Improving the methodology for identifying mild cognitive impairment in intellectually high-functioning adults using the NIH toolbox cognition battery
Open accessAbstract
Objective: Low scores on neuropsychological tests are considered objective evidence of mild cognitive impairment. In clinical practice and research, it can be challenging to identify a cognitive deficit or mild cognitive impairment in high-functioning people because they are much less likely to obtain low test scores. This study was designed to improve the methodology for identifying mild cognitive impairment in adults who have above average or superior intellectual abilities. Method: Participants completed the National Institutes of Health Toolbox for the Assessment of Neurological and Behavioral Function Cognition Battery (NIHTB-CB). The sample included 384 adults between the ages of 20 and 85 who had completed either a 4-year college degree or who scored in the above average, superior, or very superior range on a measure of intellectual functioning, the Crystallized Composite score. Algorithms were developed, based on the absence of high scores and the presence of low scores, for identifying mild cognitive impairment. Results: Base rate tables for the presence of low scores and the absence of high scores are provided. The base rate for people with high average crystalized ability obtaining any one of the following, 5 scores <63rd percentile, or 4+ scores <50th percentile, or 3+ scores ≤ 25th percentile, or 2+ scores ≤ 16th percentile, is 15.5%. Conclusions: Algorithms were developed for identifying cognitive weakness or impairment in high-functioning people. Research is needed to test them in clinical groups, and to assess their association with clinical risk factors for cognitive decline and biomarkers of acquired neurological or neurodegenerative diseases.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
Base rates of low NIHTB-CB scores among adults have been reported.
“For the NIHTB-CB, base rates of low scores among adults have been reported (Holdnack et al., 2017a; Holdnack et al., 2017b; Iverson and Karr, 2021; Karr et al., 2022a,b)”
From Cognitive weaknesses or impairments on the NIH toolbox cognition battery in children and adolescents: base rates in a normative sample and proposed methods for classification (2025) · cites this paper as Iverson and Karr, 2021
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
McKhann, G. M., Knopman, D. S., Chertkow, H., Hyman, B. T., Jack, C. R., Kawas, C. H., Klunk, W. E., Koroshetz, W. J., Manly, J. J., Mayeux, R., et al. (2011) · Alzheimer's & Dementia · doi:10.1016/j.jalz.2011.03.005 · Cited by 18,657 · see citing works
Albert, M. S., DeKosky, S. T., Dickson, D., Dubois, B., Feldman, H. H., Fox, N. C., Gamst, A., Holtzman, D. M., Jagust, W. J., Petersen, R. C., et al. (2011) · Alzheimer's & Dementia · doi:10.1016/j.jalz.2011.03.008 · Cited by 10,152 · see citing works
Mild Cognitive Impairment: Clinical Characterization and Outcome
Petersen, R. C., Smith, G. E., Waring, S. C., Ivnik, R. J., Tangalos, E. G., & Kokmen, E. (1999) · Archives of Neurology · doi:10.1001/archneur.56.3.303 · Cited by 8,980 · see citing works
Research criteria for the diagnosis of Alzheimer's disease: revising the NINCDS–ADRDA criteria
Dubois, B., Feldman, H. H., Jacova, C., DeKosky, S. T., Barberger-Gateau, P., Cummings, J., Delacourte, A., Galasko, D., Gauthier, S., Jicha, G., et al. (2007) · The Lancet Neurology · doi:10.1016/s1474-4422(07)70178-3 · Cited by 4,411 · see citing works
