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Karr JE, Rivera Mindt M, Iverson GL. Interpreting reliable change on the Spanish-language NIH toolbox cognition battery. APPLIED NEUROPSYCHOLOGY. ADULT 2024; 31:229-237. [PMID: 34904490 PMCID: PMC9976799 DOI: 10.1080/23279095.2021.2011726] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
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.
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Affiliation(s)
- Justin E Karr
- Department of Psychology, University of Kentucky, Lexington, KY, USA
| | - Monica Rivera Mindt
- Department of Psychology and Latin American and Latino Studies Institute, Fordham University, Bronx, NY, USA
- Department of Neurology, Icahn School of Medicine at Mount Sinai, Bronx, NY, USA
| | - Grant L Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Spaulding Research Institute, and Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Charlestown, MA, USA
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2
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Chaytor NS, Trapani VR, Braffett BH, Fonseca LM, Lorenzi GM, Gubitosi-Klug RA, Hitt S, Farrell K, Jacobson AM, Ryan CM. Utility of the NIH Toolbox Cognition Battery in middle to older aged adults with longstanding type 1 diabetes: The DCCT/EDIC study. Clin Neuropsychol 2024; 38:1007-1027. [PMID: 37814481 PMCID: PMC11001788 DOI: 10.1080/13854046.2023.2266876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 09/28/2023] [Indexed: 10/11/2023]
Abstract
Objective: Adults with type 1 diabetes (T1D) face an increased risk for cognitive decline and dementia. Diabetes-related and vascular risk factors have been linked to cognitive decline using detailed neuropsychological testing; however, it is unclear if cognitive screening batteries can detect cognitive changes associated with aging in T1D. Method: 1,049 participants with T1D (median age 59 years; range 43-74) from the Diabetes Control and Complications Trial (DCCT), and the follow-up Epidemiology of Diabetes Interventions and Complications (EDIC) study, completed the NIH Toolbox Cognition Battery (NIHTB-C) and Montreal Cognitive Assessment (MoCA). Neuropsychological assessments, depression, glycated hemoglobin levels (HbA1c), severe hypoglycemia, T1D complications, and vascular risk factors were assessed repeatedly over 32 years to determine associations with current NIHTB-C performance. Available cognitive data was clinically adjudicated to determine cognitive impairment status. Results: NIHTB-C scores had moderate associations (r = 0.36-0.53) with concurrently administered neuropsychological tests. In multivariate models, prior severe hypoglycemic episodes, depression symptoms, nephropathy, lower BMI, and higher HbA1c and LDL cholesterol were associated with poorer NIHTB-C Fluid Cognition Composite scores. The NIHTB-C adequately detected adjudicated cognitive impairment (Area Under the Curve = 0.86; optimal cut score ≤90). The MoCA performed similarly (Area Under the Curve = 0.83; optimal cut score ≤25). Conclusions: The NIHTB-C is sensitive to the cognitive effects of diabetes-related and vascular risk factors, correlated with neuropsychological testing, and accurately detects adjudicated cognitive impairment. These data support its use as a screening test in middle to older aged adults with T1D to determine if referral for detailed neuropsychological assessment is needed.
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Affiliation(s)
- Naomi S Chaytor
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | | | | | - Luciana M Fonseca
- Elson S. Floyd College of Medicine, Washington State University, Spokane, WA, USA
| | - Gayle M Lorenzi
- Medicine, University of California San Diego, La Jolla, CA, USA
| | - Rose A Gubitosi-Klug
- Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, OH, USA
| | - Susan Hitt
- Ophthalmology, University of Missouri, Columbia, MO, USA
| | - Kaleigh Farrell
- Rainbow Babies and Children's Hospital, Case Western Reserve University, Cleveland, OH, USA
| | - Alan M Jacobson
- NYU Langone Long Island Hospital, NYU Long Island School of Medicine, Mineola, NY, USA
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delCacho-Tena A, Christ BR, Arango-Lasprilla JC, Perrin PB, Rivera D, Olabarrieta-Landa L. Normative Data Estimation in Neuropsychological Tests: A Systematic Review. Arch Clin Neuropsychol 2024; 39:383-398. [PMID: 37950923 PMCID: PMC11042921 DOI: 10.1093/arclin/acad084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 08/28/2023] [Accepted: 09/28/2023] [Indexed: 11/13/2023] Open
Abstract
OBJECTIVE To quantify the evolution, impact, and importance of normative data (ND) calculation by identifying trends in the research literature and what approaches need improvement. METHODS A PRISMA-guideline systematic review was performed on literature from 2000 to 2022 in PubMed, Pub-Psych, and Web of Science. Inclusion criteria included scientific articles about ND in neuropsychological tests with clear data analysis, published in any country, and written in English or Spanish. Cross-sectional and longitudinal studies were included. Bibliometric analysis was used to examine the growth, productivity, journal dispersion, and impact of the topic. VOSViewer compared keyword co-occurrence networks between 1952-1999 and 2000-2022. RESULTS Four hundred twelve articles met inclusion and exclusion criteria. The most studied predictors were age, education, and sex. There were a greater number of studies/projects focusing on adults than children. The Verbal Fluency Test (12.7%) was the most studied test, and the most frequently used variable selection strategy was linear regression (49.5%). Regression-based approaches were widely used, whereas the traditional approach was still used. ND were presented mostly in percentiles (44.2%). Bibliometrics showed exponential growth in publications. Three journals (2.41%) were in the Core Zone. VOSViewer results showed small nodes, long distances, and four ND-related topics from 1952 to 1999, and there were larger nodes with short connections from 2000 to 2022, indicating topic spread. CONCLUSIONS Future studies should be conducted on children's ND, and alternative statistical methods should be used over the widely used regression approaches to address limitations and support growth of the field.
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Affiliation(s)
- Ana delCacho-Tena
- Department of Health Science, Public University of Navarre, Pamplona, Navarre, Spain
| | - Bryan R Christ
- School of Data Science and Department of Psychology, University of Virginia, Charlottesville, VA, USA
| | | | - Paul B Perrin
- School of Data Science and Department of Psychology, University of Virginia, Charlottesville, VA, USA
| | - Diego Rivera
- Department of Health Science, Public University of Navarre, Pamplona, Navarre, Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
| | - Laiene Olabarrieta-Landa
- Department of Health Science, Public University of Navarre, Pamplona, Navarre, Spain
- Instituto de Investigación Sanitaria de Navarra (IdiSNA), Pamplona, Spain
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Karr JE, Ingram EO, Pinheiro CN, Ali S, Iverson GL. Test-Retest Reliability and Reliable Change on the NIH Toolbox Cognition Battery. Arch Clin Neuropsychol 2024:acae011. [PMID: 38402512 DOI: 10.1093/arclin/acae011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 12/22/2023] [Accepted: 01/25/2024] [Indexed: 02/26/2024] Open
Abstract
OBJECTIVE Researchers and practitioners can detect cognitive improvement or decline within a single examinee by applying a reliable change methodology. This study examined reliable change through test-retest data from the English-language National Institutes of Health Toolbox Cognition Battery (NIHTB-CB) normative sample. METHOD Participants included adults (n = 138; age: M ± SD = 54.8 ± 20.0, range: 18-85; 51.4% men; 68.1% White) who completed test-retest assessments about a week apart on five fluid cognition tests, providing raw scores, age-adjusted standard scores (SS), and demographic-adjusted T-scores (T). RESULTS The Fluid Cognition Composite (SS: ICC = 0.87; T-score: ICC = 0.84) and the five fluid cognition tests had good test-retest reliability (SS: ICC range = 0.66-0.85; T-score: ICC range = 0.64-0.86). The lower and upper bounds of 70%, 80%, and 90% confidence intervals (CIs) were calculated around change scores, which serve as cutoffs for determining reliable change. Using T-scores, 90% CI, and adjustment for practice effects, 32.3% declined on one or more tests, 9.7% declined on two or more tests, 36.6% improved on one or more tests, and 5.4% improved on two or more tests. CONCLUSIONS It was common for participants to show reliable change on at least one test score, but not two or more test scores. Per an 80% CI, test-retest difference scores beyond these cutoffs would indicate reliable change: Dimensional Change Card Sort (SS ≥ 14/T ≥ 10), Flanker (SS ≥ 12/T ≥ 8), List Sorting (SS ≥ 14/T ≥ 10), Picture Sequence Memory (SS ≥ 19/T ≥ 13), Pattern Comparison (SS ≥ 11/T ≥ 8), and Fluid Cognition Composite (SS ≥ 10/T ≥ 7). The reliable change cutoffs could be applied in research or practice to detect within-person change in fluid cognition at the individual level.
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Affiliation(s)
- Justin E Karr
- Department of Psychology, College of Arts and Sciences, University of Kentucky, Lexington, KY, USA
| | - Eric O Ingram
- Department of Psychology, College of Arts and Sciences, University of Kentucky, Lexington, KY, USA
| | - Cristina N Pinheiro
- Department of Psychology, College of Arts and Sciences, University of Kentucky, Lexington, KY, USA
| | - Sheliza Ali
- Department of Neurology, College of Medicine, University of Kentucky, Lexington, KY, USA
| | - Grant L Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA, USA
- Department of Physical Medicine and Rehabilitation, Schoen Adams Research Institute at Spaulding Rehabilitation, Charlestown, MA, USA
- Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Charlestown, MA, USA
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Karr JE, Pinheiro CN, Harp JP. Performance Validity Testing on the NIH Toolbox Cognition Battery: Base Rates of Failed Embedded Validity Indicators in the Adult Normative Sample. Arch Clin Neuropsychol 2024; 39:204-213. [PMID: 37718664 PMCID: PMC10879920 DOI: 10.1093/arclin/acad071] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/25/2023] [Indexed: 09/19/2023] Open
Abstract
OBJECTIVE The goal of this study was to determine the base rates of failing proposed embedded validity indicators (EVIs) for the National Institutes of Health Toolbox Cognition Battery (NIHTB-CB) in the normative sample. METHOD Participants included adults in the NIHTB-CB normative sample with data to calculate age-adjusted standard scores (n = 855; ages: M(SD) = 46.9(17.3), range: 18-85; 65.0% women; education: M(SD) = 14.1(2.5) years) or demographically adjusted T-scores (n = 803; ages: M(SD) = 47.3(17.3), range: 18-85; 65.3% women; education: M(SD) = 14.2(2.5) years) for all tests. The NIHTB-CB includes two tests of crystallized cognition and five tests of fluid cognition. Individual norm-referenced test performances were categorized as falling above or below liberal and conservative cutoffs based on proposed univariate EVIs. The number of univariate EVI failures was summed to compute multivariable EVIs. EVI failure rates above 10% were considered high false-positive rates, indicating specificity < .90. Using chi-square analyses, the frequencies of EVI failures were compared based on gender, race/ethnicity, education, and crystallized composite. RESULTS The multivariable EVIs had predominantly low false-positive rates in the normative sample. EVI failure rates were most common among participants with low crystallized composites. Using age-adjusted standard scores, EVI failure rates varied by education, race/ethnicity, and estimated premorbid intelligence. These differences were mostly eliminated when using demographically adjusted T-scores. CONCLUSIONS Multivariable EVIs requiring ≥ 4 failures using liberal cutoffs or ≥ 3 failures using conservative cutoffs had acceptable false-positive rates (i.e., < 10%) using both age-adjusted standard scores and demographically adjusted T-scores. These multivariable EVIs could be applied to large data sets with NIHTB-CB data to screen for potentially invalid test performances.
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Affiliation(s)
- Justin E Karr
- Department of Psychology, College of Arts and Sciences, University of Kentucky, Lexington, KY, USA
| | - Cristina N Pinheiro
- Department of Psychology, College of Arts and Sciences, University of Kentucky, Lexington, KY, USA
| | - Jordan P Harp
- Department of Neurology, College of Medicine, University of Kentucky, Lexington, KY, USA
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Santos F, Renuy A, Ozguler A, Ribet C, Goldberg M, Zins M, Artaud F, Elbaz A. Norms for Usual and Fast Walking Speed in Adults 45-69 Years Old From the French General Population: Constances Study. J Am Med Dir Assoc 2024; 25:266-274. [PMID: 37944906 DOI: 10.1016/j.jamda.2023.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2023] [Revised: 09/25/2023] [Accepted: 10/01/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVES Walking speed (WS) represents an objective measure of motor function and health. We aimed to develop usual (UWS) and fast WS (FWS) norms for the general population using a regression-based approach, while considering age, sex, height, and education. DESIGN Cross-sectional analysis of a population-based study. SETTING AND PARTICIPANTS French Constances study (45-69 years). METHODS UWS/FWS were measured over 3 m (dynamic start) using photoelectric cells. We addressed selection effects (related to survey sampling and nonresponse) and missing data using a combination of inverse probability weighting (IPW) and multiple imputation (MI). Norms by sex, age, height, and education ( RESULTS Analyses are based on 44,772 participants (51.2% women) with a mean age of 56.8 years (SE = 0.2) for women and 57.3 years (SE = 0.2) for men, and a mean height of 161.4 cm (SE = 0.1) for women and 174.2 cm (SE = 0.1) for men after IPW/MI. WS estimates decreased after IPW/MI. The mean UWS was 116.9 cm/s (SE = 0.8) in women and 120.7 cm/s (SE = 0.8) in men, and the mean FWS was 168.7 cm/s (SE = 1.0) in women and 182.8 cm/s (SE = 1.2) in men. In the multiadjusted model, UWS/FWS decreased with age and increased with height and education. Men had faster FWS than women; they had slightly slower UWS than women in the low-education group, but there were no sex differences in the high-education group. CONCLUSIONS AND IMPLICATIONS We developed UWS/FWS norms by age, sex, height, and education for the French general population (45-69 years) that are available through a web app (https://cesp-proxy2.vjf.inserm.fr/NORMES-VM-EN/). These norms can be used to identify in midlife persons with lower motor performances than the general population, given their age, sex, height, and education, who are at higher risk of adverse outcomes.
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Affiliation(s)
- Félicia Santos
- Université Paris-Saclay, UVSQ, Inserm, Gustave Roussy, CESP, 94805, Villejuif, France
| | - Adeline Renuy
- Inserm, Université Paris Cité, Université Paris Saclay, Université de Versailles-Saint-Quentin-en-Yvelines (UVSQ), UMS 011 « Population-based cohorts unit », Villejuif, France
| | - Anna Ozguler
- Inserm, Université Paris Cité, Université Paris Saclay, Université de Versailles-Saint-Quentin-en-Yvelines (UVSQ), UMS 011 « Population-based cohorts unit », Villejuif, France
| | - Céline Ribet
- Inserm, Université Paris Cité, Université Paris Saclay, Université de Versailles-Saint-Quentin-en-Yvelines (UVSQ), UMS 011 « Population-based cohorts unit », Villejuif, France
| | - Marcel Goldberg
- Inserm, Université Paris Cité, Université Paris Saclay, Université de Versailles-Saint-Quentin-en-Yvelines (UVSQ), UMS 011 « Population-based cohorts unit », Villejuif, France
| | - Marie Zins
- Inserm, Université Paris Cité, Université Paris Saclay, Université de Versailles-Saint-Quentin-en-Yvelines (UVSQ), UMS 011 « Population-based cohorts unit », Villejuif, France
| | - Fanny Artaud
- Université Paris-Saclay, UVSQ, Inserm, Gustave Roussy, CESP, 94805, Villejuif, France
| | - Alexis Elbaz
- Université Paris-Saclay, UVSQ, Inserm, Gustave Roussy, CESP, 94805, Villejuif, France.
