Improving the Methodology for Identifying Mild Cognitive Impairment in Intellectually High-Functioning Adults Using the NIH Toolbox Cognition Battery

Grant L. Iverson; Justin E. Karr

doi:10.3389/fpsyg.2021.724888

Improving the Methodology for Identifying Mild Cognitive Impairment in Intellectually High-Functioning Adults Using the NIH Toolbox Cognition Battery

Research output: Contribution to journal › Article › peer-review

Abstract

Objective: Low scores on neuropsychological tests are considered objective evidence of mild cognitive impairment. In clinical practice and research, it can be challenging to identify a cognitive deficit or mild cognitive impairment in high-functioning people because they are much less likely to obtain low test scores. This study was designed to improve the methodology for identifying mild cognitive impairment in adults who have above average or superior intellectual abilities. Method: Participants completed the National Institutes of Health Toolbox for the Assessment of Neurological and Behavioral Function Cognition Battery (NIHTB-CB). The sample included 384 adults between the ages of 20 and 85 who had completed either a 4-year college degree or who scored in the above average, superior, or very superior range on a measure of intellectual functioning, the Crystallized Composite score. Algorithms were developed, based on the absence of high scores and the presence of low scores, for identifying mild cognitive impairment. Results: Base rate tables for the presence of low scores and the absence of high scores are provided. The base rate for people with high average crystalized ability obtaining any one of the following, 5 scores <63rd percentile, or 4+ scores <50th percentile, or 3+ scores ≤ 25th percentile, or 2+ scores ≤ 16th percentile, is 15.5%. Conclusions: Algorithms were developed for identifying cognitive weakness or impairment in high-functioning people. Research is needed to test them in clinical groups, and to assess their association with clinical risk factors for cognitive decline and biomarkers of acquired neurological or neurodegenerative diseases.

Original language	English
Article number	724888
Journal	Frontiers in Psychology
Volume	12
DOIs	https://doi.org/10.3389/fpsyg.2021.724888
State	Published - Sep 8 2021

Bibliographical note

Funding Information:
GI acknowledges philanthropic support from the Third Option Foundation and the Spaulding Research Institute. The above mentioned entities were not involved in the study design, interpretation of data, the writing of this article, or the decision to submit it for publication.

