Supplementary Appendix

Transcription

1 Supplementary Appendix This appendix has been provided by the authors to give readers additional information about their work. Supplement to: Satizabal CL, Beiser AS, Chouraki V, Chêne G, Dufouil C, Seshadri S. Incidence of dementia over three decades in the Framingham Heart Study. N Engl J Med 2016;374: DOI: /NEJMoa

2 Satizabal et al. SUPPLEMENTARY APPENDIX Incidence of Dementia over Three Decades in the Framingham Heart Study Table of contents Authors... 3 Supplementary methods... 4 Study sample... 4 Selection of epochs for inclusion... 4 Inception cohorts... 5 Dementia tracking... 6 Education and vascular risk factors... 8 Cardiovascular events... 9 The Framingham Stroke Risk Profile Sensitivity analyses Health differences between cohorts Increasing educational level Shared genetic variation Supplementary figures Figure S1. Study sample Figure S2. Surveillance: Dementia Tracking System in the Framingham Heart Study Supplementary tables Table S1. Dates for baseline exams per epoch and cohort Table S2. Baseline characteristics according to follow-up across epochs Table S3. Dementia tracking subgroup classification for the Original Cohort

3 Satizabal et al. Table S4. Dementia tracking subgroup classification for the Offspring Cohort Table S5. Methods and instruments considered for the screening and ascertainment of dementia cases across epochs Table S6. Sensitivity and specificity of the instruments used for dementia tracking among Framin gham participants Table S7. Baseline characteristics in participants aged years old at Epoch 2 from the Original and Offspring cohorts Table S8. Temporal trends in vascular risk factors among participants without a high school diplo ma Table S9. Temporal trends in vascular risk factors among participants with a high school diploma Table S10. Temporal trends in dementia incidence adjusting for the Framingham Stroke Risk Prof ile and its individual components measured at baseline Table S11. Temporal trends in dementia incidence adjusting for the Framingham Stroke Risk Prof ile and its individual components measured at mid-life (age 55 ±5 years) Table S12. Impact of education, vascular risk factors, and cardiovascular diseases on dementia ris k Table S13. Cognitive impairment on detailed neuropsychological assessment by educational level among participants with a normal MMSE in the MRI ancillary Study Table S14. Incident dementia by educational level among participants with a normal MMSE in the MRI ancillary Study Table S15. Incident dementia by educational level among participants reviewed for dementia in t he MRI ancillary Study Table S16. Temporal trends in dementia incidence among unrelated participants Supplementary references Framingham Heart Study forms Family interview Neurological exam Neuropsychological battery Neuropathology Dementia review

4 Satizabal et al. Authors Claudia L. Satizabal, Ph.D., Alexa S. Beiser, Ph.D., Vincent Chouraki, M.D., Ph.D., Geneviève Chêne, M.D., Ph.D., Carole Dufouil, Ph.D., and Sudha Seshadri, M.D. From the Boston University School of Medicine, Boston (C.L.S., A.S.B., V.C., S.S.) and the Framingham Heart Study, Framingham (C.L.S., A.S.B., V.C., S.S.) both in Massachusetts; and Inserm U1219 and CIC 1401-EC (Clinical Epidemiology) and University of Bordeaux, Isped (Bordeaux School of Public Health) (G.C., C.D.) both in Bordeaux, France. Corresponding Author Dr. Seshadri at the Boston University School of Medicine, Department of Neurology, 72 East Concord St., B602, Boston, MA 02118, 3

5 Satizabal et al. Supplementary methods Study sample Figure S1 describes in detail the sample size in each cohort across epochs. Selection of epochs for inclusion The first detailed cognitive assessment battery was administered to participants from the Original Cohort between examination cycles 14 ( ) and 15 ( ); and the ongoing surveillance for cognitive decline and dementia began with the 15 th examination cycle of the Original Cohort. Therefore, the baseline for the earliest epoch is that of the 15 th examination cycle for the Original Cohort. In the case of the Offspring Cohort, we selected examination cycle 2 ( ) as the baseline for epoch 1 for two reasons. First, it was the temporally closest examination cycle overlapping with the selected baseline (cycle 15) for the Original Cohort. Further, at the second Offspring examination, but not at the first, all participants were screened for possible cognitive impairment with a subjective question enquiring about the presence or absence of any memory problems. In order to have non-overlapping 5 year follow-up windows, and given that participant examinations are carried out once every four years in the Offspring Cohort, we selected every other examination cycle as the baseline for the subsequent second, third and fourth epochs. For instance, the Offspring Cohort s baseline periods for the second, third and fourth epochs correspond to exams 4, 6 and 8, respectively. Since the Original Cohort had more frequent exams than the Offspring, we carefully selected the baseline periods to be as close as possible to the Offspring exams. When more than one exam seemed suitably overlapping we selected the examination cycle that had the larger number of participants attending, and a richer palette of covariate data (i.e. data on plasma lipid levels were not available at all examinations). Some epochs are non-contiguous as a 4

6 Satizabal et al. natural consequence of the Framingham Heart Study design. Table S1 describes the selected baseline exams and corresponding dates across epochs for the Original and Offspring Cohorts. Inception cohorts In the Original Cohort, the first dementia-free inception cohort used for Epoch 1 was established by screening all participants using the Kaplan-Albert neuropsychological test battery, 1 a test battery designed by Edith Kaplan and Martin Albert. Persons who scored in the bottom 10% (lowest decile of population test scores) underwent further clinical assessment by a behavioral neurologist and if indicated, a neuropsychologist. In the Offspring Cohort we began with a subjective memory questionnaire at their second examination and evaluation of persons endorsing memory complaints. Since 1975, there has been ongoing surveillance for incident dementia. Hence, in subsequent epochs, the dementia free inception cohorts were established by only including persons known (as of 2015) to have been free of prevalent dementia at the time they attended the examination. Cognitive screening at examinations after 1981 included a Mini-Mental State Examination (MMSE). 2 A participant was flagged for more detailed assessment using educationadjusted cut-off scores and also by comparing their performance at each examination to their own scores at previous examinations. In addition, if a participant who scored above their educationadjusted MMSE cut-point and was not selected for further cognitive screening at a given examination (say, in 1990), later developed clinical dementia, we would use all available records, family interview and historical data to assign this person a date of onset for their dementia. If the onset of a person s dementia was later determined to have preceded their baseline examination in 1990, this person would no longer be included in the dementia-free inception cohort for that baseline examination In addition, between 1999 and 2013, over two-thirds of all surviving participants took a neuropsychological test battery, approximately 3 times at 6 year intervals, hence surveillance for incident dementia could be considered marginally more intensive in the last 5

7 Satizabal et al. epoch. However, in all epochs only persons with at least mild dementia at the baseline examination were excluded from the dementia-free inception cohort. Hence, our methods for establishing the dementia-free inception cohorts have remained relatively constant over the study period. A detailed description of the instruments 1-4 used to establish these cohorts is described in Table S5. Dementia tracking Details of dementia surveillance are outlined in Figure S2. The initial cognitive screen used in tracking is the MMSE, administered at each baseline examination since 1981 in the Original Cohort and since 1991 in the Offspring Cohort. Any of the following participant scores results in an MMSE flag: an absolute score of <23 for all persons, a score <24 for persons with a high school education, a score <26 for college-educated persons; a decline of 3 points since the participant s previous exam; or a decline of 5 points from their personal best score. Such MMSE cut-off points are based on normative data and previous work conducted by the New Haven Epidemiologic Catchment Area Program. 5 Participants may also be flagged by self, family or physician expressed concern either spontaneous or at a health status update, a Framingham Heart Study ancillary study examination or a Framingham Heart Study baseline examination. Participants with a flag are, if they consent, administered a full neuropsychological test battery (Table S5). At the end of this battery, a Framingham Heart Study neuropsychologist (NP) administering the neuropsychological evaluation assigns a dementia NP severity ranging from 0 = not demented, to 0.25 = very slight concern that cognitive performance is below expected level but person does not have mild cognitive impairment or dementia, 0.5 = mild cognitive impairment, 1 = mildly demented, 1.5 = at least mildly demented, possibly more, 2 = moderately demented, 2.5 = at least moderately demented, possibly more, and 3 = severely demented, or 5 = non progressive impairment. Participants with values between 0.5 and 3 are considered to have been flagged by NP, and those with values of 0, 0.25, or 5 are considered to not need further tracking. This item is used 6

8 Satizabal et al. strictly for tracking, not to designate dementia severity status. The cognitive test performance of participants assigned a dementia NP severity of 0.25 are discussed with a second senior neuropsychologist to decide if the person needs additional assessment by a neurologist. Participants flagged by NP are then referred to a Framingham Heart Study neurologist who performs a neurological exam that includes a Clinical Dementia Rating (CDR) 6 assessment. The neurologist s impression of dementia severity is recorded as 0 = none, 1 = mild, 2 = moderate, and 3 = severe, corresponding to overall CDR scores of 1, 2 and 3. Values 1 are considered to constitute a Neurology (NE) flag which results in the person s records being taken to dementia review (DR). Participants are brought to DR by a panel consisting of at least one neurologist and one neuropsychologist, at various points in their individual cognitive tracking: when they are first suspected to have dementia, when the severity of their dementia changes based on the neurologist s assessment, once after death, and if they have chosen to be a brain donor for a final time after a clinical-pathological conference at which the ante-mortem clinical and post-mortem pathological diagnoses are reconciled. Details of our dementia tracking are now expanded in the supplement. Participants who are alive are evaluated at DR if they have been: 1) flagged by NE and have either never had a full DR, or their NE severity is greater than the severity recorded at a previous DR; or 2) flagged by NP and have not yet had a FHS neurology assessment or DR, and either live outside New England or live in New England but had the NP evaluation at least 1 year earlier and had NP severity >1. Framingham Heart Study neurologists are able to see many participants who have moved to other parts of the United States by traveling to them, or when these participants travel to New England to visit with relatives, but some may be brought to review based only on assessments by their treating physician. A few persons may decline the FHS neuropsychologist or neurologist assessment and are brought to dementia review based only on their medical record and, if available, a family interview. 7

