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Saks DG, Bajorek B, Catts VS, Bentvelzen AC, Jiang J, Wen W, Mather KA, Thalamuthu A, Huang-Lung J, Nivison-Smith L, Griffiths LR, Smith RA, Sexton A, James P, Jayasena T, Poljak A, Hansra GK, Hosoki S, Park A, Hillenbrand CM, van Wijngaarden P, Chander RJ, Humphrey S, Chen R, Kochan NA, Helman TJ, Levi C, Brodtmann A, O'Sullivan MJ, Markus R, Butcher K, Parsons M, Kovacic JC, Sachdev PS. The protocol for an observational Australian cohort study of CADASIL: The AusCADASIL study. CEREBRAL CIRCULATION - COGNITION AND BEHAVIOR 2024; 6:100225. [PMID: 38841148 PMCID: PMC11152887 DOI: 10.1016/j.cccb.2024.100225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/02/2024] [Revised: 05/09/2024] [Accepted: 05/14/2024] [Indexed: 06/07/2024]
Abstract
Introduction Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy (CADASIL) is a rare genetic condition with a broad phenotypic presentation. This study aims to establish the first Australian cohort of individuals affected by CADASIL (AusCADASIL) and examine its clinical features and longitudinal course, and to investigate neuroimaging and blood biomarkers to assist in early diagnosis and identify disease progression. Methods Participants will be recruited from six study centres across Australia for an observational study of CADASIL. We aim to recruit 150 participants with diagnosed CADASIL, family history of CADASIL or suspected CADASIL symptoms, and 150 cognitively normal NOTCH3 negative individuals as controls. Participants will complete: 1) online questionnaires on medical and family history, mental health, and wellbeing; 2) neuropsychological evaluation; 3) neurological examination and brain MRI; 4) ocular examination and 5) blood sample donation. Participants will have annual follow-up for 4 years to assess their progression and will be asked to invite a study partner to corroborate their self-reported cognitive and functional abilities.Primary outcomes include cognitive function and neuroimaging abnormalities. Secondary outcomes include investigation of genetics and blood and ocular biomarkers. Data from the cohort will contribute to an international consortium, and cohort participants will be invited to access future treatment/health intervention trials. Discussion AusCADASIL will be the first study of an Australian cohort of individuals with CADASIL. The study will identify common pathogenic variants in this cohort, and characterise the pattern of clinical presentation and longitudinal progression, including imaging features, blood and ocular biomarkers and cognitive profile.
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Affiliation(s)
- Danit G. Saks
- Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, 2052, Australia
| | - Beata Bajorek
- Heart and Stroke Program, Hunter Medical Research Institute, Newcastle, 2305, Australia
- Pharmacy Department, John Hunter Hospital, Newcastle, 2305, Australia
- School of Biomedical Sciences and Pharmacy, University of Newcastle, Newcastle, 2308, Australia
| | - Vibeke S. Catts
- Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, 2052, Australia
| | - Adam C. Bentvelzen
- Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, 2052, Australia
| | - Jiyang Jiang
- Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, 2052, Australia
| | - Wei Wen
- Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, 2052, Australia
| | - Karen A. Mather
- Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, 2052, Australia
| | - Anbupalam Thalamuthu
- Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, 2052, Australia
| | - Jessie Huang-Lung
- School of Optometry and Vision Science, University of New South Wales, Sydney, 2052, Australia
| | - Lisa Nivison-Smith
- School of Optometry and Vision Science, University of New South Wales, Sydney, 2052, Australia
| | - Lyn R. Griffiths
- Genomics Research Centre, Centre for Genomics and Personalised Health, Queensland University of Technology, Brisbane, 4059, Australia
| | - Robert A. Smith
- Genomics Research Centre, Centre for Genomics and Personalised Health, Queensland University of Technology, Brisbane, 4059, Australia
| | - Adrienne Sexton
- Genomic Medicine, Royal Melbourne Hospital, Melbourne, 3052, Australia
| | - Paul James
- Genomic Medicine, Royal Melbourne Hospital, Melbourne, 3052, Australia
| | - Tharusha Jayasena
- Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, 2052, Australia
| | - Anne Poljak
- Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, 2052, Australia
- Bioanalytical Mass Spectrometry Facility, University of New South Wales, Sydney, 2052, Australia
| | - Gurpreet K. Hansra
- Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, 2052, Australia
| | - Satoshi Hosoki
- Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, 2052, Australia
| | - Ashley Park
- Department of Neurology, Royal Melbourne Hospital, Melbourne, 3052, Australia
| | | | - Peter van Wijngaarden
- Centre for Eye Research Australia, Royal Victorian Eye and Ear Hospital, Melbourne, 3002, Australia
- Ophthalmology, Department of Surgery, University of Melbourne, Melbourne, 3052, Australia
| | - Russell J. Chander
- Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, 2052, Australia
| | - Sam Humphrey
- Department of Neurology, Royal Melbourne Hospital, Melbourne, 3052, Australia
| | - Rory Chen
- Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, 2052, Australia
| | - Nicole A. Kochan
- Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, 2052, Australia
| | - Tessa J. Helman
- Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, 2052, Australia
| | - Christopher Levi
- School of Medicine and Public Health, University of Newcastle, Newcastle, 2308, Australia
- John Hunter Health and Innovation Precinct (JHHIP), Newcastle, 2305, Australia
- Neurology Department, John Hunter Hospital, Newcastle, 2305, Australia
| | - Amy Brodtmann
- Department of Neurology, Royal Melbourne Hospital, Melbourne, 3052, Australia
| | - Michael J. O'Sullivan
- Institute for Molecular Bioscience, University of Queensland, Brisbane, 4067, Australia
| | - Romesh Markus
- Department of Neurology, St Vincent's Hospital, Sydney, 2010, Australia
| | - Ken Butcher
- Department of Neurology, Prince of Wales Hospital, Sydney, 2031, Australia
| | - Mark Parsons
- School of Clinical Medicine, University of New South Wales, Sydney, 2052, Australia
| | - Jason C. Kovacic
- School of Clinical Medicine, University of New South Wales, Sydney, 2052, Australia
- Victor Chang Cardiac Research Institute, Sydney, 2010, Australia
- Cardiovascular Research Institute, Icahn School of Medicine at Mount Sinai, New York, NY, 10029, USA
| | - Perminder S. Sachdev
- Centre for Healthy Brain Ageing, Discipline of Psychiatry and Mental Health, School of Clinical Medicine, University of New South Wales, Sydney, 2052, Australia
- Neuropsychiatric Institute, Prince of Wales Hospital, Sydney, 2031, Australia
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Chaytor NS, Trapani VR, Braffett BH, Fonseca LM, Lorenzi GM, Gubitosi-Klug RA, Hitt S, Farrell K, Jacobson AM, Ryan CM. Utility of the NIH Toolbox Cognition Battery in middle to older aged adults with longstanding type 1 diabetes: The DCCT/EDIC study. Clin Neuropsychol 2024; 38:1007-1027. [PMID: 37814481 PMCID: PMC11001788 DOI: 10.1080/13854046.2023.2266876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 09/28/2023] [Indexed: 10/11/2023]
Abstract
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.
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Affiliation(s)
- Naomi S Chaytor
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | | | | | - Luciana M Fonseca
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - Gayle M Lorenzi
- Medicine, University of California San Diego, La Jolla, CA, USA
| | - Rose A Gubitosi-Klug
- Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, OH, USA
| | - Susan Hitt
- Ophthalmology, University of Missouri, Columbia, MO, USA
| | - Kaleigh Farrell
- Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, OH, USA
| | - Alan M Jacobson
- NYU Langone Long Island Hospital, NYU Long Island School of Medicine, Mineola, NY, USA
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Kang K, Seidlitz J, Bethlehem RA, Xiong J, Jones MT, Mehta K, Keller AS, Tao R, Randolph A, Larsen B, Tervo-Clemmens B, Feczko E, Dominguez OM, Nelson S, Schildcrout J, Fair D, Satterthwaite TD, Alexander-Bloch A, Vandekar S. Study design features that improve effect sizes in cross-sectional and longitudinal brain-wide association studies. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2023.05.29.542742. [PMID: 37398345 PMCID: PMC10312450 DOI: 10.1101/2023.05.29.542742] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/04/2023]
Abstract
Brain-wide association studies (BWAS) are a fundamental tool in discovering brain-behavior associations. Several recent studies showed that thousands of study participants are required to improve the replicability of BWAS because actual effect sizes are much smaller than those reported in smaller studies. Here, we perform analyses and meta-analyses of a robust effect size index (RESI) using 63 longitudinal and cross-sectional magnetic resonance imaging studies from the Lifespan Brain Chart Consortium (77,695 total scans) to demonstrate that optimizing study design is critical for improving standardized effect sizes and replicability in BWAS. A meta-analysis of brain volume associations with age indicates that BWAS with larger covariate variance have larger effect size estimates and that the longitudinal studies we examined have systematically larger standardized effect sizes than cross-sectional studies. We propose a cross-sectional RESI to adjust for the systematic difference in effect sizes between cross-sectional and longitudinal studies that allows investigators to quantify the benefit of conducting their study longitudinally. Analyzing age effects on global and regional brain measures from the United Kingdom Biobank and the Alzheimer's Disease Neuroimaging Initiative, we show that modifying longitudinal study design through sampling schemes to increase between-subject variability and adding a single additional longitudinal measurement per subject can improve effect sizes. However, evaluating these longitudinal sampling schemes on cognitive, psychopathology, and demographic associations with structural and functional brain outcome measures in the Adolescent Brain and Cognitive Development dataset shows that commonly used longitudinal models can, counterintuitively, reduce effect sizes. We demonstrate that the benefit of conducting longitudinal studies depends on the strengths of the between- and within-subject associations of the brain and non-brain measures. Explicitly modeling between- and within-subject effects avoids conflating the effects and allows optimizing effect sizes for them separately. These findings underscore the importance of considering study design features to improve the replicability of BWAS.