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Mather MA, Ho EH, Bedjeti K, Karpouzian-Rogers T, Rogalski EJ, Gershon R, Weintraub S. Measuring Multidimensional Aspects of Health in the Oldest Old Using the NIH Toolbox: Results From the ARMADA Study. Arch Clin Neuropsychol 2024:acad105. [PMID: 38216151 DOI: 10.1093/arclin/acad105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Revised: 09/27/2023] [Accepted: 11/20/2023] [Indexed: 01/14/2024] Open
Abstract
OBJECTIVE The percentage of older adults living into their 80s and beyond is expanding rapidly. Characterization of typical cognitive performance in this population is complicated by a dearth of normative data for the oldest old. Additionally, little attention has been paid to other aspects of health, such as motor, sensory, and emotional functioning, that may interact with cognitive changes to predict quality of life and well-being. The current study used the NIH Toolbox (NIHTB) to determine age group differences between persons aged 65-84 and 85+ with normal cognition. METHOD Participants were recruited in two age bands (i.e., 65-84 and 85+). All participants completed the NIHTB Cognition, Motor, Sensation, and Emotion modules. Independent-samples t-tests determined age group differences with post-hoc adjustments using Bonferroni corrections. All subtest and composite scores were then regressed on age and other demographic covariates. RESULTS The 65-84 group obtained significantly higher scores than the 85+ group across all cognitive measures except oral reading, all motor measures except gait speed, and all sensation measures except pain interference. Age remained a significant predictor after controlling for covariates. Age was not significantly associated with differences in emotion scores. CONCLUSIONS Results support the use of the NIHTB in persons over 85 with normal cognition. As expected, fluid reasoning abilities and certain motor and sensory functions decreased with age in the oldest old. Inclusion of motor and sensation batteries is warranted when studying trajectories of aging in the oldest old to allow for multidimensional characterization of health.
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Affiliation(s)
- Molly A Mather
- Mesulam Center for Cognitive Neurology and Alzheimer's Disease, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Emily H Ho
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Katy Bedjeti
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Tatiana Karpouzian-Rogers
- Mesulam Center for Cognitive Neurology and Alzheimer's Disease, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Emily J Rogalski
- Mesulam Center for Cognitive Neurology and Alzheimer's Disease, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Richard Gershon
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Sandra Weintraub
- Mesulam Center for Cognitive Neurology and Alzheimer's Disease, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
- Department of Psychiatry and Behavioral Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Kittelson AJ, Loyd BJ. Personalized Reference Values for the Two-Minute Walk Test: An Analysis of Cross-Sectional Data From the National Institutes of Health Toolbox Study. Arch Phys Med Rehabil 2023; 104:1418-1424.e1. [PMID: 37037295 PMCID: PMC10524757 DOI: 10.1016/j.apmr.2023.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 03/09/2023] [Accepted: 03/24/2023] [Indexed: 04/12/2023]
Abstract
OBJECTIVES To develop reference values for the Two-Minute Walk Test (TMWT) via 2 previously untested methods: (1) smooth age-based statistical models and (2) a neighbors-based approach accounting for age, sex, and height. DESIGN Cross-sectional observational study. SETTING National Institutes of Health Toolbox study sites across the United States. PARTICIPANTS A total of 1385 healthy, community dwelling adult participants (age 18-85 years) in the National Institutes of Health Toolbox study were included in this analysis. INTERVENTION None. MAIN OUTCOME MEASURES Reference values for TMWT were generated using 2 approaches: (1) Generalized Additive Models for Location Scale and Shape, wherein TMWT values were modeled as a smooth function of age, and (2) a semiparametric neighbors-based approach. The performance of references values was then adjudicated by examining precision (ie, the average interquartile or interdecile range of reference values), and coverage (ie, the proportion of realized values included within a given inter-percentile interval). Agreement between methods was examined by intraclass correlation coefficient. RESULTS Neighbors-based reference values demonstrated a smaller average interquartile range (149 ft; 95% confidence interval [CI], 146-152 ft), compared with age-based reference values (158 ft; 95% CI, 155-162 ft), but similar average interdecile range (neighbors-based: 369 ft; 95% CI, 360-377 ft; age-based: 374 ft; 95% CI, 366-383 ft). Coverage appeared accurate via both approaches. Agreement between approaches was high (intraclass correlation coefficient=0.96), although differences were apparent on a case-by-case basis. CONCLUSIONS Both age-based and neighbors-based reference values offer viable options for interpreting a person's TMWT performance. In this analysis, the neighbors-based approach (adjusting for height) yielded potentially clinically relevant differences in reference values for persons at extremes of height.
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Affiliation(s)
- Andrew J Kittelson
- School of Physical Therapy and Rehabilitation Science, The University of Montana - Missoula, MT
| | - Brian J Loyd
- School of Physical Therapy and Rehabilitation Science, The University of Montana - Missoula, MT.
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Beasley J, Cook L, Eidson C, Hanna S, Keilman E, Lidgard J, Rhodes V, Vetter M, Wols K, Anderson K, Bacon-Baguley T. Adult norms for the Corbett Targeted Coin Test. J Hand Ther 2023; 36:641-646. [PMID: 36914495 DOI: 10.1016/j.jht.2022.09.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2022] [Revised: 07/24/2022] [Accepted: 09/28/2022] [Indexed: 03/16/2023]
Abstract
STUDY DESIGN Clinical measurement INTRODUCTION: Dexterity is important for daily activities. The Corbett Targeted Coin Test (CTCT) measures dexterity with palm-to-finger translation and proprioceptive target placement, but lacks established norms. PURPOSE OF THE STUDY To establish norms for the CTCT with healthy adult subjects. METHODS The inclusion criteria consisted of participants that were community dwelling, non-institutionalized, able to make a fist with both hands, perform finger-to-palm translation of twenty coins, and be at least 18 years of age. CTCT standardized testing procedures were followed. Quality of performance (QoP) scores were determined by speed in seconds and number of coin drops (each a 5-second penalty). QoP was summarized within each age, gender and hand dominance subgroup using the mean, median, minimum, and maximum. Correlation coefficients were computed for relationships between age and QoP, and between handspan and QoP. RESULTS Of the 207 individuals who participated, 131 were females and 76 males with an age range of 18-86 and mean age of 37.16. Individual QoP scores ranged from 13.8 to 105.3 seconds, with median scores ranging from 28.7 to 53.3 seconds. The mean for males was 37.5 seconds for the dominant hand (range 15.7-105.3) and 42.3 seconds (range 17.9.-86.8) for the non-dominant hand. The mean for females was 34.7 seconds for the dominant hand (range 14.8-67.0) and 38.6 seconds (range 13.8.-82.7) for the non-dominant hand. Lower QoP scores indicate a faster and/or more accurate dexterity performance. Females showed better median QoP for most age groups. The best median QoP scores were seen in the 30-39 and 40-49 age ranges. DISCUSSION Our study agrees to some extent with other research that reported dexterity decreases with age, and increases with smaller hand spans. CONCLUSION Normative data for the CTCT can be a guide for clinicians evaluating and monitoring patient dexterity with palm-to-finger translation and proprioceptive target placement.
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Affiliation(s)
- Jeanine Beasley
- Department of Occupational Science and Therapy, Grand Valley State University, Grand Rapids, MI, USA.
| | - Lisa Cook
- Spectrum Health Homecare, Grand Rapids, MI, USA
| | - Carleigh Eidson
- Department of Occupational Science and Therapy Student, Grand Valley State University, Grand Rapids, MI, USA
| | - Senan Hanna
- Department of Occupational Science and Therapy Student, Grand Valley State University, Grand Rapids, MI, USA
| | - Emily Keilman
- Department of Occupational Science and Therapy Student, Grand Valley State University, Grand Rapids, MI, USA
| | | | | | | | - Kayla Wols
- Northwestern Medicine Palos Hospital, Palos Heights, IL, USA
| | - Kirk Anderson
- Department of Statistics, Grand Valley State University, Allendale, MI, USA
| | - Theresa Bacon-Baguley
- Department of Physician Studies, Grand Valley State University, Grand Rapids, MI, USA
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Iverson GL, Gaudet CE, Kissinger-Knox A, Karr JE. Normative Reference Values for Crystallized-Fluid Discrepancy Scores for the NIH Toolbox Cognition Battery. Arch Clin Neuropsychol 2023; 38:608-618. [PMID: 36225110 DOI: 10.1093/arclin/acac076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2022] [Indexed: 05/24/2023] Open
Abstract
INTRODUCTION The purpose of this study was to translate NIH Toolbox Cognition Battery (NIHTB-CB) Crystallized-Fluid discrepancy scores into research and clinical practice with adults by providing normative data for discrepancy scores for both age-adjusted standard scores (SSs) and demographically adjusted T-scores. METHOD We included adult participants from the NIHTB-CB standardization sample who denied having neurodevelopmental, medical, psychiatric, or neurological conditions (n = 730; M = 47.4 years old, SD = 17.6, range: 18-85; 64.4% women; 63.1% White). Descriptive statistics were calculated for the Fluid and Crystallized composite scores and Crystallized-Fluid discrepancy score, along with correlations between the composite scores and reliability estimates of the discrepancy score. Percentiles were calculated for the discrepancy score, with stratifications by the gender, education, and Crystallized composite for the age-adjusted SSs and demographically adjusted T-scores (T). RESULTS Crystallized-Fluid discrepancy scores ranged from -40 to 44 (M = -0.63, SD = 14.89, Mdn = -1, interquartile range [IQR]: -11 to 10) for age-adjusted SSs and from -29 to 27 (M = -0.39, SD = 10.49, Mdn = -1, IQR = -8 to 7) for demographically adjusted T-scores. Crystallized-Fluid discrepancy scores of SS = 15 and T = 11 were at the 16th percentile (1 SD below the mean) and discrepancy scores of SS = 21 and T = 15 were at the 7th percentile (1.5 SD below the mean). CONCLUSIONS Crystallized-Fluid discrepancy scores may be, with future research, a useful within-person interpretive approach for detecting a decline from pre-injury or pre-disease levels of cognitive functioning. These normative reference values assist clinicians and researchers in determining the frequency at which given Crystallized-Fluid discrepancy scores occurred among healthy adults in the normative sample.
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Affiliation(s)
- Grant L Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Spaulding Rehabilitation Institute, Charlestown, MA, USA
- MassGeneral Hospital for Children Sports Concussion Program, Boston, MA, USA
- Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Charlestown, MA, USA
| | - Charles E Gaudet
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Spaulding Rehabilitation Institute, Charlestown, MA, USA
- MassGeneral Hospital for Children Sports Concussion Program, Boston, MA, USA
- Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Charlestown, MA, USA
| | - Alicia Kissinger-Knox
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Spaulding Rehabilitation Institute, Charlestown, MA, USA
- MassGeneral Hospital for Children Sports Concussion Program, Boston, MA, USA
- Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Charlestown, MA, USA
| | - Justin E Karr
- Department of Psychology, University of Kentucky, Lexington, KY, USA
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Becker L, Condy E, Kaat A, Thurm A. How do 3-year-olds do on the NIH Toolbox Cognitive Battery? Child Neuropsychol 2023; 29:521-542. [PMID: 35876076 PMCID: PMC9873835 DOI: 10.1080/09297049.2022.2100337] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 06/28/2022] [Indexed: 01/27/2023]
Abstract
The NIH Toolbox includes a cognitive battery that provides an Early Childhood Composite score for children age 3-7. However, very few studies have evaluated feasibility when it is used in the youngest segment of this age range-3-year-olds. The current study evaluated performance on the four cognitive subtests composing the early childhood composite, two of which assess executive function, in a large sample of 3-year-olds enrolled in a Vanguard pilot of the National Children's Study. Results found that in a cohort of 609 3-year-olds (mean age = 39.6 months, SD = 1.6, 53% male, 64% White, 87% Non-Hispanic) who were administered four subtests included in the Early Childhood Composite, up to approximately 30% were unable to pass practice items on the Flanker, Dimensional Change Card Sort, and Picture Sequence Memory, whereas only approximately 3% were unable to pass practice items on the Picture Vocabulary Test. Furthermore, of those that did pass practice and achieve scores on the subtests, approximately 70% and 80% performed at or below chance level on the executive function tasks (Flanker and Dimensional Change Card Sort) and Picture Sequence Memory, respectively. Ultimately, the average 3-year-old has difficulty with three of the four NIH Toolbox tasks composing the Early Childhood Composite and may not yet have developed the requisite skills. These findings indicate that changes compatible with the developmental level of preschoolers are recommended to increase the feasibility and effectiveness of the NIH Toolbox in measuring individual cognition differences in 3-year-old children.
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Affiliation(s)
- Lindsey Becker
- Division of Translational Medicine, Eunice Kennedy Shriver National Institute of Child Health and Human Development, Bethesda, MD, USA
| | - Emma Condy
- Neurodevelopmental and Behavioral Phenotyping Service, National Institute of Mental Health, Bethesda, MD, USA
| | - Aaron Kaat
- Medical Social Science, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Audrey Thurm
- Neurodevelopmental and Behavioral Phenotyping Service, National Institute of Mental Health, Bethesda, MD, USA
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Ho EH, Verkuilen J, Fischer F. Measuring individual true change with PROMIS using IRT-based plausible values. Qual Life Res 2023; 32:1369-1379. [PMID: 36282446 PMCID: PMC10849110 DOI: 10.1007/s11136-022-03264-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2022] [Indexed: 10/31/2022]
Abstract
AIMS A primary advantage of IRT-based patient-reported outcome measures such as PROMIS short forms and computer-adaptive tests is that each estimate of the latent trait comes with a standard error. Such measurement error needs to be acknowledged, in particular when monitoring individual patients over time. In this study, we use plausible values to account for measurement error and analyze the probability of true within-individual change. METHODS We use a longitudinal, observational study of stable and exacerbated COPD patients (N = 185), providing PROMIS Physical Function and Fatigue T-scores over 3 months. At each measurement, we imputed 1000 plausible values from the scores' posterior distribution. These were then used to calculate probability of true change using a pre-specified threshold such as minimally important difference supported by the literature, or [Formula: see text] > 0. We demonstrate assessment of change in individuals and in groups, across different measures (Short Forms and CATs), and at various levels of confidence. RESULTS Using plausible value imputation and with 95% certainty, 47.5% of participants in the exacerbated group reported less fatigue, compared with 26.5% of participants in the stable group. Comparison of Short Forms and CATs suggests that CATs have better ability to detect change compared to short forms. We also illustrate this method using an individual's probability of change at different time points. CONCLUSION Plausible values offer a flexible way to include measurement error in analysis of individuals and on sample level. Assessment of probability of true change can complement existing distribution-based approaches and facilitates interpretation of improvement or decline.
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Affiliation(s)
- Emily H Ho
- Feinberg School of Medicine, Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA.
| | - Jay Verkuilen
- Graduate Center, Ph.D. Program in Educational Psychology, City University of New York, New York, NY, USA
| | - Felix Fischer
- Charité-Universitätsmedizin Berlin, Department for Psychosomatic, Corporate member of Freie Universität Berlin and Humboldt-Universität Zu Berlin, Berlin, Germany
- Berlin Institute of Health at Charité-Universitätsmedizin Berlin, Clinical Study Center, German PROMIS® National Center, Berlin, Germany
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Muhammad F, Baha A, Haynes G, Shakir H, Omini M, Martin M, Weber KA, Paliwal M, Van Hal M, Dickson D, Dhaher Y, Zhao YD, Smith ZA. Isolating Neurologic Deficits in Cervical Spondylotic Myelopathy: A Case-Controlled Study, Using the NIH Toolbox Motor Battery. Neurol Clin Pract 2023; 13:e200126. [PMID: 37064579 PMCID: PMC10101713 DOI: 10.1212/cpj.0000000000200126] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 11/08/2022] [Indexed: 03/10/2023]
Abstract
Background and Objectives Patients with cervical spondylotic myelopathy (CSM) have motor impairments, including weakness, imbalance, and loss of dexterity. The reliable assessment of these symptoms is critical for treatment decisions. This study aimed to determine, for the first time, the use of the NIH Toolbox motor battery (NIHTBm) in the objective assessment of motor deficits in patients with CSM. Methods Patients with symptoms and MRI evidence of CSM and age-matched healthy controls (HC), with no evidence of spinal disorder or surgery were included in this case-control study based on our inclusion and exclusion criteria. We performed motor tests, dexterity, gait speed, grip strength, and balance tests, using the NIHTBm in patients with CSM and HCs. Motor impairment rates were determined in patients with CSM based on the NIHTBm scores. We determined the association between NIHTBm scores and patient-reported outcome scores; patient-reported outcome measures (the modified Japanese Orthopedic Association [mJOA] and Nurick grade) to determine the association. One-way analysis of variance was used to analyze group differences and the Spearman rank correlation to determine the relationship between assessment scores. Results We enrolled 24 patients with CSM with a mean age (SD) of 57.96 (10.61) years and 24 age-matched HCs with a mean age (SD) of 53.17 (6.04) years in this study. Overall, we observed a significant decrease in the motor function T-scores mean (SD): dexterity 31.54 (14.82) vs 51.54 (9.72), grip strength 32.00 (17.47) vs 56.79 (8.46), balance 27.58 (16.65) vs 40.21 (6.35), and gait speed 0.64 (0.18) vs 0.99 (0.17) m/s, in patients with CSM compared with that in HCs. The lower extremity dysfunction scores on the NIHTBm, balance (ρ = -0.67) and gait speed (ρ = -0.62), were associated with higher Nurick grades. We observed a similar but weaker association with the Nurick grades and NIHTBm tests: dexterity (ρ = -0.49) and grip strength (ρ = -0.31) scores. The total motor mJOA showed a positive but weak association with NIHTBm scores, gait speed (ρ = 0.38), balance (ρ = 0.49), grip strength (ρ = 0.41), and dexterity (ρ = 0.45). Discussion Patients with CSM had significantly lower NIHTBm scores compared with HCs. The results from the NIHTBm are consistent with the clinical presentation of CSM showing patients have motor impairments in both upper and lower extremities. As a neurologic-specific scale, NIHTBm should be used in the evaluation and clinical management of patients with CSM.
