CNS Vital Signs Interpretation Guide

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www.CNSVS.com
Contents

Interpretation Guide: Why & How ……………………………………………………. 3

CNS Vital Signs Report ………………………………………………………………………. 4
Evaluate Effort - Test Validity Indicator …………………………………………………… 5
Evaluate Severity – Impairment Status ……………………………………………………… 7
Evaluate Pattern – Personalized Medicine ……………………………………………….. 9
CNS Vital Signs Normed Neurocognitive Tests ……………………………………….. 12
CNS Vital Signs Clinical Domain Description ……………………………………….. 13
Formulas for Calculating the Neurocognitive Domain Scores ………………14
Neurocognitive Tests and Domain Scoring Process ……………………………….. 15

One Key Difference – Measuring Millisecond Precise Cognitive Speed… “CNS Vital Signs
is sensitive in detecting cognitive impairment …uses computerized forms of traditional tests such
as Symbol Digit Modalities and Stroop …are easy to use, require significantly less time to
administer, produce instant scoring and can incorporate alternate forms, necessary to minimize
learning effect on follow-up. …also the capacity to accurately-automatically quantify "speed
factor” via multiple parameters such as reaction time, psychomotor speed, and processing
speed, increasing their sensitivity in detecting even subtle changes in information processing
speed.” ** ** Cognitive Impairment in Relapsing Remitting and Secondary Progressive Multiple Sclerosis
Patients: Efficacy of a Computerized Cognitive Screening Battery; ISRN Neurology, 2014 Mar 13

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2
 Interpretation Guide

Why CNS Vital Signs Testing Platform?

CNS Vital Signs computerized neuropsychological / neurocognitive tests enables a non-invasive,
customizable clinical procedure to efficiently and objectively assess a broad-spectrum of brain function
domain performances under challenge (cognition stress test) and the millisecond precise measurement
of important cognitive functions. The testing platform also contains 60+ well recognized, evidence-
based rating instruments to help identify clinical symptoms, behaviors, and comorbidities salient to the
evaluation and ongoing management of many neurological, psychiatric and other clinical conditions.
Serial evaluation of neurocognition can help patients and caregivers navigate problems related to daily
living, school or vocational work.

A B C
Conduct Evaluate Re-test
Neurocognitive Testing Neurocognitive Neurocognitive
Procedure Testing Results Testing Procedure

Evaluate
1
Is the Validity Indicator  Are the Scores suggestive 
(VI) suggestive of an  Effort
of  a deficit or impairment?
invalid test?

Is the Pattern salient of a 
3 2
Evaluate Evaluate
pathology or treatment 
Pattern Severity
response?
HOW?
A: After medical necessity for neurocognitive testing has been determined practices use CNS VS
assessment platform for the evaluation, management and treatment in patient care. It is important to
conduct a valid assessment and clinics can refer to and use the Test Administration Guide for optimal
results. Testing strategy should be determined using the ten neurocognitive tests and/or the sixty plus
evidenced-based rating instruments. For initial baseline evaluations or in complex presentations, a
customizable broad-spectrum battery is always an appropriate consideration or starting point.
B: Review the immediately auto-scored report to (1) 1 validate testing effort, (2)
2 evaluate the
Domain Dashboard to quickly assess the level of impairment or grade the level of severity based on
age matched norms ages 8-89, and (3) 3 Evaluate the Cognitive Domains to help rule-in, rule-out,
confirm certain clinical conditions or evaluate treatment results. Feedback to the patient on the testing
results may be presented at the clinical encounter or at a subsequent patient visit.
C: If invalid test results were noted then consider re-testing the patient to confirm clinical results. If
the test results were valid, then, as part a continuum of care, reschedule testing to track disease
progression and measure ongoing status or outcomes.
NOTE: The Validity Indicator denotes a guideline for representing the possibility of an invalid test
or domain score. “No” means a clinician should evaluate whether the test subject understood the test,
put forth their best effort, or has a clinical condition requiring further evaluation.
All assessment results should be considered 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. CNS Vital Signs is not a diagnostic. Diagnosis
is a clinical exercise that relies on data from many different sources.

3
 CNS Vital Signs Test Report Example …Current Cognitive Status View
…is auto-scored from computerized versions of VENERABLE NEUROPSYCHOLOGICAL TESTS. The results measures the MILLISECOND
PRECISE SPEED and ACCURACY of a patient’s response. TOTAL TESTING TIME depends on the number of tests and rating instruments selected.

3 1

The CNS Vital Signs Neurocognitive

Assessment Report is designed to present the
testing results in a SUMMARY DOMAIN
DASHBOARD and a DETAILED REPORT
format immediately following the testing
session. The CNS Vital Signs reports are
logical and intuitive making the reports
interpretation by a qualified health
d
professional relatively straightforward. All
assessment results should be considered 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.

Serial administered Longitudinal View

neurocognitive tests
can also be
presented in a
LONGITUDINAL
REPORT format to d
track disease
progression,
outcomes, or
treatment effects.