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Affiliation(s)
- Kaidi Kang
- Department of Biostatistics, Vanderbilt University Medical Center
| | - Jakob Seidlitz
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, The Children’s Hospital of Philadelphia
- Department of Psychiatry, University of Pennsylvania
- Lifespan Brain Institute of The Children’s Hospital of Philadelphia and Penn Medicine
| | | | - Jiangmei Xiong
- Department of Biostatistics, Vanderbilt University Medical Center
| | - Megan T. Jones
- Department of Biostatistics, Vanderbilt University Medical Center
| | - Kahini Mehta
- Department of Psychiatry, University of Pennsylvania
- Lifespan Brain Institute of The Children’s Hospital of Philadelphia and Penn Medicine
- Penn Lifespan Informatics and Neuroimaging Center (PennLINC), Perelman School of Medicine, University of Pennsylvania
| | - Arielle S. Keller
- Department of Psychiatry, University of Pennsylvania
- Lifespan Brain Institute of The Children’s Hospital of Philadelphia and Penn Medicine
- Penn Lifespan Informatics and Neuroimaging Center (PennLINC), Perelman School of Medicine, University of Pennsylvania
| | - Ran Tao
- Department of Biostatistics, Vanderbilt University Medical Center
| | - Anita Randolph
- Department of Pediatrics, University of Minnesota Medical School
| | - Bart Larsen
- Department of Pediatrics, University of Minnesota Medical School
| | - Brenden Tervo-Clemmens
- Department of Department of Psychiatry & Behavioral Sciences, University of Minnesota Medical School
| | - Eric Feczko
- Department of Pediatrics, University of Minnesota Medical School
| | | | - Steve Nelson
- Department of Pediatrics, University of Minnesota Medical School
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Damien Fair
- Department of Pediatrics, University of Minnesota Medical School
| | - Theodore D. Satterthwaite
- Department of Psychiatry, University of Pennsylvania
- Lifespan Brain Institute of The Children’s Hospital of Philadelphia and Penn Medicine
- Penn Lifespan Informatics and Neuroimaging Center (PennLINC), Perelman School of Medicine, University of Pennsylvania
| | - Aaron Alexander-Bloch
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, The Children’s Hospital of Philadelphia
- Department of Psychiatry, University of Pennsylvania
- Lifespan Brain Institute of The Children’s Hospital of Philadelphia and Penn Medicine
| | - Simon Vandekar
- Department of Biostatistics, Vanderbilt University Medical Center
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Boone AE, Perry C, Henderson WL. Addressing Participation in Adults With Postconcussive Symptoms Using Cognitive Strategy Training: A Feasibility Trial. Am J Occup Ther 2024; 78:7802180080. [PMID: 38376251 DOI: 10.5014/ajot.2024.050396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2024] Open
Abstract
IMPORTANCE Some people experience persistent symptoms after a concussion that greatly affect occupational performance. OBJECTIVE To evaluate the feasibility and preliminary effect of metacognitive strategy training in a sample of adults with postconcussive symptoms. DESIGN Single-group, prospective design. SETTING University research laboratory. PARTICIPANTS Adults with persistent concussive symptoms affecting function (N = 14). INTERVENTION Ten 45-min sessions of a metacognitive strategy training intervention, Cognitive Orientation to daily Occupational Performance (CO-OP). OUTCOMES AND MEASURES Assessed feasibility outcomes included recruitment, retention, and adherence rates, and intervention acceptability was evaluated with the Client Satisfaction Questionnaire-8. The preliminary effect was measured on occupational performance (Canadian Occupational Performance Measure), concussive symptoms (Neurobehavioral Symptom Inventory), sleep (Pittsburgh Sleep Quality Inventory), vision (College of Optometrists in Vision Development-Quality of Life Outcomes Assessment), and cognition outcomes (Dysexecutive Questionnaire, Weekly Calendar Planning Activity, and National Institutes of Health Toolbox Cognition Battery). RESULTS Acceptable recruitment (32%), retention (93%), and adherence rates (100%) were observed, along with a high level of acceptability to participants. Large intervention effects were present for occupational performance, general concussive symptoms, and cognitive functioning. CONCLUSIONS AND RELEVANCE Findings suggest that the CO-OP is feasible to administer for adults with postconcussive symptoms and perceived as suitable for the needs of this population. Feasibility findings, coupled with improvements in occupational performance outcomes, provide the foundation for a future larger scale trial. Plain-Language Summary: The Cognitive Orientation to daily Occupational Performance intervention is practical to use to address the functional impact of persistent concussive symptoms in adults. Further research is needed to evaluate the efficacy of the CO-OP intervention with this population.
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Affiliation(s)
- Anna E Boone
- Anna E. Boone, PhD, MSOT, OTR/L, is Assistant Professor, Department of Occupational Therapy, University of Missouri, Columbia;
| | - Casey Perry
- Casey Perry, BHS, is Research Assistant, Department of Occupational Therapy, University of Missouri, Columbia
| | - Whitney L Henderson
- Whitney L. Henderson, OTD, MOT, OTR/L, is Associate Clinical Professor, Department of Occupational Therapy, University of Missouri, Columbia
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Kuzmuk LE, Rebchuk AD, Deptuck HM, Cairncross M, Silverberg ND, Field TS. Three-month Practice Effect of the National Institutes of Health Toolbox Cognition Battery in Young Healthy Adults. Can J Neurol Sci 2023; 50:769-772. [PMID: 35801595 DOI: 10.1017/cjn.2022.273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The National Institutes of Health Toolbox-Cognition Battery (NIHTB-CB) is a tablet-based cognitive assessment intended for individuals with neurological diseases of all ages. NIHTB-CB practice effects (PEs), however, need clarification if this measure is used to track longitudinal change. We explored the test-retest PEs on NIHTB-CB performance at 3 months in young healthy adults (n = 22). We examined corrected T-scores normalized for demographic factors and calculated PEs using Cohen's d. There were significant PEs for all NIHTB-CB composite scores and on 4/7 subtests. This work suggests the need to further assess NIHTB-CB PEs as this may affect the interpretation of study results incorporating this battery.
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Affiliation(s)
- Leah E Kuzmuk
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Alexander D Rebchuk
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
- Division of Neurosurgery, University of British Columbia, Vancouver, Canada
| | - Halina M Deptuck
- Faculty of Education, University of British Columbia, Vancouver, Canada
| | - Molly Cairncross
- Department of Psychology, University of British Columbia, Vancouver, Canada
- Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver, Canada
| | - Noah D Silverberg
- Department of Psychology, University of British Columbia, Vancouver, Canada
- Rehabilitation Research Program, Vancouver Coastal Health Research Institute, Vancouver, Canada
| | - Thalia S Field
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
- Division of Neurology, University of British Columbia, Vancouver, Canada
- Djavad Mowafaghian Centre for Brain Health, University of British Columbia, Vancouver, Canada
- Vancouver Stroke Program, University of British Columbia, Vancouver, Canada
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Giraldo GSP, Ali ST, Kang AK, Patel TR, Budhiraja S, Gaelen JI, Lank GK, Clark JR, Mukherjee S, Singer T, Venkatesh A, Orban ZS, Lim PH, Jimenez M, Miller J, Taylor C, Szymanski AL, Scarpelli J, Graham EL, Balabanov RD, Barcelo BE, Cahan JG, Ruckman K, Shepard AG, Slutzky MW, LaFaver K, Kumthekar PU, Shetty NK, Carroll KS, Ho SU, Lukas RV, Batra A, Liotta EM, Koralnik IJ. Neurologic Manifestations of Long COVID Differ Based on Acute COVID-19 Severity. Ann Neurol 2023; 94:146-159. [PMID: 36966460 PMCID: PMC10724021 DOI: 10.1002/ana.26649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 02/15/2023] [Accepted: 03/13/2023] [Indexed: 03/27/2023]
Abstract
OBJECTIVE To characterize neurologic manifestations in post-hospitalization Neuro-PASC (PNP) and non-hospitalized Neuro-PASC (NNP) patients. METHODS Prospective study of the first 100 consecutive PNP and 500 NNP patients evaluated at a Neuro-COVID-19 clinic between 5/2020 and 8/2021. RESULTS PNP were older than NNP patients (mean 53.9 vs 44.9 y; p < 0.0001) with a higher prevalence of pre-existing comorbidities. An average 6.8 months from onset, the main neurologic symptoms were "brain fog" (81.2%), headache (70.3%), and dizziness (49.5%) with only anosmia, dysgeusia and myalgias being more frequent in the NNP compared to the PNP group (59 vs 39%, 57.6 vs 39% and 50.4 vs 33%, all p < 0.003). Moreover, 85.8% of patients experienced fatigue. PNP more frequently had an abnormal neurologic exam than NNP patients (62.2 vs 37%, p < 0.0001). Both groups had impaired quality of life in cognitive, fatigue, sleep, anxiety, and depression domains. PNP patients performed worse on processing speed, attention, and working memory tasks than NNP patients (T-score 41.5 vs 55, 42.5 vs 47 and 45.5 vs 49, all p < 0.001) and a US normative population. NNP patients had lower results in attention task only. Subjective impression of cognitive ability correlated with cognitive test results in NNP but not in PNP patients. INTERPRETATION PNP and NNP patients both experience persistent neurologic symptoms affecting their quality of life. However, they harbor significant differences in demographics, comorbidities, neurologic symptoms and findings, as well as pattern of cognitive dysfunction. Such differences suggest distinct etiologies of Neuro-PASC in these populations warranting targeted interventions. ANN NEUROL 2023;94:146-159.
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Affiliation(s)
- Gina S. Perez Giraldo
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Sareen T. Ali
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Anthony K. Kang
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Tulsi R. Patel
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Shreya Budhiraja
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Jordan I. Gaelen
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Grace K. Lank
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Jeffrey R. Clark
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Shreya Mukherjee
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Tracey Singer
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Aditi Venkatesh
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Zachary S. Orban
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Patrick H. Lim
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Millenia Jimenez
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Janet Miller
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Carolyn Taylor
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - April L Szymanski
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Jessica Scarpelli
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Edith L. Graham
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Roumen D. Balabanov
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Bianca E. Barcelo
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Joshua G. Cahan
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Kaitlyn Ruckman
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Alan G. Shepard
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Marc W. Slutzky
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Kathrin LaFaver
- Saratoga Hospital Medical Group, Neurology, Saratoga Springs, NY
| | - Priya U. Kumthekar
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Neil K. Shetty
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Katherine S. Carroll
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Sam U. Ho
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Rimas V. Lukas
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Ayush Batra
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Eric M. Liotta
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Igor J. Koralnik
- Davee Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL
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Nolin SA, Cowart H, Merritt S, McInerney K, Bharadwaj PK, Franchetti MK, Raichlen DA, Jessup CJ, Hishaw GA, Van Etten EJ, Trouard TP, Geldmacher DS, Wadley VG, Porges ES, Woods AJ, Cohen RA, Levin BE, Rundek T, Alexander GE, Visscher KM. Validity of the NIH toolbox cognitive battery in a healthy oldest-old 85+ sample. J Int Neuropsychol Soc 2023; 29:605-614. [PMID: 36239453 PMCID: PMC11172394 DOI: 10.1017/s1355617722000443] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To evaluate the construct validity of the NIH Toolbox Cognitive Battery (NIH TB-CB) in the healthy oldest-old (85+ years old). METHOD Our sample from the McKnight Brain Aging Registry consists of 179 individuals, 85 to 99 years of age, screened for memory, neurological, and psychiatric disorders. Using previous research methods on a sample of 85 + y/o adults, we conducted confirmatory factor analyses on models of NIH TB-CB and same domain standard neuropsychological measures. We hypothesized the five-factor model (Reading, Vocabulary, Memory, Working Memory, and Executive/Speed) would have the best fit, consistent with younger populations. We assessed confirmatory and discriminant validity. We also evaluated demographic and computer use predictors of NIH TB-CB composite scores. RESULTS Findings suggest the six-factor model (Vocabulary, Reading, Memory, Working Memory, Executive, and Speed) had a better fit than alternative models. NIH TB-CB tests had good convergent and discriminant validity, though tests in the executive functioning domain had high inter-correlations with other cognitive domains. Computer use was strongly associated with higher NIH TB-CB overall and fluid cognition composite scores. CONCLUSION The NIH TB-CB is a valid assessment for the oldest-old samples, with relatively weak validity in the domain of executive functioning. Computer use's impact on composite scores could be due to the executive demands of learning to use a tablet. Strong relationships of executive function with other cognitive domains could be due to cognitive dedifferentiation. Overall, the NIH TB-CB could be useful for testing cognition in the oldest-old and the impact of aging on cognition in older populations.