9 Satizabal et al. A separate review panel of Framingham Heart Study physicians performs a full postmortem medical review of all deceased Framingham participants to establish date and cause of death, and to review medical records for cardiovascular events. Since 1989 this review has also looked for any mention of cognitive impairment in the records; this is considered to be a flag at death review. Participants who have died are evaluated for post mortem DR if they: 1) had an antemortem DR; 2) died after 1989 and were flagged prior to death by MMSE, NP, NE, or were flagged at post mortem medical review; 3) died before 1989 and were flagged prior to death by MMSE, NP or NE; or 4) died before 1989 but after exam 14 (when the first cognitive battery was administered), with no flag. Each participant is categorized into one of the detailed groups displayed in Table S3 (Original Cohort) and Table S4 (Offspring Cohort). Every quarter, data sets containing MMSE dates and values; NP dates and severity; NE dates and severity; DR dates and severity; date of death and death review flag; and an indicator of refusal to participate are combined, and a SAS macro assigns the groups. Lists of participants in selected groups are generated with relevant information such as the MMSE dates and values; NP dates and severity; NE dates and severity; DR dates and severity; date of death and death review flag; refusal status; and residence. These lists are used to schedule NP and NE visits, both at the Framingham Heart Study center and in-home, and to help compile information used in participant evaluation at DR. There have been no refusals for dementia surveillance. Education and vascular risk factors The Framingham Heart Study collects extensive information at each examination cycle. For these analyses, educational achievement was dichotomized based on whether or not the participant had a high school diploma. Systolic and diastolic blood pressures and the use of antihypertensive medications were recorded during each examination. Body mass index was defined as the weight 8

10 Satizabal et al. divided by the square of height (kg/m 2 ). Smoking status was classified as current smoker or nonsmoker. Participants were identified as having diabetes when their fasting glucose levels were 7 mmol/l, random blood glucose levels were 11mmol/L, or if they had received antidiabetic medications. HDL cholesterol levels were assessed by standard enzymatic methods and participants have reported the use of lipid-lowering medications since APOE genotype status was determined in 1991 by DNA amplification techniques and restriction isotyping, 7 and for this analysis, participants were classified as carriers of at least one APOE-ε4 allele or non-carriers. Cardiovascular events Clinical stroke was defined as a sudden onset focal neurological disturbance of presumed vascular etiology lasting more than 24 hours, and transient ischemic attack (TIA) as symptoms lasting for less than 24 hours. Presence or absence of stroke or TIA is determined at a Stroke review conducted by a panel of at least 2 vascular neurologists reviewing all clinical, laboratory and imaging records from the Framingham Heart Study and outside hospitals. 8 Our definition of non-stroke cardiovascular disease included coronary heart disease (CHD), heart failure or peripheral arterial disease. CHD is defined by consensus of three Framingham Heart Study physician investigators as having a myocardial infarction (two out of three from (i) prolonged angina, (ii) ECG changes suggestive of myocardial infarction, (iii) circulating enzyme levels elevated to suggest myocardial infarction), coronary insufficiency (prolonged angina with ECG changes suggesting persistent ischemia but not infarction), angina pectoris, sudden death from presumed CHD, or non-sudden death from CHD. 9 Congestive heart failure was determined based on major (paroxysmal nocturnal dyspnea, neck-vein distention, rales, radiographic cardiomegaly, acute pulmonary edema, third heart sound, increased central venous pressure, circulation time 25 seconds, hepatojugular reflux, and pulmonary edema, visceral congestion or cardiomegaly at autopsy and significant weight loss on diuretic therapy), and minor (ankle edema, night cough, 9

11 Satizabal et al. dyspnea on exertion, hepatomegaly, pleural effusion, decrease in vital capacity, and tachycardia) clinical concurrent criteria. 10 Peripheral arterial disease was defined as vascular intermittent claudication that is exertional discomfort in the calf that appeared sooner with uphill or fast walking and was relieved by resting as determined using the Rose questionnaire Atrial fibrillation was based on the presence of atrial flutter or atrial fibrillation on electrocardiograms obtained at Framingham Heart Study examinations, clinic visits, hospital or outpatient records, or Holter monitoring reports adjudicated by at least two Framingham cardiologists. 14,15 The Framingham Stroke Risk Profile The Framingham Stroke Risk Profile (FSRP) was originally described in It integrates the effect of age, sex and baseline measurements of several vascular risk factors (systolic blood pressure, use of antihypertensive medications, presence or absence of left ventricular hypertrophy on electrocardiography, prevalent cardiovascular disease, current smoking status, and current or previous atrial fibrillation and diabetes mellitus), to describe a 10-year probability of incident stroke. An aggregate FSRP score is assigned based on the presence or absence (or levels) of individual stroke risk factors and a hazard-ratios associated with each factor. Sensitivity analyses We explored the potential impact of differences in health status between cohorts, increasing educational levels over time, and the shared genetic variance among participants on the observed trends in dementia incidence. 10

12 Satizabal et al. Health differences between cohorts We have selected a subgroup of persons aged 65 to 74 years old in Epoch 2 to explore differences in health profiles between the Original and the Offspring cohorts by comparing their baseline characteristics. Results are presented in Table S7. Increasing educational level We used data from the ancillary MRI study. In this sub-study, a detailed screening of over 60% of all living participants was undertaken between 1999 and 2004, when a large subsample of all Offspring Cohort participants having the MMSE at the seventh examination cycle underwent further neuropsychological, and if indicated, neurological assessment, regardless of their score on the preceding MMSE screening test. We calculated the percentage of participants with cognitive impairment among the participants with a passing MMSE (i.e. above the thresholds described for dementia screening) (Table S13), using education-adjusted cut-off, of incident dementia among participants with passing MMSE (Table S14), and of incident dementia among participants reviewed for dementia (Table S15). Shared genetic variation We explored the contribution of the shared genetic variation in our sample by restricting our primary analysis to a subsample of unrelated individuals. For this, we only included participants from the Original cohort and the spouses of their children from the Offspring cohort (i.e. excluding the children themselves). Results are presented in Table S16. 11

13 Satizabal et al. Supplementary figures 12

14 Satizabal et al. Figure S1. Study sample Attending exam 15 N=2,632 Included in Epoch 1 N=2,263 Attending exam 20 N=1,401 Included in Epoch 2 N=1,237 Attending exam 23 N=1,026 Included in Epoch 3 N=819 Attending exam 28 N=303 Included in Epoch 4 N=207 Original Cohort N=5,209 Aged <60 years = 181 Not in inception cohort = 159 Prevalent dementia = 24 No follow-up* = 5 Not in inception cohort = 39 Prevalent dementia = 90 No follow-up* = 35 Not in inception cohort = 41 Prevalent dementia = 117 No follow-up* = 49 Not in inception cohort = 22 Prevalent dementia = 61 No follow-up* = 13 Offspring Cohort N=5,124 Attending exam 2 N=3,863 Included in Epoch 1 N=194 Attending exam 4 N=4,019 Included in Epoch 2 N=898 Attending exam 6 N=3,532 Included in Epoch 3 N=1,514 Attending exam 8 N=3,021 Included in Epoch 4 N=1,883 Aged <60 years = 3,626 Not in inception cohort = 43 Aged <60 years = 3,010 Not in inception cohort = 110 Prevalent dementia = 1 Aged <60 years = 1,892 Not in inception cohort = 47 Prevalent dementia = 17 No follow-up* = 62 Aged <60 years = 693 Not in inception cohort = 94 Prevalent dementia = 49 No follow-up* = 302 Epoch 1 Epoch 2 Epoch 3 Epoch 4 ( ) ( ) ( ) ( ) * This refers to participants without follow-up during the specified 5-year period. Note that this is not a lost to follow-up, information on participants can be collected at further examinations or from additional sources. The dates correspond to the period in which baseline examinations were performed in each epoch 13

15 Satizabal et al. Figure S2. Surveillance: Dementia Tracking System in the Framingham Heart Study MCI or Dementia Annual Exams Alive Surveillance Flagged NP Exam & Neurological Exam Annual exam* Family Interview & Dementia Review *A flagged person testing normal on NP/NE for 2 consecutive years returned to normal surveillance pool No Dementia 14

16 Satizabal et al. Supplementary tables 15

17 Satizabal et al. Table S1. Dates for baseline exams per epoch and cohort Original Cohort Offspring Cohort Exam Dates Exam Dates Epoch Epoch Epoch Epoch

18 Satizabal et al. Table S2. Baseline characteristics according to follow-up* across epochs Epoch 1 Epoch 2 Epoch 3 Epoch 4 ( ) ( ) ( ) ( ) No FU Has FU No FU Has FU No FU Has FU No FU Has FU N 5 2, , , ,090 Age, mean (SD) 80 (7) 69 (7) 79 (7) 71 (7) 74 (8) 72 (8) 72 (8) 72 (9) P-value NS P<0.001 NS NS Women, % P-value NS NS NS NS Education, % No high school degree High school degree Some years of college College degree P-value NS NS P=0.007 NS MMSE, median [n] NA NA [n=1,217] P-value NS NS NS * Refers to follow-up during the specified 5-year period. Note that this is not lost to follow-up since information on participants can be collected at further examinations or from additional sources MMSE was only administered after epoch 1, starting at exam 17 for the Original Cohort and exam 2 for the Offspring Cohort 17

19 Satizabal et al. Computed with Wilcoxon rank sum tests FU= Follow-up; NS= non-significant; NA= non-available; MMSE= Mini-Mental State Examination 18

