Form Structure: Brief Test of Adult Cognition by Telephone (BTACT) : FITBIR : Federal Interagency Traumatic Brain Injury Research Informatics System

Form Structure: Brief Test of Adult Cognition by Telephone (BTACT)

This form structure is an organized set of data definitions for a copyrighted form

Title:

Brief Test of Adult Cognition by Telephone (BTACT)

Short Name:

BTACT

Description:

The Brief Test of Adult Cognition by Telephone (BTACT) assesses multiple dimensions central for effective functioning across adulthood: episodic memory, working memory, reasoning, verbal fluency, and executive function. The BTACT is the first instrument which includes measures of processing speed, reaction time, and task switching/inhibitory control for use over the telephone. Reference: Margie E. Lachman, Ph.D et al. Monitoring Cognitive Functioning: Psychometric Properties of the Brief Test of Adult Cognition by Telephone (BTACT) Assessment. Author manuscript; available in PMC 2015 Aug 1. Published in final edited form as: Assessment. 2014 Aug; 21(4): 404417. Published online 2013 Dec 9. doi: 10.1177/1073191113508807 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4050038/

Disease:

Traumatic Brain Injury

Organization:

BRICS/CIT/NIH

Required Program Form:

Standardization:

Standard NINDS CDE

Labels:

Form Type:

Clinical Assessment

Publication Date:

2017-10-27

Version:

1.0

Date Created:

2016-03-30

Owner:

Number of Data Elements:

eForms:

Logically grouped data elements with defined frequency at which they repeat.

#	Title	Short Description	Variable Name	Required?	Type
1	GUID	Global Unique ID which uniquely identifies a subject	GUID	Required	CDE
2	Subject identifier number	An identification number assigned to the participant/subject within a given protocol or a study.	SubjectIDNum	Optional	CDE
3	Age in years	Value for participant's subject age recorded in years.	AgeYrs	Recommended	CDE
4	Vital status	Status of participant/subject as alive or dead	VitStatus	Optional	CDE
5	Visit date	Actual interview or visit date	VisitDate	Recommended	CDE
6	Site name	The name of the site for the study	SiteName	Recommended	CDE
7	Days since baseline	The number of days since baseline	DaysSinceBaseline	Optional	CDE
8	Case control indicator	Indicator of whether subject is in the case or control arm of the study.	CaseContrlInd	Optional	CDE
9	General notes text	General notes	GeneralNotesTxt	Optional	CDE

Additional Element Groups

Listed below are your additional element groups.

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Form Administration (Appears Up To 1 Time)

#	Title	Short Description	Variable Name	Required?	Type
1	Language form administration ISO code	Code (ISO 639-2) for the language that was used for CRF/instrument/scale/etc. administration	LangCRFAdministratISOCode	Recommended	CDE
2	Language form administration ISO code other text	The free-text field related to 'Language used for CRF/instrument/scale/etc. administration ISO code' specifying other text.	LangCRFAdministratISOCodeOTH	Recommended	CDE
3	Context type	The context to which the questions were answered	ContextType	Recommended	CDE
4	Context type other text	The free-text related to ContextType specifying other text	ContextTypeOTH	Recommended	CDE
5	Data source	Source of the data provided on the case report form	DataSource	Recommended	CDE
6	Data source other text	The free-text field related to Data source specifying other text. Source of the data provided on the case report form	DataSourceOTH	Recommended	CDE

Word List Recall-Immediate (Appears Up To 15 Times)

#	Title	Short Description	Variable Name	Required?	Type
1	Trial number (numeric)	The number representing the sequence for any repeated measure test or assessment when it is performed multiple times.	TrialNumber	Recommended	CDE
2	Rey Auditory Verbal Learning Test (RAVLT) - Word list type	Type of trial, as part of Rey Auditory Verbal Learning Test (RAVLT)	RAVLTWordListTyp	Recommended	CDE
3	Rey Auditory Verbal Learning Test (RAVLT) - Correct recall total words number	Number of words correctly recalled during trial as part of Rey Auditory Verbal Learning Test (RAVLT)	RAVLTTrialCorrectWordsNum	Recommended	CDE
4	Brief Test of Adult Cognition by Telephone (BTACT) - Total number of repetitions	Total Number of repetitions, as a part of Brief Test of Adult Cognition by Telephone (BTACT)	BTACTTotalRepetitionNumber	Recommended	CDE
5	Brief Test of Adult Cognition by Telephone (BTACT) - Total Number of intrusions	Total Number of intrusions, as a part of Brief Test of Adult Cognition by Telephone (BTACT)	BTACTTotalIntrusionNumber	Recommended	CDE

Digits Backward (Appears Up To 14 Times)

