Uses of the NIH Toolbox® in Clinical Samples: A Scoping Review.

Background and Objectives: The NIH Toolbox® for the Assessment of Neurologic and Behavioral Function is a compilation of computerized measures designed to assess sensory, motor, emotional, and cognitive functioning of individuals across the life span. The NIH Toolbox was initially developed for use with the general population and was not originally validated in clinical populations. The objective of this scoping review was to assess the extent to which the NIH Toolbox has been used with clinical populations. Methods: Guided by the Joanna Briggs Methods Manual for Scoping Reviews, records were identified through searches of PubMed MEDLINE, PsycINFO, ClinicalTrials.gov, EMBASE, and ProQuest Dissertations and Theses Global (2008-2020). Database searches yielded 5,693 unique titles of original research that used at least one NIH Toolbox assessment in a sample characterized by any clinical diagnosis. Two reviewers screened titles, abstracts, and full texts for inclusion in duplicate. Conflicts at each stage of the review process were resolved by a group discussion. Results: Ultimately, 281 publication records were included in this scoping review (nJournal Articles = 104, nConference Abstracts = 84, nClinical Trial Registrations = 86, and nTheses/Dissertations = 7). The NIH Toolbox Cognition Battery was by far the most used of the 4 batteries in the measurement system (nCognition = 225, nEmotion = 49, nMotor = 29, and nSensation = 16). The most represented clinical category was neurologic disorders (n = 111), followed by psychological disorders (n = 39) and cancer (n = 31). Most (96.8%) of the journal articles and conference abstracts reporting the use of NIH Toolbox measures with clinical samples were published in 2015 or later. As of May 2021, these records had been cited a total of nearly 1,000 times. Discussion: The NIH Toolbox measures have been widely used among individuals with various clinical conditions across the life span. Our results lay the groundwork to support the feasibility and utility of administering the NIH Toolbox measures in research conducted with clinical populations and further suggest that these measures may be of value for implementation in fast-paced clinical settings as part of routine practice.

Translation and Cultural Adaptation of NIH Toolbox Cognitive Tests into Swahili and Dholuo Languages for Use in Children in Western Kenya.

OBJECTIVES: Performing high-quality and reliable cognitive testing requires significant resources and training. As a result, large-scale studies involving cognitive testing are difficult to perform in low- and middle-income settings, limiting access to critical knowledge to improve academic achievement and economic production in these populations. The NIH Toolbox® is a collection of cognitive, motor, sensory, and emotional tests that can be administered and scored using an iPad® tablet, reducing the need for training and quality monitoring; and thus, it is a potential solution to this problem. METHODS: We describe our process for translation and cultural adaptation of the existing NIH Toolbox tests of fluid cognition into the Swahili and Dholuo languages for use in children aged 3-14 years in western Kenya. Through serial forward and back translations, cognitive interviews, group consensus, outside feedback, and support from the NIH Toolbox team, we produced translated tests that have both face validity and linguistic validation. RESULTS: During our cognitive interviews, we found that the five chosen tests (one each of attention, cognitive flexibility, working memory, episodic memory, and processing speed) were generally well understood by children aged 7-14 years in our chosen populations. The cognitive interviews informed alterations in translation as well as slight changes in some images to culturally adapt the tests. CONCLUSIONS: This study describes the process by which we translated five fluid cognition tests from the NIH Toolbox into the Swahili and Dholuo languages. The finished testing application will be available for future studies, including a pilot study for assessment of psychometric properties.

Performance and interaction anxiety: specific relationships with other- and self-evaluation concerns.

This study examines whether performance anxiety (PA) is specifically associated with other-evaluation concerns and interaction anxiety (IA) with self-evaluation concerns. Individuals with public speaking fears and high levels of PA or IA were distinguishable from nonanxious controls on measures taken during a public speaking challenge. In addition, high PA individuals exhibited more observer-rated negative speech characteristics in an Other-Evaluation condition compared to a Self-Evaluation condition, but high IA individuals and nonanxious individuals did not. These results provide some evidence for the distinctiveness of these dimensions of social anxiety.

Repeatable battery for the assessment of neuropsychological status effort index performance in a medically ill geriatric sample.