20 Satizabal et al. Table S3. Dementia tracking subgroup classification for the Original Cohort Subgroup Referral Dead Has had a dementia review 1a DR < death DR 1b DR > death Final Has not had a dementia review Died a Flagged at death review DR 2b Flagged by NP or NE DR 2c Flagged by MMSE DR 2d No death review DTH RVW 2e Death reviewed; no flag by MMSE, NP or NE, or at death review Final Died < a Flagged by NP or NE DR 3b Flagged by MMSE DR 3c No flags, died exam 14 DR 3d No flags, died < exam 14 Hold 3e Mini-reviewed; no flag by MMSE, NP or NE, or by mini-review Final Alive, needs NE 4a 4b Flagged by NP, no NE or DR since NP, in New England, NP severity = 0.5 Flagged by NP, no NE or DR since NP, in New England, NP severity = 1.0 NE NE 4c Flagged by NP, no NE or DR since NP, in New England, NP NE 19

21 Satizabal et al. severity > 1, in past year Alive, needs evaluation for DR 5a Flagged by NP, no NE or DR since NP, in New England, NP severity > 1, 1 year ago DR 5b Flagged by NP, no NE or DR since NP, outside New England DR 5c Flagged by NE; no prior DR DR 5d Flagged by NE; prior DR with severity < current NE severity DR Alive, needs NP 6a Flagged by MMSE; has not had NE, NP or DR NP 6b Flagged by neurological referral; has not had NE, NP or DR NP 6c Flagged by neurological referral after NP/NE; NP/NE 1 year ago NP 6d Flagged by MMSE (with 3/5 decline) after NP/NE; NP/NE 1 NP year ago 6e Flagged by MMSE (with decline 2 ) after NP/NE; NP/NE 1 year ago Alive, no NP/NE needed unless flagged again 7a Flagged by MMSE (with decline < 2) after NP/NE; NP/NE 1 year ago 7b 7c 7d 7e 7f 7g Flagged by NE; prior DR with severity current NE severity NE/NP within 1 year; no flag Normal NE in the past 2 years flagged NP DR within 1 year DR >1 year ago, severity = severe Normal MMSE within past 4 years, no NP, NE, or DR 20

22 Satizabal et al. Alive, possibly OK 8a 8b 8c 8d 8e Normal NE flagged NP, both > 2 years ago NE/NP > 2 years ago; no flag Normal MMSE but > 4 years ago, no NP, NE, or DR No MMSE, NP, NE, or DR DR > 1 year ago, no new information since then Alive, missing information 9d Education missing (cannot flag on MMSE) DR = dementia review; NP = neuropsychological assessment; NE = neurological evaluation; MMSE = Mini-Mental State Examination; DTH RVW = death review 21

23 Satizabal et al. Table S4. Dementia tracking subgroup classification for the Offspring Cohort Subgroup Referral Dead Has had a dementia review 1a DR < death DR 1b DR > death Final Has not had a dementia review Died a Flagged at death review DR 2b Flagged by NP or NE DR 2c Flagged by MMSE DR 2d No death review DTH RVW 2e Death reviewed; no flag by MMSE, NP or NE, or at death review Final Died < a Flagged by NP or NE DR 3b Flagged by MMSE DR 3c No flags, died exam 2 DR 3d No flags, died < exam 2 Hold Alive, needs NE 4a 4b 4c Flagged by NP, no NE or DR since NP, in New England, NP severity = 0.5 Flagged by NP, no NE or DR since NP, in New England, NP severity = 1.0 Flagged by NP, no NE or DR since NP, in New England, NP severity > 1, in past year NE NE NE 22

24 Satizabal et al. Alive, needs evaluation for DR 5a Flagged by NP, no NE or DR since NP, in New England, NP severity > 1, 1 year ago DR 5b Flagged by NP, no NE or DR since NP, outside New England DR 5c Flagged by NE; no prior DR DR 5d Flagged by NE; prior DR with severity < current NE severity DR Alive, needs NP 6a Flagged by MMSE; has not had NE, NP or DR NP 6b Flagged by neuro referral; has not had NE, NP or DR NP 6c Flagged by neuro referral after NP/NE; NP/NE 1 year ago NP 6d Flagged by MMSE (with 3/5 decline) after NP/NE; NP/NE 1 year ago NP 6e Flagged by MMSE (with decline 2) after NP/NE; NP/NE 1 year ago Alive, no NP/NE needed unless flagged again 7a Flagged by MMSE (with decline < 2) after NP/NE; NP/NE 1 year ago 7b 7c 7d 7e 7f 7g Flagged by NE; prior DR with severity current NE severity NE/NP within 1 year; no flag Normal NE in past 2 years flagged NP DR within 1 year DR >1 year ago, severity=severe Normal MMSE within past 4 years, no NP, NE, or DR Alive, possibly OK 23

25 Satizabal et al. 8a 8b 8c 8d 8e Normal NE flagged NP, both > 2 years ago NE/NP > 2 years ago; no flag Normal MMSE but > 4 years ago, no NP, NE, or DR No MMSE, NP, NE, or DR DR> 1 year ago, no new information since then Alive, missing information 9d Education missing (cannot flag on MMSE) DR = dementia review; NP = neuropsychological assessment; NE = neurological evaluation; MMSE = Mini-Mental State Examination; DTH RVW = death review 24

26 Satizabal et al. Table S5. Methods and instruments considered for the screening and ascertainment of dementia cases across epochs Epoch 1 Epoch 2 Epoch 3 Epoch 4 ( ) ( ) ( ) ( ) Original Offspring Original and Offspring Cohorts Screening for Subjective dementia-free Kaplan-Albert* 1 memory MMSE 2 inception cohort question NP battery used for dementia ascertainment 3,4 WMS - Logical Memory-Immediate and Delayed Recall* WMS Visual Reproductions - Immediate and Delayed Recall* WMS Paired Associates Learning* WMS Digit Span Trail-making Test A and B WAIS Similarities* Boston Naming Test- 30 item version Controlled Word Association Test* Hooper Visual Organization Test Clock Drawing Test Wide Range Achievement Test-3 Reading Subtest Same NP battery used through Epochs 1 to 3, and additionally: Boston Diagnostic Aphasia (Cookie Theft) WAIS Block Design WAIS Information * These tests are part of the Kaplan-Albert battery. Additional tests in the Kaplan-Albert include the Digit Span Forward and Digit Span Backwards MMSE = Mini-Mental State Examination; NP = neuropsychological assessment; WMS = Wechsler Memory Scale; WAIS = Wechsler Adult Intelligence Scale 25

27 Satizabal et al. Table S6. Sensitivity and specificity of the instruments used for dementia tracking among Framingham participants Instrument (exam) N Mean age Prevalent dementia cases Dementia prevalence Among prevalent dementia cases Flagged Sens. Among nondementia cases Not Spe. Flagged Original cohort Offspring cohort Kaplan-Albert (15) 1, % 30 81% 1,588 93% MMSE (17) 2, % 63 90% 1,669 83% MMSE (20) 1, % 60 95% 1,073 86% MMSE (23) % 92 92% % MMSE (6) 1, % 12 80% 1,448 93% MMSE (7) 1, % 24* 83% 1,684 93% NP (7) 1, % 33 97% 1,397 98% MMSE/NP (7) 1, % % 1,171 88% MMSE (8) 2, % 43 93% 2,004 92% * Of 5 prevalent dementia cases not flagged at exam 7 with the MMSE, 3 took the full NP and all 3 were flagged by NP. If either flagged by both MMSE and NP, or not flagged by both MMSE and NP Sens = Sensitivity; Spe = Specificity; MMSE= Mini-Mental State Examination; NP = neuropsychological assessment 26

28 Satizabal et al. Table S7. Baseline characteristics in participants aged years old at Epoch 2 from the Original and Offspring cohorts Original cohort Offspring cohort Ageadjusted N=608 N=373 p-value* Age, years, (SD) 72 (2) 68 (2) <0.001* Women, % High school degree, % Presence of APOE-ε4 allele, % Systolic blood pressure, mmhg, mean (SD) 145 (21) 142 (20) Diastolic blood pressure, mmhg, mean (SD) 77 (11) 80 (10) Antihypertensive medication use, % Smoking, % HDL cholesterol, mg/dl, mean (SD) 48 (16) 49 (14) Body mass index, Kg/m², mean (SD) 27 (5) 27 (4) Type-2 diabetes, % Prevalent cardiovascular disease, % Prevalent stroke, % * Unadjusted 27

29 Satizabal et al. Table S8. Temporal trends in vascular risk factors among participants without a high school diploma Time periods Epoch 1 Epoch 2 Epoch 3 Epoch 4 Trend* ( ) ( ) ( ) ( ) N Systolic BP, mean (SD) 138 (19) 147 (23) 142 (21) 134 (20) Diastolic BP, mean (SD) 75 (10) 76 (11) 72 (11) 69 (11) Antihypertensive medication use, % <0.001 Smoking, % HDL cholesterol, mean (SD) 48 (15) 46 (15) 48 (17) 52 (16) Lipid-lowering agents use, % NA NA <0.001 Body mass index, mean (SD) 27 (4) 27 (5) 28 (5) 28 (5) Type-2 diabetes, % <0.001 Prevalent cardiovascular disease, % Prevalent Stroke, % * We estimated overall linear trends using the elapsed mean time (in decades) between the first epoch and each consecutive epoch, and is adjusted for age at entry 28