Mild cognitive impairment: a concept in evolution
Petersen, R. C., Caracciolo, B., Brayne, C., Gauthier, S., Jelic, V., & Fratiglioni, L. (2014) · Journal of Internal Medicine · doi:10.1111/joim.12190 · Cited by 1,694 · see citing works
Cognition assessment using the NIH Toolbox
Weintraub, S., Dikmen, S. S., Heaton, R. K., Tulsky, D. S., Zelazo, P. D., Bauer, P. J., Carlozzi, N. E., Slotkin, J., Blitz, D., Wallner-Allen, K., et al. (2013) · Neurology · doi:10.1212/wnl.0b013e3182872ded · Cited by 1,287 · see citing works
Vision assessment using the NIH Toolbox
Varma, R., McKean‐Cowdin, R., Vitale, S., Slotkin, J., & Hays, R. D. (2013) · Neurology · doi:10.1212/wnl.0b013e3182876e0a · Cited by 1,197 · see citing works
NIH Toolbox for Assessment of Neurological and Behavioral Function
Gershon, R. C., Wagster, M. V., Hendrie, H. C., Fox, N. A., Cook, K. F., & Nowinski, C. J. (2013) · Neurology · doi:10.1212/wnl.0b013e3182872e5f · Cited by 895 · see citing works
Quantification of Five Neuropsychological Approaches to Defining Mild Cognitive Impairment
Jak, A. J., Bondi, M. W., Delano-Wood, L., Wierenga, C., Corey-Bloom, J., Salmon, D. P., & Delis, D. C. (2009) · The American Journal of Geriatric Psychiatry · doi:10.1097/jgp.0b013e31819431d5 · Cited by 823 · see citing works
How Much Does Education Improve Intelligence? A Meta-Analysis
Ritchie, S. J., & Tucker-Drob, E. M. (2018) · Psychological Science · doi:10.1177/0956797618774253 · Cited by 680 · see citing works
Tabert, M. H., Manly, J. J., Liu, X., Pelton, G. H., Rosenblum, S., Jacobs, M. B., Zamora, D., Goodkind, M. S., Bell, K. L., Stern, Y., et al. (2006) · Archives of General Psychiatry · doi:10.1001/archpsyc.63.8.916 · Cited by 595 · see citing works
Mild cognitive impairment: Long-term course of four clinical subtypes
Busse, A., Hensel, A., Gühne, U., Angermeyer, M. C., & Riedel-Heller, S. G. (2006) · Neurology · doi:10.1212/01.wnl.0000249117.23318.e1 · Cited by 561 · see citing works
To Err is Human: "Abnormal" Neuropsychological Scores and Variability are Common in Healthy Adults
Binder, L. M., Iverson, G. L., & Brooks, B. L. (2009) · Archives of Clinical Neuropsychology · doi:10.1093/arclin/acn001 · Cited by 414 · see citing works
Self-citationAssessment of neurological and behavioural function: the NIH Toolbox
Gershon, R. C., Cella, D., Fox, N. A., Havlik, R. J., Hendrie, H. C., & Wagster, M. V. (2010) · The Lancet Neurology · doi:10.1016/s1474-4422(09)70335-7 · Cited by 377 · see citing works
NIH Toolbox Cognition Battery (CB): Validation of Executive Function Measures in Adults
Zelazo, P. D., Anderson, J. E., Richler, J., Wallner-Allen, K., Beaumont, J. L., Conway, K. P., Gershon, R., & Weintraub, S. (2014) · Journal of the International Neuropsychological Society · doi:10.1017/s1355617714000472 · Cited by 350 · see citing works
Outcomes of Mild Cognitive Impairment by Definition
Ganguli, M., Snitz, B. E., Saxton, J. A., Chang, C.-C. H., Lee, C.-W., Bilt, J. V., Hughes, T. F., Loewenstein, D., Unverzagt, F. W., & Petersen, R. C. (2011) · Archives of Neurology · doi:10.1001/archneurol.2011.101 · Cited by 284 · see citing works
Casaletto, K. B., Umlauf, A., Beaumont, J., Gershon, R., Slotkin, J., Akshoomoff, N., & Heaton, R. K. (2015) · Journal of the International Neuropsychological Society · doi:10.1017/s1355617715000351 · Cited by 271 · see citing works