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Affiliation(s)
- Sara A Nolin
- University of Alabama at Birmingham, Heersink School of Medicine, Evelyn F. McKnight Brain Institute, Birmingham, AL, USA
| | - Hannah Cowart
- University of Alabama at Birmingham, Heersink School of Medicine, Evelyn F. McKnight Brain Institute, Birmingham, AL, USA
| | - Stacy Merritt
- University of Miami, Miller School of Medicine, Evelyn F. McKnight Brain Institute, Miami, FL, USA
| | - Katalina McInerney
- University of Miami, Miller School of Medicine, Evelyn F. McKnight Brain Institute, Miami, FL, USA
| | - P K Bharadwaj
- University of Arizona, Evelyn F. McKnight Brain Institute, Tucson, AZ, USA
| | | | | | - Cortney J Jessup
- University of Arizona, Evelyn F. McKnight Brain Institute, Tucson, AZ, USA
| | - G Alex Hishaw
- University of Arizona, Evelyn F. McKnight Brain Institute, Tucson, AZ, USA
| | - Emily J Van Etten
- University of Arizona, Evelyn F. McKnight Brain Institute, Tucson, AZ, USA
| | - Theodore P Trouard
- University of Arizona, Evelyn F. McKnight Brain Institute, Tucson, AZ, USA
| | - David S Geldmacher
- University of Alabama at Birmingham, Heersink School of Medicine, Evelyn F. McKnight Brain Institute, Birmingham, AL, USA
| | - Virginia G Wadley
- University of Alabama at Birmingham, Heersink School of Medicine, Evelyn F. McKnight Brain Institute, Birmingham, AL, USA
| | - Eric S Porges
- University of Florida, Evelyn F. and William L. McKnight Brain Institute, Gainesville, FL, USA
| | - Adam J Woods
- University of Florida, Evelyn F. and William L. McKnight Brain Institute, Gainesville, FL, USA
| | - Ron A Cohen
- University of Florida, Evelyn F. and William L. McKnight Brain Institute, Gainesville, FL, USA
| | - Bonnie E Levin
- University of Miami, Miller School of Medicine, Evelyn F. McKnight Brain Institute, Miami, FL, USA
| | - Tatjana Rundek
- University of Miami, Miller School of Medicine, Evelyn F. McKnight Brain Institute, Miami, FL, USA
| | - Gene E Alexander
- University of Arizona, Evelyn F. McKnight Brain Institute, Tucson, AZ, USA
| | - Kristina M Visscher
- University of Alabama at Birmingham, Heersink School of Medicine, Evelyn F. McKnight Brain Institute, Birmingham, AL, USA
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8
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Bukhari H, Su C, Dhamala E, Gu Z, Jamison K, Kuceyeski A. Graph-matching distance between individuals' functional connectomes varies with relatedness, age, and cognitive score. Hum Brain Mapp 2023; 44:3541-3554. [PMID: 37042411 PMCID: PMC10203814 DOI: 10.1002/hbm.26296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 02/10/2023] [Accepted: 03/20/2023] [Indexed: 04/13/2023] Open
Abstract
Functional connectomes (FCs), represented by networks or graphs that summarize coactivation patterns between pairs of brain regions, have been related at a population level to age, sex, cognitive/behavioral scores, life experience, genetics, and disease/disorders. However, quantifying FC differences between individuals also provides a rich source of information with which to map to differences in those individuals' biology, experience, genetics or behavior. In this study, graph matching is used to create a novel inter-individual FC metric, called swap distance, that quantifies the distance between pairs of individuals' partial FCs, with a smaller swap distance indicating the individuals have more similar FC. We apply graph matching to align FCs between individuals from the the Human Connectome ProjectN = 997 and find that swap distance (i) increases with increasing familial distance, (ii) increases with subjects' ages, (iii) is smaller for pairs of females compared to pairs of males, and (iv) is larger for females with lower cognitive scores compared to females with larger cognitive scores. Regions that contributed most to individuals' swap distances were in higher-order networks, that is, default-mode and fronto-parietal, that underlie executive function and memory. These higher-order networks' regions also had swap frequencies that varied monotonically with familial relatedness of the individuals in question. We posit that the proposed graph matching technique provides a novel way to study inter-subject differences in FC and enables quantification of how FC may vary with age, relatedness, sex, and behavior.
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Affiliation(s)
- Hussain Bukhari
- Department of NeuroscienceWeill Cornell MedicineNew YorkNew YorkUSA
| | - Chang Su
- Department of BiostatisticsYale UniversityNew HavenConnecticutUSA
| | - Elvisha Dhamala
- Department of PsychologyYale UniversityNew HavenConnecticutUSA
| | - Zijin Gu
- Department of Electrical and Computer EngineeringCornell UniversityIthacaNew YorkUSA
| | - Keith Jamison
- Department of RadiologyWeill Cornell MedicineNew YorkNew YorkUSA
| | - Amy Kuceyeski
- Department of RadiologyWeill Cornell MedicineNew YorkNew YorkUSA
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9
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Zhang Q, Wei JH, Fu X, Liu X, Li XY, Liu W, Liu ZL, Duan XQ, Zheng B. Can we trust computers to assess the cognition of stroke patients? A systematic review. Front Neurol 2023; 14:1180664. [PMID: 37305744 PMCID: PMC10248476 DOI: 10.3389/fneur.2023.1180664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 05/09/2023] [Indexed: 06/13/2023] Open
Abstract
Purpose To summarize the classification of computerized cognitive assessment (CCA) tools for assessing stroke patients, to clarify their benefits and limitations, and to reveal strategies for future studies on CCA tools. Methods A literature review was performed using PubMed, Embase, Scopus, JAMA Network, Cochrane Library and PsycINFO databases from January 1st, 2010, to August 1st, 2022. Two authors independently screened the literature following the same criteria, evaluated the study quality, and collected data from the articles. Results A total of 8,697 papers were acquired from the six databases. A total of 74 potentially eligible articles were selected for review. Of these, 29 articles were not relevant to this research, 3 were reviews, 2 were not written in English, and 1 was on an ongoing trial. By screening the references of the reviews, 3 additional articles were included in this study. Thus, a total of 42 articles met the criteria for the review. In terms of the CCA tools analyzed in these studies, they included five types: virtual reality (VR)-based, robot-based, telephone-based, smartphone-based, and computer-based cognitive assessments. Patients' stages of the disease ranged from the subacute phase and rehabilitation phase to the community phase. A total of 27 studies supported the effectiveness of CCA tools, while 22 out of 42 articles mentioned their benefits and 32 revealed areas for future improvement of CCA tools. Conclusions Although the use of CCA tools for assessing the cognition of post-stroke patients is becoming popular, there are still some limitations and challenges of using such tools in stroke survivors. More evidence is thus needed to verify the value and specific role of these tools in assessing the cognitive impairment of stroke patients.
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Affiliation(s)
- Qi Zhang
- Department of Rehabilitation Medicine, Jilin University Second Hospital, Changchun, China
| | | | - Xue Fu
- Changchun University of Chinese Medicine, Changchun, China
| | - Xin Liu
- School of Computer and Communication Engineering, University of Science and Technology Beijing, Beijing, China
- Surgical Simulation Research Lab, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Xin-Yi Li
- Department of Rehabilitation Medicine, Jilin University Second Hospital, Changchun, China
| | - Wei Liu
- Department of Rehabilitation Medicine, Jilin University Second Hospital, Changchun, China
| | - Zhong-Liang Liu
- Department of Rehabilitation Medicine, Jilin University Second Hospital, Changchun, China
| | - Xiao-Qin Duan
- Department of Rehabilitation Medicine, Jilin University Second Hospital, Changchun, China
- Surgical Simulation Research Lab, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Bin Zheng
- Surgical Simulation Research Lab, Department of Surgery, University of Alberta, Edmonton, AB, Canada
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10
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Dhamala E, Yeo BTT, Holmes AJ. One Size Does Not Fit All: Methodological Considerations for Brain-Based Predictive Modeling in Psychiatry. Biol Psychiatry 2023; 93:717-728. [PMID: 36577634 DOI: 10.1016/j.biopsych.2022.09.024] [Citation(s) in RCA: 18] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 09/07/2022] [Accepted: 09/23/2022] [Indexed: 12/30/2022]
Abstract
Psychiatric illnesses are heterogeneous in nature. No illness manifests in the same way across individuals, and no two patients with a shared diagnosis exhibit identical symptom profiles. Over the last several decades, group-level analyses of in vivo neuroimaging data have led to fundamental advances in our understanding of the neurobiology of psychiatric illnesses. More recently, access to computational resources and large, publicly available datasets alongside the rise of predictive modeling and precision medicine approaches have facilitated the study of psychiatric illnesses at an individual level. Data-driven machine learning analyses can be applied to identify disease-relevant biological subtypes, predict individual symptom profiles, and recommend personalized therapeutic interventions. However, when developing these predictive models, methodological choices must be carefully considered to ensure accurate, robust, and interpretable results. Choices pertaining to algorithms, neuroimaging modalities and states, data transformation, phenotypes, parcellations, sample sizes, and populations we are specifically studying can influence model performance. Here, we review applications of neuroimaging-based machine learning models to study psychiatric illnesses and discuss the effects of different methodological choices on model performance. An understanding of these effects is crucial for the proper implementation of predictive models in psychiatry and will facilitate more accurate diagnoses, prognoses, and therapeutics.
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Affiliation(s)
- Elvisha Dhamala
- Department of Psychology, Yale University, New Haven, Connecticut; Kavli Institute for Neuroscience, Yale University, New Haven, Connecticut.
| | - B T Thomas Yeo
- Centre for Sleep & Cognition & Centre for Translational Magnetic Resonance Research, Yong Loo Lin School of Medicine, Singapore, National University of Singapore, Singapore; Department of Electrical and Computer Engineering, National University of Singapore, Singapore; N.1 Institute for Health & Institute for Digital Medicine, National University of Singapore, Singapore; Integrative Sciences and Engineering Programme, National University of Singapore, Singapore; Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, Massachusetts
| | - Avram J Holmes
- Department of Psychology, Yale University, New Haven, Connecticut; Kavli Institute for Neuroscience, Yale University, New Haven, Connecticut; Department of Psychiatry, Yale University, New Haven, Connecticut; Wu Tsai Institute, Yale University, New Haven, Connecticut.
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11
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Feldman SJ, Beslow LA, Felling RJ, Malone LA, Waak M, Fraser S, Bakeer N, Lee JEM, Sherman V, Howard MM, Cavanaugh BA, Westmacott R, Jordan LC. Consensus-Based Evaluation of Outcome Measures in Pediatric Stroke Care: A Toolkit. Pediatr Neurol 2023; 141:118-132. [PMID: 36812698 PMCID: PMC10042484 DOI: 10.1016/j.pediatrneurol.2023.01.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 01/08/2023] [Accepted: 01/16/2023] [Indexed: 01/20/2023]
Abstract
Following a pediatric stroke, outcome measures selected for monitoring functional recovery and development vary widely. We sought to develop a toolkit of outcome measures that are currently available to clinicians, possess strong psychometric properties, and are feasible for use within clinical settings. A multidisciplinary group of clinicians and scientists from the International Pediatric Stroke Organization comprehensively reviewed the quality of measures in multiple domains described in pediatric stroke populations including global performance, motor and cognitive function, language, quality of life, and behavior and adaptive functioning. The quality of each measure was evaluated using guidelines focused on responsiveness and sensitivity, reliability, validity, feasibility, and predictive utility. A total of 48 outcome measures were included and were rated by experts based on the available evidence within the literature supporting the strengths of their psychometric properties and practical use. Only three measures were found to be validated for use in pediatric stroke: the Pediatric Stroke Outcome Measure, the Pediatric Stroke Recurrence and Recovery Questionnaire, and the Pediatric Stroke Quality of Life Measure. However, multiple additional measures were deemed to have good psychometric properties and acceptable utility for assessing pediatric stroke outcomes. Strengths and weaknesses of commonly used measures including feasibility are highlighted to guide evidence-based and practicable outcome measure selection. Improving the coherence of outcome assessment will facilitate comparison of studies and enhance research and clinical care in children with stroke. Further work is urgently needed to close the gap and validate measures across all clinically significant domains in the pediatric stroke population.
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Affiliation(s)
- Samantha J Feldman
- Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Lauren A Beslow
- Division of Neurology, Children's Hospital of Philadelphia, Departments of Neurology and Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania
| | - Ryan J Felling
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Laura A Malone
- Johns Hopkins University School of Medicine and the Kennedy Krieger Institute, Baltimore, Maryland
| | - Michaela Waak
- Pediatric Critical Care Research Group, Child Health Research Centre, The University of Queensland, Queensland, Australia; Pediatric Intensive Care Unit, Queensland Children's Hospital, South Brisbane, Australia
| | - Stuart Fraser
- Division of Vascular Neurology, Department of Pediatrics, University of Texas Health Science Center, Houston, Texas
| | - Nihal Bakeer
- Indiana Hemophilia and Thrombosis Center, Indianapolis, Indiana
| | - Jo Ellen M Lee
- Department of Neurology, Nationwide Children's Hospital, Columbus, Ohio
| | | | - Melissa M Howard
- Casa Colina Hospital and Centers for Healthcare, Pomona, California
| | - Beth Anne Cavanaugh
- Division of Pediatric Neurology, Department of Pediatrics, University of Tennessee Health Science Center, Le Bonheur Children's Hospital, Memphis, Tennessee
| | - Robyn Westmacott
- Department of Psychology, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Lori C Jordan
- Division of Pediatric Neurology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee.
