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About

NIH PROMIS Cognition

NIH PROMIS for Cognition is an electronic standard assessment patient reported subjective outcomes. The electronic delivery is often beneficial compared to paper assessments as they reduce data entry errors and increase enrollment. Qolty PROMIS Cognition is the ePRO system, and can be configured as a PRO tool that provides a short and reliable assessment for sCognitionwith only the most informative items for an individual patient from an item bank based on the prior answers given by the patient.

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The PROMIS Cognitive Function measure is a brief standardized test that aims to capture the cognitive ability or mental health status of a general population or a person suffering from the disease. It is a collection of self-reported items, which measure the various dimensions of mental abilities like memory, concentration, and learning.

Although PROMIS can be implemented with pen and paper, but its strength lies in its implementation through computerized adaptive tests (CAT). The Qolty app allows anyone to take the CAT survey from the convenience of their phone, therefore irrespective of time and location. Qolty integration also means that dynamics of cognitive function over the time are easy to understand and monitor.

This questionnaire evaluates an individual’s perception of cognitive status over the past week with a subset evaluating cognitive abilities and cognitive concerns (Lai et al., 2014). The survey can be taken by patients regardless of their gender, race, marital status, nature of employment, educational level as well as treatment status (receiving treatment vs. in post-treatment follow-up), with a minimum level of education.

It follows the NIH philosophy of developing tools that can be used in the wide range of research settings, with the minimal allocation of resources, the maximum level of automation, high consistency and reliability.The PROMIS Cognitive function consists of two scales – General Concern (32 items) and Abilities (31 items), covering cognitive domains including mental acuity, concentration, memory, verbal fluency, interference with quality of life, comments from others, change from previous functioning, and multitasking.

There are three short form versions of the PROMIS Applied Cognition-Abilities scales, composed of eight, six and four items – with last two being a subset of eight. Participants rate their responses using a scale ranging from 1 (Not at all) to 5 (Very much). Once the test is done, Qolty app auto generates the T-score.            PROMIS cognitive scale assesses the mental capabilities of both the healthy and ailing population. It can be employed for epidemiological studies, clinical trials, or just to measure the effectiveness of therapy in various clinical settings (Saffer et al., 2015).

PROMIS cognitive measures are used to assess mental abilities in psychiatric settings, like in patients suffering from mood disorders, anxiety or depression. Furthermore, it can also help determine age related cognitive decline (Howland et al., 2017). Decline due to other diseases, like neurodegenerative disorder, or cancer, or long term decline in cognitive functionality related to chronic disorders like HIV or diabetes.The most widely used legacy measures for screening cognitive functions – the Mini-Mental State Examination (MMSE) and the popular Saint Louis University Mental Status (SLUMS) examination are both objectives in nature, meaning those do not incorporate patient perception, and therefore unlike PROMIS, require trained raters to score. Also compared to MMSE, PROMIS is more strongly associated with depression, highlighting the relationship between subjective cognitive deficit and depression.

PROMIS is also correlated with depression measure scale like Geriatric Depression Scale (GDS), anxiety tool like Montgomery-Asberg Depression Scale (MADRS) and activities of daily living (Instrumental Activities of Daily Living or IADLS).PROMIS Cognitive Function questionnaire is developed in English language format. But as per the aim of NIH to offer PROMIS worldwide, the surveys have been translated into Spanish for adult, and additionally in Dutch for pediatric and parent proxy measures.

The short form PROMIS Cognitive function is available in English, Spanish and Mandarin (simplified and traditional Chinese languages).

There have been several validation studies in various language groups and ethnic minorities (Fieo et al., 2016).Raw score whether from the full item bank or the short version is converted into the T-score, with 50 being the mean score. 10 T-score is one standard deviation. Therefore, score above 50 means that a person is better than the average population in mental ability, and lower score meaning worse or disability.

Internal consistency

  • Internal Consistency of both the scales of PROMIS cognitive function, measured by Cronbach’s alpha, is very high (greater than 0.9) – while 8-item test has a score of 0.98, both subsets of 4-item have 0.95, which is remarkable (Saffer et al., 2015).

