51 Longitudinal Performance on the NIH Toolbox Cognition Module in a Cognitive Aging Sample
Authors: Mather Molly A , Pollner Emma J , Ho Emily H , Gershon Richard , Weintraub Sandra 
Published: December 2023

Objective:

As the older adult population increases in the coming decades, the number of persons that develop dementia of the Alzheimer’s type (DAT) will increase accordingly. Though curative treatment for Alzheimer’s disease remains elusive, early detection of cognitive decline allows for initiation of pharmacological treatment to slow disease progression and non-pharmacological approaches to support quality of life and well-being of affected individuals and their care partners. Streamlined approaches that bridge the gap between brief screenings and comprehensive neuropsychological evaluation are needed. The NIH Toolbox Cognition Battery (NIHTB-CB) is a brief, easily administered, computerized cognitive battery that assesses various aspects of both fluid and crystallized cognitive abilities. ARMADA (Advancing Reliable Measurement in Alzheimer’s Disease and Cognitive Aging) is a multi-site study that aims to validate the NIHTB across the spectrum from normal aging to DAT. The current study utilized longitudinal data from ARMADA to determine whether performance on the NIHTB-CB detects cognitive decline in persons with normal cognition (NC), mild cognitive impairment (MCI), and mild DAT over the span of two years. We predicted that scores would decline for the MCI and DAT groups, but not for the NC group.

Participants and Methods:

Participants were 191 participants drawn from the larger ARMADA cohort aged 65-84 (nNC = 118, nMCI = 47, nDAT = 26) that completed the NIHTB-CB at baseline and 12 months. The clinical groups were significantly older than the NC group at baseline (MNC = 72.72, MMCI = 76.63, MDAT = 75.42; p < .001) and the NC and MCI groups had significantly more years of education than the DAT group (MNC = 17.03, MMCI = 16.83, MDAT = 15.54; p = .008).

Results:

Mixed model ANOVAs determined differences in uncorrected NIHTB-CB scores between clinical groups at baseline and 12 months, controlling for age and education. There were significant interactions between time and clinical group for Flanker (p < .001), Pattern Comparison (p < .001), and Picture Vocabulary (p = .001), such that the DAT group demonstrated a more negative slope of change than the NC and MCI groups. For Oral Reading, the MCI group demonstrated a more negative slope of change than the NC and DAT groups (p = .01).

Conclusions:

Differential score trajectories were found for the Flanker task, with a more negative pattern of change in scores in the DAT group compared to the NC and MCI groups. Contrary to expectation, scores decreased for the two crystallized subtests across groups, which may reflect regression to the mean given high baseline scores, especially for Picture Vocabulary; however, these results were also moderated by group with less decline in scores in the NC group, which may indicate involvement of non-crystallized abilities in executing a single word comprehension task. Group differences were subtle, which may in part reflect the relatively short period of follow up. The Flanker task appears to be most sensitive to decline in mild DAT compared to MCI and NC. Results provide preliminary support for the utility of NIHTB-CB in detecting cognitive decline along the cognitive aging to DAT spectrum.