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12
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Dhamala E, Ooi LQR, Chen J, Kong R, Anderson KM, Chin R, Yeo BTT, Holmes AJ. Proportional intracranial volume correction differentially biases behavioral predictions across neuroanatomical features, sexes, and development. Neuroimage 2022; 260:119485. [PMID: 35843514 PMCID: PMC9425854 DOI: 10.1016/j.neuroimage.2022.119485] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Revised: 07/08/2022] [Accepted: 07/13/2022] [Indexed: 01/03/2023] Open
Abstract
Individual differences in brain anatomy can be used to predict variations in cognitive ability. Most studies to date have focused on broad population-level trends, but the extent to which the observed predictive features are shared across sexes and age groups remains to be established. While it is standard practice to account for intracranial volume (ICV) using proportion correction in both regional and whole-brain morphometric analyses, in the context of brain-behavior predictions the possible differential impact of ICV correction on anatomical features and subgroups within the population has yet to be systematically investigated. In this work, we evaluate the effect of proportional ICV correction on sex-independent and sex-specific predictive models of individual cognitive abilities across multiple anatomical properties (surface area, gray matter volume, and cortical thickness) in healthy young adults (Human Connectome Project; n = 1013, 548 females) and typically developing children (Adolescent Brain Cognitive Development study; n = 1823, 979 females). We demonstrate that ICV correction generally reduces predictive accuracies derived from surface area and gray matter volume, while increasing predictive accuracies based on cortical thickness in both adults and children. Furthermore, the extent to which predictive models generalize across sexes and age groups depends on ICV correction: models based on surface area and gray matter volume are more generalizable without ICV correction, while models based on cortical thickness are more generalizable with ICV correction. Finally, the observed neuroanatomical features predictive of cognitive abilities are unique across age groups regardless of ICV correction, but whether they are shared or unique across sexes (within age groups) depends on ICV correction. These findings highlight the importance of considering individual differences in ICV, and show that proportional ICV correction does not remove the effects of cranial volume from anatomical measurements and can introduce ICV bias where previously there was none. ICV correction choices affect not just the strength of the relationships captured, but also the conclusions drawn regarding the neuroanatomical features that underlie those relationships.
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Affiliation(s)
- Elvisha Dhamala
- Department of Psychology, Yale University, New Haven, United States; Kavli Institute for Neuroscience, Yale University, New Haven, United States.
| | - Leon Qi Rong Ooi
- Centre for Sleep & Cognition & Centre for Translational Magnetic Resonance Research, Yong Loo Lin School of Medicine, Singapore, National University of Singapore, Singapore; Department of Electrical and Computer Engineering, National University of Singapore, Singapore; N.1 Institute for Health & Institute for Digital Medicine, National University of Singapore, Singapore; Integrative Sciences and Engineering Programme (ISEP), National University of Singapore, Singapore
| | - Jianzhong Chen
- Department of Electrical and Computer Engineering, National University of Singapore, Singapore; N.1 Institute for Health & Institute for Digital Medicine, National University of Singapore, Singapore; Integrative Sciences and Engineering Programme (ISEP), National University of Singapore, Singapore
| | - Ru Kong
- Centre for Sleep & Cognition & Centre for Translational Magnetic Resonance Research, Yong Loo Lin School of Medicine, Singapore, National University of Singapore, Singapore; Department of Electrical and Computer Engineering, National University of Singapore, Singapore; Integrative Sciences and Engineering Programme (ISEP), National University of Singapore, Singapore
| | - Kevin M Anderson
- Department of Psychology, Yale University, New Haven, United States
| | - Rowena Chin
- Department of Psychology, Yale University, New Haven, United States
| | - B T Thomas Yeo
- Centre for Sleep & Cognition & Centre for Translational Magnetic Resonance Research, Yong Loo Lin School of Medicine, Singapore, National University of Singapore, Singapore; Department of Electrical and Computer Engineering, National University of Singapore, Singapore; N.1 Institute for Health & Institute for Digital Medicine, National University of Singapore, Singapore; Integrative Sciences and Engineering Programme (ISEP), National University of Singapore, Singapore; Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Charlestown, MA, United States
| | - Avram J Holmes
- Department of Psychology, Yale University, New Haven, United States; Kavli Institute for Neuroscience, Yale University, New Haven, United States; Department of Psychiatry, Yale University, New Haven, United States; Wu Tsai Institute, Yale University, New Haven, United States.
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13
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A comprehensive assessment of neurocognitive and psychological functioning in adults with early-treated phenylketonuria. J Int Neuropsychol Soc 2022:1-10. [PMID: 36134437 DOI: 10.1017/s1355617722000686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Relative to youth with early-treated phenylketonuria (ETPKU), much less is known regarding the cognitive profile of adults with ETPKU. The present study aimed to address this gap by providing a comprehensive assessment of neuropsychological functioning among adults with ETPKU. METHOD A sample of 40 adults with ETPKU (ages 18 - 36) and a demographically matched group of 32 healthy individuals without PKU participated. Participants completed a comprehensive neuropsychological battery including the NIH Toolbox, Wechsler Abbreviated Scale of Intelligence - Second Edition (WASI-II), Conners' Continuous Performance Test (CPT-3), select subtests from the Weschler Adult Intelligence Scale - Fourth Edition (WAIS-IV) as well as several self-report measures of cognitive and psychoemotional functioning. Scores from these tests were combined to create cognitive composites reflecting overall task performance in the areas of verbal ability, visuospatial skills, executive functioning, motor skills, and processing speed. RESULTS No group differences were observed for full scale IQ or verbal ability. However, individuals with ETPKU demonstrated poorer performance on measures of executive functioning, processing speed, motor skills, and visuospatial skills as compared to the non-PKU group. Within the ETPKU group, recent blood phenylalanine levels (an indicator of metabolic control) were significantly correlated with performance across most cognitive domains and aspects of psychological functioning. CONCLUSIONS Present findings suggest that the neuropsychological profile of adult ETPKU is characterized by circumscribed impairments in select cognitive domains. In addition, the results underscore the importance of maintaining metabolic control across the lifespan in individuals with ETPKU.
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14
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Validation of the NIH Toolbox-Cognition Battery against legacy neurocognitive measures in adults with cognitive impairments: An exploratory analysis. J Int Neuropsychol Soc 2022; 29:472-479. [PMID: 36062530 PMCID: PMC9985667 DOI: 10.1017/s1355617722000406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The purpose of this exploratory study was to describe associations between NIH Toolbox-Cognition Battery subtests and legacy measures of neurocognitive function in two samples with neurological conditions (stroke and sickle cell disease (SCD)). METHOD This exploratory secondary analysis uses data from two studies that assessed cognition at one time point using the NIH Toolbox-Cognition Battery, the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), and subtests from the Delis-Kaplan Executive Functions System (DKEFS). People with stroke (n = 26) and SCD (n = 64) were included. Associations between the NIH Toolbox-Cognition Battery subtests and corresponding legacy measures were examined using linear correlations, Bland-Altman analysis, and Lin's Concordance Correlation Coefficient. RESULTS Linear correlations and Lin's Concordance Correlation Coefficient were poor to strong in both samples on NIH Toolbox-CB subtests: Flanker Inhibitory Control and Attention (r = .35 to .48, Lin CCC = .27 to .37), Pattern Comparison Processing Speed (r = .40 to .65, Lin CCC = .37 to .62), Picture Sequence Memory (r = .19 to .55, Lin CCC = .18 to .48), Dimensional Change Card Sort (r = .39 to .77, Lin CCC = .38 to .63), Fluid Cognition Composite (r = .88 to .90, Lin CCC = .60 to .79), and Total Cognition Composite (r = .64 to .83, Lin CCC = .60 to .78). Bland-Altman analyses demonstrated wide limits of agreement across all subtests (-3.17 to 3.78). CONCLUSIONS The NIH Toolbox-Cognition Battery subtests may behave similarly to legacy measures as an overall assessment of cognition across samples at risk for neurological impairment. Findings should be replicated across additional clinical samples.
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15
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Welbel RZ, Rand CM, Zhou A, Fadl-Alla A, Chen ML, Weese-Mayer DE, Zelko FA. Neurocognitive monitoring in congenital central hypoventilation syndrome with the NIH Toolbox®. Pediatr Pulmonol 2022; 57:2040-2047. [PMID: 35574731 PMCID: PMC9541049 DOI: 10.1002/ppul.25973] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2022] [Revised: 05/10/2022] [Accepted: 05/13/2022] [Indexed: 11/09/2022]
Abstract
Congenital central hypoventilation syndrome (CCHS) is a rare neurocristopathy, caused by mutations in the paired-like homeobox gene PHOX2B, which alters control of breathing and autonomic nervous system regulation, necessitating artificial ventilation as life-support. A broad range of neurocognitive performance has been reported in CCHS, including an array of cognitive deficits. We administered the NIH Toolbox® Cognition Battery (NTCB), a novel technology comprised of seven tasks presented via an interactive computer tablet application, to a CCHS cohort and studied its convergent and divergent validity relative to traditional clinical neurocognitive measures. The NTCB was administered to 51 CCHS participants, including a subcohort of 24 who also received traditional clinical neurocognitive testing (Wechsler Intelligence Scales). Age-corrected NTCB scores from the overall sample and subcohort were compared to population norms. Associations between NTCB indices and Wechsler Intelligence scores were studied to determine the convergent and divergent validity of the NTCB. NTCB test results indicated reduced Fluid Cognition, which measures new learning and speeded information processing (p < 0.001), but intact Crystallized Cognition, which measures past learning, in CCHS relative to population norms. Moderate to strong associations (r > 0.60) were found between age-corrected NTCB Fluid and Crystallized indices and comparable Wechsler indices, supporting the convergent and discriminant validity of the NTCB. Results reveal deficits of Fluid Cognition in individuals with CCHS and indicate that the NTCB is a valid and sensitive measure of cognitive outcomes in this population. Our findings suggest that the NTCB may play a useful role in tracking neurocognition in CCHS.