30 Satizabal et al. Table S9. Temporal trends in vascular risk factors among participants with a high school diploma Time periods Epoch 1 Epoch 2 Epoch 3 Epoch 4 Trend* ( ) ( ) ( ) ( ) n 1,526 1,558 1,918 1,946 Systolic BP, mean (SD) 136 (19) 142 (21) 137 (20) 131 (18) <0.001 Diastolic BP, mean (SD) 76 (10) 78 (10) 73 (10) 72 (10) <0.001 Antihypertensive medication use, % <0.001 Smoking, % <0.001 HDL cholesterol, mean (SD) 50 (16) 50 (16) 51 (16) 57 (18) <0.001 Lipid-lowering agents use, % NA NA <0.001 Body mass index, mean (SD) 26 (4) 27 (5) 27 (5) 28 (5) <0.001 Type-2 diabetes, % <0.001 Prevalent cardiovascular disease, % Prevalent Stroke, % * We estimated overall linear trends using the elapsed mean time (in decades) between the first epoch and each consecutive epoch, and is adjusted for age at entry 29

31 Satizabal et al. Table S10. Temporal trends in dementia incidence adjusting for the Framingham Stroke Risk Profile and its individual components measured at baseline Time periods* Cases/ Observation Periods Epoch 1 ( ) Epoch 2 ( ) Epoch 3 ( ) Epoch 4 ( ) Trend* Primary model 371/ 9,015 Ref 0.78 [ ] 0.62 [ ] 0.56 [ ] 0.80 [ ] Additionally adjusted for, FSRP 314/ 8,530 Ref 0.75 [ ] 0.62 [ ] 0.50 [ ] 0.77 [ ] Systolic blood pressure 371/ 9,009 Ref 0.80 [ ] 0.62 [ ] 0.55 [ ] 0.80 [ ] Antihypertensive medication use 370/ 8,981 Ref 0.80 [ ] 0.63 [ ] 0.60 [ ] 0.81 [ ] Smoking 369/ 8,951 Ref 0.79 [ ] 0.63 [ ] 0.58 [ ] 0.81 [ ] 30

32 Satizabal et al. Body mass index 304/ 8,335 Ref 0.71 [ ] 0.70 [ ] 0.55 [ ] 0.81 [ ] Type-2 diabetes 308/ 8,466 Ref 0.70 [ ] 0.62 [ ] 0.47 [ ] 0.76 [ ] Prevalent cardiovascular disease 371/ 9,015 Ref 0.78 [ ] 0.62 [ ] 0.57 [ ] 0.80 [ ] Prevalent atrial fibrillation 371/ 9,015 Ref 0.78 [ ] 0.61 [ ] 0.55 [ ] 0.79 [ ] * Values represent 5-year age- and sex-adjusted Hazard Ratios [95% Confidence Intervals We estimated overall linear trends using the elapsed mean time (in decades) between the first epoch and each consecutive epoch P<0.001 for trend FSRP= Framingham Stroke Risk Profile 31

33 Satizabal et al. Table S11. Temporal trends in dementia incidence adjusting for the Framingham Stroke Risk Profile and its individual components measured at mid-life (age 55 ±5 years) Time periods* Cases/ Observation Periods Epoch 1 ( ) Epoch 2 ( ) Epoch 3 ( ) Epoch 4 ( ) Trend* Primary model 371/ 9,015 Ref 0.78 [ ] 0.62 [ ] 0.56 [ ] 0.80 [ ] Additionally adjusted for, FSRP 222/ 6,783 Ref 0.73 [ ] 0.54 [ ] 0.46 [ ] 0.75 [ ] Systolic blood pressure 361/ 8,837 Ref 0.76 [ ] 0.61 [ ] 0.54 [ ] 0.79 [ ] Anti-hypertensive medication use 283/ 8,132 Ref 0.78 [ ] 0.66 [ ] 0.55 [ ] 0.81 [ ] Smoking 302/ 8,189 Ref 0.77 [ ] 0.61 [ ] 0.55 [ ] 0.80 [ ] 32

34 Satizabal et al. Body mass index 352/ 8,658 Ref 0.78 [ ] 0.62 [ ] 0.56 [ ] 0.80 [ ] Type-2 diabetes 284/ 7,418 Ref 0.76 [ ] 0.55 [ ] 0.50 [ ] 0.76 [ ] Prevalent cardiovascular disease 362/ 8,840 Ref 0.78 [ ] 0.62 [ ] 0.56 [ ] 0.80 [ ] Prevalent atrial fibrillation 362/ 8,840 Ref 0.78 [ ] 0.62 [ ] 0.56 [ ] 0.80 [ ] * Values represent 5-year age- and sex-adjusted Hazard Ratios [95% Confidence Intervals] We estimated overall linear trends using the elapsed mean time (in decades) between the first epoch and each consecutive epoch P<0.001 for trend P<0.01 for trend FSRP= Framingham Stroke Risk Profile 33

35 Satizabal et al. Table S12. Impact of education, vascular risk factors, and cardiovascular diseases on dementia risk Time periods* Epoch 1 Epoch 2 Epoch 3 Epoch 4 Interaction ( ) ( ) ( ) ( ) High school education 1.15 [ ] 0.53 [ ] 0.87 [ ] 0.6 [ ] FSRP 1.36 [ ] 1.11 [ ] 0.60 [ ] 1.3 [ ] Systolic blood pressure 1.00 [ ] 1.00 [ ] 0.99 [ ] 1.00 [ ] Antihypertensive medication use 1.06 [ ] 0.88 [ ] 0.57 [ ] 0.93 [ ] Smoking 1.69 [ ] 0.91 [ ] 0.83 [ ] 2.25 [ ] HDL cholesterol 1.00 [ ] 1.00 [ ] 1.01 [ ] 1.00 [ ] Body mass index 0.93 [ ] 0.92 [ ] 0.93 [ ] 0.93 [ ] Type-2 diabetes 1.52 [ ] 0.83 [ ] 1.06 [ ] 1.89 [ ] Prevalent cardiovascular disease 1.48 [ ] 1.44 [ ] 0.53 [ ] 1.08 [ ] Prevalent stroke 2.02 [ ] 2.67 [ ] 0.65 [ ] 1.60 [ ] Interim stroke 8.98 [ ]# 4.01 [ ] 4.72 [ ]# 1.43 [ ] Interim TIA or stroke 6.86 [ ]# 2.75 [ ] 3.47 [ ]# 1.38 [ ]

36 Satizabal et al. Prevalent atrial fibrillation 2.89 [ ]# 1.37 [ ] 1.00 [ ] 1.28 [ ] Prevalent clinical heart failure 3.28 [ ]# 0.77 [ ] 0.28 [ ] 1.57 [ ] Prevalent coronary heart disease 0.84 [ ] 1.11 [ ] 0.59 [ ] 1.11 [ ] * Values represent 5-year age- and sex-adjusted Hazard Ratios [95% Confidence Intervals] P for interaction comparing epoch 3 to epoch 1 P<0.01 P<0.05 Among participants without prevalent stroke Among participants without prevalent TIA or stroke # P<0.001 FSRP= Framingham Stroke Risk Profile 35

37 Satizabal et al. Table S13. Cognitive impairment on detailed neuropsychological assessment by educational level among participants with a normal MMSE in the MRI ancillary Study Educational level N Cognitive impairment (%) No high school degree High school degree Some years of college College degree

38 Satizabal et al. Table S14. Incident dementia by educational level among participants with a normal MMSE in the MRI ancillary Study Educational level N Incident dementia (%) No high school degree High school degree Some years of college College degree 1,

39 Satizabal et al. Table S15. Incident dementia by educational level among participants reviewed for dementia in the MRI ancillary Study Educational level N Incident dementia (%) No high school degree High school degree Some years of college College degree

40 Satizabal et al. Table S16. Temporal trends in dementia incidence among unrelated participants Time periods* Cases/ Observation Periods Epoch 1 Epoch 2 Epoch 3 Epoch 4 (1977- ( ) ( ) ( ) 1983) Trend* Total 371/ 9,015 N HR [95% CI] 2,457 Ref 2, [ ] 2, [ ] 2, [ ] 0.80 [ ] Unrelated 317/ 5,822 N HR [95% CI] 2,325 Ref 1, [ ] 1, [ ] [ ] 0.82 [ ] * Values represent 5-year age- and sex-adjusted Hazard Ratios [95% Confidence Intervals] We estimated overall linear trends using the elapsed mean time (in decades) between the first epoch and each consecutive epoch This sample includes participants from the Original cohort and Offspring Spouses only 39

41 Satizabal et al. Supplementary references 1. Farmer ME, White LR, Kittner SJ, et al. Neuropsychological test performance in Framingham: a descriptive study. Psychol Rep 1987;60: Folstein MF, Folstein SE, McHugh PR. "Mini-mental state". A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 1975;12: Au R, Seshadri S, Wolf PA, et al. New norms for a new generation: cognitive performance in the framingham offspring cohort. Exp Aging Res 2004;30: Elias MF, Elias PK, D'Agostino RB, Silbershatz H, Wolf PA. Role of age, education, and gender on cognitive performance in the Framingham Heart Study: community-based norms. Exp Aging Res 1997;23: Holzer CE, Tischler GL, Leaf PJ, Myers JK. An epidemiologic assessment of cognitive impairment in a community population. Research in Community & Mental Health Berg L. Clinical Dementia Rating (CDR). Psychopharmacol Bull 1988;24: Myers RH, Schaefer EJ, Wilson PW, et al. Apolipoprotein E epsilon4 association with dementia in a population-based study: The Framingham Heart Study. Neurology 1996;46: Carandang R, Seshadri S, Beiser A, et al. Trends in incidence, lifetime risk, severity, and 30- day mortality of stroke over the past 50 years. JAMA 2006;296: D'Agostino RB, Sr., Vasan RS, Pencina MJ, et al. General cardiovascular risk profile for use in primary care: the Framingham Heart Study. Circulation 2008;117: Kannel WB, D'Agostino RB, Silbershatz H, Belanger AJ, Wilson PW, Levy D. Profile for estimating risk of heart failure. Arch Intern Med 1999;159: Murabito JM, D'Agostino RB, Silbershatz H, Wilson WF. Intermittent claudication. A risk profile from The Framingham Heart Study. Circulation 1997;96:

