/ Psychological Tests / Cognitive Functions (Neuropsychology)

NIH Toolbox-Cognition (NIHTB-C)

Portuguese version

Under adaptation and validation for the Portuguese population of older people, by Catarina Marques-Costa, M. Salomé Pinho, Mário R. Simões and Gerardo Prieto.

Original version

National Institutes of Health & Northwestern University (2021). NIH Toolbox Administrator's Manual (v.1.23). Evanston, IL.

Theoretical background

The NIH Toolbox (published in 2012), from the American National Institutes of Health (NIH), is designed to assess behavioral and neurological function, from 3 to 85 years old, allowing to assess its evolution throughout the life span. It was built with US research funds and serves as a 'common currency' between researchers and professionals, allowing for the comparison of data and their integration in multiple studies (e.g., Big Data) (Gershon et al., 2010; Gershon et al., 2013; National Institutes of Health & Northwestern University, 2021; Wagster, 2015; Weintraub et al., 2013). 250 experts from 80 different institutions were involved in its construction. This computerized battery does not require an internet connection for its application and works through an app for the IOS operating system.

This project is part of a cooperation protocol established between Northwestern University and the University of Coimbra which aims to build the European Portuguese version of the NIH Toolbox-Cognition (part of the NIH Toolbox-Cognition Battery - NIHTB-CB). This research focuses exclusively on the population aged 60 to 85 years, and on only 5 tests of this battery (NIHTB-CB) which assesses the following cognitive functions: (i) working memory; (ii) processing speed; (iii) episodic memory; (iv) attention; (v) executive functions. The NIHTB-CB has two more language tests (which will not be validated in this first phase).

Regarding security and privacy of the app, it implements Apple's IOS data encryption (use of SQl Lite, 256-bit encryption managed by IOS) and will not store data outside the device or communicate with other applications on the device or with systems outside it while administering tests. Data export is optional and can be sent to email (encrypting the data on export), iCloud and iTunes (for more information about security and privacy in this kind of tests see Marques-Costa, Simões, Almiro, Prieto & Pinho, 2022).

Description

Assessment Domain: Cognitive.

Type of Instrument: Computerized battery (IOS app).

Application: Individual, 30 minutes.

Population: Older Adults.

Dimensions

So, the 5 tests included in this first phase are:

  1. Picture Sequence Memory Test (recall the order of each series of pictures of objects and activities, after 2 trials) – Episodic Memory;
  2. Pattern Comparison Processing Speed Test (quickly indicate if pairs of pictures are the same) – Processing Speed;
  3. List Sorting Working Memory Test (presentation of pictures with animals and/or food to name the items, according to increasing order of size, considering one or two dimensions: animals and/or food) – Working Memory
  4. Flanker Inhibitory Control and Attention Test (fixation of gaze on an included stimulus in the middle of a series and responding, while inhibiting attention to similar stimuli by flanking them) – Attention
  5. Dimensional Change Card Sort Test (two images varying in two dimensions (shape, color) to respond quickly if the series of test images and the target images of switching between dimensions match) – Executive Functions (also including attention test results).

Studies

The research planned and currently being implemented in the context of the PhD Project of Catarina Marques-Costa "Computerized Cognitive Assessment: adaptation, validation and standardization of the NIH Toolbox-Cognitive in Older Persons" (supervisors: M. Salomé Pinho, Mário R. Simões, Gerardo Prieto) include the following validation studies: 1. Community settings (context); 2. clinical settings: with Mild Cognitive Impairment (MCI) and subjects with probable (mild) Alzheimer's Disease.

Future research

The Portuguese version of the NIHTB-C is used in this moment only for research purpose. PsyAssessmentLab is available to collaborate in any research projects related to this instrument.

Funding

This work is supported by a PhD scholarship provided to Catarina Marques-Costa (SFRH/BD/128597/2017) by Portuguese national funds through the Foundation for Science and Technology (FCT), the Ministry of Science, Technology and Higher Education (MCTES), and the European Social Fund through the Human Capital Operational Programme (HCOP).