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Affiliation(s)
- Remi Z Welbel
- Department of Pediatrics, Division of Autonomic Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago and Stanley Manne Children's Research Institute, Chicago, Illinois, USA
| | - Casey M Rand
- Department of Pediatrics, Division of Autonomic Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago and Stanley Manne Children's Research Institute, Chicago, Illinois, USA
| | - Amy Zhou
- Department of Pediatrics, Division of Autonomic Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago and Stanley Manne Children's Research Institute, Chicago, Illinois, USA
| | - Allaa Fadl-Alla
- Department of Pediatrics, Division of Autonomic Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago and Stanley Manne Children's Research Institute, Chicago, Illinois, USA
| | - Maida Lynn Chen
- Department of Pediatrics, Division of Pulmonary and Sleep Medicine, University of Washington School of Medicine, Seattle Children's Hospital, Seattle, Washington, USA
| | - Debra E Weese-Mayer
- Department of Pediatrics, Division of Autonomic Medicine, Ann & Robert H. Lurie Children's Hospital of Chicago and Stanley Manne Children's Research Institute, Chicago, Illinois, USA.,Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Frank A Zelko
- Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA.,Pritzker Department of Psychiatry and Behavioral Health, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois, USA
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16
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Ott LR, Schantell M, Willett MP, Johnson HJ, Eastman JA, Okelberry HJ, Wilson TW, Taylor BK, May PE. Construct validity of the NIH toolbox cognitive domains: A comparison with conventional neuropsychological assessments. Neuropsychology 2022; 36:468-481. [PMID: 35482626 PMCID: PMC10468104 DOI: 10.1037/neu0000813] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE Previous studies have assessed the construct validity of individual subtests in the National Institutes of Health (NIH) Toolbox Cognition Battery (NIHTB-CB), though none have examined the construct validity of the cognitive domains. Importantly, the original NIHTB-CB validation studies were administered on a desktop computer, though the NIHTB-CB is now solely administered via an iPad. We examined the construct validity of each cognitive domain assessed in the NIHTB-CB, including a motor dexterity domain using the iPad application compared to a neuropsychological battery in a sample of healthy adults. METHOD Eighty-three adults aged 20-66 years (M = 44.35 ± 13.41 years) completed the NIHTB-CB and a comprehensive neuropsychological assessment. Domain scores for each of six cognitive domains (attention and executive function, episodic memory, working memory, processing speed, language, and motor dexterity) and the fluid composite were computed for both batteries. We then assessed the construct validity using Pearson correlations and intraclass correlation coefficients (ICCs) for both demographically corrected and uncorrected domains. RESULTS We found the attention and executive function, episodic memory, and processing speed domains had poor-to-adequate construct validity (ICCConsistency = -0.029 to 0.517), the working memory and motor dexterity domains and the fluid composite had poor-to-good construct validity (ICCConsistency = 0.215-0.801), and the language domain had adequate-to-good construct validity (ICCConsistency = 0.408-0.829). CONCLUSION The NIHTB-CB cognitive domains have poor-to-good construct validity, thus researchers should be aware that some tests representing cognitive constructs may not fully reflect the cognitive domain of interest. Future investigation of the construct validity and reliability of the NIHTB-CB administered using the iPad is recommended. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
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Affiliation(s)
- Lauren R. Ott
- Institute for Human Neuroscience, Boys Town National Research Hospital, Boys Town, NE USA
| | - Mikki Schantell
- Institute for Human Neuroscience, Boys Town National Research Hospital, Boys Town, NE USA
- College of Medicine, University of Nebraska Medical Center (UNMC), Omaha, NE USA
| | - Madelyn P. Willett
- Institute for Human Neuroscience, Boys Town National Research Hospital, Boys Town, NE USA
| | - Hallie J. Johnson
- Institute for Human Neuroscience, Boys Town National Research Hospital, Boys Town, NE USA
| | - Jacob A. Eastman
- Institute for Human Neuroscience, Boys Town National Research Hospital, Boys Town, NE USA
| | - Hannah J. Okelberry
- Institute for Human Neuroscience, Boys Town National Research Hospital, Boys Town, NE USA
| | - Tony W. Wilson
- Institute for Human Neuroscience, Boys Town National Research Hospital, Boys Town, NE USA
- College of Medicine, University of Nebraska Medical Center (UNMC), Omaha, NE USA
| | - Brittany K. Taylor
- Institute for Human Neuroscience, Boys Town National Research Hospital, Boys Town, NE USA
| | - Pamela E. May
- College of Medicine, University of Nebraska Medical Center (UNMC), Omaha, NE USA
- Department of Neurological Sciences, UNMC, Omaha, NE USA
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17
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Assessment of Neurological Status in Patients with Cerebrovascular Diseases through the Nursing Outcome Classification: A Methodological Study. NURSING REPORTS 2022; 12:152-163. [PMID: 35324562 PMCID: PMC8948868 DOI: 10.3390/nursrep12010016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 02/09/2022] [Accepted: 02/25/2022] [Indexed: 11/17/2022] Open
Abstract
Nurses play an important role in healthcare, and the Nursing Outcomes Classification is a key tool for the standardization of care. This study aims to validate the nursing outcome “Neurological Status” for patients with cerebrovascular diseases. A methodological study was performed in four phases. In Phase 1, the relevance of the indicators was evaluated by seven specialists and the modified kappa coefficient and content validity index were calculated. In Phase 2, conceptual and operational definitions were formulated. In addition, their content was validated with a focus group in Phase 3. In Phase 4, the results were applied in clinical practice and convergence with the National Institute of Health Stroke Scale was verified. The reliability was measured by Cronbach’s alpha. Of the 22 initial indicators, 6 were excluded. The focus group suggested changes in the definitions and the exclusion of two indicators. In Phase 4, only 13 indicators were validated due to the impossibility of measuring intracranial pressure. A strong correlation between the two scales and agreement among all the indicators were observed. Following the specialists’ review, the nursing outcome was reliable and clinically validated with 13 indicators: consciousness, orientation, language, central motor control, cranial sensory and motor function, spinal sensory and motor function, body temperature, blood pressure, heart rate, eye movement pattern, pupil size, pupil reactivity, and breathing pattern.
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18
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Dhamala E, Jamison KW, Jaywant A, Kuceyeski A. Shared functional connections within and between cortical networks predict cognitive abilities in adult males and females. Hum Brain Mapp 2022; 43:1087-1102. [PMID: 34811849 PMCID: PMC8764478 DOI: 10.1002/hbm.25709] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 10/14/2021] [Accepted: 10/21/2021] [Indexed: 01/25/2023] Open
Abstract
A thorough understanding of sex-independent and sex-specific neurobiological features that underlie cognitive abilities in healthy individuals is essential for the study of neurological illnesses in which males and females differentially experience and exhibit cognitive impairment. Here, we evaluate sex-independent and sex-specific relationships between functional connectivity and individual cognitive abilities in 392 healthy young adults (196 males) from the Human Connectome Project. First, we establish that sex-independent models comparably predict crystallised abilities in males and females, but only successfully predict fluid abilities in males. Second, we demonstrate sex-specific models comparably predict crystallised abilities within and between sexes, and generally fail to predict fluid abilities in either sex. Third, we reveal that largely overlapping connections between visual, dorsal attention, ventral attention, and temporal parietal networks are associated with better performance on crystallised and fluid cognitive tests in males and females, while connections within visual, somatomotor, and temporal parietal networks are associated with poorer performance. Together, our findings suggest that shared neurobiological features of the functional connectome underlie crystallised and fluid abilities across the sexes.
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Affiliation(s)
- Elvisha Dhamala
- Department of RadiologyWeill Cornell MedicineNew YorkNew YorkUSA
- Brain and Mind Research Institute, Weill Cornell MedicineNew YorkNew YorkUSA
- Present address:
Department of PsychologyYale UniversityNew HavenConnecticutUSA
| | - Keith W. Jamison
- Department of RadiologyWeill Cornell MedicineNew YorkNew YorkUSA
| | - Abhishek Jaywant
- Department of Psychiatry, Weill Cornell MedicineNew YorkNew YorkUSA
- Department of Rehabilitation Medicine, Weill Cornell MedicineNew YorkNew YorkUSA
- NewYork‐Presbyterian Hospital/Weill Cornell Medical CenterNew YorkNew YorkUSA
| | - Amy Kuceyeski
- Department of RadiologyWeill Cornell MedicineNew YorkNew YorkUSA
- Brain and Mind Research Institute, Weill Cornell MedicineNew YorkNew YorkUSA
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19
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Rubin MR, Tabacco G, Omeragic B, Majeed R, Hale C, Brickman AM. A Pilot Study of Cognition Among Hypoparathyroid Adults. J Endocr Soc 2022; 6:bvac002. [PMID: 35155969 PMCID: PMC8824458 DOI: 10.1210/jendso/bvac002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Indexed: 11/19/2022] Open
Abstract
Abstract
Purpose
Hypoparathyroid patients describe cognitive deficits, yet data regarding objective assessment of cognitive function are limited. We assessed cognition in a pilot study of hypoparathyroid patients using the NIH Toolbox® Adult Cognitive Battery (NIHTB-CB). We also sought to determine whether cognition relates to emotion, quality of life (QoL) and hypoparathyroidism-related biochemistries.
Methods
Nineteen hypoparathyroid patients were studied. Objective cognition was assessed with NIHTB-CB. Impairment was defined as fully demographically adjusted T-score < 1.5 SD in at least 1 cognitive domain or < 1 SD in 2 or more domains.
Results
Of the 19 participants (17 women; median age 49; 18 postsurgical), impaired demographically adjusted NIHTB-CB cognition scores were observed in 13 subjects (68%). Cognition scores correlated with self-reported perception of general health. Processing speed was the most commonly impaired cognitive domain, with T-scores that were ≤ 2 SD in 6 subjects (32%). Processing speed correlated with serum calcium (r=0.53, p=0.023) and inversely with serum phosphate (r=-0.48, p=0.042) levels.
Conclusions
Impaired cognition using the NIHTB-CB was common in this small pilot cohort of hypoparathyroid patients. Slower processing speed was present and associated with lower serum calcium and higher serum phosphate levels. Larger controlled studies with additional neuropsychological testing are needed to investigate cognitive function in hypoparathyroidism.
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Affiliation(s)
- Mishaela R Rubin
- Department of Medicine, Metabolic Bone Diseases Unit, Division of Endocrinology, Vagelos College of Physicians & Surgeons, Columbia University, New York, NY
| | - Gaia Tabacco
- Department of Medicine, Metabolic Bone Diseases Unit, Division of Endocrinology, Vagelos College of Physicians & Surgeons, Columbia University, New York, NY
- Unit of Endocrinology and Diabetes, Campus Bio-Medico, University of Rome, Rome, Italy
| | - Beatriz Omeragic
- Department of Medicine, Metabolic Bone Diseases Unit, Division of Endocrinology, Vagelos College of Physicians & Surgeons, Columbia University, New York, NY
| | - Rukshana Majeed
- Department of Medicine, Metabolic Bone Diseases Unit, Division of Endocrinology, Vagelos College of Physicians & Surgeons, Columbia University, New York, NY
| | - Christiane Hale
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain and Department of Neurology, Vagelos College of Physicians & Surgeons, Columbia University, New York, NY
| | - Adam M Brickman
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain and Department of Neurology, Vagelos College of Physicians & Surgeons, Columbia University, New York, NY
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20
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French MA, Cohen ML, Pohlig RT, Reisman DS. Fluid Cognition Relates to Locomotor Switching in Neurotypical Adults, Not Individuals After Stroke. J Neurol Phys Ther 2022; 46:3-10. [PMID: 34507340 PMCID: PMC8692381 DOI: 10.1097/npt.0000000000000373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND AND PURPOSE The ability to switch between walking patterns (ie, locomotor switching) is vital for successful community navigation and may be impacted by poststroke impairments. Thus, the purpose of this work was to examine locomotor switching and the relationship between locomotor switching and fluid cognition in individuals after stroke compared with neurotypical adults. METHODS Twenty-nine individuals more than 6 months after stroke and 18 neurotypical adults participated in a 2-day study. On day 1, participants were taught a new walking pattern on the treadmill and then locomotor switching was assessed by instructing participants to switch between the new walking pattern and their usual walking pattern. The change between these 2 patterns was calculated as the switching index. On day 2, the NIH Toolbox Cognition Battery was administered to obtain the Fluid Cognition Composite Score (FCCS), which reflected fluid cognition. The switching index was compared between groups using an analysis of covariance, and the relationship between locomotor switching and fluid cognition was assessed with regression. RESULTS Individuals after stroke had significantly lower switching indexes compared with neurotypical adults (P = 0.03). The regression showed a significant interaction between group and FCCS (P = 0.002), with the FCCS predicting the switching index in neurotypical adults but not in individuals after stroke. DISCUSSION AND CONCLUSIONS Individuals after stroke appear to have deficits in locomotor switching compared with neurotypical adults. The relationship between fluid cognition and locomotor switching was significant in neurotypical adults but not in individuals after stroke. Future work to understand the relationship between specific cognitive domains and locomotor switching is needed (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A361).
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Affiliation(s)
- Margaret A French
- Departments of Physical Therapy (M.A.F., D.S.R.) and Communication Sciences and Disorders (M.L.C.), University of Delaware, Newark; Biomechanics and Movement Science Program, University of Delaware, Newark (M.A.F., D.S.R.); and College of Health Sciences Biostatistics Core Facility, University of Delaware, Newark (R.T.P.)
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21
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Ma Y, Carlsson CM, Wahoske ML, Blazel HM, Chappell RJ, Johnson SC, Asthana S, Gleason CE. Latent Factor Structure and Measurement Invariance of the NIH Toolbox Cognition Battery in an Alzheimer's Disease Research Sample. J Int Neuropsychol Soc 2021; 27:412-425. [PMID: 33012297 PMCID: PMC8108547 DOI: 10.1017/s1355617720000922] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE This study investigated the latent factor structure of the NIH Toolbox Cognition Battery (NIHTB-CB) and its measurement invariance across clinical diagnosis and key demographic variables including sex, race/ethnicity, age, and education for a typical Alzheimer's disease (AD) research sample. METHOD The NIHTB-CB iPad English version, consisting of 7 tests, was administered to 411 participants aged 45-94 with clinical diagnosis of cognitively unimpaired, dementia, mild cognitive impairment (MCI), or impaired not MCI. The factor structure of the whole sample was first examined with exploratory factor analysis (EFA) and further refined using confirmatory factor analysis (CFA). Two groups were classified for each variable (diagnosis or demographic factors). The confirmed factor model was next tested for each group with CFA. If the factor structure was the same between the groups, measurement invariance was then tested using a hierarchical series of nested two-group CFA models. RESULTS A two-factor model capturing fluid cognition (executive function, processing speed, and memory) versus crystalized cognition (language) fit well for the whole sample and each group except for those with age < 65. This model generally had measurement invariance across sex, race/ethnicity, and education, and partial invariance across diagnosis. For individuals with age < 65, the language factor remained intact while the fluid cognition was separated into two factors: (1) executive function/processing speed and (2) memory. CONCLUSIONS The findings mostly supported the utility of the battery in AD research, yet revealed challenges in measuring memory for AD participants and longitudinal change in fluid cognition.
