Cognition among community-dwelling individuals with spinal cord injury.

Abstract

Purpose/Objective To compare the cognitive profiles of a well-characterized sample of adults with and without spinal cord injury (SCI) using the NIH Toolbox – Cognition Battery (NIHTB-CB). Research Method/Design 156 community-dwelling individuals with SCI were recruited from three academic medical centers. 156 individuals without SCI were selected from the NIHTB-CB normative database. The main outcome measures were the demographically-adjusted NIHTB-CB subtest and composite scores. Results Individuals with and without SCI performed equivalently on the NIHTB-CB crystallized composite score, suggesting comparable premorbid functioning. Individuals with SCI produced lower scores on the NIHTB-CB fluid composite score by an average of 4.5 T-score points (Cohen’s d = 0.50; a medium effect size). As a group, individuals with SCI had the most difficulty on tests of processing speed and executive functions, and some difficulty on a test of episodic memory, although effect sizes were small. These differences remained even after accounting for fine motor speed and dexterity. Individuals with tetraplegia produced lower scores than individuals with paraplegia on tests of processing speed and executive functioning. Conclusions/Implications Community-dwelling individuals with SCI are at elevated risk of mild cognitive difficulties, particularly on tasks that rely on processing speed and executive functions. The NIHTB-CB is relatively brief, samples important cognitive domains, has good normative data, and is appropriate for some individuals with SCI (those who have functional use of one hand). The battery has standardized accommodations for individuals with minor motor limitations, but timed tests are inaccessible for individuals who are unable to perform a rapid button press.

Serum CCL21 as a Potential Biomarker for Cognitive Impairment in Spinal Cord Injury

“…Not only in animal models but also in human cognitive impairment after SCI has been reported in recent years. A US study of SCI patients in residential communities showed that after SCI, the risk of cognitive impairment is increased, mainly impairing patients' processing speed and executive function for specific tasks [ 21 ].…”

Assessing the suitability of virtual reality for psychological testing.

“…More recently, a concerted effort has been made to assess the NIH-Toolbox (including the flanker task) for use in clinical populations . Construct validity for the flanker task has been shown for traumatic brain injury , spinal cord injury (M. L. Cohen et al, 2017), and stroke patients (Carlozzi et al, 2017). Finally, base rate information (Holdnack et al, 2017) and test interpretation analyses (Nitsch et al, 2017) have been performed.…”

Latent Factor Structure and Measurement Invariance of the NIH Toolbox Cognition Battery in an Alzheimer’s Disease Research Sample

“…The NIHTB-CB has many advantages as it is: (1) applicable across the lifespan, (2) brief, (3) non-proprietary, (4) based on state-of-the-art test theories and technology, and (5) available in both English and Spanish versions (Mungas et al, 2014). The validity and utility of the battery has been shown in cognitively unimpaired adults (Heaton et al, 2014;Mungas et al, 2014;Weintraub et al, 2013), and clinical samples with spinal cord injury Cohen et al, 2017), traumatic brain injury (TBI; Nitsch et al, 2017;, stroke Carlozzi, Tulsky, et al, 2017;Nitsch et al, 2017;, and intellectual disabilities (Hessl et al, 2016). In addition, a study including adults with varied cognitive statuses provided supportive findings for the validity of NIHTB-CB in assessing neurocognitive domains related to dementia (Hackett et al, 2018).…”