Evaluating cognitive performance using cognitive performance using the National Institutes of Health Toolbox
Bailey Petersen1, Ngoc-Thanh N Vo1, Nivinthiga Anton1
1Department of Physical Medicine and Rehabilitation, https://ror.org/03yjb2x39University of Pittsburgh School of Medicine, Pittsburgh, PA, U.S.
Insights
Children with severe traumatic brain injury (TBI) show worse cognitive function, particularly fluid cognition, six to twelve months post-injury compared to those with mild-moderate TBI. The NIH Toolbox Cognitive Battery effectively identifies these deficits.
Area of Science:
- Pediatric Neuropsychology
- Traumatic Brain Injury Research
- Cognitive Neuroscience
Background:
- Traumatic brain injury (TBI) in children can lead to long-term cognitive impairments.
- Differentiating cognitive outcomes based on TBI severity is crucial for targeted interventions.
- The National Institutes of Health Toolbox Cognitive Battery (NIH TB-CB) is a standardized tool for assessing cognition.
Purpose of the Study:
- To compare cognitive performance in children with complicated mild-severe TBI versus orthopedic injury (OI).
- To evaluate cognitive function using the NIH TB-CB at six and twelve months post-injury.
- To assess the impact of TBI severity on cognitive outcomes.
Main Methods:
- Recruited 231 children with complicated mild-severe TBI and 146 with OI (ages 3-18).
- Administered the NIH TB-CB at six and twelve months post-injury.
- Utilized linear mixed models and ANCOVA, adjusting for sex and socioeconomic status, to analyze cognitive composite scores (Total, Fluid, Crystallized Cognition).
Main Results:
- No significant differences in overall cognition between TBI and OI groups.
- Children with severe TBI demonstrated significantly worse Fluid and Total Cognition at both six and twelve months post-injury compared to those with complicated mild-moderate TBI.
- Fluid Cognition was primarily affected in severe TBI cases, with moderate to large effect sizes observed.
Conclusions:
- The NIH TB-CB effectively identifies cognitive deficits in children with severe TBI up to twelve months post-injury.
- Fluid cognition is a key area impacted by severe TBI in pediatric populations.
- The NIH TB-CB shows promise as a tool for monitoring cognitive recovery in children following TBI.
Objective:
We examined cognitive performance in children with complicated mild-severe traumatic brain injury (TBI) versus orthopedic injury (OI) using the National Institutes of Health Toolbox Cognitive Battery (NIH TB-CB).
Method:
We recruited children ages 3-18, hospitalized with complicated mild-severe TBI (n = 231) or orthopedic injury (OI, n = 146). Cognition was assessed using the NIH TB-CB at six and twelve months post-injury. We used linear mixed models to assess associations of injury group (TBI versus OI), timepoint (six versus twelve months), and the interaction of injury group and timepoint with NIH TB-CB Total Cognition, Fluid Cognition, and Crystallized Cognition composites, adjusted for sex and socioeconomic status (SES), with Bonferroni correction. We evaluated differences in cognition stratified by injury severity (complicated mild-moderate TBI vs severe TBI) using ANCOVA, adjusting for sex and SES.
Results:
Neither injury group nor the interaction of group and timepoint were associated with Total (group: p = 0.50; timepoint*group: p = 0.185), Fluid (group: p = 0.297; timepoint*group: p = 0.842), or Crystallized Cognition (group: p = 0.039; timepoint*group: p = 0.017). However, children with severe TBI performed significantly worse on Fluid and Total Cognition than children with complicated mild-moderate TBI at six months (Fluid: p = 0.004, partial η2 = 0.06, moderate effect, Total: p = 0.012 partial η2 = 0.03, small-moderate effect) and twelve months post-injury (Fluid: p < 0.001, partial η2 = 0.11, moderate-large effect, Total: p = 0.002, partial η2 = 0.06, moderate effect).
Conclusions:
The NIH TB-CB detects worse cognitive functioning in children with severe TBI six-twelve months post-injury, largely driven by differences in Fluid Cognition. Our findings suggest the NIH TB-CB may be suitable for monitoring cognition in children with TBI.