4
 Evaluate Effort – Validity Indicator

Evaluate Validity: The Validity Indicator (VI) helps identify the possibility of an invalid test.
Embedded measures helps evaluate whether the patient is manipulating testing performance for a
secondary gain or they simply did not read the test instructions. Examples of secondary gain
include drug or disability seeking, academic accommodation, malingering, symptom feigning, etc.
WHY? When analyzing test data, either in research, or in clinical practice, it is important to know
whether a test result is valid or not. Clinicians need to know if testing subjects misunderstood the
instructions or are generating “dubious results” or a “non-credible response pattern.” CNS Vital
Signs has developed “validity indicators” for its tests and domains that indicate whether the patient
gave poor effort or generated invalid results (feigning, malingering, etc.) Across the span of
neurological and psychiatric disorders, it is important to have “valid” tests to get a true evaluation
of a patient.
WHAT? The CNS Vital Signs A Validity Indicator (VI) is a guideline identifying the possibility
of an invalid test or domain score. When reviewing a report, a “No” in the VI column suggests the
clinician should evaluate whether the test subject understood the test, put forth their best effort, or
has a clinical condition requiring further evaluation. The CLINICAL DOMAIN validity indicators are
identified as B ‘Possibly Invalid’ based on validity data and is indicated on the suspected test(s).
The NCI (Neurocognition Index) is invalid if any test or domain is invalid.

Non-Verbal Reasoning: correct responses >= 4 and Correct > incorrect responses.

NOTE: The CNS Vital Signs batteries can be successfully completed, without assistance, by a
normal child with a 4th grade reading level. Likewise, elderly with MMSE scores above 22 can
complete the battery. Keep in mind, it is not uncommon for patients to generate an invalid result
on one test in the battery due to misreading the instructions or giving-up on the test. Proper
pretest instruction leads to a better testing experience.

5
 Evaluate Effort – Validity Indicator

HOW? The Validity Indicator alerts the clinician to the possibility of an invalid test allowing the
clinician, examiner or testing technician to question the testing subject: Do the testing results
reflect an understanding of the test and the instructions? Did the testing subject put forth their
best effort? Did they get a good night’s sleep? Does the subject have poor vision and need their
glasses? Do the results suggest willful exaggeration, e.g., malingering?
Should a subject test abnormally low triggering an “invalid” test (NO as displayed in the Validity
Indicator section of the report) then that would be a reason for retesting the individual, unless your
clinical judgment makes you believe that is the best score the patient can achieve. Like any
suspicious lab, the test should be re-administered, and it can be done with CNS Vital Signs through
the RETEST function.
Before Retesting, the test examiner or technician should reinforce the need for the subject to give
a good testing effort and use the “Validity Indicator” as a tool to help with the reinforcement. To
RETEST a subject go to MENU > RETEST SUBJECT > and select the appropriate subject and retest
the subject. Upon retest, should a subject test abnormally low again triggering yet another
“invalid” test (NO as displayed in the Validity Indicator section of the report) and the clinician
believes it was the patient’s best effort further evaluation or referrals should be considered.

CNS Vital Signs Embedded Indicators of Valid Effort

Clinical Domains TEST VALIDITY INDICATORS
Composite Memory Both Verbal and Visual Memory are Valid.
Verbal Memory  Verbal Memory raw score > 30.
Visual Memory  Visual Memory raw score > 30.
Psychomotor Speed Both FTT and SDC are Valid
Reaction Time Stroop: Simple RT < Complex RT < Stroop RT
Complex Attention Valid Stroop, CPT, and SAT. Correct > incorrect response in all tests.
Cognitive Flexibility Valid Stroop and SAT. Correct > incorrect responses in all tests.
Processing Speed SDC:  Correct Responses >= 20 AND Correct Responses > Errors
Executive Function SAT:  errors < correct responses.
Non‐Verbal Reasoning NVR:  correct responses >= 4 and Correct > incorrect responses.
Social Acuity POET:  correct responses > 3. Correct > incorrect responses
Sustained Attention 4PCPT: Part 2 > 2 correct; part 3 > 5 correct; part 4 > 5 correct. 
Working Memory Correct > incorrect responses in all parts.
CPT:   if >= 10 years old, CPT is valid if Correct Responses ‐
Simple Attention Commission Errors* >= 30, if < 10 years old CPT is valid if Correct 
Responses ‐ Commission Errors* >= 25
Motor Speed FTT: total taps >= 40 
FTT - Finger Tapping Test; SAT – Shifting Attention Test; SDC – Symbol Digit Coding Test; RT – Reaction Time; CPT –
Continuous Performance Test; POET – Perception of Emotions Test; NVR – Non-verbal Reasoning; 4PCPT – Four Part CPT
The “Validity Indicator” scoring algorithm is based on research presented (Detecting Invalidity In Neurocognitive Tests) at
International Society for CNS Clinical Trials and Methodology (ISCTM) in 2009. The poster is available on the CNS Vital Signs
website.