#	Title	Short Description	Variable Name	Required?	Type
1	Trial number (numeric)	The number representing the sequence for any repeated measure test or assessment when it is performed multiple times.	TrialNumber	Recommended	CDE
2	Wechsler Adult Intelligence Scale III (WAIS III) - Digit span backward subtest item number	Item number, as part of Wechsler Adult Intelligence Scale III (WAIS III) Digit Span Backward subtest	WAIS_IIIDSBItemNum	Recommended	CDE
3	Wechsler Adult Intelligence Scale III (WAIS III) - Digit span backward subtest number series text	Series of numbers, as part of Wechsler Adult Intelligence Scale III (WAIS III) Digit Span Backward subtest	WAIS_IIIDSBNumTxt	Recommended	CDE
4	Wechsler Adult Intelligence Scale III (WAIS III) - Digit span backward subset response text	Participant response, as part of Wechsler Adult Intelligence Scale III (WAIS III) Digit Span Backward subtest	WAIS_IIIDSBRespnsTxt	Recommended	CDE
5	Wechsler Adult Intelligence Scale III (WAIS III) - Digit span backward subtest item score	Item score calculated as a number of correct trials, as part of Wechsler Adult Intelligence Scale III (WAIS III) Digit Span Backward subtest	WAIS_IIIDSBItemScore	Recommended	CDE
6	Wechsler Adult Intelligence Scale III (WAIS III) -Digit span backward highest number score	Score is highest number of digits reached, as part of Wechsler Adult Intelligence Scale III (WAIS III) Digit Span Backward subtest	WAIS_IIIDSBHghestNumScore	Recommended	CDE
7	Wechsler Adult Intelligence Scale III (WAIS III) -Digit span backward longest string score	Score is longest string that was repeated exactly in reverse order, as part of Wechsler Adult Intelligence Scale III (WAIS III) Digit Span Backward subtest	WAIS_IIIDSBLongstStrgScore	Recommended	CDE
8	Wechsler Adult Intelligence Scale III (WAIS III) - Digit span backward subtest total raw score	Total raw score, as part of Wechsler Adult Intelligence Scale III (WAIS III) Digit Span Backward subtest	WAIS_IIIDSBTtlScore	Recommended	CDE
9	Wechsler Adult Intelligence Scale III (WAIS III) - Digit span backward subtest trial score	Trial score, as part of Wechsler Adult Intelligence Scale III (WAIS III) Digit Span Backward subtest	WAIS_IIIDSBTrialScore	Recommended	CDE

Category Fluency (Appears Up To 4 Times)

#	Title	Short Description	Variable Name	Required?	Type
1	Brief Test of Adult Cognition by Telephone (BTACT) - Category Fluency Test category	Category of responses in the Category Fluency Test, as part of Brief Test of Adult Cognition by Telephone (BTACT).	BTACTCategoryFluencyCat	Recommended	CDE
2	Brief Test of Adult Cognition by Telephone (BTACT) - Category Fluency Test correct responses number	Number of correct responses in the Category Fluency Test, as part of Brief Test of Adult Cognition by Telephone (BTACT).	BTACTCatFluencyCorrectRespNum	Recommended	CDE
3	Time range duration	Time range duration in seconds	TimeRangeDur	Recommended	UDE
4	Brief Test of Adult Cognition by Telephone (BTACT) - Total number of repetitions	Total Number of repetitions, as a part of Brief Test of Adult Cognition by Telephone (BTACT)	BTACTTotalRepetitionNumber	Recommended	CDE
5	Brief Test of Adult Cognition by Telephone (BTACT) - Total Number of intrusions	Total Number of intrusions, as a part of Brief Test of Adult Cognition by Telephone (BTACT)	BTACTTotalIntrusionNumber	Recommended	CDE

Stop and Go Task Accuracy (Appears Up To 72 Times)

