Factor structure, convergent validity, and discriminant validity of the NIH Toolbox Cognitive Health Battery (NIHTB-CHB) in adults.

The objective of this study is to evaluate the construct validity of the NIH Neurobehavioral Toolbox Cognitive Health Battery (NIHTB-CHB) in adults. Confirmatory factor analysis was used to evaluate the dimensional structure underlying the NIHTB-CHB and Gold Standard tests chosen to serve as concurrent validity criteria for the NIHTB-CHB. These results were used to evaluate the convergent and discriminant validity of the NIHTB-CHB in adults ranging from 20 to 85 years of age. Five dimensions were found to explain the correlations among NIHTB-CHB and Gold Standard tests: Vocabulary, Reading, Episodic Memory, Working Memory and Executive Function/Processing Speed. NIHTB-CHB measures and their Gold Standard analogues defined factors in a pattern that broadly supported the convergent and discriminant validity of the NIHTB-CHB tests. This 5-factor structure was found to be invariant across 20-60 year old (N=159) and 65-85 year old (N=109) age groups that were included in the current validity study. Second order Crystallized Abilities (Vocabulary and Reading) and Fluid Abilities (Episodic Memory, Working Memory, Executive/Speed) factors parsimoniously explained correlations among the five first order factors. These results suggest that the NIHTB-CHB will provide both fine-grained and broad characterization of cognition across the adult age span.

VII. NIH Toolbox Cognition Battery (CB): factor structure for 3 to 15 year olds.

Confirmatory factor analysis was used the evaluate the dimensional structure underlying the NIH Toolbox Cognition Battery (CB) and the measures chosen to serve as concurrent validity criteria for the NIH Toolbox CB. These results were used to evaluate the convergent and discriminant validity of the CB in children ranging from 3 to 15 years of age. Results were evaluated separately for a 3- to 6-year-old group and a 8- to 15-year-old group because different validation measures were used in these age groups. Three distinct dimensions were found for the 3- to 6-year-old group: Vocabulary, Reading, and Fluid Abilities. Five dimensions were found for 8-15 year olds: Vocabulary, Reading, Episodic Memory, Working Memory, and Executive Function/Processing Speed. CB measures and their validation analogues consistently defined common factors in a pattern that broadly supported the convergent and discriminant validity of the CB, but results showed higher intercorrelation and less differentiation of cognitive dimensions in younger than in older children and in older children compared with adults. Age was strongly related to the cognitive dimensions underlying test performance in both groups of children and results are consistent with broader literature showing increasing differentiation of cognitive abilities associated with the rapid brain development that occurs from early childhood into adulthood.

IV. NIH Toolbox Cognition Battery (CB): measuring language (vocabulary comprehension and reading decoding).

Mastery of language skills is an important predictor of daily functioning and health. Vocabulary comprehension and reading decoding are relatively quick and easy to measure and correlate highly with overall cognitive functioning, as well as with success in school and work. New measures of vocabulary comprehension and reading decoding (in both English and Spanish) were developed for the NIH Toolbox Cognition Battery (CB). In the Toolbox Picture Vocabulary Test (TPVT), participants hear a spoken word while viewing four pictures, and then must choose the picture that best represents the word. This approach tests receptive vocabulary knowledge without the need to read or write, removing the literacy load for children who are developing literacy and for adults who struggle with reading and writing. In the Toolbox Oral Reading Recognition Test (TORRT), participants see a letter or word onscreen and must pronounce or identify it. The examiner determines whether it was pronounced correctly by comparing the response to the pronunciation guide on a separate computer screen. In this chapter, we discuss the importance of language during childhood and the relation of language and brain function. We also review the development of the TPVT and TORRT, including information about the item calibration process and results from a validation study. Finally, the strengths and weaknesses of the measures are discussed.

I. NIH Toolbox Cognition Battery (CB): introduction and pediatric data.

This monograph presents the pediatric portion of the National Institutes of Health (NIH) Toolbox Cognition Battery (CB) of the NIH Toolbox for the Assessment of Neurological and Behavioral Function. The NIH Toolbox is an initiative of the Neuroscience Blueprint, a collaborative framework through which 16 NIH Institutes, Centers, and Offices jointly support neuroscience-related research, to accelerate discoveries and reduce the burden of nervous system disorders. The CB is one of four modules that measure cognitive, emotional, sensory, and motor health across the lifespan. The CB is unique in its continuity across childhood, adolescence, early adulthood, and old age, and in order to help create a common currency among disparate studies, it is also available at low cost to researchers for use in large-scale longitudinal and epidemiologic studies. This chapter describes the evolution of the CB; methods for selecting cognitive subdomains and instruments; the rationale for test design; and a validation study in children and adolescents, ages 3-15 years. Subsequent chapters feature detailed discussions of each test measure and its psychometric properties (Chapters 2-6), the factor structure of the test battery (Chapter 7), the effects of age and education on composite test scores (Chapter 8), and a final summary and discussion (Chapter 9). As the chapters in this monograph demonstrate, the CB has excellent psychometric properties, and the validation study provided evidence for the increasing differentiation of cognitive abilities with age.

Cognition assessment using the NIH Toolbox.

Cognition is 1 of 4 domains measured by the NIH Toolbox for the Assessment of Neurological and Behavioral Function (NIH-TB), and complements modules testing motor function, sensation, and emotion. On the basis of expert panels, the cognition subdomains identified as most important for health, success in school and work, and independence in daily functioning were Executive Function, Episodic Memory, Language, Processing Speed, Working Memory, and Attention. Seven measures were designed to tap constructs within these subdomains. The instruments were validated in English, in a sample of 476 participants ranging in age from 3 to 85 years, with representation from both sexes, 3 racial/ethnic categories, and 3 levels of education. This report describes the development of the Cognition Battery and presents results on test-retest reliability, age effects on performance, and convergent and discriminant construct validity. The NIH-TB Cognition Battery is intended to serve as a brief, convenient set of measures to supplement other outcome measures in epidemiologic and longitudinal research and clinical trials. With a computerized format and national standardization, this battery will provide a "common currency" among researchers for comparisons across a wide range of studies and populations.

Racial/Ethnic differences in the health-related quality of life of cancer patients.

Previous research has suggested that, when compared to European Americans (EAs), African Americans (AAs) are at higher risk of metastatic disease at time of cancer diagnosis, and a higher risk of shorter survival. Although AA patients have reported worse physical health than EA patients, studies have rarely addressed whether racial/ethnic disparities exist on the social, emotional, and functional aspects of health-related quality of life. Five hundred and two AA and 396 EA patients with AIDS-related malignancies or breast, colon, head/neck, and lung cancers seeking treatment within the contiguous United States and Puerto Rico participated in the present study. Responses on the Functional Assessment of Cancer Therapy-General were analyzed for possible racial/ethnic disparities using multivariable regression models and item response theory modeling to detect differential item functioning. Differential item functioning was found in six items of the Functional Assessment of Cancer Therapy-General, indicating that AA and EA participants had different probabilities of responding to these items. Compared to EAs at the same level of health-related quality of life, AAs reported more severe symptomatology on items that reflected malaise and ability to work, and less severe symptomatology on items that reflected fatigue, treatment side effects, and outlook on life. At the subscale level, AAs reported poorer physical and social well-being, but better emotional well-being, than EAs. Similar to previous studies, AA patients reported poorer physical functioning than a comparable group of EA patients. Some items appear to be responded to differently by AAs and EAs, suggesting it is important to consider race/ethnicity when evaluating responses to questions about health-related quality of life.