Construct validity of the NIH Toolbox Cognition Battery in individuals with stroke.
Noelle E Carlozzi, David S Tulsky, Timothy J Wolf and 7 others
PMID 29265865WHAT IT FOUND
The NIH Toolbox Cognition Battery tracked stroke severity and matched other cognitive tests.
Low timed-test scores may reflect hand movement speed, not only thinking, so check motor status before assuming cognitive impairment.
Key findings
01Individuals with moderate/severe stroke performed worse than those with mild stroke on both NIH Toolbox composites and all subtests except Picture Vocabulary and List Sorting when motor function was not controlled.
02When motor function was included as a covariate, group differences on the timed Pattern Comparison, Flanker, and Dimensional Change Card Sort tests were not significant.
03NIH Toolbox tests showed moderate to large correlations with corresponding neuropsychological tests, and 42.0% of participants would meet criteria for at least a mild cognitive disorder.
STILL TO COME
How it was doneWhat they foundWhat it means for OTs
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What it does not show
The study excluded people with aphasia, poor English reading, or vision poorer than 20/100, so it does not show how the battery performs in those groups. Only 6 participants had severe stroke, and severe and moderate strokes were combined. The study did not check whether participants gave full effort. It did not examine medication use, psychiatric history, or learning disability. Motor impairment affected timed tests, and controlling for it removed group differences on Pattern Comparison, Flanker, and Dimensional Change Card Sort. Because dominant hand motor speed was worse in the moderate/severe group, motor corrections may have biased against finding stroke severity differences. Executive function measures showed weaker discriminant validity and may tap multiple cognitive domains. The supplied text does not report funding or conflicts of interest.
The easy way to misread this
Do not read low scores on timed NIH Toolbox tests as evidence of cognitive impairment alone. When motor function was included as a covariate, differences on Pattern Comparison, Flanker, and Dimensional Change Card Sort were not significant.