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Affiliation(s)
- Yue Ma
- Wisconsin Alzheimer’s Disease Research Center,
University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Cynthia M. Carlsson
- Wisconsin Alzheimer’s Disease Research Center,
University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Wisconsin Alzheimer’s Institute, University of
Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Geriatric Research Education and Clinical Center, William
S. Middleton Memorial Veterans Hospital, Madison, WI, USA
| | - Michelle L. Wahoske
- Wisconsin Alzheimer’s Disease Research Center,
University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Hanna M. Blazel
- Wisconsin Alzheimer’s Disease Research Center,
University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Richard J. Chappell
- Wisconsin Alzheimer’s Disease Research Center,
University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Department of Biostatistics and Medical Informatics,
University of Wisconsin, Madison, WI, USA
- Department of Statistics, University of Wisconsin, Madison,
WI, USA
| | - Sterling C. Johnson
- Wisconsin Alzheimer’s Disease Research Center,
University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Wisconsin Alzheimer’s Institute, University of
Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Geriatric Research Education and Clinical Center, William
S. Middleton Memorial Veterans Hospital, Madison, WI, USA
| | - Sanjay Asthana
- Wisconsin Alzheimer’s Disease Research Center,
University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Geriatric Research Education and Clinical Center, William
S. Middleton Memorial Veterans Hospital, Madison, WI, USA
| | - Carey E. Gleason
- Wisconsin Alzheimer’s Disease Research Center,
University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Wisconsin Alzheimer’s Institute, University of
Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Geriatric Research Education and Clinical Center, William
S. Middleton Memorial Veterans Hospital, Madison, WI, USA
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22
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Dhamala E, Jamison KW, Jaywant A, Dennis S, Kuceyeski A. Distinct functional and structural connections predict crystallised and fluid cognition in healthy adults. Hum Brain Mapp 2021; 42:3102-3118. [PMID: 33830577 PMCID: PMC8193532 DOI: 10.1002/hbm.25420] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2020] [Revised: 03/03/2021] [Accepted: 03/10/2021] [Indexed: 12/24/2022] Open
Abstract
White matter pathways between neurons facilitate neuronal coactivation patterns in the brain. Insight into how these structural and functional connections underlie complex cognitive functions provides an important foundation with which to delineate disease‐related changes in cognitive functioning. Here, we integrate neuroimaging, connectomics, and machine learning approaches to explore how functional and structural brain connectivity relate to cognition. Specifically, we evaluate the extent to which functional and structural connectivity predict individual crystallised and fluid cognitive abilities in 415 unrelated healthy young adults (202 females) from the Human Connectome Project. We report three main findings. First, we demonstrate functional connectivity is more predictive of cognitive scores than structural connectivity, and, furthermore, integrating the two modalities does not increase explained variance. Second, we show the quality of cognitive prediction from connectome measures is influenced by the choice of grey matter parcellation, and, possibly, how that parcellation is derived. Third, we find that distinct functional and structural connections predict crystallised and fluid abilities. Taken together, our results suggest that functional and structural connectivity have unique relationships with crystallised and fluid cognition and, furthermore, studying both modalities provides a more comprehensive insight into the neural correlates of cognition.
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Affiliation(s)
- Elvisha Dhamala
- Department of Radiology, Weill Cornell Medicine, New York, New York, USA.,Brain and Mind Research Institute, Weill Cornell Medicine, New York, New York, USA
| | - Keith W Jamison
- Department of Radiology, Weill Cornell Medicine, New York, New York, USA
| | - Abhishek Jaywant
- Department of Psychiatry, Weill Cornell Medicine, New York, New York, USA.,Department of Rehabilitation Medicine, Weill Cornell Medicine, New York, New York, USA.,NewYork-Presbyterian Hospital/Weill Cornell Medical Center, New York, New York, USA
| | - Sarah Dennis
- Sarah Lawrence College, Bronxville, New York, USA
| | - Amy Kuceyeski
- Department of Radiology, Weill Cornell Medicine, New York, New York, USA.,Brain and Mind Research Institute, Weill Cornell Medicine, New York, New York, USA
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23
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French MA, Cohen ML, Pohlig RT, Reisman DS. Fluid Cognitive Abilities Are Important for Learning and Retention of a New, Explicitly Learned Walking Pattern in Individuals After Stroke. Neurorehabil Neural Repair 2021; 35:419-430. [PMID: 33754890 DOI: 10.1177/15459683211001025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND There is significant variability in poststroke locomotor learning that is poorly understood and affects individual responses to rehabilitation interventions. Cognitive abilities relate to upper extremity motor learning in neurologically intact adults, but have not been studied in poststroke locomotor learning. OBJECTIVE To understand the relationship between locomotor learning and retention and cognition after stroke. METHODS Participants with chronic (>6 months) stroke participated in 3 testing sessions. During the first session, participants walked on a treadmill and learned a new walking pattern through visual feedback about their step length. During the second session, participants walked on a treadmill and 24-hour retention was assessed. Physical and cognitive tests, including the Fugl-Meyer-Lower Extremity (FM-LE), Fluid Cognition Composite Score (FCCS) from the NIH Toolbox -Cognition Battery, and Spatial Addition from the Wechsler Memory Scale-IV, were completed in the third session. Two sequential regression models were completed: one with learning and one with retention as the dependent variables. Age, physical impairment (ie, FM-LE), and cognitive measures (ie, FCCS and Spatial Addition) were the independent variables. RESULTS Forty-nine and 34 participants were included in the learning and retention models, respectively. After accounting for age and FM-LE, cognitive measures explained a significant portion of variability in learning (R2 = 0.17, P = .008; overall model R2 = 0.31, P = .002) and retention (ΔR2 = 0.17, P = .023; overall model R2 = 0.44, P = .002). CONCLUSIONS Cognitive abilities appear to be an important factor for understanding locomotor learning and retention after stroke. This has significant implications for incorporating locomotor learning principles into the development of personalized rehabilitation interventions after stroke.
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24
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Jusko ML, Raiker JS, Campez M, Smith JN, Fosco WD, Horta L, Little K, Espinal K, Sanchez G, Mattfeld AT, Gnagy EM, Greiner AR, Coles EK, Pelham WE. Brief report: Evaluation of working memory deficits in children with ADHD using the NIH list sorting working memory task. Child Neuropsychol 2021; 27:613-620. [PMID: 33480319 DOI: 10.1080/09297049.2021.1876014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Variability in working memory (WM) task selection likely contributes to heterogeneity in effect size estimates of deficiencies in youth with attention-deficit/hyperactivity disorder (ADHD). This has resulted in the development of brief, easy to administer assessments such as the NIH List Sorting Working Memory (LSWM) task from the NIH Cognitive Toolbox in hopes of standardizing measurement of this construct. Unfortunately, substantial questions persist regarding the specific constructs being evaluated by this task (e.g., visuospatial [VS] or phonological [PH] WM) as well as the ability of this task to detect WM deficits in previously identified impaired groups (e.g., ADHD). The current study examines the extent to which the LSWM task is associated with VS and PHWM performance as well as symptoms of ADHD. Additionally, we examined the magnitude of differences between ADHD and Typically Developing (TD) youth on this task relative to empirically derived WM tasks utilized in the past. Forty-six children (25 ADHD, 21 TD) completed multiple WM tasks. The LSWM task was moderately associated with PHWM and demonstrated relatively weaker associations with VSWM. Symptoms of inattention and hyperactivity/impulsivity were unrelated to the LSWM task; whereas tasks assessing PH and VSWM were moderately associated with inattention and weakly associated with hyperactivity (VSWM only). No significant between-group differences in performance emerged on the LSWM task; however, significant large-magnitude group differences were observed on both the PH and VSWM tasks. These findings suggest that the LSWM task may lack the ability to detect WM difficulties in youth with ADHD.
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Affiliation(s)
- Morgan L Jusko
- Center for Children and Families, Florida International University, Miami, FL, USA
| | - Joseph S Raiker
- Center for Children and Families, Florida International University, Miami, FL, USA
| | - Mileini Campez
- Center for Children and Families, Florida International University, Miami, FL, USA
| | - Jessica N Smith
- Center for Children and Families, Florida International University, Miami, FL, USA
| | - Whitney D Fosco
- Department of Psychiatry and Behavioral Health, Penn State Hershey Medical Center, Hershey, PA, USA.,Department of Psychiatry and Behavioral Health, Penn State College of Medicine, Hershey, PA, USA
| | - Leonel Horta
- Center for Children and Families, Florida International University, Miami, FL, USA
| | - Kelcey Little
- Marcus Autism Center, Emory University, Atlanta, GA, USA
| | - Kisbel Espinal
- Center for Children and Families, Florida International University, Miami, FL, USA
| | - Gabriela Sanchez
- Center for Children and Families, Florida International University, Miami, FL, USA
| | - Aaron T Mattfeld
- Center for Children and Families, Florida International University, Miami, FL, USA
| | - Elizabeth M Gnagy
- Center for Children and Families, Florida International University, Miami, FL, USA
| | - Andrew R Greiner
- Center for Children and Families, Florida International University, Miami, FL, USA
| | - Erika K Coles
- Center for Children and Families, Florida International University, Miami, FL, USA
| | - William E Pelham
- Center for Children and Families, Florida International University, Miami, FL, USA
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25
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Pinto CB, Bielefeld J, Jabakhanji R, Reckziegel D, Griffith JW, Apkarian AV. Neural and Genetic Bases for Human Ability Traits. Front Hum Neurosci 2021; 14:609170. [PMID: 33390920 PMCID: PMC7772246 DOI: 10.3389/fnhum.2020.609170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Accepted: 11/25/2020] [Indexed: 11/13/2022] Open
Abstract
The judgement of human ability is ubiquitous, from school admissions to job performance reviews. The exact make-up of ability traits, however, is often narrowly defined and lacks a comprehensive basis. We attempt to simplify the spectrum of human ability, similar to how five personality traits are widely believed to describe most personalities. Finding such a basis for human ability would be invaluable since neuropsychiatric disease diagnoses and symptom severity are commonly related to such differences in performance. Here, we identified four underlying ability traits within the National Institutes of Health Toolbox normative data (n = 1, 369): (1) Motor-endurance, (2) Emotional processing, (3) Executive and cognitive function, and (4) Social interaction. We used the Human Connectome Project young adult dataset (n = 778) to show that Motor-endurance and Executive and cognitive function were reliably associated with specific brain functional networks (r 2 = 0.305 ± 0.021), and the biological nature of these ability traits was also shown by calculating their heritability (31 and 49%, respectively) from twin data.