6
 Evaluate Severity – Impairment Status

Evaluate Severity: The scores help identify cognitive deficits and their level of impairment.
Assess even slight cognitive impairment (millisecond precision) providing immediate clinical insight
into a patient’s cognitive deficits and level of impairment. This gives patients, family members and
caregivers knowledge of cognitive domains that underpin the ability to conduct activities of daily
living. CNS Vital Signs grades severity of impairment based on an age-matched normative
comparison database. Most neuropsychiatric and neurodegenerative conditions are multifactorial
in nature. Effective evaluation of neurocognitive and behavioral issues can provide a standardized
and efficient method of collecting valid and important neuropsychiatric clinical endpoints. These
neuropsychiatric clinical endpoints can systematically document a patient’s clinical course.
Altogether, CNS Vital Signs computerized testing can facilitate a more complete assessment and

-
provide a basis for patient and family feedback.
Mean

+
The CNS Vital Signs
STANDARD SCORES Psychometric
and PERCENTILE and Normative
RANKS are auto- Comparison
scored using an
algorithm based on
a normative data
set of 1600+
subjects, ranging
from Ages 8 – 90. In
the age-matched Standard Deviations -4σ -3σ -2σ -1σ 0 +1σ +2σ +3σ +4σ
normative sample Percentiles 1 5 10 20 30 40 50 60 70 80 90 95 99
subjects were: (1) in Standard Scores 55 70 85 100 115 130 145
good health, (2) had
Z Scores -4.0 -3.0 -2.0 -1.0 0 +1.0 +2.0 +3.0 +4.0
no past or present
psychiatric or T Scores 20 30 40 50 60 70 80
neurological
disorders, head
injury, or learning Above: > 110 > 74 High Function and High Capacity
disabilities, and the
(3) Sample subjects Average: 90 ‐ 110 25 ‐ 74 Normal Function and Normal Capacity
were free of any Low Average: 80 ‐ 90 9 ‐ 24 Slight Deficit and Slight Impairment
centrally acting
Low: 70 ‐ 79 2 ‐ 8 Moderate Deficit and Impairment Possible
medications. The
CNS Vital Signs Very Low: < 70 < 2 Deficit and Impairment Likely
normative data is Standard Percentile
presented in ten Scores Scores
age groups: less
than 10 years old, 10–14, 15–19; in deciles to 79, and finally, 80 years or older. The standard scores
are normalized with a mean of 100 and standard deviation of 15. Percentile Ranks is a
mathematical transformation of the standard score and an index of how the subject scored
compared to other subjects of the same age on a scale of 1 to 99. NORMAL AGING affects
performance on all CNS Vital Signs tests. A patient’s standard scores are based on data from
normal controls that are the same age. EDUCATION and SPECIAL SKILLS may also affect test
performance; therefore, concern should be taken for patients that are very intelligent or well
educated yet their scores are below average. Like any laboratory test, an abnormal result should be
the occasion for further evaluation. As with any neuropsychological tests, results can be affected
by motivation or effort level and the Validity Indicator will help identify those patients.

7
 Evaluate Severity
>115 +1SD 100 ‐1SD 85 ‐2SD 70 ‐3SD <55

Neurocognitive Above:  Average: 

Low 
Low: 
Very Low: 
Well 
Domain Above  At  Below 
Average:  Below 
Expected  Expected  Expected 
Dashboard Level Level
Borderline
Level
Expected 
Level

1 2 3
SD = Standard Deviation from the MEAN

CNS Vital Signs presents testing results in Subject (raw), Standard Scores, and Percentile Ranks.
Results obtained from a CNS Vital Signs assessment can be used to evaluate or monitor a patient’s
condition and the subsequent treatment and management of that patient. Below, is a description of
each domain category:

11. Subject Scores are computed from raw score calculations using the data values of individual
subtests and are simply the number of correct responses, incorrect responses, and reaction times.
Reaction times are in milliseconds. An ASTERISK (*) denotes that "lower score is better” e.g.,
timing, otherwise higher scores are better.

22. Standard Scores are normalized from raw scores and present an age matched score relative to
other people in a normative sample. CNS Vital Signs standardized have a mean of 100 and a
standard deviation is 15. Higher scores are always better. The schema where the mean is 100
and the standard deviation is 15 is similar to the presentation of IQ scores where the mean for
normal is 100.

33. Percentile Scores is a mathematical transformation of the standard score and an index of how
the subject scored compared to other subjects of the same age on a scale of 1 to 99. If an
individual obtained a score at the 52nd percentile (50th percentile is average), this would mean
that their performance would be equal to 52% of his same-aged peers in the general population.
Higher scores are always better.

Severity Classification Grade:

Above: > 110 > 74 High Function and High Capacity
Average: 90 ‐ 110 25 ‐ 74 Normal Function and Normal Capacity
Quick View 
Low Average: 80 ‐ 90 9 ‐ 24 Slight Deficit and Slight Impairment Age‐Matched 
Low: 70 ‐ 79 2 ‐ 8 Moderate Deficit and Impairment Possible Normative  4
Scores
Very Low: < 70 < 2 Deficit and Impairment Likely
Standard Percentile
Scores Scores

8
 Evaluate Pattern – Enabling Personalized Medicine

Variation in neurocognitive scores can be multifactorial in nature.