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Affiliation(s)
- Fauziyya Muhammad
- Department of Neurosurgery (FM, AB, HS, MO, MM, MP, ZAS), University of Oklahoma Health Sciences Center; Stephenson School of Biomedical Engineering (GH), University of Oklahoma, Norman; Department of Anesthesiology (KAW), Perioperative and Pain Medicine, Stanford School of Medicine, Palo Alto, CA; University of Texas Southwestern Medical Center (MVH, DD, YD), Dallas; and Department of Biostatistics and Epidemiology (YDZ), Hudson College of Public Health, University of Oklahoma Health Sciences Center
| | - Alaa Baha
- Department of Neurosurgery (FM, AB, HS, MO, MM, MP, ZAS), University of Oklahoma Health Sciences Center; Stephenson School of Biomedical Engineering (GH), University of Oklahoma, Norman; Department of Anesthesiology (KAW), Perioperative and Pain Medicine, Stanford School of Medicine, Palo Alto, CA; University of Texas Southwestern Medical Center (MVH, DD, YD), Dallas; and Department of Biostatistics and Epidemiology (YDZ), Hudson College of Public Health, University of Oklahoma Health Sciences Center
| | - Grace Haynes
- Department of Neurosurgery (FM, AB, HS, MO, MM, MP, ZAS), University of Oklahoma Health Sciences Center; Stephenson School of Biomedical Engineering (GH), University of Oklahoma, Norman; Department of Anesthesiology (KAW), Perioperative and Pain Medicine, Stanford School of Medicine, Palo Alto, CA; University of Texas Southwestern Medical Center (MVH, DD, YD), Dallas; and Department of Biostatistics and Epidemiology (YDZ), Hudson College of Public Health, University of Oklahoma Health Sciences Center
| | - Hakeem Shakir
- Department of Neurosurgery (FM, AB, HS, MO, MM, MP, ZAS), University of Oklahoma Health Sciences Center; Stephenson School of Biomedical Engineering (GH), University of Oklahoma, Norman; Department of Anesthesiology (KAW), Perioperative and Pain Medicine, Stanford School of Medicine, Palo Alto, CA; University of Texas Southwestern Medical Center (MVH, DD, YD), Dallas; and Department of Biostatistics and Epidemiology (YDZ), Hudson College of Public Health, University of Oklahoma Health Sciences Center
| | - Michael Omini
- Department of Neurosurgery (FM, AB, HS, MO, MM, MP, ZAS), University of Oklahoma Health Sciences Center; Stephenson School of Biomedical Engineering (GH), University of Oklahoma, Norman; Department of Anesthesiology (KAW), Perioperative and Pain Medicine, Stanford School of Medicine, Palo Alto, CA; University of Texas Southwestern Medical Center (MVH, DD, YD), Dallas; and Department of Biostatistics and Epidemiology (YDZ), Hudson College of Public Health, University of Oklahoma Health Sciences Center
| | - Michael Martin
- Department of Neurosurgery (FM, AB, HS, MO, MM, MP, ZAS), University of Oklahoma Health Sciences Center; Stephenson School of Biomedical Engineering (GH), University of Oklahoma, Norman; Department of Anesthesiology (KAW), Perioperative and Pain Medicine, Stanford School of Medicine, Palo Alto, CA; University of Texas Southwestern Medical Center (MVH, DD, YD), Dallas; and Department of Biostatistics and Epidemiology (YDZ), Hudson College of Public Health, University of Oklahoma Health Sciences Center
| | - Kenneth A Weber
- Department of Neurosurgery (FM, AB, HS, MO, MM, MP, ZAS), University of Oklahoma Health Sciences Center; Stephenson School of Biomedical Engineering (GH), University of Oklahoma, Norman; Department of Anesthesiology (KAW), Perioperative and Pain Medicine, Stanford School of Medicine, Palo Alto, CA; University of Texas Southwestern Medical Center (MVH, DD, YD), Dallas; and Department of Biostatistics and Epidemiology (YDZ), Hudson College of Public Health, University of Oklahoma Health Sciences Center
| | - Monica Paliwal
- Department of Neurosurgery (FM, AB, HS, MO, MM, MP, ZAS), University of Oklahoma Health Sciences Center; Stephenson School of Biomedical Engineering (GH), University of Oklahoma, Norman; Department of Anesthesiology (KAW), Perioperative and Pain Medicine, Stanford School of Medicine, Palo Alto, CA; University of Texas Southwestern Medical Center (MVH, DD, YD), Dallas; and Department of Biostatistics and Epidemiology (YDZ), Hudson College of Public Health, University of Oklahoma Health Sciences Center
| | - Michael Van Hal
- Department of Neurosurgery (FM, AB, HS, MO, MM, MP, ZAS), University of Oklahoma Health Sciences Center; Stephenson School of Biomedical Engineering (GH), University of Oklahoma, Norman; Department of Anesthesiology (KAW), Perioperative and Pain Medicine, Stanford School of Medicine, Palo Alto, CA; University of Texas Southwestern Medical Center (MVH, DD, YD), Dallas; and Department of Biostatistics and Epidemiology (YDZ), Hudson College of Public Health, University of Oklahoma Health Sciences Center
| | - Douglas Dickson
- Department of Neurosurgery (FM, AB, HS, MO, MM, MP, ZAS), University of Oklahoma Health Sciences Center; Stephenson School of Biomedical Engineering (GH), University of Oklahoma, Norman; Department of Anesthesiology (KAW), Perioperative and Pain Medicine, Stanford School of Medicine, Palo Alto, CA; University of Texas Southwestern Medical Center (MVH, DD, YD), Dallas; and Department of Biostatistics and Epidemiology (YDZ), Hudson College of Public Health, University of Oklahoma Health Sciences Center
| | - Yasin Dhaher
- Department of Neurosurgery (FM, AB, HS, MO, MM, MP, ZAS), University of Oklahoma Health Sciences Center; Stephenson School of Biomedical Engineering (GH), University of Oklahoma, Norman; Department of Anesthesiology (KAW), Perioperative and Pain Medicine, Stanford School of Medicine, Palo Alto, CA; University of Texas Southwestern Medical Center (MVH, DD, YD), Dallas; and Department of Biostatistics and Epidemiology (YDZ), Hudson College of Public Health, University of Oklahoma Health Sciences Center
| | - Yan Daniel Zhao
- Department of Neurosurgery (FM, AB, HS, MO, MM, MP, ZAS), University of Oklahoma Health Sciences Center; Stephenson School of Biomedical Engineering (GH), University of Oklahoma, Norman; Department of Anesthesiology (KAW), Perioperative and Pain Medicine, Stanford School of Medicine, Palo Alto, CA; University of Texas Southwestern Medical Center (MVH, DD, YD), Dallas; and Department of Biostatistics and Epidemiology (YDZ), Hudson College of Public Health, University of Oklahoma Health Sciences Center
| | - Zachary A Smith
- Department of Neurosurgery (FM, AB, HS, MO, MM, MP, ZAS), University of Oklahoma Health Sciences Center; Stephenson School of Biomedical Engineering (GH), University of Oklahoma, Norman; Department of Anesthesiology (KAW), Perioperative and Pain Medicine, Stanford School of Medicine, Palo Alto, CA; University of Texas Southwestern Medical Center (MVH, DD, YD), Dallas; and Department of Biostatistics and Epidemiology (YDZ), Hudson College of Public Health, University of Oklahoma Health Sciences Center
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Karr JE, Rodriguez JE, Rast P, Goh PK, Martel MM. A Network Analysis of Executive Functions in Children and Adolescents With and Without Attention-Deficit/Hyperactivity Disorder. Child Psychiatry Hum Dev 2023:10.1007/s10578-023-01518-9. [PMID: 36890331 DOI: 10.1007/s10578-023-01518-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/15/2023] [Indexed: 03/10/2023]
Abstract
This study applied network analysis to executive function test performances to examine differences in network parameters between demographically matched children and adolescents with and without attention-deficit/hyperactivity disorder (ADHD) (n = 141 per group; M = 12.7 ± 2.9 years-old; 72.3% boys, 66.7% White, 65.2% ≥ 12 years maternal education). All participants completed the NIH Toolbox Cognition Battery, including the Flanker, measuring inhibition, Dimensional Change Card Sort, measuring shifting, and List Sorting test, measuring working memory. Children with and without ADHD had comparable mean test performances (d range: .05-0.11) but presented with differences in network parameters. Among participants with ADHD, shifting was less central, had a weaker relationship with inhibition, and did not mediate the relationship between inhibition and working memory. These network characteristics were consistent with the executive function network structure of younger ages in prior research and may reflect an immature executive function network among children and adolescents with ADHD, aligning with the delayed maturation hypothesis.
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Affiliation(s)
- Justin E Karr
- Department of Psychology, University of Kentucky, 171 Funkhouser Drive, 012D Kastle Hall, Lexington, KY, 40506-0044, USA.
| | - Josue E Rodriguez
- Department of Psychology, University of California Davis, Davis, CA, USA
| | - Philippe Rast
- Department of Psychology, University of California Davis, Davis, CA, USA
| | - Patrick K Goh
- Department of Psychology, University of Hawai'i at Manoa, Honolulu, Hawai'i, USA
| | - Michelle M Martel
- Department of Psychology, University of Kentucky, 171 Funkhouser Drive, 012D Kastle Hall, Lexington, KY, 40506-0044, USA
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Brody LA, Kamalyan L, Karcher K, Guarena LA, Bender AA, McKenna BS, Umlauf A, Franklin D, Marquine MJ, Heaton RK. NIH Toolbox Emotion Battery Findings Among People with HIV: Normative Comparisons and Clinical Associations. Patient Relat Outcome Meas 2023; 14:15-30. [PMID: 36814680 PMCID: PMC9939807 DOI: 10.2147/prom.s391113] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 01/28/2023] [Indexed: 02/16/2023] Open
Abstract
Purpose Depression and other aspects of emotional health in people with HIV (PWH) can affect functional independence, disease progression, and overall life quality. This study used the NIH Toolbox Emotion Battery (NIHTB-EB), which assesses many features of emotional health, to more comprehensively investigate differences among adults living with and without HIV, and to identify factors associated with emotional health for PWH. Patients and Methods Participants (n=1451; age: M=50.19, SD=16.84; 47.90% women) included 433 PWH living in southern California seen from 2003 to 2021 (64.72% AIDS, 92.25% on antiretroviral therapy) and 1018 healthy participants from NIHTB-EB national normative cohort. Participants completed the NIHTB-EB and PWH underwent comprehensive HIV disease and psychiatric evaluations. We investigated differences in emotional health by HIV status via independent samples t-tests (continuous scores) and Chi2 tests ("problematic" emotional health scores). Multivariable linear regression models examined correlates of emotional health among PWH. Results PWH had significantly worse emotional health than people without HIV across Social Satisfaction (Cohen's d=0.71, p<0.001), Psychological Well-Being (Cohen's d=0.49, p<0.001) and Negative Affect (Cohen's d=0.19, p<0.01) summary T-scores, and most component scales. PWH also had higher rates of "problematic" emotional health, particularly in Social Satisfaction (45% vs 17%, p<0.0001). Poor emotional health among PWH was associated with lifetime Major Depressive and Substance Use Disorders, relationship status (lost relationship versus in relationship), unemployment, and cognitive difficulties and loss of functional independence. Conclusion The NIHTB-EB identified that difficulties with multiple aspects of emotional health are common among PWH, and appear to be relatively independent of cognitive impairment as well as HIV disease and treatment history, but are strongly associated with everyday functioning. Given the cross-sectional nature of this study, longitudinal studies should be employed to evaluate causality pertaining to predictors of emotional health in PWH. These findings may inform interventions to promote emotional wellbeing in PWH.
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Affiliation(s)
- Lilla A Brody
- Division of Geriatrics and Palliative Medicine, Weill Cornell Medicine, New York, NY, USA
- Department of Psychiatry, HIV Neurobehavioral Research Program, San Diego, CA, USA
| | - Lily Kamalyan
- Department of Psychiatry, HIV Neurobehavioral Research Program, San Diego, CA, USA
- Joint Doctoral Program in Clinical Psychology, San Diego State University/University of California, San Diego, CA, USA
| | - Kayle Karcher
- Department of Psychiatry, HIV Neurobehavioral Research Program, San Diego, CA, USA
| | - Lesley A Guarena
- Department of Psychiatry, HIV Neurobehavioral Research Program, San Diego, CA, USA
| | - Alexis A Bender
- Division of Geriatrics & Gerontology, Department of Medicine, Emory University, Atlanta, GA, USA
| | - Benjamin S McKenna
- Department of Psychiatry, HIV Neurobehavioral Research Program, San Diego, CA, USA
| | - Anya Umlauf
- Department of Psychiatry, HIV Neurobehavioral Research Program, San Diego, CA, USA
| | - Donald Franklin
- Department of Psychiatry, HIV Neurobehavioral Research Program, San Diego, CA, USA
| | - Maria J Marquine
- Division of Geriatrics, Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Robert K Heaton
- Department of Psychiatry, HIV Neurobehavioral Research Program, San Diego, CA, USA
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Weber KA, Teplin ZM, Wager TD, Law CSW, Prabhakar NK, Ashar YK, Gilam G, Banerjee S, Delp SL, Glover GH, Hastie TJ, Mackey S. Confounds in neuroimaging: A clear case of sex as a confound in brain-based prediction. Front Neurol 2022; 13:960760. [PMID: 36601297 PMCID: PMC9806266 DOI: 10.3389/fneur.2022.960760] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Accepted: 11/25/2022] [Indexed: 12/23/2022] Open
Abstract
Muscle weakness is common in many neurological, neuromuscular, and musculoskeletal conditions. Muscle size only partially explains muscle strength as adaptions within the nervous system also contribute to strength. Brain-based biomarkers of neuromuscular function could provide diagnostic, prognostic, and predictive value in treating these disorders. Therefore, we sought to characterize and quantify the brain's contribution to strength by developing multimodal MRI pipelines to predict grip strength. However, the prediction of strength was not straightforward, and we present a case of sex being a clear confound in brain decoding analyses. While each MRI modality-structural MRI (i.e., gray matter morphometry), diffusion MRI (i.e., white matter fractional anisotropy), resting state functional MRI (i.e., functional connectivity), and task-evoked functional MRI (i.e., left or right hand motor task activation)-and a multimodal prediction pipeline demonstrated significant predictive power for strength (R 2 = 0.108-0.536, p ≤ 0.001), after correcting for sex, the predictive power was substantially reduced (R 2 = -0.038-0.075). Next, we flipped the analysis and demonstrated that each MRI modality and a multimodal prediction pipeline could significantly predict sex (accuracy = 68.0%-93.3%, AUC = 0.780-0.982, p < 0.001). However, correcting the brain features for strength reduced the accuracy for predicting sex (accuracy = 57.3%-69.3%, AUC = 0.615-0.780). Here we demonstrate the effects of sex-correlated confounds in brain-based predictive models across multiple brain MRI modalities for both regression and classification models. We discuss implications of confounds in predictive modeling and the development of brain-based MRI biomarkers, as well as possible strategies to overcome these barriers.
