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

 General Details

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): 404–417. 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:
No
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:
57
eForms:
N

 Documentation


 Groups & Attached Data Elements

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.

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

 Change History

 Administrative Change History