42 Satizabal et al. 12. Kannel WB, Wolf PA, Garrison RJ. Some Risk Factors Related to the Annual Incidence of Cardiovasclar Disease and Death Using Pooled Repeated Biennal Measurements: Framingham Heart Study, 30-Year follow-up. In: Kannel WB WP, Garrison RJ, ed. The Framingham Heart Study: an epidemiological investigation of cardiovascular disease. Bethesda, MD: National Heart, Lung, and Blood Institute; 1987:NIH publication no Rose G, McCartney P, Reid DD. Self-administration of a questionnaire on chest pain and intermittent claudication. Br J Prev Soc Med 1977;31: Jefferson AL, Beiser AS, Himali JJ, et al. Low cardiac index is associated with incident dementia and Alzheimer disease: the framingham heart study. Circulation 2015;131: Wolf PA, Abbott RD, Kannel WB. Atrial fibrillation as an independent risk factor for stroke: the Framingham Heart Study. Stroke 1991;22: Wolf PA, D'Agostino RB, Belanger AJ, Kannel WB. Probability of stroke: a risk profile from the Framingham Heart Study. Stroke 1991;22:

43 Satizabal et al. Framingham Heart Study forms 42

44 Satizabal et al. Family interview 43

45 [ID] [Name] [Date] Family Interview Form (Revised 6/4/2013) 4/10/2013 Note: This form is a slight revision from the form. A new item, 7 = Impaired due to other reason, has been added to several fields. It is appropriate to use this item if the participant had impairment on a given task, but the primary reason for the impairment was not a cognitive one. For instance, if a participant was unable to shop independently due to a significant physical disability, but he/she would have been able to do so were it not for the disability, a 7 would be used. Do not add these 7s to the Blessed/CDR scores. Do not use this field if the participant was physically disabled but also had significant cognitive deficits as well. 6/4/2013 Note: This revision removes all references to the CDR for specific questions and the tabulated scores derived from those items. The CDR is only being derived based on the CDR Worksheet at the end of this form. FHS_forms_Family_interview.doc

46 [ID] [Name] [Date] FHS_forms_Family_interview.doc

47 [ID] [Name] [Date] Subject Name Subject s ID number Information Name ID Date of Interview Interviewer: Date: Interviewer ID: Person Interviewed Telephone Number Informant s relationship to participant: 1 = Spouse 2 = Brother 3 = Sister 4 = Son 5 = Daughter 6 = Grandson 7 = Granddaughter 8 = Friend 9 = Parent 99 = Other How long has informant known participant? 88 = offspring or spouse (unless marriage is recent) Living where during last 6 months (of his life)? 1 = Home 2 = Assisted Living 3 = Nursing Home 9 = Other If 2 or 3 Reason for admission: Informant living in the same household during the last 6 months? 0 = No 1 = Yes If yes: How many years living in the same household? 88 = Not Applicable 99 = Unknown How often did informant talk with participant during the last 11 months? 1 = almost every day 2 = several times a week 3 = once a week 4 = 1-3 times a month 5 = less than once a month 8 = Not applicable 9 = Unknown Any physical disabilities that impacted daily activities? 0 = No 1 = Yes 9 = Unknown If yes, what were they? FHS_forms_Family_interview.doc

48 Notes: [ID] [Name] [Date] FHS_forms_Family_interview.doc

49 [ID] [Name] [Date] Symptom Onset Was there a problem with his/her memory or thinking? 0 = No 1 = Yes 9 = Unknown Evidence of cognitive impairment If a memory problem is reported: What was the estimated year (or age) of onset of memory problems? 88 = Not Applicable 99 = Unknown 888 = Not Applicable 999 = Unknown Orientation Was s/he oriented to time? 0 = Usually 1 = Sometimes 2 = Rarely 9 = Unknown Oriented to the exact date of the month? Oriented to the exact month? Oriented to the exact year? Oriented to the exact day of the week? Tendency to dwell in the past? 0 = No 1 = Sometimes 2 = Frequently (Blessed = 1) 9 = Unknown Confused about surroundings? (i.e. unable to recognize whether at home or hospital; to discriminate between patients, doctors, nurses, or relatives) 0 = No 1 = Yes (Blessed = 1) 9 = Unknown Significantly more confused at night than during the day? 0 = No 1 = Yes (Hachinski = 1) 9 = Unknown Symptom onset date Blessed = Blessed = Blessed = Month Year XX XXXX Blessed (x/2) = /2 Hachinski (x/1) = /1 FHS_forms_Family_interview.doc

50 [ID] [Name] [Date] Notes FHS_forms_Family_interview.doc

51 [ID] [Name] [Date] Memory Was s/he able to recall recent events, such as recent outings or visits from family and friends? 0 = Usually 1 = Sometimes 2 = Rarely (Blessed = 1) 9 = Unknown Blessed = Was s/he able to recall a major event (e.g. trip, party, family wedding) within a few weeks of the event? 0 = Usually 1 = Sometimes 2 = Rarely 9 = Unknown Was s/he able to recall important information of the distant past (e.g. birthdate, wedding date, place of employment)? 0 = Usually 1 = Sometimes 2 = Rarely 9 = Unknown Was s/he able to remember short lists of items, such as a shopping list? 0 = Usually 1 = Sometimes 2 = Rarely (Blessed = 1) 9 = Unknown Blessed = Blessed (x/2) = /2 FHS_forms_Family_interview.doc

52 [ID] [Name] [Date] Notes: FHS_forms_Family_interview.doc

53 [ID] [Name] [Date] Judgment and Problem Solving In general, if you had to rate his/her abilities to solve problems, would you consider them: 0 = As good as they have ever been 1 = Good, but not as good as before 2 = Fair 3 = Poor 4 = No ability at all 9 = Unknown Rate his/her ability to cope with small sums of money (e.g. make change, leave a small tip): 0 = No loss 1 = Some loss 2 = Severe Loss (Blessed = 1) 9 = Unknown Rate his/her ability to handle complicated financial or business transactions (e.g. balance check-book, pay bills): 0 = No loss 1 = Some loss 2 = Severe Loss 9 = Unknown Would s/he have been able to handle a household emergency (e.g. plumbing leak, small fire)? 0 = As well as before 1 = Worse than before because of trouble thinking 2 = Worse than before (other reason) 9 = Unknown Could s/he understand situations or explanations? 0 = No loss 1 = Some loss 2 = Severe Loss 9 = Unknown Did s/he act appropriately in social situations and interactions with other people (other than premorbid manner)? 0 = Usually 1 = Sometimes 2 = Rarely 9 = Unknown Was s/he impulsive and/or uninhibited (i.e. doing or saying things without thinking of consequences)? 0 = No 1 = Yes 9 = Unknown Blessed = Blessed (x/1) = /1 FHS_forms_Family_interview.doc

54 Notes: [ID] [Name] [Date] FHS_forms_Family_interview.doc

55 [ID] [Name] [Date] FHS_forms_Family_interview.doc Language Did s/he have any changes in her speech? 0 = No 1 = Yes 9 = Unknown Did s/he have word finding problems? 0 = No 1 = Yes 9 = Unknown Did s/he have slurred speech? 0 = No 1 = Yes 9 = Unknown Was s/he able to understand others? 0 = Yes 6 = no, because of non-cognitive factor(s) 1 = No 9 = Unknown Was s/he able to read? 0 = Yes 6 = no, because of non-cognitive factor(s) 1 = No 9 = Unknown Was s/he able to write? 0 = Yes 6 = no, because of non-cognitive factor(s) 1 = No 9 = Unknown Visuospatial Skills Did s/he know how to get from one place to another outside his neighborhood? 0 = Usually 1 = Sometimes 2 = Rarely 9 = Unknown Was s/he able to find her way about familiar streets? 0 = Usually 1 = Sometimes 2 = Rarely (Blessed = 1) 7 = Impaired due to other reason (do not add to Blessed scale) : 9 = Unknown Blessed = Was s/he able to find his way about indoors? 0 = Usually 1 = Sometimes 2 = Rarely s (Blessed = 1) 9 = Unknown Did he have a sense of direction? 0 = No 1 = Yes 9 = Unknown Blessed (x/2) = /2 Blessed =

56 [ID] [Name] [Date] Notes: FHS_forms_Family_interview.doc

57 [ID] [Name] [Date] Community Affairs If alive: Is s/he still working If deceased: Was s/he working during the last year of life? 0 = No 1 = Yes 9 = Unknown/NA If No: Did memory or thinking problems contribute to his/her decision to retire? 0 = No 1 = Yes 9 = Unknown/NA If Yes: Did s/he have significant difficulty in her job because of problems with memory or thinking? 0 = Rarely or Never 2 = Usually 1 = Sometimes 9 = Unknown Did s/he ever drive a car? 0 = No 1 = Yes 9 = Unknown If alive: Does s/he drive a car now? If deceased: Did s/he drive during the last year of life? 0 = No 1 = Yes 9 = Unknown/NA If No. (Is/Was) this because of memory or thinking problems? 0 = No 1 = Yes 9 = Unknown/NA Was s/he able to independently shop for needs? 0 = Rarely or Never 2 = Usually 1 = Sometimes 9 = Unknown 7 = Impaired due to other reason (do not add to Blessed scale) : Was s/he able to independently carry out activities outside the home? 0 = Rarely or Never 2 = Usually 1 = Sometimes 9 = Unknown 7 = Impaired due to other reason (do not add to Blessed scale) : Did s/he participate in social activities in the community or nursing home? 0 = No 1 = Yes 9 = Unknown FHS_forms_Family_interview.doc