Construct Validity

  • Howland, Tatsuoka et al. 2016 study compared Spearman Correlation Coefficient result of PROMIS Cognition function with other tests – producing significant positive correlation for MMSE (0.24), SLUM (0.35), and IADLS (0.24) and significant inverse correlation with GDS (-0.42) and MADRS (-0.22) at p<0.001. Though this study was made for older adults, the findings are very similar for other age groups as well.
  • The Spearman Correlation result of Howland, Tatsuoka et al. 2016 has revealed that while PROMIS Cognition Ability subset is more strongly correlated with MMSE (0.24 as opposed to 0.22 for Concern subset), the Concern subset is associated strongly with baseline GDS (-0.49 against 0.30) and IADLS (0.28 against 0.21)
  • Saffer et al. 2015 have found moderate Spearman’s (rho) correlation of PROMIS cognitive abilities with GAD-7 ((Generalized Anxiety Disorder) and PHQ-9 (Patient-Health Questionnaire) tools. The 4 and 8 item scales have a correlation of about -0.47 for PHQ-9 and about -0.46 for GAD-7.
  • Saffer et al. 2015 found that the participants (adult and older adult) screened positively for depression and anxiety separately, scored significantly lower in PROMIS Applied Cognition-Abilities eight and four-item questionnaires than medical controls, (large Hedge’s g effect sizes reported (g= 1.19 and 1.32 respectively), but scored higher in both the PHQ-9 and GAD-7 questionnaires – with most being younger.

Strengths

The biggest strength of PROMIS Cognitive Function measure is that it is self-rated and freely available, it does not take more than 30 minutes to implement, no prior training or education is needed. It is perfectly fit for large scale epidemiological studies.

The tool is highly sensitive to cognitive decline over time in elderly people or those suffering from dementia, Parkinson’s, and Alzheimer’s. It has been validated in large population groups of various ethnic backgrounds.

Integration with Qolty means flexibility for patients and healthcare professionals. In most situations cognitive decline is slow, and auto data storage means that comparing the dynamics over time is easy without losing data.

Limitations

PROMIS cognitive items have some limitations, like being influenced by short term anxiety, it may not give optimal results in people suffering from memory loss. PROMIS cognitive measures also lack the ability to distinguish between Hispanic and Asian or Pacific Islander ethnic groups and the local dependencies. Certain questions may have a different interpretation for various ethnic groups thus adding to the confusion (Fieo et al., 2016).

  • PROMIS Cognitive Function is a short self-test that assesses patient’s cognitive status – memory and level of mental control
  • The test is designed for people over 18 years, irrespective of their gender, age, ethnicity, educational background, and medical status.
  • It is available in the pen-and-paper format as well as a computerized test (CAT) – the web or mobile app format.
  • Provides good insight into the cognitive status of people, and changes over the time, whether related to aging or treatment.
  • It has been validated for consistency and reliability.
  • Integration with Qolty means a higher level of automation and data integration.

Fieo, R., Ocepek-Welikson, K., Kleinman, M., Eimicke, J. P., Crane, P. K., Cella, D., & Teresi, J. A. (2016). Measurement Equivalence of the Patient Reported Outcomes Measurement Information System® (PROMIS®) Applied Cognition – General Concerns, Short Forms in Ethnically Diverse Groups. Psychological Test and Assessment Modeling, 58(2), 255–307.

Howland, M., Tatsuoka, C., Smyth, K. A., & Sajatovic, M. (2017). Evaluating PROMIS(®) applied cognition items in a sample of older adults at risk for cognitive decline. Psychiatry Research, 247, 39–42.

Lai, J., Wagner, L. I., Jacobsen, P. B., & Cella, D. (2014). Self‐reported cognitive concerns and abilities: two sides of one coin? PsychoOncology, 23(10), 1133–1141.

Saffer, B. Y., Lanting, S. C., Koehle, M. S., Klonsky, E. D., & Iverson, G. L. (2015). Assessing cognitive impairment using PROMIS® applied cognition-abilities scales in a medical outpatient sample. Psychiatry Research, 226(1), 169–172.