Using a sample of 44 clinically referred, non-litigating, older adults, we evaluated the Repeatable Battery for the Assessment of Neuropsychological Status Effort Index [RBANS EI; Silverberg, N. D., Wertheimer, J. C., & Fichtenberg, N. L. (2007). An effort index for the Repeatable Battery for the Assessment of Neurospcyhological Status (RBANS). The Clinical Neuropsychologist, 21, 841-854]. With the current RBANS EI cut-score guidelines, 31% of our sample was classified as putting forth suspect effort. With this, cognitive ability was significantly correlated with suspect effort scores. Thus, it appears that the current guidelines may not be useful in a cognitively impaired medically ill geriatric sample. Hence, further research on RBANS EI validation is warranted.

Is the Rey 15-Item Memory Test II (Rey II) a valid symptom validity test?: comparison with the TOMM.

The Rey 15-Item Memory Test II (Rey II) is a revised version of the original Rey Memory Test and is used as a measure of test-taking effort. In the present study, the concurrent validity of the Rey II was examined by comparing Rey II test scores to a well-established measure of symptom validity, the Test of Memory Malingering (TOMM). Retrospective chart review was conducted using the records of 60 veterans who were referred for outpatient neuropsychological testing and suspected of possible symptom exaggeration. Results of the study suggest that when compared to the TOMM, the Qualitative, as opposed to the Quantitative, scoring method of the Rey II was more discriminative, but showed both positive and negative predictive power that was unacceptably low, falling at .62 and .64, respectively. Clinical implications are discussed.

Is"chemobrain" a transient state? A prospective pilot study among persons with non-small cell lung cancer.

In patients with stage III non-small cell lung cancer (NSCLC), chemotherapy combined with radiation therapy modestly improves survival when compared with radiotherapy alone. In light of the small survival benefit,there is a need to quantify any potential loss of neurocognitive function that may result from chemotherapy in this patient population. The current study examines cognitive functioning in 14 stage III NSCLC patients who received treatment with cisplatin/etoposide/radiotherapy. Patients were assessed before receiving chemotherapy and at 1 and 7 months after treatment. At each time point, participants were administered a comprehensive battery of psychological and neuropsychological tests. In all, 71% of patients demonstrated cognitive impairment prior to any treatment. One month post chemotherapy, the majority of patients (62%) experienced cognitive decline; however, these negative effects apparently dissipated by 7 months post treatment, suggesting that the untoward effects of chemotherapy in these specific patients given this chemotherapy regimen may have been transitory. Cognitive decline did not appear to be associated with age, mood, fatigue, or quality-of-life measures. These findings demonstrated the importance of employing both a pre- and extended post-treatment assessment in chemotherapy research.

IQ and scores on the Mini-Mental State Examination (MMSE): controlling for effort and education among geriatric inpatients.

The Mini-Mental State Examination (MMSE) and the Peabody Picture Vocabulary Test, Third Edition (PPVT-III) were administered to 76 Extended Care Center inpatients of a Veterans Affairs Medical Center, 56 of whom did not carry a diagnosis associated with brain impairment, and 20 of whom had a diagnosis associated with degenerative or cerebrovascular conditions. MMSE and PPVT-III scores, the latter of which estimates verbal IQ, were significantly correlated in both groups, even when controlling for the effects of education. This correlation was attenuated, but remained significant, in the face of varying levels of patient effort. The findings of this study support earlier findings, which also suggest that interpretation of "impaired" performance on the MMSE for those with IQ scores below 90 should be interpreted with caution. Average MMSE scores for Wechsler IQ classifications are provided.

Patterns of cognitive change over time and relationship to age following successful treatment of Cushing's disease.

Chronically elevated levels of cortisol have been associated with changes in cognitive functioning and brain morphology. Using Cushing's disease as a model to assess the effects of high levels of cortisol on cognitive functioning, 27 patients with Cushing's disease were examined at baseline and three successive follow-up periods up to 18 months after successful surgical treatment. At all follow-up periods, patients were administered cognitive tests as well as measures of plasma and urinary free cortisol. Structural MRIs and a depression measure were taken at baseline and one-year follow-up. Results showed that there is a specific pattern of significant cognitive and morphological improvement following successful treatment. Verbal fluency and recall showed recovery, although brief attention did not. Age of participants was a significant factor as to when recovery of function occurred; younger patients regained and sustained their improvement in cognitive functioning more quickly than older participants. Improvement in verbal recall also was associated with a decrease in cortisol levels as well as an increase in hippocampal formation volume one year after treatment. Overall, these findings suggest that at least some of the deleterious effects of prolonged hypercortisolemia on cognitive functioning are potentially reversible, up to at least 18 months post treatment.