A Systematic Review and Meta-Analysis of the Use of the National Institutes of Health Toolbox Cognition Battery in Clinical Populations

Watson, Kelly H.; Ciriegio, Abagail E.; Miller, Claire F.; Roth, Marissa C.; Compas, Bruce E. · 2025 · OpenAlex-citations

DOI: 10.1007/s11065-025-09669-3

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Summary

This systematic review and meta-analysis addresses the lack of quantitative synthesis regarding the National Institutes of Health Toolbox Cognition Battery (NIHTB-CB) in clinical populations. While the NIHTB-CB is widely used as a standardized tool to assess cognitive function across the lifespan, prior research had not aggregated findings to determine its utility in identifying cognitive deficits associated with medical and psychiatric conditions. The study aimed to quantify performance differences between clinical samples and two comparison groups: population normative data and recruited control samples. The authors conducted a systematic search of PsycINFO, PubMed, and ProQuest for studies published up to December 2021, identifying 84 eligible studies comprising 6,331 clinical participants. These studies included peer-reviewed articles, dissertations, and master’s theses involving individuals with conditions listed in the ICD-11 or DSM-5. Data extraction focused on Fully Corrected T scores or Age Corrected Standard scores for the Fluid Cognition Composite (FCC), Crystallized Cognition Composite (CCC), and Total Cognition Composite. Study quality was assessed using the QUADAS-2 tool, and potential moderators such as study quality, test version, age, sex, education, and publication status were examined. The meta-analysis revealed significant cognitive deficits in clinical samples compared to both normative data and recruited controls, particularly in the Fluid Cognition Composite and its associated subtests, including attention, working memory, processing speed, and executive function. Conversely, clinical participants scored higher than normative data on Crystallized Cognition subtests, though they scored significantly lower than recruited controls. Evidence for differences in the Total Cognition Composite was mixed. The results were moderated by study quality and participant demographics, with some evidence of publication bias. The analysis also highlighted concerns regarding the validity of Version 2 scores, particularly for the Flanker Inhibitory Control and Attention subtest, where performance differed significantly from Version 1. These findings confirm that the NIHTB-CB effectively detects expected impairments in fluid cognitive abilities among clinical populations, supporting its utility as a research tool for tracking cognitive status in health conditions. However, the discrepancies in crystallized cognition scores and the identified version-specific biases suggest caution in interpretation. The study underscores the need for careful consideration of test versions and demographic corrections when using the NIHTB-CB in clinical research, providing a foundation for future standardized assessment practices.

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• individual differences