NIH Toolbox Cognition Tests Following Traumatic Brain Injury: Frequency of Low Scores

Purpose/Objective: To apply multivariate base rate analyses to the National Institutes of Health Toolbox Cognition Battery (NIHTB-CB) to facilitate the identification of cognitive impairment in individuals with traumatic brain injury (TBI). Research Method/Design: In a multisite cross-sectional desi...

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Bibliographic Details
Published in:Rehabilitation psychology 2017-11, Vol.62 (4), p.474-484
Main Authors: Holdnack, James A, Iverson, Grant L, Silverberg, Noah D, Tulsky, David S, Heinemann, Allen W
Format: Article
Language:English
Subjects:
Adolescent
Brain Injuries, Traumatic - complications
Child
Cognition
Cognition Disorders - diagnosis
Cognition Disorders - etiology
Cognitive Impairment
Cross-Sectional Studies
Female
Human
Humans
Male
National Institutes of Health (U.S.)
Neuropsychological Tests - statistics & numerical data
Reproducibility of Results
Test Battery
Traumatic Brain Injury
United States
Citations: Items that cite this one
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Summary:Purpose/Objective: To apply multivariate base rate analyses to the National Institutes of Health Toolbox Cognition Battery (NIHTB-CB) to facilitate the identification of cognitive impairment in individuals with traumatic brain injury (TBI). Research Method/Design: In a multisite cross-sectional design, 158 participants who sustained a complicated mild or moderate TBI (n = 74) or severe TBI (n = 84) at least 1 year earlier were administered the NIHTB-CB. The NIHTB-CB is comprised of 2 crystallized cognition tests (reflecting premorbid ability) and 5 fluid cognition tests, measuring processing speed, memory, and executive functioning. Base rates for obtaining 0 to 5 low fluid cognition scores were calculated across a range of cutoffs for defining a low test score (≤25th to 5th percentiles). Base rates of low scores in the TBI sample were compared to the NIHTB-CB normative sample using diagnostic accuracy statistics. Results: The proportion of the TBI sample obtaining low scores decreased as the cutoff for defining a low score decreased. Individuals with lower premorbid cognitive ability, as measured by NIHTB-CB Crystallized Composite score, tended to produce more low scores on the NIHTB-CB fluid cognition tests, even when using fully demographically adjusted scores. Certain patterns of low scores were associated with TBI (defined as likelihood ratio >2.0), whereas others were nonspecific, occurring almost as often in participants without TBI. Conclusions/Implications: Premorbid ability stratified base rate tables provided in this article can guide researchers and clinicians in the interpretation of NIHTB-CB performance in adults with TBI. Impact and Implications The National Institutes of Health (NIH) Toolbox for the Assessment of Neurological and Behavioral Function Cognition Battery is a computerized neuropsychological screening battery that can be used as a brief, efficient, and reliable cognitive assessment in clinical practice and research involving those who have sustained traumatic brain injuries. The prevalence of low scores on this battery is associated with, or influenced by, age, education, race, ethnicity, level of intelligence, and brain injury. The identification of cognitive impairment using this battery can be improved by applying multivariate base rate analyses and algorithms.
ISSN:0090-5550
1939-1544
DOI:10.1037/rep0000145