Association between NIH Toolbox Measures and Informant-Report Functional Abilities in Mild Cognitive Impairment and Dementia of the Alzheimer Type

Tatiana Karpouzian-Rogers, Northwestern University, Chicago, United States
Emily Ho, Northwestern University, Chicago, United States
Molly Mather, Northwestern University, Chicago, United States
Katy Bedjeti, Northwestern University, Chicago, United States
Richard Gershon, Northwestern University, Chicago, United States
Sandra Weintraub, Northwestern University, Chicago, United States


Activities of daily living, such as the ability to live independently, are central to an individual’s well-being and quality of life. Age-associated cognitive impairment, such as Dementia of the Alzheimer type (DAT) and Mild Cognitive Impairment (MCI), is correlated with notable difficulty in one’s ability to carry out activities of daily living, limiting independence. While most of the research on functional outcomes has focused on informant-report measures, there has been little work investigating the concordance between such informant reports and performance on measures spanning a variety of cognitive and non-cognitive domains. The NIH Toolbox for the Assessment of Neurological and Behavioral Function (NIHTB) is a computerized suite of tests spanning four health domains – Cognition, Motor, Emotion, and Sensation –  measuring multiple aspects of cognitive and neurologic functions that has been validated across the cognitive aging spectrum. The purpose of the current study is to investigate which measures of the NIHTB can predict ability to carry out activities of daily living in individuals with MCI and DAT.

Participants and Methods:

The study was part of the larger multi-site ARMADA (Advancing Reliable Measurement in Alzheimer’s disease and Cognitive Aging) study. Participants with MCI and DAT were recruited from multiple Alzheimer’s Disease Research Centers. Diagnoses were established using the Uniform Data Set V3.0 methodology and based on multiple clinical and cognitive assessments. Participants completed the NIH Toolbox, which included measures of cognition, sensation, and motor abilities. Informants completed the Functional Activities Questionnaires (FAQ), which is a multiple-choice survey assessing one’s ability to carry out several activities of daily living (e.g., “In the past four weeks, did the subject have any difficulty or need help with: Traveling out of the neighborhood, driving, or arranging to take public transportation?”). Linear regressions predicted FAQ score using NIHTB measures for MCI and DAT groups separately, adjusting for age.


Within the Cognition Battery, List Sorting Working Memory, Flanker Inhibitory Control and Attention, and Picture Vocabulary tests predicted FAQ scores in the AD groups, such that lower scores were related to greater informant-reported functional impairment. Within the motor module, the two-minute walk endurance test was related to FAQ score in the AD group in the hypothesized direction. Lastly, within the sensation module, the Odor Identification Test and Words-in-Noise test predicted FAQ scores in the MCI group.


Findings from this study demonstrated differential relationships between functional abilities and cognitive and non-cognitive measures of the NIHTB, such that cognitive and motor performance were related to functional decline in the DAT group, while sensation scores were related in the MCI group. Future analyses will examine if these differential effects are related to specific aspects of functional abilities, as well as the ability of functional outcomes to predict subsequent cognitive decline.

Category: Dementia (Alzheimer's Disease)

Keyword 1: activities of daily living
Keyword 2: dementia - Alzheimer's disease
Keyword 3: mild cognitive impairment