#	Title	Short Description	Variable Name	Required?	Type
1	Trial number (numeric)	The number representing the sequence for any repeated measure test or assessment when it is performed multiple times.	TrialNumber	Recommended	CDE
2	Brief Test of Adult Cognition by Telephone (BTACT) - Stop and Go Task Test Type	Type of test, as part of Brief Test of Adult Cognition by Telephone(BTACT).	BTACTStopAndGoTestTyp	Recommended	CDE
3	Brief Test of Adult Cognition by Telephone (BTACT) - Stop and Go Task Question Type	Type of questions asked in the Stop And Go Task, as part of Brief Test of Adult Cognition by Telephone (BTACT).	BTACTStopAndGoQstnTyp	Recommended	CDE
4	Brief Test of Adult Cognition by Telephone (BTACT) - Stop and Go Task Response Type	Type of responses in the Stop And Go Task, as part of Brief Test of Adult Cognition by Telephone (BTACT).	BTACTStopAndGoRspnsTyp	Recommended	CDE
5	Brief Test of Adult Cognition by Telephone (BTACT) - Stop and Go task normal baseline score	Total number correct in normal baseline condition, as part of Brief Test of Adult Cognition by Telephone(BTACT).	BTACTStopAndGoNormBseScore	Recommended	CDE
6	Brief Test of Adult Cognition by Telephone (BTACT) - Stop and Go task reverse baseline score	Total number correct in reverse baseline condition, as part of Brief Test of Adult Cognition by Telephone(BTACT).	BTACTStopAndGoRvrsBseScore	Recommended	CDE
7	Brief Test of Adult Cognition by Telephone (BTACT) - Stop and Go Task Experimental Task Type	Type of test, as part of Brief Test of Adult Cognition by Telephone(BTACT).	BTACTStopAndGoTotExptalTestTyp	Recommended	CDE
8	Brief Test of Adult Cognition by Telephone (BTACT) - Stop and Go Task Experimental Score	Total number correct in experimental condition, as part of Brief Test of Adult Cognition by Telephone(BTACT).	BTACTStopAndGoExptalScore	Recommended	CDE
9	Brief Test of Adult Cognition by Telephone (BTACT) - Stop and Go Task Switch Trial Score	Total number of trials correct after switch in experimental condition, as part of Brief Test of Adult Cognition by Telephone(BTACT).	BTACTStopAndGoSwtchTrlScore	Recommended	CDE
10	Brief Test of Adult Cognition by Telephone (BTACT) - Stop and Go Task NoSwitch Trial Score	Total number of other experimental trials correct, as part of Brief Test of Adult Cognition by Telephone(BTACT).	BTACTStopAndGoNoSwtchTrlScore	Recommended	CDE
11	Brief Test of Adult Cognition by Telephone (BTACT) - Median latency measurement of time lapsed in milliseconds	Median latency measurement of time lapsed in milliseconds, as a part of the Brief Test Adult Cognition by Telephone (BTACT)	BTACTMedianLatencyTimeDur	Recommended	CDE
12	Brief Test of Adult Cognition by Telephone (BTACT) - Mean latency measurement of time lapsed in milliseconds	Mean latency measurement of time lapsed in milliseconds, as a part of the Brief Test Adult Cognition by Telephone (BTACT)	BTACTMeanLatencyTimeDur	Recommended	CDE

Number Series (Appears Up To 5 Times)

#	Title	Short Description	Variable Name	Required?	Type
1	Trial number (numeric)	The number representing the sequence for any repeated measure test or assessment when it is performed multiple times.	TrialNumber	Recommended	CDE
2	Brief Test of Adult Cognition by Telephone (BTACT) - Type of responses in the number series text	Text for type of responses in the Number Series Task, as part of Brief Test of Adult Cognition by Telephone (BTACT).	BTACTNumberSeriesItemTxt	Recommended	CDE
3	Brief Test of Adult Cognition by Telephone (BTACT) - Total number of items/series completed correctly score	Score of total number of items/series completed correctly in the Number Series Task, as a part of the Brief Test Adult Cognition by Telephone (BTACT)	BTACTNumSeriesCorctRespnsScore	Recommended	CDE

30 Seconds and Counting Task (Appears Up To 1 Time)

#	Title	Short Description	Variable Name	Required?	Type
1	Brief Test of Adult Cognition by Telephone (BTACT) - Thirty Seconds and Counting Task (30-SACT) last number reached text	Text for last number reached in the Thirty Seconds and Counting Task (30-SACT), as part of Brief Test of Adult Cognition by Telephone (BTACT).	BTACTThirtySecondsLastNumTxt	Recommended	CDE
2	Brief Test of Adult Cognition by Telephone (BTACT) - Thirty Seconds and Counting Task (30-SACT) errors number	Number of errors in the Thirty Seconds and Counting Task (30-SACT), as part of Brief Test of Adult Cognition by Telephone (BTACT).	BTACTThirtySecondsErrorNum	Recommended	CDE
3	Brief Test of Adult Cognition by Telephone (BTACT) - Thirty Seconds and Counting Task (30-SACT) total score	Total number of digits produced score, as a part of the Brief Test Adult Cognition by Telephone (BTACT)	BTACTThirtySecondsTotalScore	Recommended	CDE

Word List Recall-Delayed (Appears Up To 15 Times)

#	Title	Short Description	Variable Name	Required?	Type
1	Trial number (numeric)	The number representing the sequence for any repeated measure test or assessment when it is performed multiple times.	TrialNumber	Recommended	CDE
2	Rey Auditory Verbal Learning Test (RAVLT) - Word list type	Type of trial, as part of Rey Auditory Verbal Learning Test (RAVLT)	RAVLTWordListTyp	Recommended	CDE
3	Rey Auditory Verbal Learning Test (RAVLT) - Correct recall trial A1-5 total words count	Total number of words from List A correctly recalled during Trials A1-,5 as part of Rey Auditory Verbal Learning Test (RAVLT)	RAVLTTtlCorrectWordsNum	Recommended	CDE
4	Brief Test of Adult Cognition by Telephone (BTACT) - Total number of repetitions	Total Number of repetitions, as a part of Brief Test of Adult Cognition by Telephone (BTACT)	BTACTTotalRepetitionNumber	Recommended	CDE
5	Brief Test of Adult Cognition by Telephone (BTACT) - Total Number of intrusions	Total Number of intrusions, as a part of Brief Test of Adult Cognition by Telephone (BTACT)	BTACTTotalIntrusionNumber	Recommended	CDE

Keywords

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