Funding Information:
Ritchie, S. J., and Tucker-Drob, E. M. (2018). How much does education improve intelligence? a meta-analysis. Psychol. Sci. 29, 1358–1369. doi: 10.1177/0956797618774253 Schretlen, D. J., Testas, S. M., Winicki, J. M., Pearlson, G. D., and Gordon, B. (2008). Frequency and bases of abnormal performance by healthy adults on neuropsychological testing. J. Int. Neuropsychol. Soc. 14, 436–445. doi: 10.1017/S1355617708080387 Steinberg, B. A., Bieliauskas, L. A., Smith, G. E., and Ivnik, R. J. (2005a). Mayo’s older Americans normative studies: age-and IQ-adjusted norms for the Trail-Making Test, the Stroop test, and MAE Controlled Oral Word Association Test. Clin. Neuropsychol. 19, 329–377. doi: 10.1080/138540405909 45210 Steinberg, B. A., Bieliauskas, L. A., Smith, G. E., Ivnik, R. J., and Malec, J. F. (2005b). Mayo’s older Americans normative studies: age-and IQ-adjusted norms for the Auditory Verbal Learning Test and the Visual Spatial Learning Test. Clin. Neuropsychol. 19, 464–523. doi: 10.1080/13854040590945193 Tabert, M. H., Manly, J. J., Liu, X., Pelton, G. H., Rosenblum, S., Jacobs, M., et al. (2006). Neuropsychological prediction of conversion to alzheimer disease in patients with mild cognitive impairment. Arch. Gen. Psychiatry 63, 916–924. doi: 10.1001/archpsyc.63.8.916 Taylor, M. J., and Heaton, R. K. (2001). Sensitivity and specificity of WAIS-III/WMS-III domographically corrected factor scores in neuropsychological assessment. J. Int. Neuropsychol. Soc. 7, 867–874. doi: 10.1017/S1355617701777107 Tremont, G., Hoffman, R. G., Scott, J. G., and Adams, R. L. (1998). Effect of intellectual level on neuropsychological test performance: a response to Dodrill (1997). Clin. Neuropsychol. 12, 560–567. doi: 10.1076/clin.12.4.560.7238 Tulsky, D. S., Carlozzi, N., Chiaravalloti, N. D., Beaumont, J. L., Kisala, P. A., Mungas, D., et al. (2014). NIH Toolbox Cognition Battery (NIHTB-CB): list sorting test to measure working memory. J. Int. Neuropsychol. Soc. 20, 599–610. doi: 10.1017/S135561771400040X Warner, M. H., Ernst, J., Townes, B. D., Peel, J., and Preston, M. (1987). Relationships between IQ and neuropsychological measures in neuropsychiatric populations: within-laboratory and cross-cultural replications using WAIS and WAIS-R. J. Clin. Exp. Neuropsychol. 9, 545–562. doi: 10.1080/01688638708410768 Weintraub, S., Dikmen, S. S., Heaton, R. K., Tulsky, D. S., Zelazo, P. D., Bauer, P. J., et al. (2013). Cognition assessment using the NIH Toolbox. Neurology 80(11 Suppl. 3), S54–S64. doi: 10.1212/WNL.0b013e3182872ded Weissberger, G. H., Strong, J. V., Stefanidis, K. B., Summers, M. J., Bondi, M. W., and Stricker, N. H. (2017). Diagnostic accuracy of memory measures in Alzheimer’s dementia and mild cognitive impairment: a systematic review and meta-analysis. Neuropsychol. Rev. 27, 354–388. doi: 10.1007/s11065-017-9360-6 Zelazo, P. D., Anderson, J. E., Richler, J., Wallner-Allen, K., Beaumont, J. L., Conway, K. P., et al. (2014). NIH toolbox cognition battery (CB): Validation of executive function measures in adults. J. Int. Neuropsychol. Soc. 20, 620–629. doi: 10.1017/S1355617714000472 Conflict of Interest: GI has received research support from test publishing companies in the past, including PAR, Inc., ImPACT Applications, Inc., and CNS Vital Signs. He receives royalties for one neuropsychological test (Wisconsin Card Sorting Test-64 Card Version). He serves as a scientific advisor for NanoDx©R , Sway Operations, LLC, and Highmark, Inc. He has a clinical and consulting practice in forensic neuropsychology, including expert testimony, involving individuals who have sustained mild TBIs. He has received research funding from several test publishing companies, including ImPACT Applications, Inc., CNS Vital Signs, and Psychological Assessment Resources (PAR, Inc.). He has received research funding as a principal investigator from the National Football League, and subcontract grant funding as a collaborator from the Harvard Integrated Program to Protect and Improve the Health of National Football League Players Association Members. He acknowledges unrestricted philanthropic support from ImPACT Applications, Inc., the Mooney-Reed Charitable Foundation, and the National Rugby League.

Publisher Copyright:
© Copyright © 2021 Iverson and Karr.

Keywords

NIH Toolbox
cognition
cognitive dysfunction
neuropsychological tests
psychometrics

ASJC Scopus subject areas

Psychology (all)

Access to Document

10.3389/fpsyg.2021.724888

Cite this

@article{d00972634a4d4decbe94831a207083f4,

title = "Improving the Methodology for Identifying Mild Cognitive Impairment in Intellectually High-Functioning Adults Using the NIH Toolbox Cognition Battery",

abstract = "Objective: Low scores on neuropsychological tests are considered objective evidence of mild cognitive impairment. In clinical practice and research, it can be challenging to identify a cognitive deficit or mild cognitive impairment in high-functioning people because they are much less likely to obtain low test scores. This study was designed to improve the methodology for identifying mild cognitive impairment in adults who have above average or superior intellectual abilities. Method: Participants completed the National Institutes of Health Toolbox for the Assessment of Neurological and Behavioral Function Cognition Battery (NIHTB-CB). The sample included 384 adults between the ages of 20 and 85 who had completed either a 4-year college degree or who scored in the above average, superior, or very superior range on a measure of intellectual functioning, the Crystallized Composite score. Algorithms were developed, based on the absence of high scores and the presence of low scores, for identifying mild cognitive impairment. Results: Base rate tables for the presence of low scores and the absence of high scores are provided. The base rate for people with high average crystalized ability obtaining any one of the following, 5 scores <63rd percentile, or 4+ scores <50th percentile, or 3+ scores ≤ 25th percentile, or 2+ scores ≤ 16th percentile, is 15.5%. Conclusions: Algorithms were developed for identifying cognitive weakness or impairment in high-functioning people. Research is needed to test them in clinical groups, and to assess their association with clinical risk factors for cognitive decline and biomarkers of acquired neurological or neurodegenerative diseases.",

keywords = "NIH Toolbox, cognition, cognitive dysfunction, neuropsychological tests, psychometrics",

