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Form Structure: NIH ToolBox Cognition Domain Picture Sequence Memory Test

This form structure is an organized set of data definitions for a copyrighted form
Title:
NIH ToolBox Cognition Domain Picture Sequence Memory Test
Short Name:
NIHTBPictureSeqMemoryTest
Description:
Cognition Domain: The Picture Sequence Memory Test is a measure developed for the assessment of episodic memory for ages 3-85 years. It involves recalling increasingly lengthy series of illustrated objects and activities that are presented in a particular order on the computer screen, with corresponding audio recorded phrases played. Copyright 2012 Northwestern University and the National Institutes of Health. http://www.nihtoolbox.org/Pages/NIH-Toolbox-Terms-and-Conditions.aspx
Disease:
Traumatic Brain Injury General (For all diseases)
Organization:
NIH/CIT/DCB
Required Program Form:
No
Standardization:
Standard NINDS CDE
Labels:
Form Type:
Clinical Assessment
Publication Date:
2016-09-30
Version:
1.0
Date Created:
2016-05-27
Owner:
Number of Data Elements:
35
eForms:
N
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 Context type  The context to which the questions were answered ContextType Recommended CDE
2 Context type other text  The free-text related to ContextType specifying other text ContextTypeOTH Recommended CDE
3 Data source  Source of the data provided on the case report form DataSource Recommended CDE
4 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

NIH Toolbox Administration (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 NIH Toolbox - Test domain battery type 

(Retired)

 		Type of domain battery for the NIH Toolbox test being administered, as a part of the NIH Toolbox NIHTBTestDomainBatteryTyp Recommended CDE
2 NIH Toolbox - Test domain battery type other  The free-text related to NIHTBTestDomainBatteryTyp specifying other text, as part of the NIH Toolbox NIHTBTestDomainBatteryTypOTH Recommended CDE
3 NIH Toolbox - Test name type  Type of NIH Toolbox test being administered, as part of the NIH Toolbox NIHTBAdminTestNameTyp Recommended CDE
4 NIH Toolbox - Test name type other  The free-text related to NIHTBAdminTestNameTyp specifying other text, as part of the NIH Toolbox NIHTBAdminTestNameTypOTH Recommended CDE
5 NIH Toolbox - Test administration language type  Type of language for test being administrated, as part of the NIH Toolbox NIHTBTestAdminLanguageTyp Recommended CDE
6 NIH Toolbox - Form administered type  Type of NIH Toolbox form being administered, as part of the NIH Toolbox NIHTBFormAdminTyp Recommended CDE
7 NIH Toolbox - Test administration language type other  Free-text related to NIHTBTestAdminLanguageTyp specifying other text, as part of the NIH Toolbox NIHTBTestAdminLanguageTypOTH Recommended CDE
8 NIH Toolbox - Test administration flag type  Type of flag for the NIH Toolbox test being administered, as part of the NIH Toolbox NIHTBAdminTestFlagTyp Recommended CDE
9 NIH Toolbox - Test administration flag indicator  Indicator of a flag for the NIH Toolbox test being administered, as part of the NIH Toolbox NIHTBAdminTestFlagInd Recommended CDE

NIH Toolbox Picture Sequence Memory Test (Appears Up To 4 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 NIH Toolbox Cognition Domain Picture Sequence Memory Test - Sequence length number  Number for length of picture sequence administered, as part of the NIH Toolbox Cognition Domain Picture Sequence Memory Test NIHTBPSMTSequenceLengthNum Recommended CDE
3 NIH Toolbox Cognition Domain Picture Sequence Memory Test - Correct adjacent pairs number  The number of correct adjacent pairs as part of the NIH Toolbox Cognition Domain Picture Sequence Memory Test, including iPad app NIHTBPSMTCorrectAdjPairsNum Recommended CDE

NIH Toolbox Picture Sequence Memory Test Scoring (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 NIH Toolbox Cognition Domain Picture Sequence Memory Test - Theta score  Theta score computed as part of the NIH Toolbox Cognition Domain Picture Sequence Memory Test, including iPad app NIHTBPSMTThetaScore Recommended CDE
2 NIH Toolbox Cognition Domain Picture Sequence Memory Test - Computed score  Computed score as part of the NIH Toolbox Cognition Domain Picture Sequence Memory Test NIHTBPSMTComputedScore Recommended CDE
3 NIH Toolbox Performance Measures (web and CAT) - Age-adjusted scale score  Age-adjusted scale score, as part of the NIH Toolbox Performance Measures (web and CAT) NIHTBPMAgeAdjSclScore Recommended CDE
4 NIH Toolbox Performance Measures - Age-adjusted national percentile value  Value of age-adjusted national percentile, as part of the NIH Toolbox Performance Measures NIHTBPMAgeAdjNationalPctVal Recommended CDE
5 NIH Toolbox Performance Measures - Fully-adjusted scale score  Fully-adjusted scale score, as part of the NIH Toolbox Performance Measures NIHTBPMFullyAdjSclScore Recommended CDE
6 NIH Toolbox Performance Measures (web and CAT) - Unadjusted scale score  Unadjusted scale score, as part of the NIH Toolbox Performance Measures (web and CAT) NIHTBPMUnadjSclScore Recommended CDE
7 NIH Toolbox - Standard error  Standard error (a statistical measure of variance that represents the margin of error for the Tscore), as part of the NIH Toolbox Web, Cat and iPad Cognition measures such as: Picture Vocabulary Test and Oral Reading Recognition Test. NIHTBStandardError Optional CDE

NIH Toolbox Cognitive Composite Scores (Appears Up To 1 Time)

# Title Short Description Variable Name Required? Type
1 NIH Toolbox Cognition Domain - Fluid Cognition Composite Score  NIH Toolbox Fluid Cognition Composite Score, as a part of the cognition domain of NIH Toolbox NIHTBFluidCognitionCompScore Recommended CDE
2 NIH Toolbox Cognition Domain - Cognitive Function Composite Score (DCCS)  NIH Toolbox Cognitive Function Composite Score, as a part of cognition domain of the NIH Toolbox NIHTBCognitFunctCompositeScore Recommended CDE
3 NIH Toolbox Cognition Domain - Early Childhood Composite Score  NIH Toolbox Early Childhood Composite Score, as a part of cognition domain of the NIH Toolbox NIHTBEarlyChildhdCompsiteScore Recommended CDE
Keywords

Change History