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Affiliation(s)
- Camila Bonin Pinto
- Department of Physiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States.,Center for Translational Pain Research, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Jannis Bielefeld
- Department of Physiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States.,Center for Translational Pain Research, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Rami Jabakhanji
- Department of Physiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States.,Center for Translational Pain Research, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Diane Reckziegel
- Department of Physiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States.,Center for Translational Pain Research, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - James W Griffith
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - A Vania Apkarian
- Department of Physiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States.,Center for Translational Pain Research, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States.,Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States.,Department of Anesthesiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
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26
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Downes M, Keenan L, Duane Y, Duffy K, Fortune G, Geoghegan R, Conroy H, McMahon C. Executive function in children with sickle cell anemia on transfusion: NIH toolbox utility in the clinical context. Clin Neuropsychol 2020; 36:1573-1588. [PMID: 33200651 DOI: 10.1080/13854046.2020.1847325] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE The aim of this study was to establish the utility of the NIH Toolbox as a cognitive screener of executive functions in the clinical context. Additionally, we aimed to investigate whether age and time on transfusion were related to executive function performance. Method: Twenty-eight children and adolescents with sickle cell anemia (SCA) between 8 and 18 years (M = 13.28, SD = 3.05) on transfusion treatment were included. Participants completed five NIH Toolbox tasks (three executive function tasks and two non-executive function control tasks). Results: Mean scores on one of the three executive function measures (inhibitory control) fell below the average range (M = 81.36, SD = 14.01) with approximately 70% of children from both groups below the average range. Scores for processing speed (M = 86.82, SD = 22.01) and cognitive flexibility (M = 85.75, SD = 12.67) were low averages. As expected, scores on non-executive measures (language and memory) fell within the average range. No significant differences were observed between children with silent stroke and no stroke on executive function measures. Older age (p < .01) and length of time on transfusion (p < .05) predicted lower inhibitory control scores. Conclusions: Findings provide evidence for poor development of inhibitory control with age in this patient population. As the NIH Toolbox successfully highlighted expected deficits in this patient population, this study supports the use of this tool as a brief screening measure for children with SCD. The clinical and theoretical implications of the findings are discussed.
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Affiliation(s)
- M Downes
- School of Psychology, University College Dublin, Dublin, Ireland
| | - L Keenan
- School of Psychology, University College Dublin, Dublin, Ireland
| | - Y Duane
- Children's Health Ireland at Crumlin, Dublin, Ireland
| | - K Duffy
- School of Psychology, University College Dublin, Dublin, Ireland.,Children's Health Ireland at Crumlin, Dublin, Ireland
| | - G Fortune
- Children's Health Ireland at Crumlin, Dublin, Ireland
| | - R Geoghegan
- Children's Health Ireland at Crumlin, Dublin, Ireland
| | - H Conroy
- Children's Health Ireland at Crumlin, Dublin, Ireland
| | - C McMahon
- Children's Health Ireland at Crumlin, Dublin, Ireland
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27
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Assessment of Prorated Scoring of an Abbreviated Protocol for the National Institutes of Health Toolbox Cognition Battery. J Int Neuropsychol Soc 2020; 26:1045-1050. [PMID: 33081872 DOI: 10.1017/s1355617720001010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To evaluate an abbreviated NIH Toolbox Cognition Battery (NIHTB-CB) protocol that can be administered remotely without any in-person assessments, and explore the agreement between prorated scores from the abbreviated protocol and standard scores from the full protocol. METHODS Participant-level age-corrected NIHTB-CB data were extracted from six studies in individuals with a history of stroke, mild traumatic brain injury (mTBI), treatment-resistant psychosis, and healthy controls, with testing administered under standard conditions. Prorated fluid and total cognition scores were estimated using regression equations that excluded the three fluid cognition NIHTB-CB instruments which cannot be administered remotely. Paired t tests and intraclass correlations (ICCs) were used to compare the standard and prorated scores. RESULTS Data were available for 245 participants. For fluid cognition, overall prorated scores were higher than standard scores (mean difference = +4.5, SD = 14.3; p < 0.001; ICC = 0.86). For total cognition, overall prorated scores were higher than standard scores (mean difference = +2.7, SD = 8.3; p < 0.001; ICC = 0.88). These differences were significant in the stroke and mTBI groups, but not in the healthy control or psychosis groups. CONCLUSIONS Prorated scores from an abbreviated NIHTB-CB protocol are not a valid replacement for the scores from the standard protocol. Alternative approaches to administering the full protocol, or corrections to scoring of the abbreviated protocol, require further study and validation.
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28
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Psychometric Properties of the NIH Toolbox Cognition Battery in Healthy Older Adults: Reliability, Validity, and Agreement with Standard Neuropsychological Tests. J Int Neuropsychol Soc 2019; 25:857-867. [PMID: 31256769 PMCID: PMC6733640 DOI: 10.1017/s1355617719000614] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Few independent studies have examined the psychometric properties of the NIH Toolbox Cognition Battery (NIHTB-CB) in older adults, despite growing interest in its use for clinical purposes. In this paper we report the test-retest reliability and construct validity of the NIHTB-CB, as well as its agreement or concordance with traditional neuropsychological tests of the same construct to determine whether tests could be used interchangeably. METHODS Sixty-one cognitively healthy adults ages 60-80 completed "gold standard" (GS) neuropsychological tests, NIHTB-CB, and brain MRI. Test-retest reliability, convergent/discriminant validity, and agreement statistics were calculated using Pearson's correlations, concordance correlation coefficients (CCC), and root mean square deviations. RESULTS Test-retest reliability was acceptable (CCC = .73 Fluid; CCC = .85 Crystallized). The NIHTB-CB Fluid Composite correlated significantly with cerebral volumes (r's = |.35-.41|), and both composites correlated highly with their respective GS composites (r's = .58-.84), although this was more variable for individual tests. Absolute agreement was generally lower (CCC = .55 Fluid; CCC = .70 Crystallized) due to lower precision in fluid scores and systematic overestimation of crystallized composite scores on the NIHTB-CB. CONCLUSIONS These results support the reliability and validity of the NIHTB-CB in healthy older adults and suggest that the fluid composite tests are at least as sensitive as standard neuropsychological tests to medial temporal atrophy and ventricular expansion. However, the NIHTB-CB may generate different estimates of performance and should not be treated as interchangeable with established neuropsychological tests.
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Brearly TW, Rowland JA, Martindale SL, Shura RD, Curry D, Taber KH. Comparability of iPad and Web-Based NIH Toolbox Cognitive Battery Administration in Veterans. Arch Clin Neuropsychol 2019; 34:524-530. [PMID: 30260372 PMCID: PMC9586718 DOI: 10.1093/arclin/acy070] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2018] [Revised: 08/01/2018] [Accepted: 08/08/2018] [Indexed: 10/18/2023] Open
Abstract
OBJECTIVE The purpose of this study was to evaluate the comparability of National Institutes of Health Toolbox Cognitive Battery test scores across iPad application and web-based personal computer administration platforms. Original test norms were developed using a personal computer-based administration and no previous studies assessing platform comparability have been published. METHOD Participants (N = 62; final analyzed sample n = 49) were combat-exposed post-deployment veterans without neurologic disorder, severe mental illness, current substance use disorder, or a history of moderate or severe traumatic brain injury. All participants completed both iPad and web-based versions of tests on the same day in an experimental within-subjects crossover design. Standalone validity measures were incorporated to exclude invalid performance. Outcome measures included the Dimensional Change Card Sort Test, Flanker Inhibitory Control and Attention Test, List Sorting Working Memory Test, and Pattern Comparison Processing Speed Test. RESULTS Score differences between platforms were found on the Flanker Inhibitory Control and Attention Test. Scores were moderately correlated across tests, with the exception of low correlations for the Pattern Comparison Processing Speed Test. Most participants preferred iPad to web administration, regardless of administration order. CONCLUSIONS Results suggest caution when interpreting iPad-acquired scores, particularly for the Flanker Inhibitory Control and Attention Test. iPad-based testing offers valuable improvements; however, the development of iPad-specific norms may be necessary to ensure valid interpretation of acquired data.
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Affiliation(s)
- Timothy W. Brearly
- Mid-Atlantic Mental Illness Research, Education, and Clinical Center and Research & Academic Affairs Service Line, Salisbury VA Health Care System, Salisbury, NC, USA
- Neuropsychology Assessment Service, Directorate of Behavioral Health (Consultation & Education), Walter Reed National Military Medical Center, Bethesda, MD, USA
- Department of Psychiatry and Behavioral Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Jared A. Rowland
- Mid-Atlantic Mental Illness Research, Education, and Clinical Center and Research & Academic Affairs Service Line, Salisbury VA Health Care System, Salisbury, NC, USA
- Department of Psychiatry and Behavioral Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Department of Neurobiology & Anatomy, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Mid-Atlantic Mental Illness Research, Education, and Clinical Center and Mental Health & Behavioral Sciences Service Line, Salisbury VA Health Care System, Salisbury, NC, USA
| | - Sarah L. Martindale
- Mid-Atlantic Mental Illness Research, Education, and Clinical Center and Research & Academic Affairs Service Line, Salisbury VA Health Care System, Salisbury, NC, USA
- Department of Psychiatry and Behavioral Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Mid-Atlantic Mental Illness Research, Education, and Clinical Center and Mental Health & Behavioral Sciences Service Line, Salisbury VA Health Care System, Salisbury, NC, USA
| | - Robert D. Shura
- Department of Psychiatry and Behavioral Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
- Mid-Atlantic Mental Illness Research, Education, and Clinical Center and Mental Health & Behavioral Sciences Service Line, Salisbury VA Health Care System, Salisbury, NC, USA
- Via College of Osteopathic Medicine, Blacksburg, VA, USA
| | - David Curry
- Mid-Atlantic Mental Illness Research, Education, and Clinical Center and Research & Academic Affairs Service Line, Salisbury VA Health Care System, Salisbury, NC, USA
| | - Kathy H. Taber
- Mid-Atlantic Mental Illness Research, Education, and Clinical Center and Research & Academic Affairs Service Line, Salisbury VA Health Care System, Salisbury, NC, USA
- Via College of Osteopathic Medicine, Blacksburg, VA, USA
- Baylor College of Medicine, Houston, TX, USA
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Babakhanyan I, Carlozzi NE, McKenna BS, Casaletto KB, Heinemann AW, Heaton RK. National Institutes of Health Toolbox Emotion Battery: Application of Summary Scores to Adults With Spinal Cord Injury, Traumatic Brain Injury, and Stroke. Arch Phys Med Rehabil 2019; 100:1863-1871. [PMID: 31153854 DOI: 10.1016/j.apmr.2019.05.024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 03/23/2019] [Accepted: 05/04/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To examine the validity of factor analytically based summary scores that were developed using the National Institutes of Health Toolbox Emotion Battery (NIHTB-EB); (ie, psychological well-being, social satisfaction, negative affect) normative sample in individuals with neurologic conditions. DESIGN Cross-sectional, observational cohort. SETTING Community. PARTICIPANTS A total of 1036 English-speaking adults from the National Institutes of Health Toolbox (NIHTB) normative project and 604 community-dwelling adults with neurologic conditions including spinal cord injury (SCI n=209), traumatic brain injury (TBI n=184), and stroke (cerebrovascular accident [CVA] n=211) (N=1640). INTERVENTION Not applicable. MAIN OUTCOME MEASURES The NIHTB-EB. RESULTS A series of univariate analyses comparing summary scores across the 4 groups (SCI, TBI, CVA, normative group) were conducted to identify group differences. Base rates (defined as >1 SD toward the problematic direction) were also identified. The normative group demonstrated better emotional functioning characterized by greater social satisfaction and psychological well-being (normative group > SCI, TBI, CVA; P's <.0001), and less negative affect (normative group < SCI, P=.016; normative group < TBI, P<.001; normative group < CVA; P=.034) compared with each neurologic group. Using base rates to identify problematic emotions for the 3 summary scores, there were higher rates of problematic emotions on all 3 summary scores for the neurologic groups compared with the normative group. CONCLUSIONS The NIHTB-EB summary scores demonstrate an increased prevalence of problematic emotions among individuals with 3 neurologic conditions, and might be useful for identifying individuals with similar conditions and potentially in need of psychological support.
