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Umlauf A, Vaida F, Gupta S, Cherner M, Gershon RC, Heaton RK. Automated procedure for demographic adjustments on cognitive test scores. APPLIED NEUROPSYCHOLOGY. ADULT 2023:1-10. [PMID: 38052056 PMCID: PMC11150334 DOI: 10.1080/23279095.2023.2288231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
Performances of normal people on cognitive tests are known to vary by demographic characteristics, such as age, education, and sex. Thus, cognitive test scores should be corrected for demographic influences when they are used to detect below-expected results due to disease or injury involving the central nervous system (CNS). Normative corrections, if estimated from a large, diverse, and well-characterized cohort of controls, help to remove expected differences in cognitive performance associated with normal demographic characteristics and associated socio-economic disadvantages. In this paper, we (1) describe in detail the process of generating regression-based normative standards, and its advantages and limitations, (2) provide recommendations for applying these normative standards to data from individuals and populations at risk for CNS dysfunction, and (3) introduce an R package, test2norm, that contains functions for producing and applying normative formulas to generate demographically corrected scores for measuring deviations from expected, normal cognitive performances.
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Affiliation(s)
- Anya Umlauf
- University of California San Diego, La Jolla, CA, USA
| | - Florin Vaida
- University of California San Diego, La Jolla, CA, USA
| | | | | | - Richard C Gershon
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA
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Fox RS, Zhang M, Amagai S, Bassard A, Dworak EM, Han YC, Kassanits J, Miller CH, Nowinski CJ, Giella AK, Stoeger JN, Swantek K, Hook JN, Gershon RC. Uses of the NIH Toolbox® in Clinical Samples: A Scoping Review. Neurol Clin Pract 2022; 12:307-319. [PMID: 36382124 PMCID: PMC9647815 DOI: 10.1212/cpj.0000000000200060] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 05/10/2022] [Indexed: 11/15/2022]
Abstract
Background and Objectives The NIH Toolbox® for the Assessment of Neurologic and Behavioral Function is a compilation of computerized measures designed to assess sensory, motor, emotional, and cognitive functioning of individuals across the life span. The NIH Toolbox was initially developed for use with the general population and was not originally validated in clinical populations. The objective of this scoping review was to assess the extent to which the NIH Toolbox has been used with clinical populations. Methods Guided by the Joanna Briggs Methods Manual for Scoping Reviews, records were identified through searches of PubMed MEDLINE, PsycINFO, ClinicalTrials.gov, EMBASE, and ProQuest Dissertations and Theses Global (2008-2020). Database searches yielded 5,693 unique titles of original research that used at least one NIH Toolbox assessment in a sample characterized by any clinical diagnosis. Two reviewers screened titles, abstracts, and full texts for inclusion in duplicate. Conflicts at each stage of the review process were resolved by a group discussion. Results Ultimately, 281 publication records were included in this scoping review (nJournal Articles = 104, nConference Abstracts = 84, nClinical Trial Registrations = 86, and nTheses/Dissertations = 7). The NIH Toolbox Cognition Battery was by far the most used of the 4 batteries in the measurement system (nCognition = 225, nEmotion = 49, nMotor = 29, and nSensation = 16). The most represented clinical category was neurologic disorders (n = 111), followed by psychological disorders (n = 39) and cancer (n = 31). Most (96.8%) of the journal articles and conference abstracts reporting the use of NIH Toolbox measures with clinical samples were published in 2015 or later. As of May 2021, these records had been cited a total of nearly 1,000 times. Discussion The NIH Toolbox measures have been widely used among individuals with various clinical conditions across the life span. Our results lay the groundwork to support the feasibility and utility of administering the NIH Toolbox measures in research conducted with clinical populations and further suggest that these measures may be of value for implementation in fast-paced clinical settings as part of routine practice.
