CNS Vital Signs Computerized Neurocognitive Test

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The CNS Vital Signs computerized neuropsychological test platform is used to measure brain function or cognitive domains and examining testing effort for both children and adults (ages 8 – 90 years). The test is used to rapidly evaluate and subsequently track and manage neuropsychiatric symptoms, behaviors, and comorbidities. Results of testing are provided immediately after a test is completed and typically taken in context with other relevant clinical information such as history, physical examination, other psychological or neuropsychological tests, lab results, imaging studies, etc., in accordance with good clinical practice standards. Clinicians and researchers may choose an appropriate test set from ten normed neuropsychological tests along with an additional sixteen research subtests as well as over 50 (PRO) patient reported outcome questionnaires or instruments.

Technically, the platform runs on Windows, IOS and web environments. Response times are measured with millisecond precision. Symptom validity or invalid responses are measured as embedded indicators within the neurocognitive tests. There are an infinite number of test forms.The majority of subtests are based on conventional neuropsychological tests (e.g., the Rey Memory Test, Stroop), however, some of these measures are new such as the shifting attention test (e.g., Shifting set test) enabling a more granular view of executive function.

The normed testing options consist of the following subtests:

  • The Verbal Memory Test measuring learning and recognition memory for words; immediate and delayed recall
  • The Visual Memory Test measuring learning and recognition memory for geometric shapes; immediate and delayed recall
  • The Finger Tapping Test measuring ability to perform hand motor movements to produce and satisfy an intention towards a manual action and goal
  • The Symbol Digit Coding Test measures ability to recognizes and processes information i.e., perceiving, attending/responding to incoming information, motor speed, fine motor coordination, and visual-perceptual ability
  • The Stroop Test measures how quickly a subject can react, in milliseconds, to a simple and increasingly complex direction set and inhibition / disinhibition of frontal or executive tasks
  • The Shifting Attention Test measures the ability to recognize and respond to rules, categories, and manages or navigates rapid decision making.
  • The CPT or Continuous Performance Test measures ability to track and respond to a single defined stimulus over lengthy periods of time while performing vigilance and response inhibition quickly and accurately.
  • The Perception of Emotions Test measures how well a subject can perceive, identify, and react to specific emotions.
  • The Non‐Verbal Reasoning Test measures how well a subject can perceive and understand the meaning of visual or abstract information and recognizing relationships between visual‐abstract concepts.
  • The Four Part CPT Test (N-Back) measures a subject's working memory or how well a subject can perceive and attend to symbols using short-term memory processes and sustained attention or how well a subject can direct and focus cognitive activity on specific stimuli.

The Neurocognitive domains assessed with the CNS Vital Signs tests are:

  • Complex Memory

Multimodal Testing: 50+ PRO - Patient Reported Outcome questionnaires or instruments

The 50+ (PRO) Patient Reported Outcome questionnaires or instruments made available in the CNS Vital Signs assessment platform supplements clinical evaluation and management activities by helping make sure the right questions have been asked and by rating the severity of the illness or impairment. The use of PRO rating scales can help formalize the assessment approach, helps ensure thoroughness, may clarify the presence or absence of disorders, generally provides an index of severity, and helps facilitate the determination of response to treatment and disease course over time.

Patient Reported Outcome Questionnaires and Instruments Number of Questions
Medical Outcomes Survey (MOS) SF-36 36
NeuroPsych Questionnaire 207
NeuroPsych Questionnaire Brief e.g. follow-up 45
Zung Self-Rating Depression Scale 20
Zung Self-Rating Anxiety Scale 20
Stanford Geriatric Depression Scale 15
Stanford Geriatric Depression Scale 30
Epworth Sleepiness Scale 8
Pittsburgh Sleep Quality Index 10
Sedation Scale 1
Alertness Rating Scale 1
Alcohol Use Disorders Identification Test (AUDIT) e.g. SBIRT Screens 10
Drug Use Questionnaire (DAST) e.g. SBIRT Screens 20
Pain Catastrophizing Scale (PCS) 13
Adult ADHD Self-Report Scale (ASRS-v1.1) Symptom Checklist 18
Vanderbilt ADHD Diagnostic Parent Rating Scale 53
Vanderbilt ADHD Diagnostic Teacher Rating Scale 43
Vanderbilt Assessment Follow-up Parent Rating Scale 38
Vanderbilt Assessment Follow-up Teacher Rating Scale 38
Pediatric Symptom Checklist (PSC) 35
Pediatric Symptom Checklist-Youth Report (Y-PSC) 35
Pediatric Symptom Checklist (PSC-17) 17
Screen for Child Anxiety Related Disorders (SCARED) Child Version 41
Screen for Child Anxiety Related Disorders (SCARED) Parent Version 41
Child Obsessive-Compulsive Disorder Inventory (OCD-C) 20
Social Anxiety Scale for Children and Adolescents (SASCA) 20
Childhood Cancer Survivor Study Neurocognitive Questionnaire (CCSS) 25
Neurobehavioral Symptom Inventory (NSI) 22
PTSD Checklist (PCL-5) 20
PTSD Checklist - Civilian Version (PCL-C) 17
PTSD Checklist - Civilian Version (PCL-C) 17
PTSD Checklist - Stressor Specific Version (PCL-S) 17
Combat Exposure Scale (CES) 7
Life Events Checklist (LEC) 25
Dizziness Handicap Inventory (DHI) 20
Adult Obsessive-Compulsive Disorder Inventory (OCD-A) 20
Head Injury Questionnaire (HIQ) 90
Memory Questionnaire (MEMQ) 27
DRRI Section A: Pre-Deployment Life Events 15
DRRI Section B: Childhood Experiences 15
DRRI Section C: Training and Deployment Preparation 14
DRRI Section D: Deployment Environment 20
DRRI Section E: Life and Family Concerns 14
DRRI Section F: Unit Support 12
DRRI Section G: Relationship Within Unit 14
DRRI Section H: Deployment Concerns 15
DRRI Section I: Combat Experiences 15
DRRI Section J: Post-Battle Experiences 20
DRRI Section K: Exposure to Nuclear, Biological, Chemical Agents 15
DRRI Section L: Post-Deployment Support 20
DRRI Section M: Post-Deployment Life Events 17

