Assessment of Prorated Scoring of an Abbreviated Protocol for the National Institutes of Health Toolbox Cognition Battery.

Alexander D Rebchuk,Molly Cairncross,Ivan J Torres,Arshia Alimohammadi,Thalia S Field,Noah D Silverberg,Michelle Yuan

doi:10.1017/s1355617720001010

Abstract

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. 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. 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. 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.

Highlights

Cognition is an important outcome in research trials and clinical practice (McInnes et al, 2017; Sheffield et al, 2018; Tang et al, 2018)
Data were available for 245 participants: 77 (31.4%) healthy controls, 66 (26.7%) individuals with mild traumatic brain injury (mTBI), 63 (25.7%) with a history of stroke, and 39 (15.9%) with active psychosis
Healthy controls had the lowest percentage (33.8%) of prediction errors greater than ±0.5 SD, followed by those with psychosis (35.9%), mTBI (42.4%), and stroke (49.2%). These differences were not statistically significant (p = 0.275). The aim of this exploratory study was to assess the validity of a prorated score, based on a proposed abbreviated NIHTB-CB

Summary

Introduction

Cognition is an important outcome in research trials and clinical practice (McInnes et al, 2017; Sheffield et al, 2018; Tang et al, 2018). To provide a common metric of cognition in the context of clinical research, the NIH Toolbox Cognition Battery (NIHTB-CB) was introduced. The NIHTB-CB is comprised of seven instruments: two assessing crystallized cognition (Picture Vocabulary and Oral Reading Recognition) and five assessing fluid cognition (Flanker Inhibitory Control and Attention, List Sorting Working Memory, Dimensional Change Card Sort, Pattern Comparison Processing Speed, and Picture Sequence Memory) (Weintraub et al, 2013). Of these, both instruments that assess crystallized cognition and two that assess fluid cognition (List Sorting Working Memory and Picture Sequence Memory). The other three fluid cognition instruments are scored based on accuracy and reaction time, and require in-person inputs into the tablet

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Conclusion