Demographically Corrected Normative Standards for the English Version of the NIH Toolbox Cognition Battery

Abstract Demographic factors impact neuropsychological test performances and accounting for them may help to better elucidate current brain functioning. The NIH Toolbox Cognition Battery (NIHTB-CB) is a novel neuropsychological tool, yet the original norms developed for the battery did not adequately account for important demographic/cultural factors known to impact test performances. We developed norms fully adjusting for all demographic variables within each language group (English and Spanish) separately. The current study describes the standards for individuals tested in English. Neurologically healthy adults (n=1038) and children (n=2917) who completed the NIH Toolbox norming project in English were included. We created uncorrected scores weighted to the 2010 Census demographics, and applied polynomial regression models to develop age-corrected and fully demographically adjusted (age, education, sex, race/ethnicity) scores for each NIHTB-CB test and composite (i.e., Fluid, Crystallized, and Total Composites). On uncorrected NIHTB-CB scores, age and education demonstrated significant, medium-to-large associations, while sex showed smaller, but statistically significant effects. In terms of race/ethnicity, a significant stair-step effect on uncorrected NIHTB-CB scores was observed (African American<Hispanic<White). After applying normative corrections, NIHTB-CB no longer demonstrated any significant associations with demographic factors. The previously developed norms still maintained significant associations with demographic factors, and demonstrated more variable impairment rates in segments of the healthy normative sample. Similar to other neuropsychological tests, demographic factors demonstrated significant associations with unadjusted NIHTB-CB scores. Application of fully corrected scores will help account for unwanted variance that is associated with non-clinical factors to more accurately reflect effects of disease-related changes in brain function. (JINS, 2015, 21, 378–391)

[1]  R. Heaton,et al.  Demographically Corrected Norms for the California Verbal Learning Test , 2000, Journal of clinical and experimental neuropsychology.

[2]  Y. Stern,et al.  Reading level attenuates differences in neuropsychological test performance between African American and White elders , 2002, Journal of the International Neuropsychological Society.

[3]  J. Horn.  CHAPTER 16 – Organization of Data on Life-Span Development of Human Abilities , 1970 .

[4]  J. Horn.  Organization of abilities and the development of intelligence. , 1968, Psychological review.

[5]  P. Gasquoine.  Race-Norming of Neuropsychological Tests , 2009, Neuropsychology Review.

[6]  B. Reed,et al.  Spanish and English neuropsychological assessment scales: relationship to demographics, language, cognition, and independent function. , 2005, Neuropsychology.

[7]  Y. Stern,et al.  Acculturation, Reading Level, and Neuropsychological Test Performance Among African American Elders , 2004, Applied neuropsychology.

[8]  N. Fox,et al.  Cognition assessment using the NIH Toolbox , 2013, Neurology.

[9]  Jerry Slotkin,et al.  VIII. NIH Toolbox Cognition Battery (CB): composite scores of crystallized, fluid, and overall cognition. , 2013, Monographs of the Society for Research in Child Development.

[10]  Robert K. Heaton,et al.  Reliability and Validity of Composite Scores from the NIH Toolbox Cognition Battery in Adults , 2014, Journal of the International Neuropsychological Society.

[11]  P. Royston,et al.  Stability of multivariable fractional polynomial models with selection of variables and transformations: a bootstrap investigation , 2003, Statistics in medicine.

[12]  R. Cattell,et al.  Abilities : Their Structure , Growth , and Action , 2015 .

[13]  W. Deming,et al.  On a Least Squares Adjustment of a Sampled Frequency Table When the Expected Marginal Totals are Known , 1940 .

[14]  I. Grant,et al.  The 50 and 100-Item Short Forms of the Paced Auditory Serial Addition Task (PASAT): Demographically Corrected Norms and Comparisons with the Full PASAT in Normal and Clinical Samples , 2003, Journal of clinical and experimental neuropsychology.

[15]  Carla J. Reicks,et al.  The impact of HIV-associated neuropsychological impairment on everyday functioning , 2004, Journal of the International Neuropsychological Society.

[16]  J. Manly,et al.  Cancellation test performance in African American, Hispanic, and White elderly , 2004, Journal of the International Neuropsychological Society.

[17]  Michael J. Taylor,et al.  Demographically corrected norms for African Americans and Caucasians on the Hopkins Verbal Learning Test–Revised, Brief Visuospatial Memory Test–Revised, Stroop Color and Word Test, and Wisconsin Card Sorting Test 64-Card Version , 2011, Journal of clinical and experimental neuropsychology.

[18]  David C. Hoaglin,et al.  Practical Considerations in Raking Survey Data , 2009 .

[19]  Michael J. Taylor,et al.  Sensitivity and specificity of WAIS–III/WMS–III demographically corrected factor scores in neuropsychological assessment , 2001, Journal of the International Neuropsychological Society.

[20]  N. Fox,et al.  NIH Toolbox for Assessment of Neurological and Behavioral Function , 2013, Neurology.

[21]  I. Grant,et al.  Neuropsychological Assessment of Neuropsychiatric and Neuromedical Disorders , 2009 .

[22]  D. Loewenstein,et al.  A comparative analysis of neuropsychological test performance of Spanish-speaking and English-speaking patients with Alzheimer's disease. , 1993, Journal of gerontology.

[23]  Karon F Cook,et al.  Norming plans for the NIH Toolbox , 2013, Neurology.