Demographically Corrected Normative Standards for the Spanish Language Version of the NIH Toolbox Cognition Battery

Abstract

Objectives Hispanics are the fastest growing ethnicity in the United States, yet there are limited well-validated neuropsychological tools in Spanish, and an even greater paucity of normative standards representing this population. The Spanish NIH Toolbox Cognition Battery (NIHTB-CB) is a novel neurocognitive screener; however, the original norms were developed combining Spanish- and English-versions of the battery. We developed normative standards for the Spanish NIHTB-CB, fully adjusting for demographic variables and based entirely on a Spanish-speaking sample. Methods A total of 408 Spanish-speaking neurologically healthy adults (ages 18–85 years) and 496 children (ages 3–7 years) completed the NIH Toolbox norming project. We developed three types of scores: uncorrected based on the entire Spanish-speaking cohort, age-corrected, and fully demographically corrected (age, education, sex) scores for each of the seven NIHTB-CB tests and three composites (Fluid, Crystallized, Total Composites). Corrected scores were developed using polynomial regression models. Demographic factors demonstrated medium-to-large effects on uncorrected NIHTB-CB scores in a pattern that differed from that observed on the English NIHTB-CB. For example, in Spanish-speaking adults, education was more strongly associated with Fluid scores, but showed the strongest association with Crystallized scores among English-speaking adults. Results Demographic factors were no longer associated with fully corrected scores. The original norms were not successful in eliminating demographic effects, overestimating children’s performances, and underestimating adults’ performances on the Spanish NIHTB-CB. Conclusions The disparate pattern of demographic associations on the Spanish versus English NIHTB-CB supports the need for distinct normative standards developed separately for each population. Fully adjusted scores presented here will aid in more accurately characterizing acquired brain dysfunction among U.S. Spanish-speakers.

National Institutes of Health Toolbox Emotion Battery for English- and Spanish-speaking adults: normative data and factor-based summary scores

“…Therefore, normalized T -scores on the Spanish NIHTB-EB represent an individual’s affective characteristics compared to our large normative cohort of Spanish-speaking adults. 22 …”

Performance of Hispanics and Non-Hispanic Whites on the NIH Toolbox Cognition Battery: the roles of ethnicity and language backgrounds

“…Thus, the Hispanic-English was the primary reference group used as comparison for one-to-one demographic matching with the NH White and Hispanic-Spanish groups. For further details regarding the English and Spanish speaking normative groups, please see Casaletto et al 2015 and 2016. Hispanic-Spanish individuals included in the current study, however, were significantly younger (40.7 vs. 45.1 years, p =0.02) and had higher levels of education (13.6 vs. 9.9 years, p <0.001) as compared to those in the overall normative Hispanic-Spanish sample.…”

Uncorrected versus demographically-corrected scores on the NIH Toolbox Cognition Battery in persons with traumatic brain injury and stroke.

“…These domains can be broadly divided into crystallized and fluid cognitive abilities; composite indices were calculated to represent overall cognitive functioning in both the crystallized and fluid domains (Heaton et al, 2014). The NIHTB-CB, which is suitable for individuals ages 3 through 85 and is available in both English and Spanish, has demonstrated strong convergent and discriminant validity and excellent test–retest reliability (Casaletto et al, 2016; Weintraub et al, 2014). …”