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

Nitsch, Kristian P.; Casaletto, Kaitlin B.; Carlozzi, Noelle E.; Tulsky, David S.; Heinemann, Allen W.; Heaton, Robert K.

doi:10.1037/rep0000122

Cited by 10 publications

(13 citation statements)

References 56 publications

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“…Major studies in this population suggests women perform better in areas such as verbal memory, attention, and working memory ( Ratcliff et al., 2007 ), however the lack of normative test scoreuse/reporting with neuropsychological data reporting complicates interpretation of TBI-specific sex differences. In fact, demographic differences in NIH toolbox neuropsychological test score performance among TBI/Stroke populations account for ~1/3 of the variance in scores, a finding that drops to ~5% when correcting for demographic differences in the general population ( Nitsch et al., 2017 ). Our findings suggest that despite correcting for demographic influences on component score performance, women with TBI perform worse when adjusting for covariates like education and injury severity.…”

Section: Discussionmentioning

confidence: 99%

Early chronic systemic inflammation and associations with cognitive performance after moderate to severe TBI

Milleville

Awan

DiSanto

et al. 2021

Brain, Behavior, & Immunity - Health

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Background Cognitive dysfunction adversely effects multiple functional outcomes and social roles after TBI. We hypothesize that chronic systemic inflammation exacerbates cognitive deficits post-injury and diminishes functional cognition and quality of life (QOL). Yet few studies have examined relationships between inflammation and cognition after TBI. Associations between early chronic serum inflammatory biomarker levels, cognitive outcomes, and QOL 6-months and 12-months after moderate-to-severe TBI were identified using unweighted (uILS) and weighted (wILS) inflammatory load score (ILS) formation. Methods Adults with moderate-to-severe TBI (n = 157) completed neuropsychological testing, the Functional Impairment Measure Cognitive Subscale (FIM-Cog) and self-reported Percent Back to Normal scale 6 months (n = 139) and 12 months (n = 136) post-injury. Serial serum samples were collected 1–3 months post-TBI. Cognitive composite scores were created as equally weighted means of T-scores derived from a multidimensional neuropsychological test battery. Median inflammatory marker levels associated with 6-month and 12-month cognitive composite T-scores (p < 0.10) were selected for ILS formation. Markers were quartiled, and quartile ranks were summed to generate an uILS. Marker-specific β-weights were derived using penalized ridge regression, multiplied by standardized marker levels, and summed to generate a wILS. ILS associations with cognitive composite scores were assessed using multivariable linear regression. Structural equation models assessed ILS influences on functional cognition and QOL using 12-month FIM-Cog and Percent Back to Normal scales. Results ILS component markers included: IL-1β, TNF-α, sIL-4R, sIL-6R, RANTES, and MIP-1β. Increased sIL-4R levels were positively associated with overall cognitive composite T-scores in bivariate analyses, while remaining ILS markers were negatively associated with cognition. Multivariable receiver operator curves (ROC) showed uILS added 14.98% and 31.93% relative improvement in variance captured compared to the covariates only base model (age, sex, education, Glasgow Coma Scale score) when predicting cognitive composite scores at 6 and 12 months, respectively; wILS added 33.99% and 36.87% relative improvement in variance captured. Cognitive composite mediated wILS associations with FIM-Cog scores at 12 months, and both cognitive composite and FIM-Cog scores mediated wILS associations with QOL. Conclusions Early chronic inflammatory burden is associated with cognitive performance post-TBI. wILS explains greater variance in cognitive composite T-scores than uILS. Linking inflammatory burden associated with cognitive deficits to functional outcome post-TBI demonstrates the potential impact of immunotherapy interventions aimed at improving cognitive recovery post-TBI.

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Section: Discussionmentioning

confidence: 99%

Early chronic systemic inflammation and associations with cognitive performance after moderate to severe TBI

Milleville

Awan

DiSanto

et al. 2021

Brain, Behavior, & Immunity - Health

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“…Construct validity for the flanker task has been shown for traumatic brain injury , spinal cord injury (M. L. Cohen et al, 2017), and stroke patients (Carlozzi et al, 2017). Finally, base rate information (Holdnack et al, 2017) and test interpretation analyses (Nitsch et al, 2017) have been performed.…”

Section: Methodsmentioning

confidence: 99%

“…L. Cohen et al, 2017), and stroke patients (Carlozzi et al, 2017). Finally, base rate information (Holdnack et al, 2017) and test interpretation analyses (Nitsch et al, 2017) have been performed.…”

Section: Methodsmentioning

confidence: 99%

Assessing the suitability of virtual reality for psychological testing.

Roberts

Yeap

Seah

et al. 2019

Psychological Assessment

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Virtual reality (VR) is rapidly becoming an inexpensive, mainstream technology. VR technology is superambulatory as it allows participants to be examined under standardized environments and tests anywhere. In addition, it can test participants in different virtual spaces, including environments that are unsafe, inaccessible, costly or difficult to set up, or even nonexistent. We summarize the benefits and potential problems of VR technology, but we also move beyond theoretical approaches and present a customizable, open-source VR system (PSY-VR) that allows scalable psychological testing in modifiable VR environments. This system allows users to modify the environment using a simple graphical interface, without programming expertise. Moreover, as a proof-of-concept, we compare responses in a typical Flanker task between a real laboratory and a painstakingly matched virtual laboratory. Results indicate that the VR responses are comparable to real life testing, demonstrating the utility of VR for psychological assessment studies. The predicted rapid advancement of VR immersive technologies, as well the ease of their integration with physiological metrics ensures that VR-based assessment will be the modus operandi of psychological assessment in the future. This will allow controllable, low-cost assessment on a global scale. Public Significance StatementThis study examines whether virtual reality can be used as a replacement for a controlled testing room in psychological assessment. We also present a virtual reality complete system that researchers can modify and use for their own research purposes. Virtual reality can be used to test multiple groups of people around the world in a controlled and unbiased way.

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“…The NIHTB-CB has many advantages as it is: (1) applicable across the lifespan, (2) brief, (3) non-proprietary, (4) based on state-of-the-art test theories and technology, and (5) available in both English and Spanish versions (Mungas et al, 2014). The validity and utility of the battery has been shown in cognitively unimpaired adults (Heaton et al, 2014;Mungas et al, 2014;Weintraub et al, 2013), and clinical samples with spinal cord injury Cohen et al, 2017), traumatic brain injury (TBI; Nitsch et al, 2017;, stroke Carlozzi, Tulsky, et al, 2017;Nitsch et al, 2017;, and intellectual disabilities (Hessl et al, 2016). In addition, a study including adults with varied cognitive statuses provided supportive findings for the validity of NIHTB-CB in assessing neurocognitive domains related to dementia (Hackett et al, 2018).…”

Section: Introductionmentioning

confidence: 99%

Latent Factor Structure and Measurement Invariance of the NIH Toolbox Cognition Battery in an Alzheimer’s Disease Research Sample

Carlsson

Wahoske

et al. 2020

J Int Neuropsychol Soc

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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.

show abstract

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

Cited by 10 publications

References 56 publications

Early chronic systemic inflammation and associations with cognitive performance after moderate to severe TBI

Early chronic systemic inflammation and associations with cognitive performance after moderate to severe TBI

Assessing the suitability of virtual reality for psychological testing.

Latent Factor Structure and Measurement Invariance of the NIH Toolbox Cognition Battery in an Alzheimer’s Disease Research Sample

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