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Affiliation(s)
- Ida Babakhanyan
- Department of Psychiatry, University of California San Diego, San Diego, CA.
| | - Noelle E Carlozzi
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI
| | - Benjamin S McKenna
- Department of Psychiatry, University of California San Diego, San Diego, CA
| | - Kaitlin B Casaletto
- Memory and Aging Center, University of California San Francisco, Department of Neurology, San Francisco, CA
| | - Allen W Heinemann
- Shirley Ryan AbilityLab and Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, IL
| | - Robert K Heaton
- Department of Psychiatry, University of California San Diego, San Diego, CA
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Hackett K, Krikorian R, Giovannetti T, Melendez-Cabrero J, Rahman A, Caesar EE, Chen JL, Hristov H, Seifan A, Mosconi L, Isaacson RS. Utility of the NIH Toolbox for assessment of prodromal Alzheimer's disease and dementia. ALZHEIMER'S & DEMENTIA: DIAGNOSIS, ASSESSMENT & DISEASE MONITORING 2018; 10:764-772. [PMID: 30505926 PMCID: PMC6247399 DOI: 10.1016/j.dadm.2018.10.002] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Introduction The NIH Toolbox Cognition Battery (NIHTB-CB) is a computer-based protocol not yet validated for clinical assessment. Methods We administered the NIHTB-CB and traditional neuropsychological tests to 247 Memory Disorders and Alzheimer's Prevention Clinic patients with subjective cognitive decline, mild cognitive impairment, mild dementia due to Alzheimer's disease, and normal cognition. Principal component analysis, partial correlations, and univariate general linear model tests were performed to assess construct validity. Discriminant function analyses compared classification accuracy. Results Principal component analysis identified three conceptually coherent factors: memory (MEMNIH), executive function (EFNIH), and crystallized intelligence (CINIH). These factors were strongly associated with corresponding traditional tests and differed across diagnostic groups as expected. Both NIHTB and traditional batteries yielded strong overall discriminative ability (>80%). Discussion The NIHTB-CB is a valid method to assess neurocognitive domains pertinent to aging and dementia and has utility for applications in a memory clinic setting.
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Affiliation(s)
- Katherine Hackett
- Department of Psychology, Temple University, Philadelphia, PA, USA
- Corresponding author. Tel.: +914-582-7581; Fax: +215-204-5539.
| | - Robert Krikorian
- Department of Psychiatry and Behavioral Neuroscience, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | | | | | - Aneela Rahman
- Department of Neurology, Weill Cornell Medicine and NewYork-Presbyterian, New York, NY, USA
| | | | - Jaclyn L. Chen
- Stony Brook University School of Medicine, New York, NY, USA
| | - Hollie Hristov
- Department of Neurology, Weill Cornell Medicine and NewYork-Presbyterian, New York, NY, USA
| | | | - Lisa Mosconi
- Department of Neurology, Weill Cornell Medicine and NewYork-Presbyterian, New York, NY, USA
| | - Richard S. Isaacson
- Department of Neurology, Weill Cornell Medicine and NewYork-Presbyterian, New York, NY, USA
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Sinha P, Wong AWK, Kallogjeri D, Piccirillo JF. Baseline Cognition Assessment Among Patients With Oropharyngeal Cancer Using PROMIS and NIH Toolbox. JAMA Otolaryngol Head Neck Surg 2018; 144:978-987. [PMID: 29710116 PMCID: PMC6248179 DOI: 10.1001/jamaoto.2018.0283] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Accepted: 03/15/2018] [Indexed: 12/20/2022]
Abstract
Importance Cognitive dysfunction (CD) is recognized by the American Cancer Society as a treatment effect in head and neck cancer, but the extent of this problem at baseline in oropharyngeal cancer (OPC), the most common subsite in current practice, to our knowledge has never been studied. Objective To assess the baseline cognition of patients with OPC using National Institutes of Health (NIH)-sponsored instruments of Patient-Reported Outcomes Measurement Information System (PROMIS) and NIH Toolbox Cognitive Battery (NIHTB-CB). Design, Setting, and Participants This was a prospective cohort study conducted at a tertiary academic center. Of 83 consecutive patients, newly diagnosed as having OPC from September 2016 to May 2017, 16 were ineligible, 8 refused to participate, and 3 were lost to follow-up after screening, resulting in 56 study participants. Main Outcomes and Measures Self-perceived and objective cognition with PROMIS and NIHTB-CB standardized T scores, respectively, were main outcomes. Impairment was defined as (1) T scores less than 0.5 SD for PROMIS; (2) T score less than 1.5 SD in at least 1 cognitive domain or less than 1 SD in 2 or more domains for NIHTB-CB total cognition; and (3) T score per previously published criteria for NIHTB-CB intelligence-stratified cognition. Results Of the 56 study participants (52 men, 4 women; median age, 59 years [range, 42-77 years]), 19 (34%) had a college degree, and 20 (36%) had a professional or technical occupation. Thirty (about 53%) were never-smokers, 26 (46%) were never-drinkers, 29 (52%) were obese, 13 (23%) had a moderate to severe comorbidity, 3 (5%) used antidepressants, and 25 (52%) had hearing loss. Impaired self-reported, NIHTB-CB total, and intelligence-stratified cognition scores were observed in 6 (11%), 18 (32%), and 12 (21%), respectively. Among all variables, objective impairment was more common in men (23% vs 0%) and those with p16-negative OPC (33% vs 20%), moderate to severe comorbidity (31% vs 18%), and hearing loss (31% vs 12%). Conclusions and Relevance Impaired objective cognition was more common at baseline than self-reported, and was more frequent in men, participants with p16-negative OPC, moderate to severe comorbidity, and hearing loss. NIHTB-CB allowed immediate scoring of demographically adjusted cognitive function. In clinical practice, these scores can be used to identify patients with impaired cognition at baseline who may be susceptible to developing further impairment after treatment. Identification of impairment at baseline will help to institute early cognitive interventions, which may lead to an improved posttreatment quality of life.
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Affiliation(s)
- Parul Sinha
- Department of Otolaryngology–Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Alex W. K. Wong
- Program in Occupational Therapy & Department of Neurology, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Dorina Kallogjeri
- Department of Otolaryngology–Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Jay F. Piccirillo
- Department of Otolaryngology–Head and Neck Surgery, Washington University School of Medicine in St Louis, St Louis, Missouri
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Carlozzi NE, Goodnight S, Umlauf A, Heaton RK, Heinemann AW, Schalet BD, Gershon RC, Tulsky DS. Motor-free composites from the National Institutes of Health Toolbox Cognition Battery (NIHTB-CB) for people with disabilities. Rehabil Psychol 2018; 62:464-473. [PMID: 29265867 DOI: 10.1037/rep0000185] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
PURPOSE/OBJECTIVE The National Institutes of Health Toolbox Cognition Battery (NIHTB-CB) includes a group of brief measures (i.e., 30 min) designed to assess language, processing speed, working memory, episodic memory, and executive functioning. These subtests can be combined to create composite scores that reflect fluid and crystallized cognition, as well as overall cognition. The battery is of limited utility with individuals who have impaired upper extremity motor functioning. This manuscript examines the accuracy of the Oral Symbol Digit Modalities Test as a substitute for the Pattern Comparison Processing Speed Test for computing motor-free composite scores. Research Method/Design: Individuals with spinal cord injury (SCI; n = 188), traumatic brain injury (TBI; n = 159), or stroke (n = 180) completed the NIHTB-CB. We used the Oral Symbol Digit Modalities Test to create a Motor-Free Pattern Comparison score; this was used to create revised, Motor-Free Composite scores for Fluid Cognition and Overall Cognition. RESULTS Although there were statistically significant overall differences between the two Fluid and Overall Cognition composite scores for some of the clinical groups (scores based on the motor-free approach were significantly higher than the original score), these differences were small and partly because of overclassification of impaired processing speed in participants with motor impairment. There was good to substantial agreement with regard to "impairment" classification between the two sets of Original and Motor-Free composite scores. CONCLUSIONS/IMPLICATIONS Although the Motor-Free scores are not a perfect match for the Original Composite scores, they provide a reliable and valid way to examine overall and fluid cognition in individuals with upper extremity motor impairments. (PsycINFO Database Record
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Affiliation(s)
- Noelle E Carlozzi
- Department of Physical Medicine and Rehabilitation, University of Michigan
| | - Siera Goodnight
- Department of Physical Medicine and Rehabilitation, University of Michigan
| | - Anya Umlauf
- Department of Psychiatry, University of California San Diego
| | - Robert K Heaton
- Department of Psychiatry, University of California San Diego
| | | | - Benjamin D Schalet
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University
| | - Richard C Gershon
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University
| | - David S Tulsky
- Center for Health Assessment Research and Translation, University of Delaware
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Tulsky DS, Holdnack JA, Cohen ML, Heaton RK, Carlozzi NE, Wong AWK, Boulton AJ, Heinemann AW. Factor structure of the NIH Toolbox Cognition Battery in individuals with acquired brain injury. Rehabil Psychol 2018; 62:435-442. [PMID: 29265864 DOI: 10.1037/rep0000183] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVE The National Institutes of Health Toolbox Cognition Battery (NIHTB-CB) measures reading, vocabulary, episodic memory, working memory, executive functioning, and processing speed. While previous research has validated the factor structure in healthy adults, the factor structure has not been examined in adults with neurological impairments. Thus, this study evaluated the NIHTB-CB factor structure in individuals with acquired brain injury. METHOD A sample of 392 individuals (ages 18-84) with acquired brain injury (n = 182 TBI, n = 210 stroke) completed the NIHTB-CB along with neuropsychological tests as part of a larger, multisite research project. RESULTS Confirmatory factor analyses supported a 5-factor solution that included reading, vocabulary, episodic memory, working memory, and processing speed/executive functioning. This structure generally held in TBI and stroke subsamples as well as in subsamples of those with severe TBI and stroke injuries. CONCLUSIONS The factor structure of the NIHTB-CB is similar in adults with acquired brain injury to adults from the general population. We discuss the implications of these findings for clinical practice and clinical research. (PsycINFO Database Record
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Affiliation(s)
- David S Tulsky
- Departments of Physical Therapy and Psychological and Brain Sciences, University of Delaware
| | - James A Holdnack
- The Center on Health Assessment Research and Translation, University of Delaware
| | - Matthew L Cohen
- The Center on Health Assessment Research and Translation, University of Delaware
| | - Robert K Heaton
- Department of Psychiatry, University of California-San Diego School of Medicine
| | - Noelle E Carlozzi
- Center for Clinical Outcomes Development and Application, University of Michigan Medical Center
| | - Alex W K Wong
- Department of Occupational Therapy and Neurology, Washington University School of Medicine
| | - Aaron J Boulton
- The Center for Health Assessment Research and Translation, University of Delaware
| | - Allen W Heinemann
- Department of Physical Medicine and Rehabilitation, Feinberg School of Medicine, Northwestern University
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Tulsky DS, Heinemann AW. The clinical utility and construct validity of the NIH Toolbox Cognition Battery (NIHTB-CB) in individuals with disabilities. Rehabil Psychol 2017; 62:409-412. [PMID: 29265861 PMCID: PMC10801711 DOI: 10.1037/rep0000201] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
A State-of-the-Science conference on measurement with disability populations recommended "...the development of cognitive and psychosocial outcome measures, using computer-adaptive testing...that are low in respondent burden and valid across patient populations," (Clohan et al., 2007, p. 1537). Following this recommendation, the National Institute on Disability, Independent Living, and Rehabilitation Research (NIDILRR) prioritized the development of measures of cognitive functioning for individuals with disabilities, noting that measures of cognitive functioning "have not been developed for systemic application in the field of medical rehabilitation. Cognition is both a rehabilitation outcome and a factor related to broader functional and community outcomes for individuals with a wide variety of disabling conditions" (Office of Special Education & Rehabilitation Services, 2009, p. 37193). From this came the NIH Toolbox for the Assessment of Neurological and Behavioral Function project (NIH Toolbox) which provides a comprehensive set of cognitive, motor, sensory, and emotional health and function measures for use in clinical, longitudinal, and epidemiological research. The nine papers comprising this special section of Rehabilitation Psychology reflect the sustained collaborative efforts of more than two dozen investigators working at six sites over the past 8 years. They are an initial attempt to validate the NIHTB-CB in disability samples, and they provide initial evidence that the NIHTB-CB can be used with individuals who have TBI, SCI, or stroke. The articles published here reflect the fulfillment of recommendations made during a state-of-the-science conference in 2007. (PsycINFO Database Record
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Affiliation(s)
- David S Tulsky
- Center for Health Assessment Research and Translation, University of Delaware
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