Frequency and bases of abnormal performance by healthy adults on neuropsychological testing
Schretlen, D. J., Testa, S. M., Winicki, J. M., Pearlson, G. D., & Gordon, B. (2008) · Journal of the International Neuropsychological Society · doi:10.1017/s1355617708080387 · Cited by 207 · see citing works
NIH Toolbox Cognition Battery (NIHTB-CB): List Sorting Test to Measure Working Memory
Tulsky, D. S., Carlozzi, N., Chiaravalloti, N. D., Beaumont, J. L., Kisala, P. A., Mungas, D., Conway, K., & Gershon, R. (2014) · Journal of the International Neuropsychological Society · doi:10.1017/s135561771400040x · Cited by 196 · see citing works
Neuropsychological characteristics of mild cognitive impairment subgroups
López, O. L. (2005) · Journal of Neurology Neurosurgery & Psychiatry · doi:10.1136/jnnp.2004.045567 · Cited by 195 · see citing works
Language Measures of the NIH Toolbox Cognition Battery
Gershon, R. C., Cook, K. F., Mungas, D., Manly, J. J., Slotkin, J., Beaumont, J. L., & Weintraub, S. (2014) · Journal of the International Neuropsychological Society · doi:10.1017/s1355617714000411 · Cited by 189 · see citing works
Steinberg, B. A., Bieliauskas, L. A., Smith, G. E., & Ivnik, R. J. (2005) · The Clinical Neuropsychologist · doi:10.1080/13854040590945210 · Cited by 174 · see citing works
TAYLOR, M. J., & HEATON, R. K. (2001) · Journal of the International Neuropsychological Society · doi:10.1017/s1355617701777107 · Cited by 174 · see citing works
Brooks, B. L., Iverson, G. L., Holdnack, J. A., & Feldman, H. (2008) · Journal of the International Neuropsychological Society · doi:10.1017/s1355617708080521 · Cited by 156 · see citing works
Self-citationWeissberger, G. H., Strong, J. V., Stefanidis, K. B., Summers, M. J., Bondi, M. W., & Stricker, N. H. (2017) · Neuropsychology Review · doi:10.1007/s11065-017-9360-6 · Cited by 152 · see citing works
Measuring Episodic Memory Across the Lifespan: NIH Toolbox Picture Sequence Memory Test
DIKMEN, S. S., Bauer, P. J., Weıntraub, S., Mungas, D., Slotkin, J., Beaumont, J. L., Gershon, R. C., Temkin, N. R., & Heaton, R. K. (2014) · Journal of the International Neuropsychological Society · doi:10.1017/s1355617714000460 · Cited by 147 · see citing works
Base Rates of “Impaired” Neuropsychological Test Performance Among Healthy Older Adults
Palmer, B. (1998) · Archives of Clinical Neuropsychology · doi:10.1016/s0887-6177(97)00037-1 · Cited by 142 · see citing works
NIH Toolbox Cognitive Battery (NIHTB-CB): The NIHTB Pattern Comparison Processing Speed Test
Carlozzi, N. E., Tulsky, D. S., Chiaravalloti, N. D., Beaumont, J. L., Weintraub, S., Conway, K., & Gershon, R. C. (2014) · Journal of the International Neuropsychological Society · doi:10.1017/s1355617714000319 · Cited by 107 · see citing works
Norming plans for the NIH Toolbox
Beaumont, J. L., Havlik, R., Cook, K. F., Hays, R. D., Wallner-Allen, K., Korper, S. P., Lai, J.-S., Nord, C., Zill, N., Choi, S., et al. (2013) · Neurology · doi:10.1212/wnl.0b013e3182872e70 · Cited by 106 · see citing works
Brooks, B. L., Holdnack, J. A., & Iverson, G. L. (2010) · Assessment · doi:10.1177/1073191110385316 · Cited by 97 · see citing works
Self-citationSteinberg, B. A., Bieliauskas, L. A., Smith, G. E., Ivnik, R. J., & Malec, J. F. (2005) · The Clinical Neuropsychologist · doi:10.1080/13854040590945193 · Cited by 76 · see citing works
Interpreting Patterns of Low Scores on the NIH Toolbox Cognition Battery