The brain develops and ages… based on genetics and external environmental challenges e.g.
maternal health, education, exercise, diet, life experiences, socioeconomic status, health status,
attitudinal and emotional factors, physical / medical comorbidities, treatments, etc.
Evaluate Pattern: Impairment pattern helps identify pathologies and possible comorbidities.
CNS Vital Signs cognitive testing procedure provides valid and reliable clinical endpoints to help in the
evaluation and management of patients. Many conditions at the group level are associated with
cognitive impairments. Attention should be paid to the nature (speed and accuracy) and response
pattern as well as errors. Patient's scoring well below average in one domain or below average in two
domain areas, might well be impaired and should be evaluated further. The first step in evaluating
such a patient is to repeat the test under more favorable circumstances. Like any laboratory test,
repetitive results outside of normal should be investigated. If the scores are low the second time, a
targeted work-up may be necessary.
Psychometric Measures to Evaluate Treatment Response and Outcomes
Adapted From:
Effect of Methylphenidate on
Neurocognitive Test Battery;
Journal of Clinical Psychopharmacology;
Volume 34, Number 4, August 2014

...Findings revealed controls

scored better than ADHD
subjects and ADHD subjects
scored better on MPH than
Evaluate the neuropsychological characteristics of PI - predominantly inattentive, with no drug
R – restrictive, and CB - combined (inattentive & hyperactive) AD/HD subtypes...
Comparisons of CNSVS Domain Scores Between the AD/HD Groups Before MPH Medication Administration Comparisons After MPH Administration

PI R CB Control Pairwise PI R CB
Baseline Measurements Mean (SD) Mean (SD) Mean (SD) Mean (SD) P Comparisons Mean (SD) Mean (SD) Mean (SD)
Neurocognition Index 87.62 (14.66) 90.71 (11.77) 90.25 (11.14) 96.91 (10.87) <0.001* (PI=R=CB) < control 95.53 (11.96) 98.66 (11.62) 97.38 (10)
Composite Memory 84.56 (21.86) 87.97 (19.5) 91.89 (20.92) 96.73 (18.82) 0.01 PI < control 81.27 (22.57) 85.59 (20.44) 85.9 (17.7)
Psychomotor speed 92.96 (10.49) 94.12 (10.87) 93.63 (12.54) 99.77 (16.58) <0.001 (PI=R=CB) < control 98.88 (9.77) 99.8 (11.09) 99.73 (10.52)
Reaction time 78.54 (21.63) 83.15 (18.42) 81.86 (16.49) 83.26 (28.57) 0.65* 88.25 (19.19) 89.88 (17.98) 86.43 (17.92)
Complex attention 91.38 (24.6) 94.92 (16.81) 90.77 (18.41) 102.15 (12.45) <0.001* (PI=R=CB) < control 105.51 (16.27) 108.53 (17.14) 107.58 (12.63)
Cognitive flexibility 90.84 (16.15) 93.32 (15.51) 91.15 (14.1) 102.82 (15.28) <0.001 (PI=R=CB) < control 104.77 (15.63) 108.42 (14.14 106.58 (13.74)
Symbol Digit Coding (Processing Speed Domain)
Correct responses 41.24 (12.73) 41.82 (13.8) 40.23 (12.36) 48.18 (11.77) <0.001 (PI=R=CB) < control …Study included 360 children and
Errors 0.92 (1.18) 1.09 (1.26) 1 (2.28) 3.6 (5.53) <0.001* (PI=R=CB) < control
adolescents (277 boys, 83 girls)
Shifting Attention Test (Executive Function Domain) between 7 and 15 years of age
Correct responses 34.44 (10.09) 35.43 (11.33) 34.07 (9.95) 42.23 (9.98) <0.001 (PI=R=CB) < control who had been diagnosed with
Errors 15.34 (7.83) 15.71 (9.41) 17.52 (8.02) 11.55 (6.06) <0.001* (PI=R=CB) > control ADHD at the Department of Child
Correct reaction time 1290.6 (133.52) 1224.91(236.4) 1233.39 (175) 1188.6 (222.75) 0.01* CB > control and Adolescent Psychiatry using K-
CPT (Simple Attention Domain) SADS-PL and DSM-IV
CPT Correct 38.54 (2.61) 37.84 (5.25) 38.3 (2.71) 39.19 (1.14) <0.001* R > control
…Subjects were grouped
Omission 1.46 (2.61) 1.61 (2.15) 1.7 (2.71) 0.81 (1.14) <0.001* CB > control
according to ADHD subtypes as PI
Commission errors 3.42 (4.65) 11.59 (66.7) 3.99 (4.02) 1.71 (1.68) <0.001* R > control, CB > control
Choice RT correct 506.84 (79.92) 490.2 (100.28) 515.36 (81.96) 470.5 (68.55) <0.001 PI < control (n = 51), R (n = 65), and CB (n =
*The Welch ANOVA test was used for comparisons between diagnostic groups, and post hoc comparisons were performed with Tamhane’s T2 test. All other comparisons
165). Seventy-nine healthy children
were performed with the ANOVA test, and post hoc tests were performed with the Tukey test. were recruited into the study as
the control group
*** Attention-deficit/hyperactivity disorder *** RESTRICTIVE (DSM-V): If criterion A1 (inattention) is met, but
(ADHD); Søren Dalsgaard; Eur Child Adolesc no more than two symptoms from criterion A2 (hyperactivity /
Psychiatry (2013) 22 (Suppl 1):S43–S48 impulsivity) have been present for the past 6 months.

