependent relationship such that greater left-lateralization of a network would be associated with greater right-lateralization of a different network within individuals, and that this pattern would be systematic across individuals. A language network was among the three networks identified as being significantly left-lateralized, and attention and executive control networks were among the five networks identified as being significantly right-lateralized. Next, correlation matrices, an exploratory factor analysis, and confirmatory factor analyses were used to test the second hypothesis and examine the organization of lateralized networks. We found general support for a dependent relationship between highly left- and right-lateralized networks, meaning that across subjects, greater left lateralization of a given network (such as a language network) was linked to greater right lateralization of another network (such as a ventral attention/salience network) and vice versa. These results further our understanding of brain organization at the macro-scale network level in individuals, carrying specific relevance for neurodevelopmental conditions characterized by disruptions in lateralization such as autism and schizophrenia.

Effects of age on the relationship between sleep quality and cognitive performance: Findings from the Human Connectome Project-Aging cohort

BACKGROUND

The association between sleep quality and cognition is widely established, but the role of aging in this relationship is largely unknown.

OBJECTIVE

To examine how age impacts the sleep-cognition relationship and determine whether there are sensitive ranges when the relationship between sleep and cognition is modified. This investigation could help identify individuals at risk for sleep-related cognitive impairment.

SUBJECTS

Sample included 711 individuals (ages 36.00-89.8359.66 ± 14.9155.7 % female) from the Human Connectome Project-Aging (HCP-A).

METHODS

The association between sleep quality (Pittsburgh Sleep Quality Index, PSQI) and cognition (Crystallized Cognition Composite and Fluid Cognition Composite from the NIH Toolbox, the Trail Making Test, TMT, and the Rey Auditory Verbal Learning Test, RAVLT) was measured using linear regression models, with sex, race, use of sleep medication, hypertension, and years of education as covariates. The interaction between sleep and age on cognition was tested using the moderation analysis, with age as both continuous linear and nonlinear (quadratic) terms.

RESULTS

There was a significant interaction term between the PSQI and nonlinear age term (age2) on TMT-B (p = 0.02) and NIH Toolbox crystallized cognition (p = 0.02), indicating that poor sleep quality was associated with worse performance on these measures (sensitive age ranges 50-75 years for TMT-B and 66-70 years for crystallized cognition).

CONCLUSIONS

The sleep-cognition relationship may be modified by age. Individuals in the middle age to early older adulthood age band may be most vulnerable to sleep-related cognitive impairment.

A psychometric evaluation of the NIH Toolbox fluid cognition tests adapted for Swahili and Dholuo languages in Kenyan children and adolescents

OBJECTIVE

Our objective was to evaluate the psychometric properties of the culturally adapted NIH Toolbox African Languages® when used in Swahili and Dholuo-speaking children in western Kenya.

METHOD

Swahili-speaking participants were recruited from Eldoret and Dholuo-speaking participants from Ajigo; all were <14 years of age and enrolled in primary school. Participants completed a demographics questionnaire and five fluid cognition tests of the NIH Toolbox® African Languages program, including Flanker, Dimensional Change Card Sort (DCCS), Picture Sequence Memory, Pattern Comparison, and List Sorting tests. Statistical analyses examined aspects of reliability, including internal consistency (in both languages) and test-retest reliability (in Dholuo only).

RESULTS

Participants included 479 children (n = 239, Swahili-speaking; n = 240, Dholuo-speaking). Generally, the tests had acceptable psychometric properties for research use within Swahili- and Dholuo-speaking populations (mean age = 10.5; SD = 2.3). Issues related to shape identification and accuracy over speed limited the utility of DCCS for many participants, with approximately 25% of children unable to match based on shape. These cultural differences affected outcomes of reliability testing among the Dholuo-speaking cohort, where accuracy improved across all five tests, including speed.

CONCLUSIONS

There is preliminary evidence that the NIH Toolbox ® African Languages potentially offers a valid assessment of development and performance using tests of fluid cognition in Swahili and Dholuo among research settings. With piloting underway across other diverse settings, future research should gather additional evidence on the clinical utility and acceptability of these tests, specifically through the establishment of norming data among Kenyan regions and evaluating these psychometric properties.

Oscillatory dynamics serving visual selective attention during a Simon task

Selective attention is an important component of cognitive control and is essential for day-to-day functioning. The Simon task is a common test of visual selective attention that has been widely used to probe response selection, inhibition and cognitive control. However, to date, there is a dearth of literature that has focused on the oscillatory dynamics serving task performance in the selective attention component of this task. In this study, 32 healthy adults (mean age: 33.09 years, SD: 7.27 years) successfully completed a modified version of the Simon task during magnetoencephalography. All magnetoencephalographic data were pre-processed and transformed into the time-frequency domain. Significant oscillatory brain responses were imaged using a beamforming approach, and peak task-related neural activity was extracted to examine the temporal dynamics. Across both congruent and Simon conditions, our results indicated robust decreases in alpha (8-12 Hz) activity in the bilateral occipital regions and cuneus during task performance, while increases in theta (3-6 Hz) oscillatory activity were detected in regions of the dorsal frontoparietal attention network, including the dorsolateral prefrontal cortex, frontal eye fields and insula. Lastly, whole-brain condition-wise analyses showed Simon interference effects in the theta range in the superior parietal region and the alpha range in the posterior cingulate and inferior frontal cortices. These findings provide network-specific insights into the oscillatory dynamics serving visual selective attention.

The effects of an exercise intervention on executive function among overweight adults with obstructive sleep apnea

PURPOSE

Obstructive sleep apnea (OSA) is associated with poorer executive function. This study examined the effects of a comprehensive exercise intervention on executive function in overweight adults with mild and moderate-to-severe OSA.

METHODS

Participants aged between 30 and 65 years, with a body mass index (BMI) ranging from 27 to 42 kg/m^2, participated in a 6-week exercise program. Standardized polysomnographic recording methods provided total Apnea-Hypopnea Index (AHI) and level of hypoxemia. Executive function was assessed using the NIH Toolbox Flanker Inhibitory Control Test. A submaximal treadmill exercise test evaluated cardiorespiratory fitness. Participants with baseline total AHI between 5 and 14.9 events/h were classified as mild OSA and participants with baseline total AHI 15 ≥ events/h were classified as moderate-to-severe OSA.

RESULTS

Fifteen participants completed 18 exercise sessions. Significant differences between OSA categories at baseline were observed for sleep characteristics, but not for fitness or executive function. Wilcoxon Signed Rank Tests showed significant increases in median values for the Flanker Test in the moderate-to-severe category only, z = 2.429, p < .015, η² = .737.

CONCLUSION

Six weeks of exercise improved executive function in overweight individuals with moderate-to-severe OSA, but not in those with mild OSA.

Link between fluid/crystallized intelligence and global/local visual abilities across adulthood

Human visual processing involves the extraction of both global and local information from a visual stimulus. Such processing may be related to cognitive abilities, which is likely going to change over time as we age. We aimed to investigate the impact of healthy aging on the association between visual global vs local processing and intelligence. In this context, we collected behavioral data during a visual search task in 103 adults (50 younger/53 older). We extracted three metrics reflecting global advantage (faster global than local processing), and visual interference in detecting either local or global features (based on interfering visual distractors). We found that older, but not younger, adults with higher levels of fluid and crystallized intelligence showed stronger signs of global advantage and interference effects during local processing, respectively. The present findings also provide promising clues regarding how participants consider and process their visual world in healthy aging.