author = "Iverson, {Grant L.} and Karr, {Justin E.}",

note = "Funding Information: GI acknowledges philanthropic support from the Third Option Foundation and the Spaulding Research Institute. The above mentioned entities were not involved in the study design, interpretation of data, the writing of this article, or the decision to submit it for publication. Funding Information: Ritchie, S. J., and Tucker-Drob, E. M. (2018). How much does education improve intelligence? a meta-analysis. Psychol. Sci. 29, 1358–1369. doi: 10.1177/0956797618774253 Schretlen, D. J., Testas, S. M., Winicki, J. M., Pearlson, G. D., and Gordon, B. (2008). Frequency and bases of abnormal performance by healthy adults on neuropsychological testing. J. Int. Neuropsychol. Soc. 14, 436–445. doi: 10.1017/S1355617708080387 Steinberg, B. A., Bieliauskas, L. A., Smith, G. E., and Ivnik, R. J. (2005a). Mayo{\textquoteright}s older Americans normative studies: age-and IQ-adjusted norms for the Trail-Making Test, the Stroop test, and MAE Controlled Oral Word Association Test. Clin. Neuropsychol. 19, 329–377. doi: 10.1080/138540405909 45210 Steinberg, B. A., Bieliauskas, L. A., Smith, G. E., Ivnik, R. J., and Malec, J. F. (2005b). Mayo{\textquoteright}s older Americans normative studies: age-and IQ-adjusted norms for the Auditory Verbal Learning Test and the Visual Spatial Learning Test. Clin. Neuropsychol. 19, 464–523. doi: 10.1080/13854040590945193 Tabert, M. H., Manly, J. J., Liu, X., Pelton, G. H., Rosenblum, S., Jacobs, M., et al. (2006). Neuropsychological prediction of conversion to alzheimer disease in patients with mild cognitive impairment. Arch. Gen. Psychiatry 63, 916–924. doi: 10.1001/archpsyc.63.8.916 Taylor, M. J., and Heaton, R. K. (2001). Sensitivity and specificity of WAIS-III/WMS-III domographically corrected factor scores in neuropsychological assessment. J. Int. Neuropsychol. Soc. 7, 867–874. doi: 10.1017/S1355617701777107 Tremont, G., Hoffman, R. G., Scott, J. G., and Adams, R. L. (1998). Effect of intellectual level on neuropsychological test performance: a response to Dodrill (1997). Clin. Neuropsychol. 12, 560–567. doi: 10.1076/clin.12.4.560.7238 Tulsky, D. S., Carlozzi, N., Chiaravalloti, N. D., Beaumont, J. L., Kisala, P. A., Mungas, D., et al. (2014). NIH Toolbox Cognition Battery (NIHTB-CB): list sorting test to measure working memory. J. Int. Neuropsychol. Soc. 20, 599–610. doi: 10.1017/S135561771400040X Warner, M. H., Ernst, J., Townes, B. D., Peel, J., and Preston, M. (1987). Relationships between IQ and neuropsychological measures in neuropsychiatric populations: within-laboratory and cross-cultural replications using WAIS and WAIS-R. J. Clin. Exp. Neuropsychol. 9, 545–562. doi: 10.1080/01688638708410768 Weintraub, S., Dikmen, S. S., Heaton, R. K., Tulsky, D. S., Zelazo, P. D., Bauer, P. J., et al. (2013). Cognition assessment using the NIH Toolbox. Neurology 80(11 Suppl. 3), S54–S64. doi: 10.1212/WNL.0b013e3182872ded Weissberger, G. H., Strong, J. V., Stefanidis, K. B., Summers, M. J., Bondi, M. W., and Stricker, N. H. (2017). Diagnostic accuracy of memory measures in Alzheimer{\textquoteright}s dementia and mild cognitive impairment: a systematic review and meta-analysis. Neuropsychol. Rev. 27, 354–388. doi: 10.1007/s11065-017-9360-6 Zelazo, P. D., Anderson, J. E., Richler, J., Wallner-Allen, K., Beaumont, J. L., Conway, K. P., et al. (2014). NIH toolbox cognition battery (CB): Validation of executive function measures in adults. J. Int. Neuropsychol. Soc. 20, 620–629. doi: 10.1017/S1355617714000472 Conflict of Interest: GI has received research support from test publishing companies in the past, including PAR, Inc., ImPACT Applications, Inc., and CNS Vital Signs. He receives royalties for one neuropsychological test (Wisconsin Card Sorting Test-64 Card Version). He serves as a scientific advisor for NanoDx{\textcopyright}R , Sway Operations, LLC, and Highmark, Inc. He has a clinical and consulting practice in forensic neuropsychology, including expert testimony, involving individuals who have sustained mild TBIs. He has received research funding from several test publishing companies, including ImPACT Applications, Inc., CNS Vital Signs, and Psychological Assessment Resources (PAR, Inc.). He has received research funding as a principal investigator from the National Football League, and subcontract grant funding as a collaborator from the Harvard Integrated Program to Protect and Improve the Health of National Football League Players Association Members. He acknowledges unrestricted philanthropic support from ImPACT Applications, Inc., the Mooney-Reed Charitable Foundation, and the National Rugby League. Publisher Copyright: {\textcopyright} Copyright {\textcopyright} 2021 Iverson and Karr.",

