Interpreting reliable change on the Spanish-language NIH toolbox cognition battery

Justin E. Karr, Monica Rivera Mindt, Grant L. Iverson

Research output: Contribution to journalArticlepeer-review

1 Scopus citations


This study applied a reliable change methodology to the test-retest data from the Spanish-language NIH Toolbox Cognition Battery (NIHTB-CB) normative sample. Participants included Spanish-speaking adults (n = 48; 54.2% women, 100% Latinx) evaluated twice within one to two weeks on the Spanish-language NIHTB-CB, consisting of two crystallized and five fluid cognitive tests. Test-retest means, standard deviations, and intraclass correlations were used to calculate upper and lower bounds of 70, 80, and 90% confidence intervals (CIs) around change scores, with these bounds used as cutoffs for inferring reliable change. Cutoffs were calculated for raw scores, age-adjusted standard scores (SS; M = 100, SD = 15), and demographic-adjusted T-scores (T; M = 50, SD = 10), adjusting for age, gender, and education. Test-retest change scores on the Spanish-language NIHTB-CB exceeding the following cutoffs indicate reliable change based on an 80% CI (i.e., values exceeding these cutoffs indicate greater decline or greater improvement than 90% of the sample): Dimensional Change Card Sort (SS ≥ 15/T ≥ 11), Flanker (SS ≥ 13/T ≥ 10), List Sorting (SS ≥ 13/T ≥ 9), Picture Sequence Memory (SS ≥ 14/T ≥ 9), Pattern Comparison (SS ≥ 14/T ≥ 10), Picture Vocabulary (SS ≥ 8/T ≥ 6), Oral Reading (SS ≥ 7/T ≥ 5), Fluid Cognition Composite (SS ≥ 12/T ≥ 9), Crystallized Cognition Composite (SS ≥ 6/T ≥ 5), and Total Cognition Composite (SS ≥ 8/T ≥ 7). These cutoffs are one of few resources to interpret cognitive change at retest among Spanish-speaking patients and participants.

Original languageEnglish
JournalApplied Neuropsychology:Adult
StateAccepted/In press - 2021

Bibliographical note

Funding Information:
Dr. Grant Iverson acknowledges unrestricted philanthropic support from the Mooney-Reed Charitable Foundation, Heinz Family Foundation, Boston Bolts, National Rugby League, ImPACT® Applications, Inc., and the Spaulding Research Institute. He has a clinical practice in forensic neuropsychology, including expert opinions, involving individuals who have sustained mild TBIs. He has received research support from test publishing companies in the past, including ImPACT® Applications Systems, Psychological Assessment Resources, and CNS Vital Signs. He has received grant support from the NFL and the Harvard Integrated Program to Protect and Improve the Health of NFLPA Members. He serves as a scientific advisor for NanoDx™, Sway Medical, and Highmark, Inc. Dr. Rivera Mindt acknowledges research funding from the National Institutes of Health/National Institute on Aging, the Alzheimer’s Association, and Genentech.

Publisher Copyright:
© 2021 Taylor & Francis Group, LLC.


  • Cognition
  • Hispanic Americans
  • culturally competent care
  • neuropsychological tests
  • psychometrics

ASJC Scopus subject areas

  • Neuropsychology and Physiological Psychology
  • Developmental and Educational Psychology


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