Holdnack, J. A., Tulsky, D. S., Brooks, B. L., Slotkin, J., Gershon, R. C., Heinemann, A. W., & Iverson, G. L. (2017) · Archives of Clinical Neuropsychology · doi:10.1093/arclin/acx032 · Cited by 64 · see citing works
Self-citationEXPECTANCY OF IMPAIRED NEUROPSYCHOLOGICAL TEST SCORES IN A NON-CLINICAL SAMPLE
Axelrod, B. N., & Wall, J. R. (2007) · International Journal of Neuroscience · doi:10.1080/00207450600941189 · Cited by 62 · see citing works
Brooks, B. L., Sherman, E. M. S., & Iverson, G. L. (2010) · Archives of Clinical Neuropsychology · doi:10.1093/arclin/acq005 · Cited by 61 · see citing works
Self-citationMinimizing Misdiagnosis: Psychometric Criteria for Possible or Probable Memory Impairment
Brooks, B. L., Iverson, G. L., Feldman, H., & Holdnack, J. A. (2009) · Dementia and Geriatric Cognitive Disorders · doi:10.1159/000215390 · Cited by 55 · see citing works
Self-citationBrooks, B. L., Iverson, G. L., & White, T. J. H. (2009) · Archives of Clinical Neuropsychology · doi:10.1093/arclin/acp061 · Cited by 54 · see citing works
Self-citationWarner, M. H., Ernst, J. A., Townes, B. D., And, J. P., & Preston, M. W. (1987) · Journal of Clinical and Experimental Neuropsychology · doi:10.1080/01688638708410768 · Cited by 54 · see citing works
Healthy children and adolescents obtain some low scores across a battery of memory tests
BROOKS, B. L., IVERSON, G. L., SHERMAN, E. M. S., & HOLDNACK, J. A. (2009) · Journal of the International Neuropsychological Society · doi:10.1017/s1355617709090651 · Cited by 50 · see citing works
Self-citationEffect of Intellectual Level on Neuropsychological Test Performance: A Response to Dodrill (1997)
Tremont, G. N., Hoffman, R. G., Scott, J. G., & Adams, R. L. (1998) · The Clinical Neuropsychologist · doi:10.1076/clin.12.4.560.7238 · Cited by 48 · see citing works
Karr, J. E., Garcia-Barrera, M. A., Holdnack, J. A., & Iverson, G. L. (2018) · The Clinical Neuropsychologist · doi:10.1080/13854046.2017.1334828 · Cited by 46 · see citing works
Self-citationUnderstanding and Using Multivariate Base Rates with the WAIS–IV/WMS–IV
Brooks, B. L., Iverson, G. L., & Holdnack, J. A. (2013) · Elsevier eBooks · doi:10.1016/b978-0-12-386934-0.00002-x · Cited by 44 · see citing works
Self-citationKarr, J. E., García-Barrera, M. A., Holdnack, J. A., & Iverson, G. L. (2016) · Archives of Clinical Neuropsychology · doi:10.1093/arclin/acw105 · Cited by 37 · see citing works
Self-citationAbove-Average Intelligence and Neuropsychological Test Score Performance
Horton, A. M. (1999) · International Journal of Neuroscience · doi:10.3109/00207459908994326 · Cited by 30 · see citing works
Multivariate base rates for the assessment of executive functioning among children and adolescents
Cook, N. E., Karr, J. E., Brooks, B. L., Garcia-Barrera, M. A., Holdnack, J. A., & Iverson, G. L. (2019) · Child Neuropsychology · doi:10.1080/09297049.2018.1543389 · Cited by 18 · see citing works
Self-citationKarr, J. E., & Iverson, G. L. (2020) · Neuropsychology · doi:10.1037/neu0000691 · Cited by 15 · see citing works
Self-citationKarr, J. E., García-Barrera, M. A., Holdnack, J. A., & Iverson, G. L. (2019) · Journal of the International Neuropsychological Society · doi:10.1017/s1355617719001218 · Cited by 13 · see citing works
Self-citation
Flagged first, then by citations
Research works printed but not linked: 1
- Reitan R. M. Wolfson D. (1993). The Halstead-Reitan Neuropsychological Test Battery: Theory and Clinical Interpretation, 2nd Edn. Tucson, AZ: Neuropsychology Press.