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Affiliation(s)
- Rina S Fox
- Northwestern University (RSF, MZ, SA, AB, EMD, YCH, JK, CHM, CJN, AKG, JNS, KS, JNH, RCG), Chicago, IL; and University of Arizona (RSF), Tucson
| | - Manrui Zhang
- Northwestern University (RSF, MZ, SA, AB, EMD, YCH, JK, CHM, CJN, AKG, JNS, KS, JNH, RCG), Chicago, IL; and University of Arizona (RSF), Tucson
| | - Saki Amagai
- Northwestern University (RSF, MZ, SA, AB, EMD, YCH, JK, CHM, CJN, AKG, JNS, KS, JNH, RCG), Chicago, IL; and University of Arizona (RSF), Tucson
| | - Adrianna Bassard
- Northwestern University (RSF, MZ, SA, AB, EMD, YCH, JK, CHM, CJN, AKG, JNS, KS, JNH, RCG), Chicago, IL; and University of Arizona (RSF), Tucson
| | - Elizabeth M Dworak
- Northwestern University (RSF, MZ, SA, AB, EMD, YCH, JK, CHM, CJN, AKG, JNS, KS, JNH, RCG), Chicago, IL; and University of Arizona (RSF), Tucson
| | - Y Catherine Han
- Northwestern University (RSF, MZ, SA, AB, EMD, YCH, JK, CHM, CJN, AKG, JNS, KS, JNH, RCG), Chicago, IL; and University of Arizona (RSF), Tucson
| | - Jessica Kassanits
- Northwestern University (RSF, MZ, SA, AB, EMD, YCH, JK, CHM, CJN, AKG, JNS, KS, JNH, RCG), Chicago, IL; and University of Arizona (RSF), Tucson
| | - Corinne H Miller
- Northwestern University (RSF, MZ, SA, AB, EMD, YCH, JK, CHM, CJN, AKG, JNS, KS, JNH, RCG), Chicago, IL; and University of Arizona (RSF), Tucson
| | - Cindy J Nowinski
- Northwestern University (RSF, MZ, SA, AB, EMD, YCH, JK, CHM, CJN, AKG, JNS, KS, JNH, RCG), Chicago, IL; and University of Arizona (RSF), Tucson
| | - Amy K Giella
- Northwestern University (RSF, MZ, SA, AB, EMD, YCH, JK, CHM, CJN, AKG, JNS, KS, JNH, RCG), Chicago, IL; and University of Arizona (RSF), Tucson
| | - Jordan N Stoeger
- Northwestern University (RSF, MZ, SA, AB, EMD, YCH, JK, CHM, CJN, AKG, JNS, KS, JNH, RCG), Chicago, IL; and University of Arizona (RSF), Tucson
| | - Kathleen Swantek
- Northwestern University (RSF, MZ, SA, AB, EMD, YCH, JK, CHM, CJN, AKG, JNS, KS, JNH, RCG), Chicago, IL; and University of Arizona (RSF), Tucson
| | - Julie N Hook
- Northwestern University (RSF, MZ, SA, AB, EMD, YCH, JK, CHM, CJN, AKG, JNS, KS, JNH, RCG), Chicago, IL; and University of Arizona (RSF), Tucson
| | - Richard C Gershon
- Northwestern University (RSF, MZ, SA, AB, EMD, YCH, JK, CHM, CJN, AKG, JNS, KS, JNH, RCG), Chicago, IL; and University of Arizona (RSF), Tucson
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Lee J, Dudley-Javoroski S, Shields RK. Motor demands of cognitive testing may artificially reduce executive function scores in individuals with spinal cord injury. J Spinal Cord Med 2021; 44:253-261. [PMID: 30943119 PMCID: PMC7952072 DOI: 10.1080/10790268.2019.1597482] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Objective: To determine whether the motor demands of cognitive tests contribute to differences in cognitive function scores in participants with and without spinal cord injury (SCI).Design: Cohort study.Setting: Rehabilitation research laboratory.Participants: 68 individuals without SCI ("NON") and 22 individuals with motor complete SCI ("SCI").Interventions: None.Outcome Measures: NIH Toolbox cognitive assessments, including two with motor demands and reaction-time based scoring (Dimensional Change Card Sort (DCCS), Flanker Inhibitory Control and Attention (Flanker) and two without timed scoring (List Sorting Working Memory (List Sorting), Picture Sequence Memory Test (Picture Sequence). Tests were administered with and without the assistance of a proctor on two randomly-determined days (>24 hr interval). For DCCS and Flanker, the motor-task score offset was estimated as the difference between the proctored and non-proctored scores.Results: For demographically-corrected data, proctoring reduced DCCS and Flanker scores (P < 0.001) but mitigated apparent differences between SCI and NON (all P > 0.403). SCI and NON did not differ for List Sorting (P > 0.072) but did differ significantly for Picture Sequence (P < 0.001). Significant practice effects existed for memory-based tests (List Sorting and Picture Sequence); all P < 0.015, effect size>0.645.Conclusions: DCCS and Flanker scores for individuals with SCI may be artificially reduced consequent to secondary motor demands of the tests. Proctoring and computation of a motor-response score offset enables comparisons to be made between individuals with SCI and a Non-SCI control cohort; however, further work is needed to determine whether offset-adjusted scores can be compared to standardized normative values.