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Affiliation(s)
- Kenneth A. Weber
- Systems Neuroscience and Pain Lab, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, United States,*Correspondence: Kenneth A. Weber II
| | - Zachary M. Teplin
- Systems Neuroscience and Pain Lab, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Tor D. Wager
- Department of Psychological and Brain Sciences, Dartmouth College, Hanover, NH, United States
| | - Christine S. W. Law
- Systems Neuroscience and Pain Lab, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Nitin K. Prabhakar
- Division of Physical Medicine and Rehabilitation, Department of Orthopaedic Surgery, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Yoni K. Ashar
- Department of Psychiatry, Weill Cornell Medicine, New York, NY, United States
| | - Gadi Gilam
- Systems Neuroscience and Pain Lab, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, United States,The Institute of Biomedical and Oral Research, Faculty of Dental Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | | | - Scott L. Delp
- Department of Bioengineering and Mechanical Engineering, Stanford University, Palo Alto, CA, United States
| | - Gary H. Glover
- Radiological Sciences Laboratory, Department of Radiology, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Trevor J. Hastie
- Department of Statistics, Stanford University, Palo Alto, CA, United States
| | - Sean Mackey
- Systems Neuroscience and Pain Lab, Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
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Condy EE, Becker L, Farmer C, Kaat AJ, Chlebowski C, Kozel BA, Thurm A. NIH Toolbox Cognition Battery Feasibility in Individuals With Williams Syndrome. AMERICAN JOURNAL ON INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2022; 127:473-484. [PMID: 36306408 DOI: 10.1352/1944-7558-127.6.473] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 01/25/2022] [Indexed: 06/16/2023]
Abstract
The NIH Toolbox Cognition Battery (NIHTB-CB) was developed for epidemiological and longitudinal studies across a wide age span. Such a tool may be useful for intervention trials in conditions characterized by intellectual disability (ID), such as Williams syndrome (WS). Three NIHTB-CB tasks, including two executive functioning (Flanker, Dimensional Change Card Sort) and one episodic memory (Picture Sequence Memory) task, were given to 47 individuals with WS, ages 4 to 50, to evaluate feasibility (i.e., proportion of valid administrations) in this population. Findings indicated that NIHTB-CB tests showed good feasibility. Flanker and DCCS age-corrected scores were negatively correlated with age and showed floor effects, indicating these scores may not be useful for quantifying performance on these NIHTB-CB tests in ID.
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Affiliation(s)
- Emma E Condy
- Emma E. Condy, National Institute of Mental Health
| | - Lindsey Becker
- Lindsey Becker, Eunice Kennedy Shriver National Institute of Child Health & Human Development
| | | | - Aaron J Kaat
- Aaron J. Kaat, Northwestern University Feinberg School of Medicine
| | | | - Beth A Kozel
- Beth A. Kozel, National Heart, Lung, and Blood Institute
| | - Audrey Thurm
- Audrey Thurm, National Institute of Mental Health
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Tennant IA, Hull DM, Fagan MA, Casaletto KB, Heaton RK, James Bateman C, Erickson KI, Forrester T, Boyne M. Assessment of cross-cultural measurement invariance of the NIH toolbox fluid cognition measures between Jamaicans and African-Americans. APPLIED NEUROPSYCHOLOGY. ADULT 2022:1-9. [PMID: 36167328 DOI: 10.1080/23279095.2022.2126939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
The NIH Toolbox Cognitive Battery (NIHTB-CB) was developed as a common-metric, computerized cognitive screener for research. Although extensively normed and validated in Americans of different ethnicities, there is little data on how generalizable such results would be when used outside of the United States. The objective of this study was to assess measurement invariance (MI) of the NIHTB-CB across Jamaican and African-American samples and determine appropriateness of comparisons across groups. Multi-group confirmatory factor analyses using a single-factor model were conducted using five tests of fluid cognitive abilities from the NIHTB-CB, which assess working memory, episodic memory, processing speed, and executive function. MI was tested sequentially for configural, metric and scalar invariance. 125 Jamaican and 154 American adults of African descent were included. The Jamaican mean age was 31.6 ± 8.6 years (57% males) compared to 43.5 ± 15.5 years (25% males) for the African-American group. The Jamaicans had on average 11.3 ± 2.7 years of education compared to 13.9 ± 2.6 years for the African-Americans. We found metric and configural invariance across both samples but not scalar invariance. These findings suggest that the single factor emerging from the NIHTB-CB measures the same construct, i.e. fluid cognitive ability, in both groups and hence the battery is appropriate for assessments within cultures. However, lack of scalar invariance indicates that direct cross-cultural comparisons of performance levels should be interpreted with caution, also suggesting that U.S. normative standards are not generalizable to the Jamaican population.
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Affiliation(s)
- Ingrid A Tennant
- Department of Surgery, Radiology, Anaesthesia and Intensive Care, The University of the West Indies, Mona, Jamaica
| | - Darrell M Hull
- Department of Educational Psychology, University of North Texas, Denton, TX, USA
| | - Marcus A Fagan
- Center for Research Design and Analysis, Texas Women's University, Denton, TX, USA
| | - Kaitlin B Casaletto
- Department of Neurology, Memory and Aging Center, University of California, San Francisco, CA, USA
| | - Robert K Heaton
- Department of Psychiatry, University of California at San Diego, La Jolla, CA, USA
| | - Caryl James Bateman
- Department of Sociology, Psychology and Social Work, The University of the West Indies, Mona, Jamaica
| | - Kirk I Erickson
- Department of Psychology, University of Pittsburgh, Pittsburgh, PA, USA
- College of Science, Health, Engineering, and Education, Murdoch University, Murdoch, Australia
- PROFITH "PROmoting FITness and Health through physical activity" Research Group, Department of Physical Education and Sports, Faculty of Sport Sciences, University of Granada, Granada, Spain
| | - Terrence Forrester
- Solutions for Developing Countries, The University of the West Indies, Mona, Jamaica
| | - Michael Boyne
- Department of Medicine, The University of the West Indies, Mona, Jamaica
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Taylor BK, Frenzel MR, Eastman JA, Wiesman AI, Wang YP, Calhoun VD, Stephen JM, Wilson TW. Reliability of the NIH toolbox cognitive battery in children and adolescents: a 3-year longitudinal examination. Psychol Med 2022; 52:1718-1727. [PMID: 33032665 PMCID: PMC8589010 DOI: 10.1017/s0033291720003487] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 07/15/2020] [Accepted: 09/07/2020] [Indexed: 11/06/2022]
Abstract
BACKGROUND The Cognitive Battery of the National Institutes of Health Toolbox (NIH-TB) is a collection of assessments that have been adapted and normed for administration across the lifespan and is increasingly used in large-scale population-level research. However, despite increasing adoption in longitudinal investigations of neurocognitive development, and growing recommendations that the Toolbox be used in clinical applications, little is known about the long-term temporal stability of the NIH-TB, particularly in youth. METHODS The present study examined the long-term temporal reliability of the NIH-TB in a large cohort of youth (9-15 years-old) recruited across two data collection sites. Participants were invited to complete testing annually for 3 years. RESULTS Reliability was generally low-to-moderate, with intraclass correlation coefficients ranging between 0.31 and 0.76 for the full sample. There were multiple significant differences between sites, with one site generally exhibiting stronger temporal stability than the other. CONCLUSIONS Reliability of the NIH-TB Cognitive Battery was lower than expected given early work examining shorter test-retest intervals. Moreover, there were very few instances of tests meeting stability requirements for use in research; none of the tests exhibited adequate reliability for use in clinical applications. Reliability is paramount to establishing the validity of the tool, thus the constructs assessed by the NIH-TB may vary over time in youth. We recommend further refinement of the NIH-TB Cognitive Battery and its norming procedures for children before further adoption as a neuropsychological assessment. We also urge researchers who have already employed the NIH-TB in their studies to interpret their results with caution.
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Affiliation(s)
- Brittany K. Taylor
- Department of Neurological Sciences, Cognitive Neuroscience of Development & Aging (CoNDA) Center, and the Center for Magnetoencephalography, University of Nebraska Medical Center, Omaha, NE, USA
| | - Michaela R. Frenzel
- Department of Neurological Sciences, Cognitive Neuroscience of Development & Aging (CoNDA) Center, and the Center for Magnetoencephalography, University of Nebraska Medical Center, Omaha, NE, USA
| | - Jacob A. Eastman
- Department of Neurological Sciences, Cognitive Neuroscience of Development & Aging (CoNDA) Center, and the Center for Magnetoencephalography, University of Nebraska Medical Center, Omaha, NE, USA
| | - Alex I. Wiesman
- Department of Neurological Sciences, Cognitive Neuroscience of Development & Aging (CoNDA) Center, and the Center for Magnetoencephalography, University of Nebraska Medical Center, Omaha, NE, USA
| | - Yu-Ping Wang
- Department of Biomedical Engineering, Tulane University, New Orleans, LA, USA
| | | | | | - Tony W. Wilson
- Department of Neurological Sciences, Cognitive Neuroscience of Development & Aging (CoNDA) Center, and the Center for Magnetoencephalography, University of Nebraska Medical Center, Omaha, NE, USA
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20
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Karr JE, Rivera Mindt M, Iverson GL. Algorithms for Operationalizing Mild Cognitive Impairment Using the Spanish-Language NIH Toolbox Cognition Battery. Arch Clin Neuropsychol 2022; 37:1608-1618. [PMID: 35739338 DOI: 10.1093/arclin/acac042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Neuropsychologists would benefit from flexible methods for operationalizing psychometric cognitive impairment in Spanish-speaking examinees that vary in association with intelligence, education, and sociocultural characteristics. The current study combined low and high score base rates (BRs) for the Spanish-language NIH Toolbox Cognition Battery (NIHTB-CB) to identify score combinations that are uncommon within different stratifications of the normative sample and may indicate cognitive impairment. METHOD The Spanish-language NIHTB-CB normative sample included 250 healthy Latinx adults with complete data on two crystallized and five fluid cognitive tests (M = 38.8 ± 13.7 years old, 72.0% women). Test performances were converted into age-adjusted and demographically adjusted normed scores, adjusting for age, gender, and education. The frequencies at which participants obtained one or more low scores or few to no high scores on fluid cognitive tests were combined into algorithms that occurred at BRs approximately 1 SD (~16%) or 1.5 SDs (~7%) below the mean. RESULTS Algorithms are provided for age-adjusted and demographically adjusted scores, with BRs stratified by crystallized ability, education, and sociocultural characteristics. Using demographically adjusted norms, the BR of obtaining any one of the following, 5 scores <50th, 4+ scores ≤25th, 3+ scores ≤16th, or 2+ scores ≤9th percentile, approximates 1 SD below the mean in participants born (BR = 16.2%) or educated abroad (BR = 18.6%), who are monolingual Spanish speakers (BR = 16.4%) or who reside in low-income households (BR = 13.6%). CONCLUSIONS These algorithms offer a flexible approach to operationalizing psychometric cognitive impairment, through which different definitions can be applied to different examinees based on varying crystallized ability, education, and sociocultural characteristics.
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Affiliation(s)
| | - Monica Rivera Mindt
- Department of Psychology, Latin American and Latino Studies Institute, Fordham University, New York, NY, USA.,Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Grant L Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA.,Spaulding Rehabilitation Hospital and Spaulding Research Institute, Charlestown, MA, USA.,Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Charlestown, MA, USA
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21
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Horton AL, Russell BS, Tambling RR, Britner PA, Hutchison M, Tomkunas AJ. Predictors of children's emotion regulation outcomes during COVID-19: Role of conflict within the family. FAMILY RELATIONS 2022; 71:FARE12717. [PMID: 35942050 PMCID: PMC9350158 DOI: 10.1111/fare.12717] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 01/20/2022] [Accepted: 03/13/2022] [Indexed: 06/02/2023]
Abstract
Objective This work aimed to analyze the role of family conflict on children's emotion regulation and stress outcomes during the COVID-19 pandemic. Background The COVID-19 pandemic brought novel stress to families. The stress experienced could impact family relationships-specifically, perceptions of closeness and patterns of conflict. Positive family environment and high-quality family relationships are associated with adaptive coping and lower levels of stress among children. Method Data were collected online from 110 participants at baseline and again 30 days later. Associations between parent-child relationship, sibling relationships, and child stress and emotion regulation outcomes 30 days later were tested through multiple stepwise regression. Results Both significant regression models suggest that parent-child conflict is the strongest predictor of child stress and negativity over the 30-day assessment period. Sibling conflict predicted child stress but not negativity. Conclusion Family conflict during the COVID-19 pandemic influenced children's emotion regulation outcomes as seen through significant associations between child-parent conflict, sibling conflict, perceived child stress, and children's negativity. Implications Family scientists and practitioners should consider interventions that help parents teach their children how to cope with their own stresses and emotions after conflict.
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Affiliation(s)
- Abagail L. Horton
- Department of Human Development and Family SciencesUniversity of ConnecticutStorrsConnecticutUnited States
| | - Beth S. Russell
- Department of Human Development and Family SciencesUniversity of ConnecticutStorrsConnecticutUnited States
| | - Rachel R. Tambling
- Department of Human Development and Family SciencesUniversity of ConnecticutStorrsConnecticutUnited States
| | - Preston A. Britner
- Department of Human Development and Family SciencesUniversity of ConnecticutStorrsConnecticutUnited States
| | - Morica Hutchison
- Department of Human Development and Family SciencesUniversity of ConnecticutStorrsConnecticutUnited States
| | - Alexandria J. Tomkunas
- Department of Human Development and Family SciencesUniversity of ConnecticutStorrsConnecticutUnited States
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22
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Predicting the handgrip strength across the age span: Cross-validating reference equations from the 2011 NIH toolbox norming study. J Hand Ther 2022; 35:131-141. [PMID: 33563510 DOI: 10.1016/j.jht.2020.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 09/27/2020] [Accepted: 11/24/2020] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN This is a cross-sectional observational study. BACKGROUND Reference equations for describing hand-grip strength across the age span were derived from the 2011 NIH Toolbox norming study. PURPOSE The purpose of this study was to cross-validate reference equations by evaluating its predicting power on a separate, independent data set from the 2011-2014 National Health and Nutrition Examination Survey (NHANES) study METHODS: Observed hand-grip strength data from 13,676 noninstitutionalized participants were obtained from the NHANES study. Best values (best from 3 trials) and the mean values (averaged from 3 trials) were determined for each hand. Using the age (yr), height (m), and weight (kg), we computed predicted grip strength values for dominant and nondominant hands using the reference equations. For validation, three predictability measures: the correlation coefficient, residuals, and accuracy, were used along with the Bland-Altman plot. RESULTS The predicted values highly correlated with observed values (r = 0.90, ICC = 0.89). In predicting best values, means (SD) of residuals were 1.41 (5.57) and 1.03 (5.44) kg for dominant and nondominant hands, respectively. In predicting mean values, means (SD) of residuals were -0.23 (5.42) and -0.54 (5.31) kg for dominant and nondominant hands, respectively. Root mean square error ranged from 4.10 (female's nondominant mean values) to 6.74 (male's dominant best values). About 5.56% fell outside of the 95% confidence interval of the prediction. CONCLUSIONS We acknowledged that the two studies' hand-grip protocols (NIH Toolbox, NHANES) were different. Results provided the preliminary predicting performance of the reference equations derived from the NIH Toolbox study.
