Dataset Information

Utility of the NIH Toolbox for assessment of prodromal Alzheimer's disease and dementia.

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 (MEM_NIH), executive function (EF_NIH), and crystallized intelligence (CI_NIH). 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.

SUBMITTER: Hackett K

PROVIDER: S-EPMC6247399 | biostudies-literature | 2018

REPOSITORIES: biostudies-literature

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Publications

Utility of the NIH Toolbox for assessment of prodromal Alzheimer's disease and dementia.

Hackett Katherine K Krikorian Robert R Giovannetti Tania T Melendez-Cabrero Josefina J Rahman Aneela A Caesar Emily E EE Chen Jaclyn L JL Hristov Hollie H Seifan Alon A Mosconi Lisa L Isaacson Richard S RS

Alzheimer's & dementia (Amsterdam, Netherlands) 20181102

<h4>Introduction</h4>The NIH Toolbox Cognition Battery (NIHTB-CB) is a computer-based protocol not yet validated for clinical assessment.<h4>Methods</h4>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 mo ...[more]

PMID: 30505926

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Project description:BackgroundTo demonstrate feasibility and utility of the iPad version of the NIH Toolbox Cognition Battery (NIHTB-CB) in a clinical trial of older adults.MethodsFifty-one adults, aged 55 and older without dementia were tested twice on NIHTB-CB and more traditional paper-and-pencil neuropsychological measures after meal ingestion, with approximately a 4-week interval. We also compared performances at Time 1 and Time 2 for significant change. We also extracted the response times and errors for available NIHTB-CB subtests to determine subtle changes in performance.ResultsOver the interval, improvement in fluid cognitive measures was noted at Time 2 (t = -3.07, p = 0.004), whereas crystallized measures were unchanged. Tests of fluid cognition negatively correlated with age, particularly for the second visit. Analysis of the average speed per item showed that, for two of the tests, speed increased at Time 2. Traditional neuropsychological tests correlated with many of the NIHTB-CB measures. Response times for all five timed tests decreased at Time 2, although only statistically significant for Picture Sequence and Picture Vocabulary.ConclusionsThe iPad version of the NIH Toolbox Cognition Battery appears to be an adequate measure to assess cognitive functioning in a clinical trial of older adults. Psychometric analyses suggest stability in measures of crystallized functioning, whereas measures of fluid abilities revealed improvements over the short time frame of the study. Response times and errors for individual tests revealed intriguing relationships that should be further evaluated to determine the utility in clinical sample analysis, as this could aid identification of subtle cognitive change over short periods. Additional studies with larger sample sizes will be helpful to understanding the reliability, sensitivity, and specificity of the NIHTB-CB sub-scores in older adults. In addition, further evaluations with clinical populations, including individuals with cognitive impairment, are warranted.

Project description:ImportanceCognitive 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.ObjectiveTo 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 participantsThis 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 measuresSelf-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.ResultsOf 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 relevanceImpaired 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.

Dataset Information

Utility of the NIH Toolbox for assessment of prodromal Alzheimer's disease and dementia.

Introduction

Methods

Results

Discussion

Publications

Utility of the NIH Toolbox for assessment of prodromal Alzheimer's disease and dementia.

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