9
 Evaluate Pattern – Enabling Personalized Medicine

Joe, a 60-year-old male is presenting

Amnestic MCI Baseline: 60-Year-Old Male Initial MMSE 25* with memory and concentration concerns
and was given CNS Vital Signs Clinical
Battery and scored below average
compared to his peers in 6 of 11
cognitive domains. His lowest scores
were in domains sensitive to amnestic
(memory related) MCI.
After considering the H&P, lab results,
patient and informant memory
questionnaire, sleep scales and the
cognitive test results; Joe was referred for
Amnestic MCI Longitudinal View: 60-Year-Old Male a sleep study. Later he was prescribed
NCI - Neurocognition Index CPAP and appropriate therapy.
CNS Vital Signs allowed a fine
Standard Score

110
characterization of Joe’s clinical course,
90 including apparent variation due to
80 compliance with therapy. Patient and
70
wife were positively influenced by
revelation of objective cognitive testing
0 performance, which proved useful in
03/12/2012 3/16/13 11/16/13 2/07/14 demonstrating probable effects of
compliance.
CNS VS Correlation to Alzheimer’s ApoE Polymorphisms Adopted from: Schmechel et al. International
Congress Alzheimer's Disease Paris 2011

є4/є4 є3/є4 є3/є3 є2/є3

Correlation to
NCI
53.5 72 90.5 102
Biological Markers

Memory
70 88.5 89 96

Verbal 74 90 93 101
Memory

Visual 82.5 90 93.5 101

Memory
...Study included 107 postmenopausal
Processing 58.5 71 78.5 90.5
women between the ages of 52 and 65 (mean
Speed
56.6 ± 3.5)
Executive 42.5 54 88 106
Function …Subjects were qualified as "normal" with
MOCA scores between 26 and 30
Psychomotor 72 78 90 97.5
Speed
...Findings revealed ApoE polymorphisms
Reaction 58.5 82 91 95 correlated to levels of cognitive function
Time where as expected ε3/ε4, or ε4/ε4 scored
poorly while ε2/ε3 groups scored much
Complex 43 54 92 109.5
better.
Attention

Cognitive 39.5 53 88 106 Adapted from: Bojar, Iwona & Wójcik-Fatla, Angelina & Owoc, Alfred & Lewiński,
Andrzej. (2012). Polymorphisms of apolipoprotein E gene and cognitive
Flexibility functions of postmenopausal women, measured by battery of computer tests -
Central Nervous System Vital Signs. Neuro endocrinology letters. 33. 385-92.

30 40 50 60 70 80 90 100 110 120

Average Standard Scores for cognitive functions in
particular groups of ApoE gene polymorphisms. 10
 Evaluate Pattern – Suggestive Pathology

Like most neuropsychological or psychological tests, clinicians will recognize, over time, which domains
reveal the clinical conditions of their patients. The profiles below may help clinicians evaluate test results.
The profiles are based on thousands of well-characterized patients, as well as a review of published
literature and data.
Nature of Pattern = Most Sensitive = Moderate Sensitivity = Less Sensitivity
BRIEF‐CORE BRAIN  Composite  Verbal  Visual  Psycho  Reaction  Complex  Cognitive  Processing  Executive  Simple  Motor 
FUNCTION DOMAINS Memory Memory Memory motor   Time Attention Flexibility Speed Function Attention Speed
Speed

ADD – AD/HD

Mild Cog Impair ‐MCI

Amnestic MCI

Non‐Amnestic MCI

Early Dementia
Multiple Sclerosis

Sleep
Depression

Chemo Brain
mTBI – Concussion

Brain injury and Stroke domain score performance may vary depending on a number of factors that 
include type of blow to the head, site of the blow, location of stroke and the patient’s individual history. 
Epilepsy Neurocognitive Function is dependent on the type of epilepsy and medication effect. Note:  
Cognitive function is more frequently impaired in people with epilepsy than in the general 
population, and the degree of cognitive impairment varies according to the epilepsy syndrome. 
Behavioral disorders are also more frequent in people with epilepsy than in individuals who do not 
have epilepsy. Behavioral disturbance is observed more frequently in people with drug‐resistant 
epilepsy, frequent seizures, and/or associated neurological or mental abnormalities. In children and 
adolescents, some data suggests a close link between behavior/cognition and some specific epilepsy 
syndromes.  Optimal management requires a careful balance between, on the one hand, the desire 
to reach early and maximal seizure control and, on the other, the need to avoid tolerability problems 
related to cognitive and behavioral impairments. 
Chronic Pain Neurocognitive Function is dependent on medication effect and pain pathology. CNS VS is ideal for 
measuring a baseline status and treatment outcomes. 