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Boyne P, Doren S, Scholl V, Staggs E, Whitesel D, Carl D, Shatz R, Sawyer R, Awosika OO, Reisman DS, Billinger SA, Kissela B, Vannest J, Dunning K. Preliminary Outcomes of Combined Treadmill and Overground High-Intensity Interval Training in Ambulatory Chronic Stroke. Front Neurol 2022; 13:812875. [PMID: 35185766 PMCID: PMC8854218 DOI: 10.3389/fneur.2022.812875] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 01/11/2022] [Indexed: 12/20/2022] Open
Abstract
Purpose Locomotor high-intensity interval training (HIIT) is a promising intervention for stroke rehabilitation. However, overground translation of treadmill speed gains has been somewhat limited, some important outcomes have not been tested and baseline response predictors are poorly understood. This pilot study aimed to guide future research by assessing preliminary outcomes of combined overground and treadmill HIIT. Materials and Methods Ten participants >6 months post-stroke were assessed before and after a 4-week no-intervention control phase and a 4-week treatment phase involving 12 sessions of overground and treadmill HIIT. Results Overground and treadmill gait function both improved during the treatment phase relative to the control phase, with overground speed changes averaging 61% of treadmill speed changes (95% CI: 33–89%). Moderate or larger effect sizes were observed for measures of gait performance, balance, fitness, cognition, fatigue, perceived change and brain volume. Participants with baseline comfortable gait speed <0.4 m/s had less absolute improvement in walking capacity but similar proportional and perceived changes. Conclusions These findings reinforce the potential of locomotor HIIT research for stroke rehabilitation and provide guidance for more definitive studies. Based on the current results, future locomotor HIIT studies should consider including: (1) both overground and treadmill training; (2) measures of cognition, fatigue and brain volume, to complement typical motor and fitness assessment; and (3) baseline gait speed as a covariate.
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Affiliation(s)
- Pierce Boyne
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, OH, United States
- *Correspondence: Pierce Boyne
| | - Sarah Doren
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, OH, United States
| | - Victoria Scholl
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, OH, United States
| | - Emily Staggs
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, OH, United States
| | - Dustyn Whitesel
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, OH, United States
| | - Daniel Carl
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, OH, United States
| | - Rhonna Shatz
- Department of Neurology and Rehabilitation Medicine, College of Medicine, University of Cincinnati, Cincinnati, OH, United States
| | - Russell Sawyer
- Department of Neurology and Rehabilitation Medicine, College of Medicine, University of Cincinnati, Cincinnati, OH, United States
| | - Oluwole O. Awosika
- Department of Neurology and Rehabilitation Medicine, College of Medicine, University of Cincinnati, Cincinnati, OH, United States
| | - Darcy S. Reisman
- Department of Physical Therapy, College of Health Sciences, University of Delaware, Newark, DE, United States
| | - Sandra A. Billinger
- Department of Physical Therapy and Rehabilitation Science, School of Health Professions, University of Kansas Medical Center, Kansas City, KS, United States
| | - Brett Kissela
- Department of Neurology and Rehabilitation Medicine, College of Medicine, University of Cincinnati, Cincinnati, OH, United States
| | - Jennifer Vannest
- Department of Communication Sciences and Disorders, College of Allied Health Sciences, University of Cincinnati, Cincinnati, OH, United States
| | - Kari Dunning
- Department of Rehabilitation, Exercise and Nutrition Sciences, College of Allied Health Sciences, University of Cincinnati, Cincinnati, OH, United States
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Wade NE, McCabe CJ, Wallace AL, Gonzalez MR, Hoh E, Infante MA, Mejia MH, Haist F. Clouding up cognition?: Secondhand cannabis and tobacco exposure related to cognitive functioning in youth. BIOLOGICAL PSYCHIATRY GLOBAL OPEN SCIENCE 2022; 3:233-242. [PMID: 37124351 PMCID: PMC10140452 DOI: 10.1016/j.bpsgos.2022.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 01/27/2022] [Accepted: 01/29/2022] [Indexed: 11/30/2022] Open
Abstract
Background Increasing legalization of cannabis, in addition to longstanding rates of tobacco use, raises concerns for possible cognitive decrements from secondhand smoke or environmental exposure, although little research exists. We investigate the relation between cognition and secondhand and environmental cannabis and tobacco exposure in youth. Methods The Adolescent Brain Cognitive Development (ABCD) Study year 2 follow-up (N = 5580; 48% female) cognitive performance and secondhand or environmental cannabis or tobacco exposure data were used. Principal components analysis identified a global cognition factor. Linear mixed-effects models assessed global cognition and individual cognitive task performance by cannabis and/or tobacco environmental exposure. Sociodemographics and other potential confounds were examined. p values were adjusted using the false discovery rate method. Results Global cognition was not related to any exposure group after testing corrections and considering confounds. Beyond covariates and family- and site-level factors, secondhand tobacco was related to poorer visual memory (p = .02), and environmental tobacco was associated with poorer visuospatial (p = .02) and language (p = .008) skills. Secondhand cannabis was related to cognition, but not after controlling for potential confounders (p > .05). Environmental cannabis was related to better oral reading (p = .01). Including covariates attenuated effect sizes. Conclusions Secondhand tobacco exposure was associated with poorer visual memory, while environmental tobacco exposure was related to poorer language and visuospatial skills. Secondhand cannabis was not related to cognition after controlling for sociodemographic factors, but environmental cannabis exposure was related to better reading. Because, to our knowledge, this is the first known study of its kind and thus preliminary, secondhand cannabis should continue to be investigated to confirm results.
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Affiliation(s)
- Natasha E. Wade
- Department of Psychiatry, University of California San Diego, San Diego, California
- Address correspondence to Natasha E. Wade, Ph.D.
| | - Connor J. McCabe
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Washington
| | - Alexander L. Wallace
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin
| | - Marybel R. Gonzalez
- Department of Psychiatry, University of California San Diego, San Diego, California
| | - Eunha Hoh
- School of Public Health, San Diego State University, San Diego, California
| | - M. Alejandra Infante
- Department of Psychiatry, University of California San Diego, San Diego, California
| | - Margie Hernandez Mejia
- San Diego State University/University of California San Diego Joint Doctoral Program in Clinical Psychology, San Diego, California
| | - Frank Haist
- Department of Psychiatry, University of California San Diego, San Diego, California
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Russell BS, Tomkunas AJ, Hutchison M, Tambling RR, Horton AL. The Protective Role of Parent Resilience on Mental Health and the Parent-Child Relationship During COVID-19. Child Psychiatry Hum Dev 2022; 53:183-196. [PMID: 34533667 PMCID: PMC8447807 DOI: 10.1007/s10578-021-01243-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/05/2021] [Indexed: 12/24/2022]
Abstract
The COVID-19 pandemic is linked to particularly potent psychological effects for children and their caregivers while families adjust to new daily routines for work, education, and self-care. Longitudinal associations are presented from a national sample of 271 parents (mean age = 35.29 years, 48.5% female) on resilience, mental health and stress indicators, and parenting outcomes. Multigroup path model results indicate significant associations between resilience and parent stress or parent perceived child stress initiates a sequence of significant linkages to parent depression, followed by caregiver burden and parent-child relationship quality. This final set of linkages between depression and both parenting outcomes were significantly stronger for men, who also reported higher rates of perceived child stress. Results suggest that fathers' depression symptoms and associated spill-over to perceived child stress is producing stronger effects on their parenting experiences than effects reported by mothers.
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Affiliation(s)
- Beth S Russell
- Department of Human Development & Family Sciences, University of Connecticut, 348 Mansfield Rd. U-1058, Storrs, CT, 06269, USA.
| | - Alexandria J Tomkunas
- Department of Human Development & Family Sciences, University of Connecticut, 348 Mansfield Rd. U-1058, Storrs, CT, 06269, USA
| | - Morica Hutchison
- Department of Human Development & Family Sciences, University of Connecticut, 348 Mansfield Rd. U-1058, Storrs, CT, 06269, USA
| | - Rachel R Tambling
- Department of Human Development & Family Sciences, University of Connecticut, 348 Mansfield Rd. U-1058, Storrs, CT, 06269, USA
| | - Abagail L Horton
- Department of Human Development & Family Sciences, University of Connecticut, 348 Mansfield Rd. U-1058, Storrs, CT, 06269, USA
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Karr JE, Mindt MR, Iverson GL. Assessing Cognitive Decline in High-Functioning Spanish-Speaking Patients: High Score Base Rates on the Spanish-Language NIH Toolbox Cognition Battery. Arch Clin Neuropsychol 2021; 37:939-951. [PMID: 34973058 PMCID: PMC9297149 DOI: 10.1093/arclin/acab097] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/09/2021] [Indexed: 01/02/2023] Open
Abstract
OBJECTIVE Prior research has focused on the normal frequency of obtaining low scores on a neuropsychological test battery, but few studies have examined the normal frequency of obtaining high scores. This study involved the preparation of high score multivariate base rates for the Spanish-language National Institutes of Health (NIH) Toolbox Cognition Battery (NIHTB-CB). METHOD Participants included 250 healthy Latinx adults (age range: 19-80) from the Spanish-language NIHTB-CB normative sample who completed the full battery (two crystallized and four fluid cognition tests). Multivariate base rates, stratified by education, crystallized ability, and sociocultural characteristics, quantified the frequency at which participants obtained one or more "high" fluid test scores (i.e., ≥50th, ≥63rd, ≥75th, ≥84th, ≥91st, ≥95th, and ≥ 98th percentile). RESULTS It was common for participants to obtain one or more high scores (i.e., 50.8% obtained one or more scores ≥84th percentile) and uncommon for participants to obtain "no" high scores, especially when using non-conventional thresholds for defining a high score (i.e., 10.8% obtained no scores ≥50th percentile). High scores were more commonly obtained by participants with greater education and higher crystallized ability, who were bilingual, born and educated within the United States, and from higher income households. CONCLUSIONS This study demonstrated that participants administered multiple neuropsychological tests commonly obtain high scores, and that the frequency of high scores varies by education, crystallized ability, and sociocultural characteristics. The absence of high scores may be indicative of cognitive impairment among examinees who are higher functioning, have greater education, and have specific sociocultural characteristics (e.g., bilingualism, higher socioeconomic status).
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Affiliation(s)
- Justin E Karr
- Corresponding author at: Ph.D. via post at Department of Psychology, University of Kentucky, 171 Funkhouser Drive, 012D Kastle Hall, Lexington, KY 40506-0044. E-mail address: (Justin E. Karr)
| | - Monica Rivera Mindt
- Department of Psychology and Latin American and Latino Studies Institute, Fordham University, New York, NY, USA,Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Grant L Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA,Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Charlestown, MA, USA,Spaulding Research Institute, Charlestown, MA, USA,Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Charlestown, MA, USA
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Darling AM, Richey RE, Akins JD, Saunders EFH, Matthew Brothers R, Greaney JL. Cerebrovascular reactivity is blunted in young adults with major depressive disorder: The influence of current depressive symptomology. J Affect Disord 2021; 295:513-521. [PMID: 34509066 PMCID: PMC8667006 DOI: 10.1016/j.jad.2021.08.061] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 08/20/2021] [Accepted: 08/24/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND In middle-aged adults with depression, cerebral vasodilatory reactivity is blunted; however, this has not been examined in treatment-naïve young adults with major depressive disorder (MDD). We tested the hypothesis that cerebrovascular reactivity would be blunted in young adults (18-30 yrs) with MDD compared to healthy non-depressed adults (HA) and would be attenuated to a greater extent in adults with symptomatic MDD (sMDD) compared to adults with MDD in remission (euthymic MDD; eMDD). METHODS Sixteen adults with MDD [21±3yrs; n = 8 sMDD (6 women); n = 8 eMDD (5 women)] and 14 HA (22±3yrs; 9 women) participated. End-tidal carbon dioxide concentration (PETCO2; capnograph), beat-to-beat mean arterial pressure (MAP; finger photoplethysmography), middle cerebral artery blood velocity (MCAv; transcranial Doppler ultrasound), and internal carotid artery (ICA) diameter and blood velocity (Doppler ultrasound) were continuously measured during baseline and rebreathing-induced hypercapnia. Cerebrovascular reactivity was calculated as the relative increase in vascular conductance during hypercapnia. RESULTS In adults with MDD, cerebrovascular reactivity in the MCA (∆39±9 HA vs. ∆31±13% MDD, p = 0.04), but not the ICA (∆36±24 HA vs. ∆34±18% MDD, p = 0.84), was blunted compared to HA. In the MCA, cerebrovascular reactivity was reduced in adults with sMDD compared to adults with eMDD (∆36±11 eMDD vs. ∆25±13% sMDD, p = 0.02). LIMITATIONS The cross-sectional nature approach limits conclusions regarding the temporal nature of this link. CONCLUSION These data indicate that MCA cerebrovascular reactivity is blunted in young adults with MDD and further modulated by current depressive symptomology, suggesting that the management of depressive symptomology may secondarily improve cerebrovascular health.
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Affiliation(s)
- Ashley M Darling
- Department of Kinesiology, The University of Texas at Arlington, 655W. Mitchell Street, Arlington, TX 76010, United States
| | - Rauchelle E Richey
- Department of Kinesiology, The University of Texas at Arlington, 655W. Mitchell Street, Arlington, TX 76010, United States; Department of Integrative Physiology, University of North Texas Health Science Center at Fort Worth, Fort Worth, TX, United States
| | - John D Akins
- Department of Kinesiology, The University of Texas at Arlington, 655W. Mitchell Street, Arlington, TX 76010, United States
| | - Erika F H Saunders
- Department of Psychiatry and Behavioral Health, Penn State College of Medicine, Hershey, PA, United States
| | - R Matthew Brothers
- Department of Kinesiology, The University of Texas at Arlington, 655W. Mitchell Street, Arlington, TX 76010, United States
| | - Jody L Greaney
- Department of Kinesiology, The University of Texas at Arlington, 655W. Mitchell Street, Arlington, TX 76010, United States.
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Iverson GL, Karr JE. Improving the Methodology for Identifying Mild Cognitive Impairment in Intellectually High-Functioning Adults Using the NIH Toolbox Cognition Battery. Front Psychol 2021; 12:724888. [PMID: 34566807 PMCID: PMC8457516 DOI: 10.3389/fpsyg.2021.724888] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 08/12/2021] [Indexed: 11/27/2022] Open
Abstract
Objective: Low scores on neuropsychological tests are considered objective evidence of mild cognitive impairment. In clinical practice and research, it can be challenging to identify a cognitive deficit or mild cognitive impairment in high-functioning people because they are much less likely to obtain low test scores. This study was designed to improve the methodology for identifying mild cognitive impairment in adults who have above average or superior intellectual abilities. Method: Participants completed the National Institutes of Health Toolbox for the Assessment of Neurological and Behavioral Function Cognition Battery (NIHTB-CB). The sample included 384 adults between the ages of 20 and 85 who had completed either a 4-year college degree or who scored in the above average, superior, or very superior range on a measure of intellectual functioning, the Crystallized Composite score. Algorithms were developed, based on the absence of high scores and the presence of low scores, for identifying mild cognitive impairment. Results: Base rate tables for the presence of low scores and the absence of high scores are provided. The base rate for people with high average crystalized ability obtaining any one of the following, 5 scores <63rd percentile, or 4+ scores <50th percentile, or 3+ scores ≤ 25th percentile, or 2+ scores ≤ 16th percentile, is 15.5%. Conclusions: Algorithms were developed for identifying cognitive weakness or impairment in high-functioning people. Research is needed to test them in clinical groups, and to assess their association with clinical risk factors for cognitive decline and biomarkers of acquired neurological or neurodegenerative diseases.