Uses for CNS Vital Signs[edit]

CNS Vital Signs is utilized by medical providers and researchers to evaluate and manage patients presenting with a psychological or neurological complaints as well as to test drug effect. CNS Vital Signs was designed to be used in busy clinical and research settings for a variety of populations such as:

Neurodegenerative Disorders (e.g., MS, MCI - Mild Cognitive Impairment, Early Dementia, Epilepsy, Parkinson’s, etc.)

Neurodevelopmental Conditions (e.g., AD/HD, Asperger's, etc.)

Neuropsychiatric (e.g., Pain, Depression/Anxiety, Substance Abuse, PTSD, Eating Disorders etc.)

Neurotrauma (e.g., TBI)

Neurocognitive manifestations in conditions such as Cancer, Obesity, Post-surgery, Mild Hepatic

Encephalopathy, Metabolic / Diabetes, Cardiovascular, Prion or Lyme Disease, Exercise / Human

Performance, Neurotoxicity, Genetic Phenotype, Medication Effects, HIV - HAND, etc. as well as aid in the monitoring of their progression (e.g. rehabilitation), and measuring the response of the disorder to treatment.

See also[edit]

References[edit]

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2. Bojar I, Wojcik-Fatla A, Owoc A, Lewinski A. Polymorphisms of apolipoprotein E gene and cognitive functions of postmenopausal women, measured by battery of computer tests - Central Nervous System Vital Signs. Neuro Endocrinol Lett. 2012;33(4):385-92. PubMed PMID 22936261.

3. Iverson GL, Brooks BL, Langenecker SA, Young AH. Identifying a cognitive impairment subgroup in adults with mood disorders. J Affect Disord. 2011 Aug;132(3):360-7. doi: 10.1016/j.jad.2011.03.001. Epub 2011 Mar 25. PubMed PMID 21439647.

4. Brooks BL, Barlow KM. A methodology for assessing treatment response in Hashimoto's encephalopathy: a case study demonstrating repeated computerized neuropsychological testing. J Child Neurol. 2011 Jun;26(6):786-91. doi: 10.1177/0883073810391532. Epub 2011 Feb 10. PubMed PMID 21311082.

5. King AL, Valença AM, E Silva AC, Cerqueira AC, Ferraz LM, Nardi AE. Huntington's Disease: Two-Year Observational Follow-Up of Executive Function Evaluation with CNS Vital Signs Test in an Adult Patient. Case Rep Med. 2011;2011:385894. doi: 10.1155/2011/385894. Epub 2011 Dec 4. PubMed PMID 22203851; PubMed Central PMCID: PMC3235665.

6. Iverson GL, Brooks BL, Young AH. Rapid computerized assessment of neurocognitive deficits in bipolar disorder. Appl Neuropsychol. 2009 Jul;16(3):207-13. doi: 10.1080/ 09084280903098778. PubMed PMID 20183173.

7. Gualtieri CT, Johnson LG. A computerized test battery sensitive to mild and severe brain injury. Medscape J Med. 2008 Apr 15;10(4):90. PubMed PMID 18504479; PubMed Central PMCID: PMC2390690.

8. Gualtieri CT, Johnson LG. Reliability and validity of a computerized neurocognitive test battery, CNS Vital Signs. Arch Clin Neuropsychol. 2006 Oct;21(7):623-43. Epub 2006 Oct 2. PubMed PMID 17014981.

9. Gualtieri CT, Johnson LG. Comparative neurocognitive effects of 5 psychotropic anticonvulsants and lithium. MedGenMed. 2006 Aug 23;8(3):46. PubMed PMID 17406176; PubMed Central PMCID: PMC1781293.

10. Gualtieri CT, Johnson LG. Neurocognitive testing supports a broader concept of mild cognitive impairment. Am J Alzheimers Dis Other Demen. 2005 Nov-Dec;20(6):359-66. Erratum in: Am J Alzheimers Dis Other Demen. 2006 Mar-Apr;21(2):3 p preceding 73. PubMed PMID 16396441. Dementia 5 (5): 266–81. PMID 7951684.

11. Brooks BL, Sherman EM. Computerized neuropsychological testing to rapidly evaluate cognition in pediatric patients with neurologic disorders. J Child Neurol. 2012 Aug;27(8):982-91. doi: 10.1177/0883073811430863. Epub 2012 Jan 30. PubMed PMID: 22290863.

Further reading[edit]