year = "2021",

month = sep,

day = "8",

doi = "10.3389/fpsyg.2021.724888",

language = "English",

volume = "12",

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TY - JOUR

T1 - Improving the Methodology for Identifying Mild Cognitive Impairment in Intellectually High-Functioning Adults Using the NIH Toolbox Cognition Battery

AU - Iverson, Grant L.

AU - Karr, Justin E.

N1 - Funding Information: GI acknowledges philanthropic support from the Third Option Foundation and the Spaulding Research Institute. The above mentioned entities were not involved in the study design, interpretation of data, the writing of this article, or the decision to submit it for publication. Funding Information: Ritchie, S. J., and Tucker-Drob, E. M. (2018). How much does education improve intelligence? a meta-analysis. Psychol. Sci. 29, 1358–1369. doi: 10.1177/0956797618774253 Schretlen, D. J., Testas, S. M., Winicki, J. M., Pearlson, G. D., and Gordon, B. (2008). Frequency and bases of abnormal performance by healthy adults on neuropsychological testing. J. Int. Neuropsychol. Soc. 14, 436–445. doi: 10.1017/S1355617708080387 Steinberg, B. A., Bieliauskas, L. A., Smith, G. E., and Ivnik, R. J. (2005a). Mayo’s older Americans normative studies: age-and IQ-adjusted norms for the Trail-Making Test, the Stroop test, and MAE Controlled Oral Word Association Test. Clin. Neuropsychol. 19, 329–377. doi: 10.1080/138540405909 45210 Steinberg, B. A., Bieliauskas, L. A., Smith, G. E., Ivnik, R. J., and Malec, J. F. (2005b). Mayo’s older Americans normative studies: age-and IQ-adjusted norms for the Auditory Verbal Learning Test and the Visual Spatial Learning Test. Clin. Neuropsychol. 19, 464–523. doi: 10.1080/13854040590945193 Tabert, M. H., Manly, J. J., Liu, X., Pelton, G. H., Rosenblum, S., Jacobs, M., et al. (2006). Neuropsychological prediction of conversion to alzheimer disease in patients with mild cognitive impairment. Arch. Gen. Psychiatry 63, 916–924. doi: 10.1001/archpsyc.63.8.916 Taylor, M. J., and Heaton, R. K. (2001). Sensitivity and specificity of WAIS-III/WMS-III domographically corrected factor scores in neuropsychological assessment. J. Int. Neuropsychol. Soc. 7, 867–874. doi: 10.1017/S1355617701777107 Tremont, G., Hoffman, R. G., Scott, J. G., and Adams, R. L. (1998). Effect of intellectual level on neuropsychological test performance: a response to Dodrill (1997). Clin. Neuropsychol. 12, 560–567. doi: 10.1076/clin.12.4.560.7238 Tulsky, D. S., Carlozzi, N., Chiaravalloti, N. D., Beaumont, J. L., Kisala, P. A., Mungas, D., et al. (2014). NIH Toolbox Cognition Battery (NIHTB-CB): list sorting test to measure working memory. J. Int. Neuropsychol. Soc. 20, 599–610. doi: 10.1017/S135561771400040X Warner, M. H., Ernst, J., Townes, B. D., Peel, J., and Preston, M. (1987). Relationships between IQ and neuropsychological measures in neuropsychiatric populations: within-laboratory and cross-cultural replications using WAIS and WAIS-R. J. Clin. Exp. Neuropsychol. 9, 545–562. doi: 10.1080/01688638708410768 Weintraub, S., Dikmen, S. S., Heaton, R. K., Tulsky, D. S., Zelazo, P. D., Bauer, P. J., et al. (2013). Cognition assessment using the NIH Toolbox. Neurology 80(11 Suppl. 3), S54–S64. doi: 10.1212/WNL.0b013e3182872ded Weissberger, G. H., Strong, J. V., Stefanidis, K. B., Summers, M. J., Bondi, M. W., and Stricker, N. H. (2017). Diagnostic accuracy of memory measures in Alzheimer’s dementia and mild cognitive impairment: a systematic review and meta-analysis. Neuropsychol. Rev. 27, 354–388. doi: 10.1007/s11065-017-9360-6 Zelazo, P. D., Anderson, J. E., Richler, J., Wallner-Allen, K., Beaumont, J. L., Conway, K. P., et al. (2014). NIH toolbox cognition battery (CB): Validation of executive function measures in adults. J. Int. Neuropsychol. Soc. 20, 620–629. doi: 10.1017/S1355617714000472 Conflict of Interest: GI has received research support from test publishing companies in the past, including PAR, Inc., ImPACT Applications, Inc., and CNS Vital Signs. He receives royalties for one neuropsychological test (Wisconsin Card Sorting Test-64 Card Version). He serves as a scientific advisor for NanoDx©R , Sway Operations, LLC, and Highmark, Inc. He has a clinical and consulting practice in forensic neuropsychology, including expert testimony, involving individuals who have sustained mild TBIs. He has received research funding from several test publishing companies, including ImPACT Applications, Inc., CNS Vital Signs, and Psychological Assessment Resources (PAR, Inc.). He has received research funding as a principal investigator from the National Football League, and subcontract grant funding as a collaborator from the Harvard Integrated Program to Protect and Improve the Health of National Football League Players Association Members. He acknowledges unrestricted philanthropic support from ImPACT Applications, Inc., the Mooney-Reed Charitable Foundation, and the National Rugby League. Publisher Copyright: © Copyright © 2021 Iverson and Karr.