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Affiliation(s)
- Grant L Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, United States.,Spaulding Rehabilitation Hospital and Spaulding Research Institute, Charlestown, MA, United States.,Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Charlestown, MA, United States
| | - Justin E Karr
- Department of Psychology, University of Kentucky, Lexington, KY, United States
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Karr JE, Mindt MR, Iverson GL. A Multivariate Interpretation of the Spanish-Language NIH Toolbox Cognition Battery: The Normal Frequency of Low Scores. Arch Clin Neuropsychol 2021; 37:338-351. [PMID: 34327533 DOI: 10.1093/arclin/acab064] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2021] [Revised: 05/24/2021] [Accepted: 07/13/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE The current study involved the preparation of multivariate base rates for the Spanish-language NIH Toolbox Cognition Battery (NIHTB-CB) based on the U.S. normative sample, quantifying the normal frequency of low scores among healthy adults. METHOD Participants included 250 healthy Latinx adults (M = 38.8 ± 13.7 years old, range: 19-80; 72.0% women; education: M = 11.5 ± 3.9 years) who completed the full Spanish-language NIHTB-CB, including two tests of crystallized cognition and five tests of fluid cognition. Multivariate base rates quantified the frequency at which participants obtained 1 or more fluid scores ≤25th, ≤16th, ≤9th, ≤5th, and ≤2nd percentile, per age-adjusted or demographically adjusted (age, gender, education) normed scores. RESULTS A substantial minority of participants had 1 or more low scores (e.g., 40.4% had 1 or more age-adjusted score ≤16th percentile). The frequencies of low scores increased with fewer years of education and lower crystallized cognitive ability. Higher frequencies of low scores were observed among participants who were born and educated abroad, versus within the USA; monolingual Spanish speakers, versus bilingual Spanish/English speakers; and from households below the national median income, versus households above the national median. CONCLUSION Low scores were common and related to crystallized ability, education, and sociocultural variables. Although using demographically adjusted scores reduced group differences related to sociocultural variables, group differences were not eliminated, indicating that age, gender, and education score adjustments do not fully explain the associations between sociocultural variables and test performances. These stratified base rates may be useful when working with Spanish-speaking patients with diverse sociocultural characteristics.
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Affiliation(s)
- Justin E Karr
- Department of Psychology, University of Kentucky, Lexington, KY, USA
| | - Monica Rivera Mindt
- Department of Psychology and Latin American and Latino Studies Institute, Fordham University, New York, NY, USA.,Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Grant L Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Charlestown, MA, USA.,Spaulding Rehabilitation Hospital and Spaulding Rehabilitation Institute, Charlestown, MA, USA.,Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Charlestown, MA, USA
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Shapiro ALB, Dabelea D, Stafford JM, D'Agostino R, Pihoker C, Liese AD, Shah AS, Bellatorre A, Lawrence JM, Henkin L, Saydah S, Wilkening G. Cognitive Function in Adolescents and Young Adults With Youth-Onset Type 1 Versus Type 2 Diabetes: The SEARCH for Diabetes in Youth Study. Diabetes Care 2021; 44:1273-1280. [PMID: 33905344 PMCID: PMC8247514 DOI: 10.2337/dc20-2308] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Accepted: 03/11/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Poor cognition has been observed in children and adolescents with youth-onset type 1 (T1D) and type 2 diabetes (T2D) compared with control subjects without diabetes. Differences in cognition between youth-onset T1D and T2D, however, are not known. Thus, using data from SEARCH for Diabetes in Youth, a multicenter, observational cohort study, we tested the association between diabetes type and cognitive function in adolescents and young adults with T1D (n = 1,095) or T2D (n = 285). RESEARCH DESIGN AND METHODS Cognition was assessed via the National Institutes of Health Toolbox Cognition Battery, and age-corrected composite Fluid Cognition scores were used as the primary outcome. Confounder-adjusted linear regression models were run. Model 1 included diabetes type and clinical site. Model 2 additionally included sex, race/ethnicity, waist-to-height ratio, diabetes duration, depressive symptoms, glycemic control, any hypoglycemic episode in the past year, parental education, and household income. Model 3 additionally included the Picture Vocabulary score, a measure of receptive language and crystallized cognition. RESULTS Having T2D was significantly associated with lower fluid cognitive scores before adjustment for confounders (model 1; P < 0.001). This association was attenuated to nonsignificance with the addition of a priori confounders (model 2; P = 0.06) and Picture Vocabulary scores (model 3; P = 0.49). Receptive language, waist-to-height ratio, and depressive symptoms remained significant in the final model (P < 0.01 for all, respectively). CONCLUSIONS These data suggest that while youth with T2D have worse fluid cognition than youth with T1D, these differences are accounted for by differences in crystallized cognition (receptive language), central adiposity, and mental health. These potentially modifiable factors are also independently associated with fluid cognitive health, regardless of diabetes type. Future studies of cognitive health in people with youth-onset diabetes should focus on investigating these significant factors.
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Affiliation(s)
- Allison L B Shapiro
- Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO .,Lifecourse Epidemiology of Adiposity and Diabetes Center, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Dana Dabelea
- Department of Pediatrics, School of Medicine, University of Colorado Anschutz Medical Campus, Aurora, CO.,Lifecourse Epidemiology of Adiposity and Diabetes Center, University of Colorado Anschutz Medical Campus, Aurora, CO.,Department of Epidemiology, Colorado School of Public Health, Anschutz Medical Campus, Aurora, CO
| | - Jeanette M Stafford
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC
| | | | | | - Angela D Liese
- Department of Epidemiology and Biostatistics, Arnold School of Public Health, University of South Carolina, Columbia, SC
| | - Amy S Shah
- Department of Pediatrics, Cincinnati Children's Hospital Medical Center and The University of Cincinnati, Cincinnati, OH
| | - Anna Bellatorre
- Lifecourse Epidemiology of Adiposity and Diabetes Center, University of Colorado Anschutz Medical Campus, Aurora, CO
| | - Jean M Lawrence
- Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA
| | - Leora Henkin
- Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC
| | - Sharon Saydah
- Division of Diabetes Translation, Centers for Disease Control and Prevention, Atlanta, GA
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Katzan I, Schuster A, Kinzy T. Physical Activity Monitoring Using a Fitbit Device in Ischemic Stroke Patients: Prospective Cohort Feasibility Study. JMIR Mhealth Uhealth 2021; 9:e14494. [PMID: 33464213 PMCID: PMC7854036 DOI: 10.2196/14494] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 05/01/2020] [Accepted: 05/13/2020] [Indexed: 12/12/2022] Open
Abstract
Background Continuous tracking of ambulatory activity in real-world settings using step activity monitors has many potential uses. However, feasibility, accuracy, and correlation with performance measures in stroke patients have not been well-established. Objective The primary study objective was to determine adherence with wearing a consumer-grade step activity monitor, the Fitbit Charge HR, in home-going ischemic stroke patients during the first 90 days after hospital discharge. Secondary objectives were to (1) determine accuracy of step counts of the Fitbit Charge HR compared with a manual tally; (2) calculate correlations between the Fitbit step counts and the mobility performance scores at discharge and 30 days after stroke; (3) determine variability and change in weekly step counts over 90 days; and (4) evaluate patient experience with using the Fitbit Charge HR poststroke. Methods A total of 15 participants with recent mild ischemic stroke wore a Fitbit Charge HR for 90 days after discharge and completed 3 mobility performance tests from the National Institutes of Health Toolbox at discharge and Day 30: (1) Standing Balance Test, (2) 2-Minute Walk Endurance Test, and (3) 4-Meter Walk Gait Speed Test. Accuracy of step activity monitors was assessed by calculating differences in steps recorded on the step activity monitor and a manual tally during 2-minute walk tests. Results Participants had a mean age of 54 years and a median modified Rankin scale score of 1. Mean daily adherence with step activity monitor use was 83.6%. Mean daily step count in the first week after discharge was 4376. Daily step counts increased slightly during the first 30 days after discharge (average increase of 52.5 steps/day; 95% CI 32.2-71.8) and remained stable during the 30-90 day period after discharge. Mean step count difference between step activity monitor and manual tally was –4.8 steps (–1.8%). Intraclass correlation coefficients for step counts and 2-minute walk, standing balance, and 4-meter gait speed at discharge were 0.41 (95% CI –0.14 to 0.75), –0.12 (95% CI –0.67 to 0.64), and 0.17 (95% CI –0.46 to 0.66), respectively. Values were similarly poor at 30 days. Conclusions The use of consumer-grade Fitbit Charge HR in patients with recent mild stroke is feasible with reasonable adherence and accuracy. There was poor correlation between step counts and gait speed, balance, and endurance. Further research is needed to evaluate the association between step counts and other outcomes relevant to patients, including patient-reported outcomes and measures of physical function.
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Affiliation(s)
- Irene Katzan
- Neurological Institute Center for Outcomes Research and Evaluation, Cleveland Clinic, Cleveland, OH, United States.,Cerebrovascular Center, Cleveland Clinic, Cleveland, OH, United States
| | - Andrew Schuster
- Neurological Institute Center for Outcomes Research and Evaluation, Cleveland Clinic, Cleveland, OH, United States
| | - Tyler Kinzy
- Neurological Institute Center for Outcomes Research and Evaluation, Cleveland Clinic, Cleveland, OH, United States
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Evans EA, Cook NE, Iverson GL, Townsend EL, Duhaime AC. Assessing Physical Function and Mobility following Pediatric Traumatic Brain Injury with the NIH Toolbox Motor Battery: A Feasibility Study. Phys Occup Ther Pediatr 2021; 41:56-73. [PMID: 32396483 PMCID: PMC7657981 DOI: 10.1080/01942638.2020.1758985] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
AIMS Traumatic brain injury (TBI) can impair physical function in children. The NIH Toolbox Motor Battery (NIHTB-M) was designed to be a brief assessment of physical function, but no studies have examined its use in children with TBI. This study aims to describe the feasibility of using the NIHTB-M to assess children with TBI. METHODS The NIHTB-M was administered to children with TBI 2 weeks (n = 22) and/or 6 months (n = 23) following injury. This descriptive study summarizes participant performance, administration challenges, and the association between NIHTB-M scores, participant characteristics, and subjective report of physical function. RESULTS Of the NIHTB-M domains, deficits in endurance and balance were most prevalent. Children aged 5 to 16 years could complete the assessment per administration guidelines, except for a few cases (n = 3) where orthopedic injuries limited participation. Younger children (aged 3 to 4) had difficulty following the NIHTB-M directions. Technological issues impacted balance assessment in several cases (n = 6). CONCLUSION The NIHTB-M is brief to administer, generally well tolerated by school-aged children and, despite occasional technological challenges, is a feasible performance-based battery for assessment of children with TBI for clinical and research purposes. Additional investigation of psychometric properties and ceiling and floor effects is needed.
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Affiliation(s)
- Emily A Evans
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA.,Center for Gerontology and Healthcare Research, Brown University, Rhode Island, USA
| | - Nathan E Cook
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA.,MassGeneral Hospital for Children™ Sports Concussion Program, Massachusetts General Hospital, Boston, Massachusetts, USA.,Spaulding Rehabilitation Hospital, Boston, Massachusetts, USA
| | - Grant L Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts, USA.,MassGeneral Hospital for Children™ Sports Concussion Program, Massachusetts General Hospital, Boston, Massachusetts, USA.,Spaulding Rehabilitation Hospital and Spaulding Research Institute, Boston, Massachusetts, USA.,Home Base, A Red Sox Foundation and Massachusetts General Hospital Program, Boston, Massachusetts, USA
| | - Elise L Townsend
- Department of Physical Therapy, School of Health and Rehabilitation Sciences, MGH Institute of Health Professions, Boston, Massachusetts, USA
| | - Ann-Christine Duhaime
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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- San Francisco General Hospital and Trauma Center, University of California, San Francisco, California, USA
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Curiel Cid RE, Crocco EA, Kitaigorodsky M, Beaufils L, Peña PA, Grau G, Visser U, Loewenstein DA. A Novel Computerized Cognitive Stress Test to Detect Mild Cognitive Impairment. J Prev Alzheimers Dis 2021; 8:135-141. [PMID: 33569559 PMCID: PMC10026190 DOI: 10.14283/jpad.2021.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND The Loewenstein Acevedo Scales of Semantic Interference and Learning (LASSI-L) is a novel and increasingly employed instrument that has outperformed widely used cognitive measures as an early correlate of elevated brain amyloid and neurodegeneration in prodromal Alzheimer's Disease (AD). The LASSI-L has distinguished those with amnestic mild cognitive impairment (aMCI) and high amyloid load from aMCI attributable to other non-AD conditions. The authors designed and implemented a web-based brief computerized version of the instrument, the LASSI-BC, to improve standardized administration, facilitate scoring accuracy, real-time data entry, and increase the accessibility of the measure. OBJECTIVE The psychometric properties and clinical utility of the brief computerized version of the LASSI-L was evaluated, together with its ability to differentiate older adults who are cognitively normal (CN) from those with amnestic Mild Cognitive Impairment (aMCI). METHODS After undergoing a comprehensive uniform clinical and neuropsychological evaluation using traditional measures, older adults were classified as cognitively normal or diagnosed with aMCI. All participants were administered the LASSI-BC, a computerized version of the LASSI-L. Test-retest and discriminant validity was assessed for each LASSI-BC subscale. RESULTS LASSI-BC subscales demonstrated high test-retest reliability, and discriminant validity was attained. CONCLUSIONS The LASSI-BC, a brief computerized version of the LASSI-L is a valid and useful cognitive tool for the detection of aMCI among older adults.
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Affiliation(s)
- R E Curiel Cid
- Rosie E. Curiel, Psy.D., Associate Professor of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, 1695 NW 9th Avenue, Suite 3202, Miami, FL 33136.
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Meredith LR, Lim AC, Ray LA. Neurocognitive performance in alcohol use disorder using the NIH toolbox: Role of severity and sex differences. Drug Alcohol Depend 2020; 216:108269. [PMID: 32906037 PMCID: PMC7972314 DOI: 10.1016/j.drugalcdep.2020.108269] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 08/05/2020] [Accepted: 08/26/2020] [Indexed: 01/09/2023]
Abstract
AIMS Sustained heavy alcohol consumption is associated with a range of neurocognitive deficits. Yet, past research centers on a severe profile of alcohol use disorder (AUD), with persons recruited from in-patient settings. The current project aims to compare neurocognitive performance between individuals seeking AUD outpatient treatment with healthy comparisons while considering the association between performance, disorder severity, and sex. METHODS Enrollment included two matched groups (N = 125; 34 % female): 77 treatment-seeking individuals with AUD; 48 healthy comparison individuals with low drinking patterns. Neurocognitive performance on NIH Toolbox subtests measuring attention, inhibition, episodic memory, working memory, language, and processing speed were compared across groups. Within the AUD group, analyses examined the relationship between performance, disorder severity, recent alcohol consumption, and sex. RESULTS AUD group did not perform significantly lower than healthy comparisons on neurocognition subtests assessed. Within AUD group, females displayed significantly higher processing speeds than males (p = .007). Disorder severity and alcohol consumption were not significantly related to performance. However, a significant interaction between disorder severity and sex emerged (p = .010), with higher severity associated with poorer performance in males but not females, on a subtest measuring attention and inhibition. CONCLUSIONS Effect of heavy alcohol use on neurocognitive performance was not detected in this outpatient AUD sample. Weaknesses in domains of attention and inhibition may be correlated with AUD severity among males, but not females. Further research on AUD severity and sex in understanding individual differences in neurocognition is warranted, particularly using novel tools for large scale phenotyping, such as the NIH Toolbox.