Contacts

Catarina Marques-Costa (marquescosta.cm@gmail.com)

M. Salomé Pinho (salome@fpce.uc.pt)

References

  1. Gershon, R. C., Cella, D., Fox, N. A., Havlik, R. J., Hendrie, H. C., & Wagster, M. V. (2010). Assessment of neurological and behavioural function: the NIH Toolbox. Lancet Neurology, 9(2), 138-139. https://doi.org/10.1016/S1474-4422(09)70335-7
  2. Gershon, R. C., Wagster, M. V., Hendrie, H. C., Fox, N. A., Cook, K. F., & Nowinski, C. J. (2013). NIH toolbox for assessment of neurological and behavioral function. Neurology, 80(11 Supplement 3), S2-S6. https://doi.org/​10.​1212/​WNL.​0b013e3182872e5f
  3. Marques-Costa, C., Almiro, P. A., & Simões, M. R. (2018). Computerized Cognitive Tests (CCT) in elderly: A psychometric review. Revue Européenne de Psychologie Appliquée, 68(2), 61-68. https://doi.org/10.1016/j.erap.2018.04.002
  4. Marques-Costa, C., Gonçalves, M.M., & Simões, M.R. (2016). Testes computorizados na avaliação de adultos idosos [Computerized tests in the assessment of older adults]. In Horácio Firmino, Mário R. Simões, Joaquim Cerejeira (Eds.), Saúde mental das pessoas mais velhas [Mental health of older people] (pp. 165-181). Lidel, Edições Técnicas.
  5. Marques-Costa, C., Pinho, M. S., Simões, M. R. & Prieto, G. (2018). Novas tecnologias e instrumentos de avaliação neuropsicológica inovadores: O caso da NIH Toolbox-Cognitiva [New technologies and innovative neuropsychological assessment instruments: The case of the NIH Toolbox-Cognitive]. 10º Congresso Ibero-americano de Diagnóstico e Avaliação Psicológica; Coimbra, PT.
  6. Marques-Costa, C., Pinho, M. S., Simões, M. R. & Prieto, G. (2018, Fevereiro). Qual a relevância da NIH Toolbox-Cognitiva para avaliar as pessoas idosas portuguesas? [What is the relevance of the NIH Toolbox-Cognitive to assess Portuguese elderly people?] [Blog post]. Retrieved from https://naap.pt/noticias/artigo1/
  7. Marques-Costa, C., Pinho, M.S., Simões, M.R. & Prieto, G. (2020). The NIH Toolbox Cognition Battery App in healthy aging and cognitive decline due to Alzheimers’ Disease and Mild Cognitive Impairment. European Journal of Public Health, 30(Suppl.2), ckaa040.032. https://doi.org/10.1093/eurpub/ckaa040.032
  8. Marques-Costa, C., Simões, M.R., Almiro, P., Prieto, G. & Pinho, M.S. (2023). Integrating technology in neuropsychological assessment: Main obstacles, new developments and potential issues in assessment through tablets. European Psychologist, 28(1), 1-11. https://doi.org/10.1027/1016-9040/a000484
  9. National Institutes of Health & Northwestern University (2021). NIH Toolbox Administrator's Manual (v.1.23). Evanston, IL. Retrieved from: https://nihtoolbox.my.salesforce.com/sfc/p/#2E000001H4ee/a/2E0000001VRd/3G_CJzK_P0zkAdGD50rR7F0umkl5_DasSjXJ26tK.oI
  10. Parsey, CM, Bagger, JE, Trittschuh, EH, & Hanson, AJ. (2021). Utility of the iPad NIH Toolbox Cognition Battery in a clinical trial of older adults. Journal of American Geriatrics Society. 69(12), 3519-3528. https://doi.org/10.1111/jgs.17382
  11. Scott, E. P., Sorrell, A., & Benitez, A. (2019). Psychometric Properties of the NIH Toolbox Cognition Battery in Healthy Older Adults: Reliability, Validity, and Agreement with Standard Neuropsychological Tests. Journal of the International Neuropsychological Society: JINS, 25(8), 857–867. https://doi.org/10.1017/S1355617719000614
  12. Wagster, M. (October, 2015). The NIH Toolbox®: Setting a standard for biomedical research. [Blog post]. Retrieved from https://www.nia.nih.gov/research/blog/2015/10/nih-toolboxr-setting-standard-biomedical-research
  13. Weintraub, S., Dikmen, S. S., Heaton, R. K., Tulsky, D. S., Zelazo, P. D., Bauer, P. J., ... & Gershon, R. C. (2013). Cognition assessment using the NIH Toolbox. Neurology, 80(11 Supplement 3), S54-S64. https://doi.org/10.1212/WNL.0b013e3182872ded
  14. Weintraub, S., Dikmen, S. S., Heaton, R. K., Tulsky, D. S., Zelazo, P. D., Slotkin, J., ... & Gershon, R. (2014). The cognition battery of the NIH toolbox for assessment of neurological and behavioral function: validation in an adult sample. Journal of the International Neuropsychological Society, 20(6), 567-578. https://doi.org/10.1017/S1355617714000320