PY - 2021/9/8

Y1 - 2021/9/8

N2 - Objective: Low scores on neuropsychological tests are considered objective evidence of mild cognitive impairment. In clinical practice and research, it can be challenging to identify a cognitive deficit or mild cognitive impairment in high-functioning people because they are much less likely to obtain low test scores. This study was designed to improve the methodology for identifying mild cognitive impairment in adults who have above average or superior intellectual abilities. Method: Participants completed the National Institutes of Health Toolbox for the Assessment of Neurological and Behavioral Function Cognition Battery (NIHTB-CB). The sample included 384 adults between the ages of 20 and 85 who had completed either a 4-year college degree or who scored in the above average, superior, or very superior range on a measure of intellectual functioning, the Crystallized Composite score. Algorithms were developed, based on the absence of high scores and the presence of low scores, for identifying mild cognitive impairment. Results: Base rate tables for the presence of low scores and the absence of high scores are provided. The base rate for people with high average crystalized ability obtaining any one of the following, 5 scores <63rd percentile, or 4+ scores <50th percentile, or 3+ scores ≤ 25th percentile, or 2+ scores ≤ 16th percentile, is 15.5%. Conclusions: Algorithms were developed for identifying cognitive weakness or impairment in high-functioning people. Research is needed to test them in clinical groups, and to assess their association with clinical risk factors for cognitive decline and biomarkers of acquired neurological or neurodegenerative diseases.

AB - Objective: Low scores on neuropsychological tests are considered objective evidence of mild cognitive impairment. In clinical practice and research, it can be challenging to identify a cognitive deficit or mild cognitive impairment in high-functioning people because they are much less likely to obtain low test scores. This study was designed to improve the methodology for identifying mild cognitive impairment in adults who have above average or superior intellectual abilities. Method: Participants completed the National Institutes of Health Toolbox for the Assessment of Neurological and Behavioral Function Cognition Battery (NIHTB-CB). The sample included 384 adults between the ages of 20 and 85 who had completed either a 4-year college degree or who scored in the above average, superior, or very superior range on a measure of intellectual functioning, the Crystallized Composite score. Algorithms were developed, based on the absence of high scores and the presence of low scores, for identifying mild cognitive impairment. Results: Base rate tables for the presence of low scores and the absence of high scores are provided. The base rate for people with high average crystalized ability obtaining any one of the following, 5 scores <63rd percentile, or 4+ scores <50th percentile, or 3+ scores ≤ 25th percentile, or 2+ scores ≤ 16th percentile, is 15.5%. Conclusions: Algorithms were developed for identifying cognitive weakness or impairment in high-functioning people. Research is needed to test them in clinical groups, and to assess their association with clinical risk factors for cognitive decline and biomarkers of acquired neurological or neurodegenerative diseases.

KW - NIH Toolbox

KW - cognition

KW - cognitive dysfunction

KW - neuropsychological tests

KW - psychometrics

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Improving the Methodology for Identifying Mild Cognitive Impairment in Intellectually High-Functioning Adults Using the NIH Toolbox Cognition Battery

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