The Nature of the Pattern can vary based on many intrinsic and extrinsic
factors: “Over the past century, the syndrome currently referred to as attention-deficit
hyperactivity disorder (AD/HD) has been conceptualized in relation to varying cognitive problems
including attention, reward response, executive functioning, and other cognitive processes. More
recently, it has become clear that whereas ADHD is associated at the group level with a range of
cognitive impairments, no single cognitive dysfunction characterizes all children with ADHD. In other
words, ADHD is not a one-size-fits-all phenomenon. Patients with this syndrome do not fit into any
one category and present with widely differing co-occurring disorders—including varying cognitive
profiles.” Source: Cognitive Impairments With ADHD, Psychiatric Times. Vol. 26 No. 3, 2009

11
 10 Normed Neurocognitive Tests
VBM measures recognition memory for WORDS. Fifteen words are presented,
■ Learning Words one by one, on the screen every two seconds. For immediate recognition
Verbal Memory
■ Memory for Words (learning phase), the participant must identify those words nested among
(VBM)
■ Word Recognition fifteen new words. Then, after six more tests, there is a delayed recognition
Approx. 3 Minutes
■ Immediate and Delayed Recall memory trial. Subjects respond using the SPACE BAR.

VIM measures recognition memory for ABSTRACT FIGURES or SHAPES. Fifteen

■ Learning Shapes
Visual Memory geometric figures are presented, one by one, on the screen. For immediate
■ Memory for Shapes
(VIM) recognition (learning phase), the participant must identify those figures nested
■ Shapes Recognition
Approx. 3 Minutes among fifteen new figures. Then, after five more tests, there is a delayed
■ Immediate and Delayed Recall
recognition memory trial. Subjects respond using the SPACE BAR.

FTT test has subjects respond by pressing the SPACE BAR with their right
Finger Tapping
■ Motor Speed index finger as many times as they can in 10 seconds. They do this once for
(FTT)
■ Fine Motor Control practice, and then there are three test trials. The test is repeated with the left
Approx. 2 Minutes
hand.

SDC test consists of serial presentations of screens, each of which contains a

■ Complex Information bank of eight symbols above and eight empty boxes below. The participant
Symbol Digit Processing Accuracy types in the number on the NUMBER ROW that corresponds to the symbol
Coding (SDC) ■ Complex Attention that is highlighted. Only the digits from 2 through 9 are used; this is to avoid
Approx. 4 Minutes ■ Visual-Perceptual Speed the confusion between “1” and “I” on the keyboard. The computer program
■ Information Processing Speed does not allow a person to use a numerical pad preventing a distinct
advantage for those who are skilled at using the numerical pad or for those that
are right- versus left-handed.

Stroop test has three parts. In the first part, the words RED, YELLOW, BLUE, and
GREEN (printed in black) appear at random on the screen, and the participant
■ Simple Reaction Time
presses the space bar as soon as the test subject sees the word. In the second
Stroop Test (ST) ■ Complex Reaction Time
part, the words RED, YELLOW, BLUE, and GREEN appear on the screen, printed in
Approx. 4 - 5 ■ Stroop Reaction Time
color. The participant is asked to press the space bar when the color of the word
Minutes ■ Inhibition / Disinhibition
matches what the word says. In the third part, the words RED, YELLOW, BLUE, and
■ Frontal or Executive Skills
GREEN appear on the screen, printed in color. The participant is asked to press
the SPACE BAR when the color of the word does not match what the word says.

SAT test is a measure of ability to shift from one instruction set to another
■ Executive Function quickly and accurately. Participants are instructed to match geometric objects
Shifting Attention ■ Shifting Sets: Rules, either by shape or by color. Three figures appear on the screen, one on top and
(SAT) Categories, & Rapid two on the bottom. The top figure is either a square or a circle. The bottom
Approx. 2.5 Minutes Decision Making figures are a square and a circle. The figures are either red or blue (mixed
■ Reaction Time randomly). The participant is asked to match one of the bottom figures to the
top figure. The rules change at random (i.e., match the figures by shape, for
another, by color) and subject responds by pressing the two SHIFT KEYS.

CPT test is a measure of vigilance or sustained attention or attention over time.

Continuous ■ Sustained Attention
The test subject is asked to respond to the target stimulus “B” but not to any
Performance (CPT) B ■ Choice Reaction Time
other letter. The stimuli are presented at random. Subject responds by pressing
Approx. 5 Minutes ■ Impulsivity
the SPACE BAR.