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Affiliation(s)
| | - Aaron C. Lim
- Department of Psychology, University of California, Los Angeles, CA, USA
| | - Lara A. Ray
- Department of Psychology, University of California, Los Angeles, CA, USA,Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA,Corresponding author at: University of California Los Angeles, Department of Psychology, 1285 Franz Hall, Box 951563, Los Angeles, CA 90095-1563, USA. (L.A. Ray)
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Kiselica AM, Webber TA, Benge JF. Using multivariate base rates of low scores to understand early cognitive declines on the uniform data set 3.0 Neuropsychological Battery. Neuropsychology 2020; 34:629-640. [PMID: 32338945 PMCID: PMC7484046 DOI: 10.1037/neu0000640] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
OBJECTIVE Low neuropsychological test scores are commonly observed even in cognitively healthy older adults. For batteries designed to assess for and track cognitive decline in older adults, documenting the multivariate base rates (MBRs) of low scores is important to differentiate expected from abnormal low score patterns. Additionally, it is important for our understanding of mild cognitive impairment and preclinical declines to and determine how such score patterns predict future clinical states. METHOD The current study utilized Uniform Data Set Neuropsychological Battery 3.0 (UDS3NB) data for 5,870 English-speaking, older adult participants from the National Alzheimer's Coordinating Center from 39 Alzheimer's disease Research Centers from March 2015 to December 2018. MBRs of low scores were identified for 2,608 cognitively healthy participants that had completed all cognitive measures. The association of abnormal MBR patterns with subsequent conversion to mild cognitive impairment and dementia were explored. RESULTS Depending on the operationalization of "low" score, the MBR of demographically adjusted scores ranged from 1.40 to 79.2%. Posttest probabilities using MBR methods to predict dementia status at 2-year follow up ranged from .06 to .33, while posttest probabilities for conversion to mild cognitive impairment (MCI) ranged from .12-.32. CONCLUSIONS The data confirm that abnormal cognitive test scores are common among cognitively normal older adults. Using MBR criteria may improve our understanding of MCI. They may also be used to enrich clinical trial selection processes through recruitment of at-risk individuals. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Affiliation(s)
| | - Troy A Webber
- Mental Health Care Line, Michael E. DeBakey VA Medical Center
| | - Jared F Benge
- Department of Neurology, Baylor Scott and White Health
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Brunt VE, LaRocca TJ, Bazzoni AE, Sapinsley ZJ, Miyamoto-Ditmon J, Gioscia-Ryan RA, Neilson AP, Link CD, Seals DR. The gut microbiome-derived metabolite trimethylamine N-oxide modulates neuroinflammation and cognitive function with aging. GeroScience 2020; 43:377-394. [PMID: 32862276 DOI: 10.1007/s11357-020-00257-2] [Citation(s) in RCA: 79] [Impact Index Per Article: 19.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 08/18/2020] [Indexed: 12/13/2022] Open
Abstract
Aging is associated with declines in cognitive performance, which are mediated in part by neuroinflammation, characterized by astrocyte activation and higher levels of pro-inflammatory cytokines; however, the upstream drivers are unknown. We investigated the potential role of the gut microbiome-derived metabolite trimethylamine N-oxide (TMAO) in modulating neuroinflammation and cognitive function with aging. Study 1: In middle-aged and older humans (65 ± 7 years), plasma TMAO levels were inversely related to performance on NIH Toolbox Cognition Battery tests of memory and fluid cognition (both r2 = 0.07, p < 0.05). Study 2: In mice, TMAO concentrations in plasma and the brain increased in parallel with aging (r2 = 0.60), suggesting TMAO crosses the blood-brain barrier. The greater TMAO concentrations in old mice (27 months) were associated with higher brain pro-inflammatory cytokines and markers of astrocyte activation vs. young adult mice (6 months). Study 3: To determine if TMAO independently induces an "aging-like" decline in cognitive function, young mice (6 months) were supplemented with TMAO in chow for 6 months. Compared with controls, TMAO-supplemented mice performed worse on the novel object recognition test, indicating impaired memory and learning, and had increased neuroinflammation and markers of astrocyte activation. Study 4: Human astrocytes cultured with TMAO vs. control media exhibited changes in cellular morphology and protein markers consistent with astrocyte activation, indicating TMAO directly acts on these cells. Our results provide translational insight into a novel pathway that modulates neuroinflammation and cognitive function with aging, and suggest that TMAO might be a promising target for prevention of neuroinflammation and cognitive decline with aging.
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Affiliation(s)
- Vienna E Brunt
- Department of Integrative Physiology, University of Colorado Boulder, 1725 Pleasant St, 354 UCB, Boulder, CO, 80309, USA
| | - Thomas J LaRocca
- Department of Integrative Physiology, University of Colorado Boulder, 1725 Pleasant St, 354 UCB, Boulder, CO, 80309, USA
- Department of Health and Exercise Science and the Center for Healthy Aging, Colorado State University, Fort Collins, CO, USA
| | - Amy E Bazzoni
- Department of Integrative Physiology, University of Colorado Boulder, 1725 Pleasant St, 354 UCB, Boulder, CO, 80309, USA
| | - Zachary J Sapinsley
- Department of Integrative Physiology, University of Colorado Boulder, 1725 Pleasant St, 354 UCB, Boulder, CO, 80309, USA
| | - Jill Miyamoto-Ditmon
- Department of Integrative Physiology, University of Colorado Boulder, 1725 Pleasant St, 354 UCB, Boulder, CO, 80309, USA
| | - Rachel A Gioscia-Ryan
- Department of Integrative Physiology, University of Colorado Boulder, 1725 Pleasant St, 354 UCB, Boulder, CO, 80309, USA
| | - Andrew P Neilson
- Department of Food Science and Technology, Virginia Tech, Blacksburg, VA, USA
- Plants for Human Health Institute, Department of Food, Bioprocessing and Nutrition Sciences, North Carolina State University, Kannapolis, NC, USA
| | - Christopher D Link
- Department of Integrative Physiology, University of Colorado Boulder, 1725 Pleasant St, 354 UCB, Boulder, CO, 80309, USA
| | - Douglas R Seals
- Department of Integrative Physiology, University of Colorado Boulder, 1725 Pleasant St, 354 UCB, Boulder, CO, 80309, USA.
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Gershon RC, Fox RS, Manly JJ, Mungas DM, Nowinski CJ, Roney EM, Slotkin J. The NIH Toolbox: Overview of Development for Use with Hispanic Populations. J Int Neuropsychol Soc 2020; 26:567-575. [PMID: 32063249 PMCID: PMC7319898 DOI: 10.1017/s1355617720000028] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Hispanics/Latinos are the largest and fastest-growing minority population in the United States. To facilitate appropriate outcome assessment of this expanding population, the NIH Toolbox for Assessment of Neurological and Behavioral Function® (NIH Toolbox®) was developed with particular attention paid to the cultural and linguistic needs of English- and Spanish-speaking Hispanics/Latinos. METHODS A Cultural Working Group ensured that all included measures were appropriate for use with Hispanics/Latinos in both English and Spanish. In addition, a Spanish Language Working Group assessed all English-language NIH Toolbox measures for translatability. RESULTS Measures were translated following the Functional Assessment of Chronic Illness Therapy (FACIT) translation methodology for instances where language interpretation could impact scores, or a modified version thereof for more simplified translations. The Spanish versions of the NIH Toolbox Cognition Battery language measures (i.e., Picture Vocabulary Test, Oral Reading Recognition Test) were developed independently of their English counterparts. CONCLUSIONS The Spanish-language version of the NIH Toolbox provides a much-needed set of tools that can be selected as appropriate to complement existing protocols being conducted with the growing Hispanic/Latino population in the United States.
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Affiliation(s)
- Richard C. Gershon
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Rina S. Fox
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jennifer J. Manly
- Taub Institute for Research on Alzheimer's Disease and the Aging Brain, Department of Neurology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Dan M. Mungas
- Department of Neurology, University of California, Davis, Davis, CA, USA
| | - Cindy J. Nowinski
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Ellen M. Roney
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jerry Slotkin
- The Center for Health Assessment Research and Translation, University of Delaware, Newark, DE, USA
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Assessing meaning & purpose in life: development and validation of an item bank and short forms for the NIH PROMIS ®. Qual Life Res 2020; 29:2299-2310. [PMID: 32306302 DOI: 10.1007/s11136-020-02489-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2020] [Indexed: 01/07/2023]
Abstract
PURPOSE A sense of meaning and purpose is important for people living with acute and chronic illness. It can buffer the effects of stress and facilitate adaptive coping. As part of the Patient-Reported Outcomes Measurement Information System (PROMIS), we developed and validated an item response theory (IRT)-based measure of meaning and purpose in life. METHODS Informed by a literature review and patient and content-expert input, we wrote 52 items to assess meaning and purpose and administered them to a general population sample (n = 1000) along with the Meaning in Life Questionnaire-Presence of Meaning Subscale (MLQ-Presence) and the Life Engagement Test (LET). We split the sample in half for exploratory factor analysis (EFA) followed by confirmatory factor analysis (CFA). IRT analyses included assessments of differential item functioning (DIF). RESULTS Participants had a mean age of 47.8 years and 50.3% were male. EFA revealed one dominant factor and CFA yielded a good fitting model for a 37-item bank (CFI = 0.962, TLI = 0.960, RMSEA = 0.085). All items were free of sex, age, education, and race DIF. Internal consistency reliability estimates ranged from α = 0.90 (4-item short form) to α = 0.98 (37-item bank). The 8-item Meaning and Purpose short form was correlated with the MLQ-Presence (r = 0.89), the LET (r = 0.79), and the full PROMIS Meaning and Purpose item bank (r = 0.98). CONCLUSIONS The PROMIS Meaning and Purpose measures demonstrated sufficient unidimensionality and displayed good internal consistency, model fit, and convergent validity. Further psychometric testing of the PROMIS Meaning and Purpose item bank and short forms in people with chronic diseases will help evaluate the generalizability of this new tool.
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Fox RS, Manly JJ, Slotkin J, Devin Peipert J, Gershon RC. Reliability and Validity of the Spanish-Language Version of the NIH Toolbox. Assessment 2020; 28:457-471. [PMID: 32264689 DOI: 10.1177/1073191120913943] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
The psychometric properties of the English-language NIH Toolbox for Assessment of Neurological and Behavioral Function (NIH Toolbox) have been examined in numerous populations. This study evaluated the reliability and validity of the Spanish-language NIH Toolbox. Participants were children aged 3 to 7 years and adults aged 18 to 85 years who took part in the NIH Toolbox norming study in Spanish. Results supported the internal consistency reliability of included measures. Test-retest reliability was strong for most tests, though it was weaker for the test of olfaction among children and the test of locomotion among adults. Spearman's correlations and general linear models showed Spanish tests were often associated with age, sex, and education. Convergent validity for the two language measures that underwent more intensive development, evaluated via Spearman's correlations with legacy measures, was strong. Results support using the Spanish-language NIH Toolbox to measure neurological and behavioral functioning among Spanish-speaking individuals in the United States.
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Affiliation(s)
- Rina S Fox
- Northwestern University, Chicago, IL, USA
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Hubbard NA, Siless V, Frosch IR, Goncalves M, Lo N, Wang J, Bauer CCC, Conroy K, Cosby E, Hay A, Jones R, Pinaire M, Vaz De Souza F, Vergara G, Ghosh S, Henin A, Hirshfeld-Becker DR, Hofmann SG, Rosso IM, Auerbach RP, Pizzagalli DA, Yendiki A, Gabrieli JDE, Whitfield-Gabrieli S. Brain function and clinical characterization in the Boston adolescent neuroimaging of depression and anxiety study. Neuroimage Clin 2020; 27:102240. [PMID: 32361633 PMCID: PMC7199015 DOI: 10.1016/j.nicl.2020.102240] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 03/09/2020] [Accepted: 03/10/2020] [Indexed: 12/28/2022]
Abstract
We present a Human Connectome Project study tailored toward adolescent anxiety and depression. This study is one of the first studies of the Connectomes Related to Human Diseases initiative and is collecting structural, functional, and diffusion-weighted brain imaging data from up to 225 adolescents (ages 14-17 years), 150 of whom are expected to have a current diagnosis of an anxiety and/or depressive disorder. Comprehensive clinical and neuropsychological evaluations and longitudinal clinical data are also being collected. This article provides an overview of task functional magnetic resonance imaging (fMRI) protocols and preliminary findings (N = 140), as well as clinical and neuropsychological characterization of adolescents. Data collection is ongoing for an additional 85 adolescents, most of whom are expected to have a diagnosis of an anxiety and/or depressive disorder. Data from the first 140 adolescents are projected for public release through the National Institutes of Health Data Archive (NDA) with the timing of this manuscript. All other data will be made publicly-available through the NDA at regularly scheduled intervals. This article is intended to serve as an introduction to this project as well as a reference for those seeking to clinical, neurocognitive, and task fMRI data from this public resource.
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Affiliation(s)
- N A Hubbard
- Massachusetts Institute of Technology, Cambridge, MA, United States; University of Nebraska-Lincoln, Lincoln, NE, United States
| | - V Siless
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - I R Frosch
- Massachusetts Institute of Technology, Cambridge, MA, United States
| | - M Goncalves
- Massachusetts Institute of Technology, Cambridge, MA, United States
| | - N Lo
- Massachusetts Institute of Technology, Cambridge, MA, United States
| | - J Wang
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - C C C Bauer
- Massachusetts Institute of Technology, Cambridge, MA, United States
| | - K Conroy
- Boston University, Boston, MA, United States
| | - E Cosby
- Harvard Medical School, Boston, MA, United States; McLean Hospital, Belmont, MA, United States
| | - A Hay
- Boston University, Boston, MA, United States
| | - R Jones
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - M Pinaire
- Boston University, Boston, MA, United States
| | - F Vaz De Souza
- Harvard Medical School, Boston, MA, United States; Massachusetts General Hospital, Boston, MA, United States
| | - G Vergara
- Harvard Medical School, Boston, MA, United States; McLean Hospital, Belmont, MA, United States
| | - S Ghosh
- Massachusetts Institute of Technology, Cambridge, MA, United States; Harvard Medical School, Boston, MA, United States
| | - A Henin
- Harvard Medical School, Boston, MA, United States; Massachusetts General Hospital, Boston, MA, United States
| | - D R Hirshfeld-Becker
- Harvard Medical School, Boston, MA, United States; Massachusetts General Hospital, Boston, MA, United States
| | - S G Hofmann
- Boston University, Boston, MA, United States
| | - I M Rosso
- Harvard Medical School, Boston, MA, United States; McLean Hospital, Belmont, MA, United States
| | - R P Auerbach
- Columbia University, New York, NY, United States
| | - D A Pizzagalli
- Harvard Medical School, Boston, MA, United States; McLean Hospital, Belmont, MA, United States
| | - A Yendiki
- Athinoula A. Martinos Center for Biomedical Imaging, Massachusetts General Hospital, Boston, MA, United States; Harvard Medical School, Boston, MA, United States
| | - J D E Gabrieli
- Massachusetts Institute of Technology, Cambridge, MA, United States
| | - S Whitfield-Gabrieli
- Massachusetts Institute of Technology, Cambridge, MA, United States; Northeastern University, Boston, MA, United States.
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Russell BS, Hutchison M, Tambling R, Tomkunas AJ, Horton AL. Initial Challenges of Caregiving During COVID-19: Caregiver Burden, Mental Health, and the Parent-Child Relationship. Child Psychiatry Hum Dev 2020; 51:671-682. [PMID: 32749568 PMCID: PMC7398861 DOI: 10.1007/s10578-020-01037-x] [Citation(s) in RCA: 332] [Impact Index Per Article: 83.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Research confirms that the mental health burdens following community-wide disasters are extensive, with pervasive impacts noted in individuals and families. It is clear that child disaster outcomes are worst among children of highly distressed caregivers, or those caregivers who experience their own negative mental health outcomes from the disaster. The current study used path analysis to examine concurrent patterns of parents' (n = 420) experience from a national sample during the early months of the U.S. COVID-19 pandemic. The results of a multi-group path analysis, organized by parent gender, indicate good fit to the data [X2(10) = 159.04, p < .01]. Results indicate significant linkages between parents' caregiver burden, mental health, and perceptions of children's stress; these in turn are significantly linked to child-parent closeness and conflict, indicating possible spillover effects for depressed parents and compensatory effects for anxious parents. The impact of millions of families sheltering in place during the COVID-19 pandemic for an undefined period of time may lead to unprecedented impacts on individuals' mental health with unknown impacts on child-parent relationships. These impacts may be heightened for families whose caregivers experience increased mental health symptoms, as was the case for fathers in the current sample.