58 [ID] [Name] [Date] Notes: FHS_forms_Family_interview.doc

59 [ID] [Name] [Date] Home and Hobbies Was s/he able to perform household tasks? 0 = No Loss 1 = Some Loss 2 = Severe Loss (Blessed = 1) 7 = Impaired due to other reason (do not add to Blessed scale) : 9 = Unknown Blessed = At what level did s/he perform household chores? 0 = Normal function in usual activities 1 = Functions in usual activities but not as usual level 2 = Functions independently in some activities (operates appliances, such as a vacuum cleaner, prepares simple meals) 3 = Functions in limited activities only (with some supervision, washes dishes, sets table) 4 = No meaningful function (performs simple activities such as making a bed, with much supervision) 7 = Impaired due to other reason (do not add to Blessed scale) : 9 = Unknown Were there specific hobbies that s/he used to do but stopped (sewing, reading, gardening, going to theater, sports)? 0 = No 1 = Yes (Blessed = 1) Describe: 7 = Impaired due to other reason (do not add to Blessed scale) : 9 = Unknown Blessed = FHS_forms_Family_interview.doc Blessed (x/2) = /2

60 Notes: [ID] [Name] [Date] (Does/Did) (he/she) perform household activities such as cooking, cleaning, grocery shopping, making beds, doing laundry, yard work, taking out the trash, minor repairs? FHS_forms_Family_interview.doc

61 [ID] [Name] [Date] Personal Care Eating? 0 = Cleanly with proper utensils 1 = Messily with spoon only (Blessed = 1) 2 = Simple solids (for example, biscuits) (Blessed = 2) 3 = Has to be fed (Blessed = 3) 7 = Impaired due to other reason (do not add to Blessed scale) : 9 = Unknown Blessed = Washing? 0 = Unaided 1 = Needs prompting 2 = Sometimes needs help 3 = Always or nearly always needs help 7 = Impaired due to other reason (do not add to Blessed scale) : 9 = Unknown Dressing? 0 = Unaided 1 = Occasionally misplaced buttons, etc. (Blessed = 1) 2 = Wrong sequence, commonly forgotten items (Blessed = 2) 3 = Unable to dress (Blessed = 3) 7 = Impaired due to other reason (do not add to Blessed scale) : 9 = Unknown Blessed = Incontinence/sphincter control? 0 = Complete control 1 = Occasionally wets bed (Blessed = 1) 2 = Frequently wets bed (Blessed = 2) 3 = Doubly incontinent (Blessed = 3) 9 = Unknown Blessed = Blessed (x/9) = /9 FHS_forms_Family_interview.doc

62 [ID] [Name] [Date] Notes: FHS_forms_Family_interview.doc

63 [ID] [Name] [Date] Mood and Personality (Part I) Did s/he have a change in personality or mood (e.g. outbursts of anger or suspiciousness)? 0 = No 1 = Yes 9 = Unknown Did s/he ever take any medication for mood or thinking problems? 0 = No 1 = Yes 9 = Unknown Did s/he show decreased initiative or growing apathy? 0 = No 1 = Yes (Blessed = 1) 9 = Unknown Did s/he demonstrate a worsening in manners (i.e. increasingly rude or a lack of regard for the feelings of others)? 0 = No 1 = Yes (Blessed = 1) (Hachinski = 1) 9 = Unknown Was s/he unwilling to do things other than his own way (i.e. increasingly rigid)? 0 = No 1 = Yes (Blessed = 1) 9 = Unknown Blessed = Blessed = Hachinski = Blessed = Was s/he increasingly self-centered and only interested in doing things having directly to do with himself? 0 = No 1 = Yes (Blessed = 1) 9 = Unknown Blessed = Had s/he demonstrated a change in his emotional responsiveness to family members (i.e. less or more affectionate to an exaggerated degree)? (coarsening of affect) 0 = No 1 = Yes (Blessed = 1) 9 = Unknown Blessed = Did s/he ever have any hallucinations or delusions? 0 = No 1 = Yes 9 = Unknown Describe: Blessed (x/5) = /5 Hachinski (x/1) = /1 FHS_forms_Family_interview.doc

64 [ID] [Name] [Date] Notes: FHS_forms_Family_interview.doc

65 [ID] [Name] [Date] Mood and Personality (Part II) (Is/Was) s/he increasingly irritable or angry about relatively unimportant things (e.g. impaired emotional control)? 0 = No 1 = Yes (Blessed = 1) 9 = Unknown Blessed = (Does/Did) s/he frequently seem unaffected by important emotional events such as the death of a friend or family member (e.g. diminished emotional responsiveness)? 0 = No 1 = Yes (Blessed = 1) 9 = Unknown Blessed = (Does/Did) s/he show an exaggerated new interest in sexual topics? 0 = No 1 = Yes (Blessed = 1) 9 = Unknown Blessed = (Does/Did) s/he frequently pace or wander without apparent purpose? 0 = No 1 = Yes (Blessed = 1) 7 = NA due to other reason (do not add to Blessed scale) : 9 = Unknown Blessed = (Does/Did) s/he have episodes of frequent tearfulness or laughter in inappropriate situations? (If only laughter, Blessed = 1) 0 = No 1 = Yes (Hachinski = 1) 9 = Unknown Hachinski = Blessed = (Has/Had) s/he been preoccupied with bodily complaints more so than in the past? 0 = No 1 = Yes (Hachinski = 1) 7 = NA due to other reason (do not add to Blessed scale) : 9 = Unknown Hachinski = Blessed (x/5) = /5 Hachinski (x/2) = /2 FHS_forms_Family_interview.doc

66 [ID] [Name] [Date] Notes: FHS_forms_Family_interview.doc

67 [ID] [Name] [Date] General Questions (Part I) If memory and/or personality changes have been reported Had s/he been significantly more depressed since the change in memory or personality began? 0 = No 8 = Not Applicable 1 = Yes (Hachinski = 1) 9 = Unknown Hachinski = If memory and/or personality changes have been reported Did the change in personality or memory develop abruptly within a period of several days or hours? 0 = No 8 = Not Applicable 1 = Yes (Hachinski = 2) 9 = Unknown Hachinski = If answered Yes to above question: Was the onset of the change in personality or memory clearly due to a specific event such as an infection, stroke, or head injury? 0 = No 8 = Not Applicable 1 = Yes 9 = Unknown If memory and/or personality changes have been reported Had there been a worsening of these personality or memory changes over time? 0 = No (If no worsening of personality, Hachinski = 1) 1 = Yes 8 = Not Applicable 9 = Unknown Hachinski = If memory and/or personality changes have been reported Was worsening gradual and progressive, or did it occur by steps, or was there a fluctuation of worsening & improvement? 0 = No Worsening 1 = Gradual and Progressive 2 = Stepwise Deterioration (Hachinski = 1) 3 = Fluctuating Course (Hachinski = 2) 8 = Not Applicable 9 = Unknown Hachinski = Had s/he ever complained of any of the following symptoms? 1) Sudden confusion? 2) Trouble with balance, coordination, or walking? 3) Dizziness or loss of consciousness? 0 = No 1 = Yes (Hachinski = 2) 9 = Unknown Hachinski = If yes, what was the event? Hachinski (x/8) = /8 FHS_forms_Family_interview.doc

68 Notes: ID: Name: Date of Interview: 24 FHS_forms_Family_interview.doc

69 ID: Name: Date of Interview: 25 General Questions (Part II) Did s/he ever complain of any of the following signs? 1) Weakness or numbness on one side of the body or face? 2) Difficulty speaking or understanding speech? 3) Sudden blindness involving one eye? 0 = No 1 = Yes (Hachinski = 2) 9 = Unknown Hachinski = Did s/he ever have a stroke in the past? 0 = None 1-6 = One to Six (If one or more, Hachinski = 2) 7 = Seven or more 9 = Unknown Hachinski = Was s/he ever told that she had high blood pressure (hypertension)? 0 = No 1 = Yes (Hachinski = 1) 9 = Unknown Hachinski = Was s/he ever been told that she had atherosclerosis, or hardening of the arteries? 0 = No 1 = Yes (Hachinski = 1) 9 = Unknown Hachinski = Was s/he ever diagnosed with dementia, senility, or Alzheimer s Probable dementia present disease? 0 = No 1 = Yes 9 = Unknown What specific diagnosis was given? 1 = Alzheimer s disease 2 = Parkinson s disease 3 = Senility 4 = Multiple Strokes 5 = Other 8 = Not Applicable 9 = Unknown Dementia subtype At what age was s/he diagnosed? 888 = Not Applicable 999 = Unknown Has s/he ever had a CT, Where: MRI, or other brain scan? 0 = No 1 = Yes When: 9 = Unknown To the best of your knowledge, when was s/he really her old self (be certain to specify that this question is in reference to memory and thinking abilities)? Age of mild/moderate dementia Last date of normal cognitive status If subject is deceased - What was the status of his/her memory/mental status at the time of death? 0 = Normal 1 = Somewhat impaired 2 = Mildly impaired 3 = Moderately impaired 4 = Severely impaired 8 = Not Applicable 9 = Unknown Cognitive status at the time of death Hachinski (x/6) = /6 FHS_forms_Family_interview.doc

70 ID: Name: Date of Interview: 26 Notes: FHS_forms_Family_interview.doc

71 ID: Name: Date of Interview: 27 Conclusions Interviewer s Assessment of Respondent s Reliability as a Historian. 0 = Poor 1 = Fair 2 = Good 3 = Excellent Tabulated Blessed Score 99 = Unknown (x/29) Tabulated Hachinski Score 99 = Unknown (x/18) Clinical Dementia Rating (CDR) Rating Global 0 Memory 0 Orientation 0 Judgment & Problem Solving 0 Community Affairs 0 Home & Hobbies 0 Personal Care 0 Is informant willing to be contacted again? 0 = No 1 = Yes 9 = Unknown FHS_forms_Family_interview.doc