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Affiliation(s)
- Jinhyun Lee
- Department of Physical Therapy and Rehabilitation Science, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Shauna Dudley-Javoroski
- Department of Physical Therapy and Rehabilitation Science, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Richard K. Shields
- Department of Physical Therapy and Rehabilitation Science, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA,Correspondence to: Richard K. Shields, Department of Physical Therapy and Rehabilitation Science, University of Iowa, 1-252 Medical Education Building, Iowa City, IA52242, USA.
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Joseph ALC, Peterson HA, Garcia KM, McNally SM, Mburu TK, Lippa SM, Dsurney J, Chan L. Rey Tangled Line Test: A measure of processing speed in TBI. Rehabil Psychol 2019; 64:445-452. [PMID: 31246042 PMCID: PMC6803037 DOI: 10.1037/rep0000284] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Neuropsychological assessment plays a key role in characterizing and detecting cognitive impairment after traumatic brain injury (TBI). The Rey Tangled Line Test (RTLT), an understudied neuropsychological assessment thought to be capable of detecting visual processing deficits, was examined to determine which cognitive abilities may contribute to performance on the test in participants with a history of TBI. METHOD One-hundred participants with a history of mild to severe TBI were administered a battery of neuropsychological tests assessing attention, executive functioning, memory, visual construction, motor functioning, and processing speed between 30 days and 5 years postinjury. An exploratory principal components analysis (PCA) was performed to determine which cognitive tests the RTLT was most highly associated with. RESULTS No difference in RTLT latency was present between mild and moderate/severe TBI. The PCA resulted in 5 factors. RTLT latency had a significant primary factor loading on the "processing speed" factor, and a secondary loading on the "motor" factor. Forty-two percent of participants had an impaired latency score. CONCLUSIONS RTLT latency appears to measure processing speed, and likely aspects of motor functioning, in our sample. The RTLT may be useful as a rapid assessment in individuals with a history of TBI to detect cognitive deficit before initiating further cognitive testing or rehabilitation efforts. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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Affiliation(s)
- Annie-Lori C. Joseph
- Rehabilitation Medicine Department, National Institutes of Health Clinical Center, Bethesda, MD, USA
| | - Hope A. Peterson
- Rehabilitation Medicine Department, National Institutes of Health Clinical Center, Bethesda, MD, USA
| | - Katelyn M. Garcia
- Center for Neuroscience and Regenerative Medicine, National Institutes of Health Clinical Center, Bethesda, MD, USA
| | - Shannon M. McNally
- Center for Neuroscience and Regenerative Medicine, National Institutes of Health Clinical Center, Bethesda, MD, USA
| | - Tracyann K. Mburu
- Center for Neuroscience and Regenerative Medicine, National Institutes of Health Clinical Center, Bethesda, MD, USA
| | - Sara M. Lippa
- Defense and Veterans Brain Injury Center, Bethesda, MD, USA
- National Intrepid Center of Excellence, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | | | - Leighton Chan
- Rehabilitation Medicine Department, National Institutes of Health Clinical Center, Bethesda, MD, USA
- Center for Neuroscience and Regenerative Medicine, National Institutes of Health Clinical Center, Bethesda, MD, USA
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