Cognition assessment using the NIH Toolbox

Abstract

Cognition is 1 of 4 domains measured by the NIH Toolbox for the Assessment of Neurological and Behavioral Function (NIH-TB), and complements modules testing motor function, sensation, and emotion. On the basis of expert panels, the cognition subdomains identified as most important for health, success in school and work, and independence in daily functioning were Executive Function, Episodic Memory, Language, Processing Speed, Working Memory, and Attention. Seven measures were designed to tap constructs within these subdomains. The instruments were validated in English, in a sample of 476 participants ranging in age from 3 to 85 years, with representation from both sexes, 3 racial/ethnic categories, and 3 levels of education. This report describes the development of the Cognition Battery and presents results on test-retest reliability, age effects on performance, and convergent and discriminant construct validity. The NIH-TB Cognition Battery is intended to serve as a brief, convenient set of measures to supplement other outcome measures in epidemiologic and longitudinal research and clinical trials. With a computerized format and national standardization, this battery will provide a "common currency" among researchers for comparisons across a wide range of studies and populations.

Figure. Episodic memory scores vs language scores across age

(A) NIH Toolbox Picture Sequence Memory Test scores show improvement into early adulthood and then decline from the 50s on. Administration set size varied by age group as follows: ages 3 to 4 years, 6 pictures; 5 to 6 years, 9 pictures; 8 years, 12 pictures; 9 to 60 years, 15 pictures, and 65 to 85 years, 9 pictures. (B) Results for NIH Toolbox Reading and Vocabulary scores (reported as a “theta,” or individual ability score, based on item response theory analyses) show improvement sustained into adulthood. The data points in both A and B represent the mean score ± standard error.