Utility of the iPad NIH Toolbox Cognition Battery in a clinical trial of older adults

Background To demonstrate feasibility and utility of the iPad version of the NIH Toolbox Cognition Battery (NIHTB‐CB) in a clinical trial of older adults. Methods Fifty‐one adults, aged 55 and older without dementia were tested twice on NIHTB‐CB and more traditional paper‐and‐pencil neuropsychological measures after meal ingestion, with approximately a 4‐week interval. We also compared performances at Time 1 and Time 2 for significant change. We also extracted the response times and errors for available NIHTB‐CB subtests to determine subtle changes in performance. Results Over the interval, improvement in fluid cognitive measures was noted at Time 2 (t = −3.07, p = 0.004), whereas crystallized measures were unchanged. Tests of fluid cognition negatively correlated with age, particularly for the second visit. Analysis of the average speed per item showed that, for two of the tests, speed increased at Time 2. Traditional neuropsychological tests correlated with many of the NIHTB‐CB measures. Response times for all five timed tests decreased at Time 2, although only statistically significant for Picture Sequence and Picture Vocabulary. Conclusions The iPad version of the NIH Toolbox Cognition Battery appears to be an adequate measure to assess cognitive functioning in a clinical trial of older adults. Psychometric analyses suggest stability in measures of crystallized functioning, whereas measures of fluid abilities revealed improvements over the short time frame of the study. Response times and errors for individual tests revealed intriguing relationships that should be further evaluated to determine the utility in clinical sample analysis, as this could aid identification of subtle cognitive change over short periods. Additional studies with larger sample sizes will be helpful to understanding the reliability, sensitivity, and specificity of the NIHTB‐CB sub‐scores in older adults. In addition, further evaluations with clinical populations, including individuals with cognitive impairment, are warranted.