Cited by
Sorted by citations
Recent Advances in Neuropsychological Test Interpretation for Clinical Practice
Kiselica, A. M., Karr, J. E., Mikula, C. M., Ranum, R. M., Benge, J. F., Medina, L. D., & Woods, S. P. (2023) · Neuropsychology Review · doi:10.1007/s11065-023-09596-1 · Cited by 64 · see citing works
Self-citationKarr, J. E., Hakun, J. G., Elbich, D., Pinheiro, C. N., Schmitt, F. A., & Segerstrom, S. C. (2023) · Journal of the International Neuropsychological Society · doi:10.1017/s1355617723000607 · Cited by 13 · see citing works
Self-citationIverson, G. L., Gaudet, C. E., Kissinger-Knox, A. M., & Karr, J. E. (2022) · Archives of Clinical Neuropsychology · doi:10.1093/arclin/acac076 · Cited by 7 · see citing works
Self-citationEstimating the prevalence of Non-Verbal Learning Disability (NVLD) from the ABCD sample
Coccaro, A., Banich, M. T., Mammarella, I. C., & Mario Liotti, A. (2024) · Scientific Reports · doi:10.1038/s41598-024-58639-x · Cited by 6 · see citing works
Rogne, A. G., Sigurðardóttir, S., Raudeberg, R., Hassel, B., & Dahlberg, D. (2024) · Brain Injury · doi:10.1080/02699052.2024.2347565 · Cited by 5 · see citing works
Detection of Cognitive Impairment From eSAGE Metadata Using Machine Learning
Kawakami, R., Wright, K., Scharre, D. W., & Ning, X. (2023) · Alzheimer Disease & Associated Disorders · doi:10.1097/wad.0000000000000593 · Cited by 3 · see citing works
Karr, J. E., & Ali, S. (2025) · The Clinical Neuropsychologist · doi:10.1080/13854046.2025.2510332 · Cited by 3 · see citing works
Self-citationRomero, K., Coleman, A., Heir, A. S., Leach, L. R., & Proulx, G. B. (2022) · Archives of Clinical Neuropsychology · doi:10.1093/arclin/acac050 · Cited by 3 · see citing works
Björkdahl, A., & Larsson, J. (2026) · Journal of Rehabilitation Medicine · doi:10.2340/jrm.v58.45473 · Cited by 2 · see citing works
Karr, J. E., Mindt, M. R., & Iverson, G. L. (2022) · Archives of Clinical Neuropsychology · doi:10.1093/arclin/acac042 · Cited by 2 · see citing works
Self-citationCook, N. E., Iverson, G. L., & Karr, J. E. (2025) · Frontiers in Psychology · doi:10.3389/fpsyg.2025.1473095
Self-citationDuff, K. M., Presley, C., King, J. B., Hoffman, J. M., & Raudeberg, R. (2025) · Journal of the International Neuropsychological Society · doi:10.1017/s1355617725101227
Considerations in Alzheimer’s Disease in Women
Just, C., Seibert, K., Chan, C. K., Maldonado-Correa, C., & Jones, D. (2026) · Current Neurology and Neuroscience Reports · doi:10.1007/s11910-026-01504-3
- Authors
- Iverson, G. L., & Karr, J. E.
- Affiliations
- Harvard University (US)
- University of Kentucky (US)
- Corresponding author
- Iverson, Grant L.
- Venue
- Frontiers in Psychology
- Publisher
- Frontiers Media SA
- Published
- 2021-09-08
- Volume
- 12
- Pages
- 724888-724888
- ISSN
- 1664-1078 (ISSN-L)
- PMC
- PMC8457516
- OpenAlex
- W3197444602
- Cited by
- 13
- References
- 46
- Citations by year
- 2026: 2 · 2025: 3 · 2024: 2 · 2023: 3 · 2022: 3
- FWCI
- 1.44
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Frontiers in Psychology (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, other-oa)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- UKnowledge (University of Kentucky) (submittedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Spaulding Research Institute
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Social Sciences › Psychology › Experimental and Cognitive Psychology › Cognitive Abilities and Testing
- Social Sciences › Psychology › Clinical Psychology › Historical and Modern Theater Studies
- Keywords
- mild cognitive impairment, high-functioning adults, NIH Toolbox Cognition Battery, cognitive screening, identification algorithm, crystallized intelligence, base rates, cognitive decline, neurodegenerative diseases, neuropsychological assessment
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