The POET measures how well a subject can perceive and identify specific
emotions. "Social cognition" or "emotional acuity" has been defined as "the way
Perception of ■ Social Cognition or in which people make sense of other people and themselves". It is the ability to
Emotions (POET) Emotional Acuity perceive and understand social information. The reaction times in POET are
Approx. 2 Minutes ■ Choice Reaction Time much longer than in the other tests, indicating the complexity of central
processes governing emotional acuity. Subjects respond using the SPACE BAR.

The NVRT measures how well a subject can perceive and understand the
meaning of visual or abstract information and recognizing relationships
Non-Verbal ■ Reasoning between visual-abstract concepts. The NVRT is comprised of 15 matrices, or
Reasoning (NVRT) ■ Reasoning Recognition visual analogies. The matrices are progressively more difficult. Non-verbal or
Approx. 3.5 Minutes Speed visual-abstract reasoning is the process of perceiving issues and reaching
conclusions using symbols or generalizations rather than concrete information.
Subjects respond using the SPACE BAR.

The 4PCPT test is a four-part test that measures a subject's working memory and
sustained attention. PART ONE - is a simple reaction time test, PART TWO - is a
4-Part Continuous variant of the continuous performance test, the reaction times that are
■ Sustained Attention generated are "choice reaction times". PART THREE - is a "one back" CPT. The
Performance (FPCPT)
■ Working Memory subject must respond to a figure only if the figure immediately preceding was
Approx. 7 Minutes
the same. PART FOUR - is a "two-back" CPT. It is a difficult task and is used to
measure working memory. Parts two, three, and four of the tests are used to
calculate sustained attention domain. Subjects respond using the SPACE BAR.

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 CNS Vital Signs Clinical Domain Description
Single Test Domain Multiple  Test Domain

Measure: An average score derived from the domain scores or a general assessment of the overall neurocognitive
Neurocognitive 
status of the patient. Relevance: Summary views tend to be most informative when evaluating a population, a
Index  (NCI) condition category, and outcomes.

Composite  Measure: How well subject can recognize, remember, and retrieve words and geometric figures. Relevance:
Memory  Remembering a scheduled test, recalling an appointment, taking medications, and attending class.

Verbal  Measure: How well subject can recognize, remember, and retrieve words. Relevance: Remembering a scheduled
Memory  test, recalling an appointment, taking medications, and attending class.

Visual  Measure: How well subject can recognize, remember and retrieve geometric figures. Relevance: Remembering
Memory graphic instructions, navigating, operating machines, recalling images, and/or remember a calendar of events.

Measure: How well a subject perceives, attends, responds to visual-perceptual information, and performs motor
Psychomotor  speed and fine motor coordination. Relevance: Ability preform simple motor skills and dexterity through cognitive
Speed  functions i.e., use of precision instruments or tools, performing mental and physical coordination i.e., driving a car,
playing a musical instrument.

Measure: How quickly the subject can react, in milliseconds, to a simple and increasingly complex direction set.
Reaction 
Relevance: Driving a car, attending to conversation, tracking and responding to a set of simple instructions, taking
Time* longer to decide what response to make.

Complex  Measure: Ability to track and respond to a variety of stimuli over lengthy periods of time and/or perform mental
Attention tasks requiring vigilance quickly and accurately. Relevance: Self-regulation and behavioral control.

Measure: How well subject is able to adapt to rapidly changing and increasingly complex set of directions and/or to
Cognitive 
manipulate the information. Relevance: Reasoning, switching tasks, decision-making, impulse control, strategy
Flexibility formation, attending to conversation.

Measure: How well a subject recognizes and processes information i.e., perceiving, attending/responding to incoming
Processing 
information, motor speed, fine motor coordination, and visual-perceptual ability. Relevance: Ability to recognize and
Speed  respond/react i.e., fitness-to-drive, occupation issues, possible danger/risk signs or issues with accuracy and detail.

Measure: How well a subject recognizes rules, categories, and manages or navigates rapid decision making.
Executive 
Relevance: Ability to sequence tasks and manage multiple tasks simultaneously as well as tracking and responding
Function to a set of instructions.

Simple  Measure: Ability to track and respond to a single defined stimulus over lengthy periods of time while performing
Attention vigilance and response inhibition quickly and accurately. Relevance: Self-regulation and simple attention control.

Motor  Measure: Ability to perform movements to produce and satisfy an intention towards a manual action and goal.
Speed Relevance: Preparation and production of simple manual dexterity actions e.g. manipulate and maneuver objects.

Measure: How well a subject can perceive, process, and respond to emotional cues. Relevance: Spectrum
Social 
screen, ability to recognize social cues or read facial expressions. Provides insight into inappropriate behavior,
Acuity decreased inhibition, insensitivity to social standards, and social behavioral regulation.

Measure: How well is subject able to recognize, reason and respond to non-verbal visual-abstract stimuli.
Reasoning
Relevance: Problem solving skills, ability to forge insights, discern meaning, and ability to perceive relationships.

Sustained  Measure: How well a subject can direct and focus cognitive activity on specific stimuli. Relevance: How well a
Attention subject can focus and complete task or activity, sequence action, and focus during complex thought.