72 ID: Name: Date of Interview: 28 n Memory Orientatio n Judgment & Problem Solving Communi ty Affairs Home & Hobbies Personal Care Global Clinical Dementia Rating (CDR) Worksheet None 0 No memory loss or slight inconsistent forgetfulness Fully oriented Solves everyday problems & handles business & financial affairs well; judgment good in relation to past performance Independent function at usual level in job, shopping, volunteer and social groups Life at home, hobbies, and intellectual interests Questionabl e 0.5 Consistent slight forgetfulness; partial recollection of events; benign forgetfulness Fully oriented except for slight difficulty with time relationships Slight impairment in solving problems, similarities, and differences Slight impairment in these activities Life at home, hobbies, and intellectual interests slightly impaired Fully capable of self-care Mild 1 Moderate memory loss; more marked for recent events; defect interferes with everyday activities Moderate difficulty with time relationships; oriented for place at examination; may have geographic disorientation elsewhere Moderate difficulty in handling problems, similarities, and differences; social judgment usually maintained Unable to function independently at these activities although may still be engaged in some; appears normal to casual inspection Mild but definite impairment of function at home; more difficult chores abandoned; more complicated hobbies and interests abandoned Needs prompting Moderate 2 Severe memory loss; only highly learned material retained; new material rapidly lost Severe difficulty with time relationships; usually disoriented to time, often to place Severely impaired in handling problems, similarities, and differences; social judgment usually impaired Severe 3 Domain CDR Score Severe memory loss; only fragments remain 0 Oriented to 0 person only Unable to make judgments or solve problems 0 No pretense of independent function outside home Appears well enough to be Appears too ill to be taken to taken to functions functions outside a family outside a home family home Only simple chores preserved; very restricted interests; poorly maintained Requires assistance in dressing, hygiene, keeping of personal effects 0 No significant 0 function in home Requires much help with personal care; frequent incontinence 0 Computed Global CDR Score* *Using CDR Algorithm (Morris et al, 1993) 0 FHS_forms_Family_interview.doc

73 ID: Name: Date of Interview: 29 TIMELINE DATES: FHS_forms_Family_interview.doc

74 Satizabal et al. Neurological exam 73

75 Date of Exam (mm/dd/yyyy) Examiner: NEUROLOGICAL EXAM Subject Name: ID Number: Date of Birth: (Month, Day, Year) Sex: (1=Male, 2=Female) Site: (1=Hospital, 2=Clinic, 3=Home, 4=Institution, 5=Other) - History Chief source of subject s history ( 0=None 1=Patient 2=Spouse 3=Family Member 4=Friend 5=Medical Record 6=Nurse 7=Combination 9=Unknown ) If combination, please specify What is the reliability of the source? (0=Good 1=Fair 2=Poor) History of Neurological Disease: (0=No 1=Yes 2=Maybe 9=Unknown) Is there a history of documented stroke in the past? Is there a history of Parkinson s Disease? Is there a history of dementia? Is there a history of depression? Rows highlighted in gray are only to be filled for stroke related visits Stroke Number (8=N/A) Date of Stroke: (Month, Day, Year) (If not in stroke study, date of exam) Visit: (1=Acute, 3=3 month, 4=6 month, 5=12 month, 6=24 month, 7=Control, 9=Other neurological) Matched Study ID Number (Visit 4 or Visit 7): (0=Cohort, 1=Offspring, 2=Omni) - 1

76 Reconstructed (Visit 1 only): (0=No, 1=Yes) Date of Reconstruction: (Month, Day, Year) Location prior to stroke (Visit 1 only): (1=Inpatient, 2=Nursing home, 3=Rehabilitation, 4=Home with professional help 5=Home, independent, 9=Unknown) MRI Obtained (Visits 4, 6 or 7): (0=No, 1=Yes, normal, 2=Yes, abnormal, 3=Yes, abnormal, confirms index stroke, 8=N/A, 9=Unknown) CURRENT SIGNS / SYMPTOMS SINCE LAST VISIT DURATION COMMENTS (0=No, 1=Acute visit 1, 2=Reconstructed acute visit 1, 3=Symptoms since last visit, 8=N/A, 9=Unknown) Unconsciousness: (0=No, 1=Yes, 2=Maybe, 8=N/A, 9=Unknown) Sudden speech difficulty: (0=No, 1=Dysarthria, 2=Dysphasia, 3=Both, 4=Maybe, 8=N/A, 9=Unknown) Sudden Muscular Weakness: (0=No, 1=Left, 2=Right, 3=Both, 4=Maybe, 8=N/A, 9=Unknown) Numbness, tingling: (0=No, 1=Left, 2=Right, 3=Both, 4=Maybe, 8=N/A, 9=Unknown) Sudden Visual Defect: (0=No, 1=Left, 2=Right, 3=Hemian left, 4=Hemian right, 5=Maybe, 6=Both, 8=N/A, 9=Unknown) Double Vision: (0=No, 1=Yes, 2=Maybe, 8=N/A, 9=Unknown) Other: (0=No, 1=Yes. Please specify ) Time of onset (0-24 hours): (98=N/A, 99=Unknown). Activity at onset: (1=Active (during time awake), 2=Sleep, 3=Rising, 4=Procedure related, 8=N/A, 9=Unknown) Detailed description of episode (include TIA's - duration and number preceding and following stroke) if applicable 2

77 [Behavioral changes section is optional for stroke visit 1 but should be completed for other visits.] Behavior Changes Has there been a significant change in behavior or mental status? ( 0=No 1=Yes 2=Maybe 9= Unknown) If yes or maybe, specify: [ ] What is the duration (in years) of the change? Is there confusion present? Does the subject have trouble walking? Does the subject have trouble sleeping? Has the subject experienced urinary incontinence? Has the subject experienced abnormal behavior? Has the subject experienced hallucinations? 0=No 1=Yes, most of the time 2=Yes, sometimes 8=not applicable 9= Unknown Medications A Has the subject taken any of the following medications? If yes or maybe, specify. 0=No 1=Yes, currently or in the past year 2=Yes, not in the past year, but in the past 1-3 years 3=Maybe 9=Unknown Neuroleptics? [ ] Antidepressants? [ ] Hypnotics or tranquilizers? [ ] Prescription treatment for dementia? [ ] Non prescription Memory pills? [ ] Thyroid medication? [ ] B 12 supplementation? [ ] Estrogen? [ ] Other medications? [ ] 3

78 Medications B Has the subject taken any of the following medications? If yes or maybe, specify. 0=No 1=Yes, currently or in the past year 2=Yes, not in the past year, but in the past 1-3 years 3=Maybe 9=Unknown Aspirin [ ] Other antiplatelet [ ] Warfarin [ ] Anti hypertensive [ ] Statin [ ] Examiner believes that speech difficulty is present: Type of language disability: (0=No, 1=Yes, 2=Maybe, 8=Not tested, 9=Unknown) (0=None, 1=Dysarthria, 2=Dysphasia, 3=Both, 8=Not tested, 9=Unknown) If Dysphasic (1=fluent, 2= nonfluent, 3=global, 4=other) Degree of language disability: (0=None, 1=Mild, 2=Moderate, 3=Severe, 8=Not tested, 9=Unknown) Mental Status Examination Is the subject oriented? Specify [ ] 0=No 1=Yes, x1 2=Yes, x2 3=Yes, x3 9=unknown Subject given sentence to remember (7 elements) Tom and Bill went fishing. They caught 3 black bass. 4

79 (CIRCLE ONE NUMBER FOR EACH STATEMENT) Normal Abnormal Maybe Not tested Unknown Spontaneous speech, Specify: Read: A stitch in time saves nine Interpret: A stitch in time saves nine Do what is written: OPEN YOUR MOUTH Praxis: Hammering Repetition: No ifs, ands, or buts Naming: Parts of watch - band, crystal, stems, hands Calculation: 3 pencils at 28 cents each change from $ Attention: Recite months backward Write sentence: 0=Normal 1=Abnormal 2=Maybe 8=Not tested 9=unknown Draw a clock: (to read 10 minutes past 11) 0=Normal 1=Abnormal 2=Maybe 8=Not tested 9=unknown 5

80 Copy this drawing: 0=Normal 1=Abnormal 2=Maybe 8=Not tested 9=unknown Number of elements in Tom and Bill story recalled. (7) (enter number recalled) Tom and Bill went fishing. They caught 3 black bass = Not tested 9 = unknown Vessels Carotid bruit: 0 = No 1 = Yes, Left 2 = Yes, Right Carotid bruit transmitted from the heart: Ocular bruit: 3 = Yes, Both 4= Maybe 9 = Unknown 6

81 Visual system Examination Visual acuity (JAEGER NUMBER)? 88=worse than 20/800 99=unknown, not tested (right eye) (left eye) Does the subject have any visual field defect? 0=No 1=Hemianopia or quadrantanopia L 2=Hemianopia or quadrantanopia R 3=Bitemporal Hemianopia 4=Monocular L 5=Monocular R 6=Bilateral visual deficits of other pattern. Specify 8=N/A 9=Unknown Does the subject have an abnormality in any of the following? If yes, specify. Fundi? [ ] Pupils [ ] EOM (including range, saccades) [ ] 0=No deficit 1=Left 2=Right 3=Both 4=Maybe 9=Unknown (describe: ) Nystagmus [ ] Neurological Examination Does the subject have any of the following conditions? Abnormal facial sensations (pin and touch) Abnormal facial motion/weakness face Hearing deficit Tongue protrusion: ( 0=Midline, 1=To right, 2=To left, 9=Unknown) 0=No 1=Left 2=Right 3=Both 9=Unknown Swallowing difficulty: ( 0=No, 1=Yes, 2=Maybe, 8=Not tested, 9=Unknown ) 7