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Affiliation(s)
- B S Russell
- Department of Human Development & Family Sciences, University of Connecticut, 348 Mansfield Road, Unit 1058, Storrs, CT, 06269-1058, USA.
| | - M Hutchison
- Department of Human Development & Family Sciences, University of Connecticut, 348 Mansfield Road, Unit 1058, Storrs, CT, 06269-1058, USA
| | - R Tambling
- Department of Human Development & Family Sciences, University of Connecticut, 348 Mansfield Road, Unit 1058, Storrs, CT, 06269-1058, USA
| | - A J Tomkunas
- Department of Human Development & Family Sciences, University of Connecticut, 348 Mansfield Road, Unit 1058, Storrs, CT, 06269-1058, USA
| | - A L Horton
- Department of Human Development & Family Sciences, University of Connecticut, 348 Mansfield Road, Unit 1058, Storrs, CT, 06269-1058, USA
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Bohannon RW, Wang YC, Yen SC, Grogan KA. Handgrip Strength: A Comparison of Values Obtained From the NHANES and NIH Toolbox Studies. Am J Occup Ther 2019; 73:7302205080p1-7302205080p9. [PMID: 30915969 DOI: 10.5014/ajot.2019.029538] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE Handgrip dynamometry is probably the most commonly used method to characterize overall human muscle strength. OBJECTIVE To compare and summarize grip strength measurements obtained from two population-based studies. DESIGN Secondary data analysis. SETTING AND PARTICIPANTS Data from (1) the 2011-2014 National Health and Nutrition Examination Survey (NHANES) with 13,918 participants and (2) the 2011 normative phase of the National Institutes of Health (NIH) Toolbox project with 3,594 participants. OUTCOMES AND MEASURES The NHANES values used were the mean and best of three trials; the NIH Toolbox value used was the one maximum trial after a practice trial. RESULTS General linear model analysis revealed that values obtained from the NIH Toolbox differed from NHANES best values but not from NHANES mean values. The analysis also indicated, regardless of the values used, that grip strength differed significantly between dominant and nondominant sides, males and females, and age groups. We provide updated reference values for handgrip strength. CONCLUSIONS AND RELEVANCE On the basis of these analyses, we summarize grip strength measures obtained from the NHANES and NIH Toolbox for side, gender, and age group strata. Reference values are essential to assist in the interpretation of testing results and clinical decision making.
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Affiliation(s)
- Richard W Bohannon
- Richard W. Bohannon, DPT, EdD, PT, is Professor, Department of Physical Therapy, College of Pharmacy and Health Sciences, Campbell University, Buies Creek, NC
| | - Ying-Chih Wang
- Ying-Chih Wang, PhD, OTR/L, is Associate Professor, Department of Occupational Science and Technology, University of Wisconsin-Milwaukee;
| | - Sheng-Che Yen
- Sheng-Che Yen, PhD, PT, is Assistant Professor, Department of Physical Therapy, Northeastern University, Boston, MA
| | - Kimberly A Grogan
- Kimberly A. Grogan, MS, OTR/L, is Clinician, Northern Suburban Special Education District, Highland Park, IL
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Wang YC, Bohannon RW, Kapellusch J, Washburn D, Li X, Yen SC, Rahman MH. Between-side differences in hand-grip strength across the age span: Findings from 2011-2014 NHANES and 2011 NIH Toolbox studies. Laterality 2019; 24:697-706. [PMID: 30987530 DOI: 10.1080/1357650x.2019.1604727] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
This project was undertaken to describe percentage differences in the grip strength between the dominant and nondominant-sides of left- and right-handed males and females across the age span. Data used in the project were from population-based samples of participants: 13,653 from the 2011-2014 National Health and Nutrition Examination Survey (NHANES) and 3,571 from the 2011 normative phase of the National Institutes of Health (NIH) Toolbox project. Depending on how percentage differences were calculated, the overall grip strength was a mean 5.0-5.6% greater on the dominant than nondominant side. The percentage differences were significantly greater for individuals who were right-hand dominant rather than left-hand dominant. The differences also varied according to gender. We present summary data for percentage differences stratified by study, handedness, and gender. The values can be used to determine whether grip strength on one side is limited relative to the other.
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Affiliation(s)
- Ying-Chih Wang
- Department of Occupational Science & Technology, University of Wisconsin-Milwaukee , Milwaukee , WI , USA
| | - Richard W Bohannon
- Department of Physical Therapy, College of Pharmacy and Health Sciences, Campbell University , Buies Creek , NC , USA
| | - Jay Kapellusch
- Department of Occupational Science & Technology, University of Wisconsin-Milwaukee , Milwaukee , WI , USA
| | - Dana Washburn
- Department of Occupational Science & Technology, University of Wisconsin-Milwaukee , Milwaukee , WI , USA
| | - Xiaoyan Li
- Department of Physical Medicine and Rehabilitation, University of Texas Medical School at Houston , Houston , TX , USA.,TIRR Memorial Hermann Research Center , Houston , TX , USA
| | - Sheng-Che Yen
- Department of Physical Therapy, Northeastern University , Boston , MA , USA
| | - Mohammad H Rahman
- Department of Biomedical Engineering/Mechanical Engineering, University of Wisconsin-Milwaukee , Milwaukee , WI , USA
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Plummer EA, Wang Q, Larson-Nath CM, Scheurer JM, Ramel SE. Body composition and cognition in preschool-age children with congenital gastrointestinal anomalies. Early Hum Dev 2019; 129:5-10. [PMID: 30562643 PMCID: PMC6382521 DOI: 10.1016/j.earlhumdev.2018.12.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2018] [Revised: 10/30/2018] [Accepted: 12/02/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Children with congenital gastrointestinal anomalies (CGIAs) experience multiple stressors while hospitalized in neonatal intensive care units during an essential time of growth and development. Early stress and inadequate nutrition are linked to altered growth patterns and later neurodevelopmental delays. In other at-risk populations, improved fat-free mass (FFM) accretion is associated with improved cognitive outcomes. OBJECTIVE To determine if body composition is associated with cognitive function in preschool-age children with CGIAs. STUDY DESIGN An observational study examined body composition and cognition in 34 preschool-age children with CGIAs. Anthropometric measurements and body composition testing via air displacement plethysmography were obtained. Measurements were compared with a reference group of healthy, term-born children. Cognition was measured with the NIH Toolbox Early Childhood Cognition Battery. Linear regression was used to test the association of body composition with cognitive function. RESULTS Compared with the reference group, children with CGIAs had similar anthropometric measurements (weight, height, and body mass index z-scores) and body composition at preschool-age. Processing speed scores were lower than standardized means (p = 0.001). Increased FFM was associated with higher receptive vocabulary scores (p = 0.001), cognitive flexibility scores (p = 0.005), and general cognitive function scores (p = 0.05). CONCLUSIONS At preschool-age, children with CGIAs have similar growth and body composition to their peers. In children with CGIAs, higher FFM was associated with higher cognitive scores. Closer tracking of body composition and interventions aimed at increasing FFM may improve long-term outcomes in this population.
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Affiliation(s)
- Erin A. Plummer
- Division of Neonatology, Department of Pediatrics University of Minnesota, Minneapolis, MN, United States
| | - Qi Wang
- Clinical and Translational Science Institute University of Minnesota, Minneapolis, MN, United States
| | - Catherine M. Larson-Nath
- Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics University of Minnesota, Minneapolis, MN, United States
| | - Johannah M. Scheurer
- Division of Neonatology, Department of Pediatrics University of Minnesota, Minneapolis, MN, United States
| | - Sara E. Ramel
- Division of Neonatology, Department of Pediatrics University of Minnesota, Minneapolis, MN, United States
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Improving Methodological Standards in Behavioral Interventions for Cognitive Enhancement. JOURNAL OF COGNITIVE ENHANCEMENT 2019. [DOI: 10.1007/s41465-018-0115-y] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
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Hand-Grip Strength: Normative Reference Values and Equations for Individuals 18 to 85 Years of Age Residing in the United States. J Orthop Sports Phys Ther 2018; 48:685-693. [PMID: 29792107 DOI: 10.2519/jospt.2018.7851] [Citation(s) in RCA: 124] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Background Hand-grip strength is an indicator of overall strength and a predictor of important outcomes. Up-to-date, population-specific reference values for measurements of grip strength are needed to properly interpret strength outcomes. Objectives To provide population-based grip-strength reference values and equations for US residents 18 to 85 years of age. Methods Hand-grip data from 1232 participants 18 to 85 years of age were extracted from the database of the 2011 normative phase of the US National Institutes of Health Toolbox project in this cross-sectional study. Descriptive reference values and equations were derived from the data. Results The authors present grip-strength reference values using summary statistics (mean, standard deviation, and percentile). The mean grip strength ranged from 49.7 kg for the dominant hand of men 25 to 29 years of age to 18.7 kg for the nondominant hand of women 75 to 79 years of age. The researchers also present reference regression equations for the dominant and nondominant sides of men and women. The explanatory variables in the equations are age, height, and weight. Conclusion The normative reference values and equations provided in this study may serve as a guide for interpreting grip-strength measurements obtained from tested individuals. J Orthop Sports Phys Ther 2018;48(9):685-693. Epub 23 May 2018. doi:10.2519/jospt.2018.7851.
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Holdnack JA, Tulsky DS, Slotkin J, Tyner CE, Gershon R, Iverson GL, Heinemann AW. Nih toolbox premorbid ability adjustments: Application in a traumatic brain injury sample. Rehabil Psychol 2018; 62:496-508. [PMID: 29265870 DOI: 10.1037/rep0000198] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
PURPOSE/OBJECTIVE Metrics to estimate premorbid cognitive ability, such as word reading tests, are important for clinical determination of cognitive changes following brain injury. In the present study, reading adjusted scores for the National Institutes of Health Toolbox Cognition Battery (NIHTB-CB) fluid tests were developed and validated with a sample of individuals with traumatic brain injury (TBI), to evaluate the clinical utility of reading-adjusted scores. Research Method/Design: The development sample included 843 adult participants, ages 20-85, from the NIHTB-CB standardization sample. A sample of 158 participants with complicated mild or moderate TBI (n = 74) or severe TBI (n = 84) were administered the NIHTB-CB, and comprised the validation sample. Scores were derived for the five fluid tests using four adjustment models: age-only, demographic-only, age-and-reading, and demographic-and-reading referenced scores. RESULTS Estimated premorbid ability varies depending on the reference model. Scores from each of the four reference models differentiated the comparison and TBI samples at the group level. However, performance varied by premorbid ability. CONCLUSIONS/IMPLICATIONS Premorbid ability affects identification of cognitive difficulties after TBI. Reading referenced scores provide an individualized estimate of the effects of premorbid ability than demographic characteristics alone. Each model identified a similar number of individuals as having cognitive difficulties; however, the models differed on which individuals had cognitive difficulties. The models had higher disagreement rates in the clinical compared with the comparison sample, particularly for individuals with lower premorbid ability. Clinical use and caveats are discussed. (PsycINFO Database Record
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Affiliation(s)
- James A Holdnack
- The Center for Health Assessment Research and Translation, University of Delaware
| | - David S Tulsky
- The Center for Health Assessment Research and Translation, University of Delaware
| | - Jerry Slotkin
- The Center for Health Assessment Research and Translation, University of Delaware
| | - Callie E Tyner
- The Center for Health Assessment Research and Translation, University of Delaware
| | - Richard Gershon
- Department of Medical Social Sciences, Northwestern University
| | - Grant L Iverson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School
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Four-Meter Gait Speed: Normative Values and Reliability Determined for Adults Participating in the NIH Toolbox Study. Arch Phys Med Rehabil 2018; 100:509-513. [PMID: 30092204 DOI: 10.1016/j.apmr.2018.06.031] [Citation(s) in RCA: 81] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 06/22/2018] [Accepted: 06/26/2018] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To establish reference values and determine test-retest reliability for usual and maximal 4-meter gait speed. DESIGN Cross-sectional observational study. SETTING Offices in 10 geographically dispersed cities in the United States. PARTICIPANTS Men and women (N=1320), aged 18 to 85 years, enrolled in the National Institutes of Health Toolbox norming study. INTERVENTION Not applicable. MAIN OUTCOME MEASURES Specifically used were data from men and women who were timed over 4 meters (after a static start) while walking at their usual and maximum speeds. Norms for usual and maximum gait speed were derived using data from 1320 participants. Test-retest reliability for 164 participants was described using paired t tests, intraclass correlation coefficients (ICCs), and minimal detectable changes (MDCs). RESULTS Mean usual speed was 1.12 meters per second, whereas mean maximum speed was 1.61 meters per second. As a general linear model showed 4-meter gait speed to differ significantly according to gait condition (speed), sex, and age group; estimates of normal were calculated accordingly. The usual speed of 80- to 85-year-old women was lowest at 0.95 meters per second; the maximum speed of 18- to 29-year-old men was highest at 1.85 meters per second. Test-retest measures did not differ significantly, but the ICCs were only fair and the MDCs were high. CONCLUSIONS Normative reference values provided herein may be helpful in interpreting measurements of 4-meter gait speed obtained from adult men and women. The limited reliability of the gait speed measurements, however, limits their usefulness in making judgments regarding change.
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Paolillo EW, McKenna BS, Nowinski CJ, Thomas ML, Malcarne VL, Heaton RK. NIH Toolbox® Emotion Batteries for Children: Factor-Based Composites and Norms. Assessment 2018; 27:607-620. [PMID: 29618218 DOI: 10.1177/1073191118766396] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The recently released National Institutes of Health Toolbox (NIHTB) batteries for neurological and behavioral function were designed to serve as standardized, common measures in clinical and epidemiological research. The current study aimed to examine constructs assessed by the self-report and parental proxy-report scales in the NIHTB Emotion Battery (NIHTB-EB) for Children by using factor analyses on data from the U.S. national normative sample of 2,916 English-speaking children. This battery contains 31 scales designed to assess both positive and negative aspects of social and emotional functioning that are considered developmentally relevant at each of three age ranges (3-7, 8-12, and 13-17 years). Results revealed four similar self-report factors for ages 8 to 12 years and 13 to 17 years. Proxy reports for ages 3 to 7 years revealed three factors, and for ages 8 to 12 years two factors. Based on the standardization sample data, age- and gender-corrected norms are presented for all NIHTB-EB individual scales and factor-based composites.
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Affiliation(s)
- Emily W Paolillo
- San Diego State University, San Diego, CA, USA.,University of California San Diego, La Jolla, CA, USA
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50
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Babakhanyan I, McKenna BS, Casaletto KB, Nowinski CJ, Heaton RK. National Institutes of Health Toolbox Emotion Battery for English- and Spanish-speaking adults: normative data and factor-based summary scores. PATIENT-RELATED OUTCOME MEASURES 2018; 9:115-127. [PMID: 29588623 PMCID: PMC5859895 DOI: 10.2147/prom.s151658] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background The National Institutes of Health Toolbox Emotion Battery (NIHTB-EB) is a "common currency", computerized assessment developed to measure the full spectrum of emotional health. Though comprehensive, the NIHTB-EB's 17 scales may be unwieldy for users aiming to capture more global indices of emotional functioning. Methods NIHTB-EB was administered to 1,036 English-speaking and 408 Spanish-speaking adults as a part of the NIH Toolbox norming project. We examined the factor structure of the NIHTB-EB in English- and Spanish-speaking adults and developed factor analysis-based summary scores. Census-weighted norms were presented for English speakers, and sample-weighted norms were presented for Spanish speakers. Results Exploratory factor analysis for both English- and Spanish-speaking cohorts resulted in the same 3-factor solution: 1) negative affect, 2) social satisfaction, and 3) psychological well-being. Confirmatory factor analysis supported similar factor structures for English- and Spanish-speaking cohorts. Model fit indices fell within the acceptable/good range, and our final solution was optimal compared to other solutions. Conclusion Summary scores based upon the normative samples appear to be psychometrically supported and should be applied to clinical samples to further validate the factor structures and investigate rates of problematic emotions in medical and psychiatric populations.
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Affiliation(s)
- Ida Babakhanyan
- Defense and Veteran's Brain Injury Center, Camp Pendleton.,Department of Psychiatry, University of California, San Diego, La Jolla
| | | | - Kaitlin B Casaletto
- Department of Neurology, University of California, San Francisco, San Francisco, CA
| | - Cindy J Nowinski
- Department of Medical Social Sciences, Northwestern University, Chicago, IL, USA
| | - Robert K Heaton
- Department of Psychiatry, University of California, San Diego, La Jolla
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