Measure: How well a subject can perceive and attend to symbols using short-term memory processes (4PCPT).
Working 
Relevance: Ability to carry out short-term memory tasks that support decision making, problem solving, planning,
Memory and execution. Enables “right-now” responses.

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Formulas for Calculating the Neurocognitive Domain Scores:

Single Test Domain Multiple  Test Domain

BRIEF‐CORE        
Domain Score Calculations:  1600+ Norms, Ages 8 to 90  
Clinical Domains 
Neurocognition Index ‐ Average of five domain scores: Composite Memory, Psychomotor Speed, 
Reaction Time,  Complex Attention , and Cognitive Flexibility ; representing 
NCI a form of a global score of neurocognition
VBM Correct Hits Immediate + VBM Correct Passes Immediate + VBM 
Correct Hits Delay + VBM Correct Passes Delay + VIM Correct Hits 
Composite Memory Immediate + VIM Correct Passes Immediate + VIM Correct Hits Delay + 
VIM Correct Passes Delay 
VBM Correct Hits Immediate + VBM Correct Passes Immediate + VBM 
Verbal Memory  Correct Hits Delay + VBM Correct Passes Delay
VIM Correct Hits Immediate + VIM Correct Passes Immediate + VIM 
Visual Memory  Correct Hits Delay + VIM Correct Passes Delay

Psychomotor Speed FTT Right Taps Average + FTT Left Taps Average + SDC Correct Responses 

Reaction Time (ST Complex Reaction Time Correct + Stroop Reaction Time Correct) / 2 
Stroop Commission Errors + SAT Errors + CPT Commission Errors + CPT 
Complex Attention Omission Errors 

Cognitive Flexibility SAT Correct Responses  ‐ SAT Errors  ‐ Stroop Commission Errors 

Processing Speed SDC Correct Responses ‐ SDC Errors 

Executive Function SAT Correct Responses ‐ SAT Errors 
Continuous Performance (CPT) Correct Responses minus CPT Commission 
Simple Attention Errors
Finger Tapping Test Right Taps Average + Finger Tapping Test Left Taps 
Motor Speed Average 
Clinical Domains Domain Score Calculations:  700+ Norms, Ages 8 to 90  
Working Memory (4PCPT Part 4 Correct Responses) ‐ (4PCPT Part 4 Incorrect Responses)
(4PCPT Part 2 Correct Responses + 4PCPT Part 3 Correct Responses + 
Sustained Attention 4PCPT Part 4 Correct Responses) – (4PCPT Part 2 Incorrect Responses + 
4PCPT Part 3 Incorrect Responses + 4PCPT Part 4 Incorrect Responses)
Social Acuity POET Correct Responses – POET Commission Errors
Reasoning (non‐verbal) NVRT Correct Responses – NVRT Commission Errors

Abbreviations Defined:
VBM – Verbal Memory Test; VIM – Visual Memory Test; SDC – Symbol Digit Coding
Test; SAT – Shifting Attention Test; FTT - Finger Tapping Test; ST – Stroop Test; CPT –
Continuous Performance Test; 4PCPT – Four Part CPT; POET – Perception of Emotions
Test; NVR – Non-verbal Reasoning Test.

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Neurocognitive Tests and Domain Scoring Process

The CNS Vital Signs domain scores are derived by summing primary raw scores from
one (blue shaded box) or multiple (green shaded box) tests. Domain scores are
presented as Subject (raw) Scores, Standard Scores, and Percentile Ranks. Subject
Scores are computed from raw score calculations using the data values of individual
subtests and are simply the number of correct responses, incorrect responses,
commission responses, omission responses and reaction times. The Brief-Core Battery
of the seven tests below score eleven Neurocognitive Domains and the Neurocognitive
Index. All ten tests can be custom configured to meet clinical testing or research
needs.
Single Test Domain
Neurocognitive Index 
Domain
Global 

(NCI) Multiple  Test Domain

Composite  Psychomotor   Reaction  Cognitive  Complex 

Memory Speed Time Flexibility Attention

Verbal  Visual  Motor  Processing  Executive  Simple 

Memory Memory Speed Speed Function Attention

Verbal  Visual  Finger  Symbol Digit  Stroop Shifting  Continuous 

Memory  Memory Tapping Coding Test Attention Performance
(VBM) (VIM) (FTT) (SDC) (ST) (SAT) (CPT)
Approx. 3 Minutes Approx. 3 Minutes Approx. 2 Minutes Approx. 4 Minutes Approx. 2.5 Minutes Approx. 2.5 Minutes Approx. 5 Minutes

Brief‐Core Battery:  Tests a broad spectrum of cognitive domains
Perception of  Non‐Verbal  4‐Part Continuous 
Emotions Reasoning Performance
(POET) (NVRT) (FPCPT)
Approx. 2 Minutes Approx. 3.5 Minutes Approx. 7 Minutes

Social  Working  Sustained 

Reasoning
Acuity Memory Attention

15