82 Spasticity limbs: (0=No, 1=Left, 2=Right, 3=Both, 4=Maybe, 9=Unknown) Weakness (record maximum deficit of worst affected muscle group in each limb): Arm left Arm right Leg left Leg right 0 = No movement 1 = Twitch 2 = Move, with gravity eliminated 3 = Resists gravity 4 = Mild strength/ some weakness 5 = Full strength 9 = Unknown Are deep tendon reflexes normal? (0=Normal, 1=Abnormal increase, 2=Abnormal decrease, 9=Unknown) (In the figure below please enter reflexes using the usual convention of 0: absent, 1: decreased, 2 normal, 3: hyperreflexia; 4: clonus (note this differs from convention used above; these data will not be entered in database, used for review) If abnormal, what is the site of the deep tendon reflex abnormality? (0=No, 1=Left, 2=Right, 3=Both, 8=N/A, 9=Unknown) Frontal lobe signs (abnormal grasp or following response, frontal release reflexes, abulia etc.)? ( 0=No 1=Left 2=Right 3=Both 9=Unknown) Plantars: Is the Babinski sign present? Is cerebellar dysfunction present? Is pseudobulbar lability (IEED) present? ( 0=No 1=Left 2=Right 3=Both 9=Unknown) (0=No 1=Left 2=Right 3=Both 9=Unknown) (0=No 1=Yes 2=Maybe 9=Unknown) 8

83 Is there sensory impairment? (0=No 1=Hemisensory loss 2=Peripheral loss in lower extremities 3=Other pattern 9=Unknown) If there is any sensory impairment, which modalities are affected? (1=touch 2=pain 3=vibration 4=multiple 8=not applicable) If there is any Hemisensory loss, Location: (0=No, 1=Left, 2=Right, 3=Both, 4=Maybe, 9=Unknown) If there is Ataxia, Degree: (0=None, 1=Mild, 2=Moderate, 3=Severe, 8=N/A, 9=Unknown) Type: (0= No, 1= truncal, 2= limb, 3=both) Location: (0=No, 1=Left, 2=Right, 3=Both, 4=Maybe, 9=Unknown) Degree: (0=None, 1=Mild, 2=Moderate, 3=Severe, 8=N/A, 9=Unknown) Gait disturbance: (0=None, 1=Hemiparetic, 2=Ataxic, 3=Broad based, 4=Other neurological, 5=Orthopedic, 6=Combination, 7=Unable to walk, 8=N/A, 9=Unknown) (If 3-6 please describe: ) Does the subject have any of the following conditions? Rigidity Tremor If so, specify type: [ _ ] Bradykinesia 0=No 1=Left 2=Right 3=Both 9=Unknown Postural instability Examiner s Impressions on Examination Frontal lobe syndrome Dementia Parkinsonism Toxic Metabolic Encephalopathy Depression 0=No 1=Mild 2=Moderate 3=Severe 9=Unknown 9

84 Additional Impressions (CDR score and DSM-IV Criteria are Optional for visit 1 stroke) Myoclonus: (0=No, 1=Yes, 2=Maybe, 9=Unknown) Clinical Dementia Rating Scale Score (CDR score) CDR Memory scale CDR Orientation scale CDR Judgment and Problem Solving CDR Community Affairs CDR Home and Hobbies CDR Personal Care CDR Overall Classification 0=None 0.5=Question 1=Mild 2=Moderate 3=Severe 9=Unknown DSM-IV Criteria: Memory Impairment Apraxia Agnosia Aphasia Executive Dysfunction Impaired Abstraction 0=None 1=Yes 2=Maybe 9=Unknown Any neurological signs present referable to stroke in past: ( 0= No, 1= Major, 2= Minor, 8= N/A, 9= Unknown) Other neurological diseases (opinion based on history and exam), specify ( 0= None, 1= Migraine, 2= Parkinson s disease, 3= Parkinsonism, 4= Seizures, 5= Lumber disc, 6= Peripheral neuropathy, 7= Combination, 8 = Other, Specify and code, 9= Unknown) 10

85 Examiner believes current episode was a stroke: (VISIT 1 ONLY) (For routine stroke follow-up and control code 8 = not applicable) (0=No, 1=Yes, 2=Maybe, 8=N/A, 9=Unknown) Type of stroke: (VISIT 1 ONLY) (0=No, 1=ABI, 2=CE, 3=SH, 4=ICH, 5=LAC, 6=Other, 8=N/A, 9=Unknown) Site of lesion: (VISIT 1 ONLY) (0=No, 1=Left hemisphere, 2=Right hemisphere, 3=Brain stem, 4=Bilateral hemisphere, 5=Left cerebellum, 6=Right cerebellum, 7= Bilateral cerebellum, 8=N/A, 9=Unknown) Extent of disability: (VISIT 1 ONLY) (0=None, 1=Mild, 2=Moderate, 3=Severe, 4=Total, 8=N/A, 9=Unknown) Examiner believes current episode was preceded by TIA, describe: (VISIT 1 ONLY) (For routine stroke follow-up and control code 8 = not applicable) (0=No, 1=Yes, 2=Maybe, 8=N/A, 9=Unknown) Current episode - TIA only: (VISIT 1 ONLY) (0=No, 1=Yes, 2=Maybe, 8=N/A, 9=Unknown) CT scan: (0=Not done, 1=Done, normal, 2=Done, Abnormal, 8=N/A, 9=Unknown) CTA : (0=Not done, 1=Done, normal, 2=Done, Abnormal, 8=N/A, 9=Unknown) MRI: (0=Not done, 1=Done, normal, 2=Done, Abnormal, 8=N/A, 9=Unknown) MRA: (0=Not done, 1=Done, normal, 2=Done, Abnormal, 8=N/A, 9=Unknown) Stroke confirmed by CT: 0 = No 1 = Yes Stroke confirmed by CTA: 6 = No 7 = Yes Stroke confirmed by MRI: 2 = No 3 = Yes 4 = Confirmed by both CT and MRI, 5 = Not confirmed by CT and MRI, 11 = Confirmed by CTA and MRI, 12 = Not confirmed by CTA and MRI, 8 = N/A, 9 = Unknown Days between stroke and CT/MRI: (988=Not done, 998=N/A, 999=Unknown) Angiographically proven arterial disease (Arteriogram/ D.S.A.): Left carotid artery disease Right carotid artery disease Vertebro basilar system disease Other intracranial artery disease NICS (R): (0=Not done, 1=Normal, 2=Abnormal, 3=? or borderline, 8=N/A, 9=Unknown) 0 = Not done 1 = No 2 = Less than 50% stenosis 3 = 50-90% stenosis 4 = 90+% stenosis 5 = Complete occlusion 8 = N/A 9 = Unknown NICS (L): (0=Not done, 1=Normal, 2=Abnormal, 3=? or borderline, 8=N/A, 9=Unknown) 11

86 Thank you for filling in this form. Now, please do the following: 1. If this is a stroke visit, please fill in the NIHSS. 2. If you believe this person has a Parkinsonian syndrome, please fill in the PD addendum. 3. If you have filled in the CDR scores, please refer to the table defining each category and pick the single best option. FORM CODE: NE (Version: jjh_ ) Keyer 1: Keyer 2: 12

87 Satizabal et al. Neuropsychological battery 86

88 «Id» «LName», «FName» «E_yr» NP Battery, Long Form (v. 09/19/2014) Neuropsychological Test Battery Long Form (Version 09/19/2014) Subject Name: «FName» «LName» (not keyed) Study ID: «Id0» - «Id1»«Id2»«Id3»«Id4» Brain Bank Participant: 0=No 1=Yes Age: «Age1»«Age2»«Age3» (not keyed) Date of Testing (mm/dd/yyyy) Examiner (print name): If relevant, Second Examiner (print name): (leave name & ID@ blank if no second examiner) (not keyed) «Edate» Examiner ID#: Second Examiner ID#: (leave blank if n/a) 8 or 10 or 98 Dementia study: Cognitive Clinic Study Membership 66 or 96 Dementia study: BB only (at time of exam) 83 or 93 Dementia study: Original cohort, NOT Cognitive or BB «E_typ 77 Stroke study e» 81 or 91 MRI study (short battery) 87 or 97 Gen 3 MRI study 55 Other: Exam tape recorded? 0 = No 1 = Yes 2 = Partial Current marital status: 1 = Single (never married) 2 = Married 3 = Widowed 4 = Divorced 5 = Separated 6 = Other 9 = Unknown Right 1 Left 2 Ambidextrous (see next) 3 Unknown 9 Participant s handedness: If Ambidextrous, which is the preferred writing hand? Right 1 Left 2 Unknown 9 Familial handedness: (Blood Relatives only) All right 1 Some left (see below) 2 Unknown 9 ***If some left-handed, place a 1 next to all that apply: grandparent(s) parents sibling(s) aunt(s)/uncle(s) cousin(s) children/grandchildren If children/grandchildren only, do other family line(s) better explain it? 0 = No 1 = Yes Refer to most recent NP Scoring Manual for scoring instructions. NP001 1

89 «Id» «LName», «FName» «E_yr» NP Battery, Long Form (v. 09/19/2014) TURN OFF YOUR CELL PHONE TURN ON RECORDER Occupation List 1. MOG A Professional, Technical and Related Occupations 2. MOG B Executive, Administrative, and Managerial Occupations 3. MOG C Sales Occupations 4. MOG D Administrative Support Occupations, Including Clerical 5. MOG E Precision Production, Craft, and Repair Occupations 6. MOG F Machine Operators, Assemblers, and Inspectors 7. MOG G Transportation and Material Moving Occupations 8. MOG H Handlers, Equipment Cleaners, Helpers, and Laborers 9. MOG K Service Occupations, Except Private Household 10. Never employed for pay (e.g., homemaker) 11. Unknown Occupational Classification System Manual (OCSM), based on the 1990 Census of Population and Housing Classified Index of Industries and Occupations, U.S. Bureau of Labor Statistics (BLS). Home page: Search by Job Title: Standardized tests used in this battery: Wechsler Adult Intelligence Scale (WAIS) Wechsler Adult Intelligence Scale Revised (WAIS-R) Wechsler Adult Intelligence Scale 4 th Edition (WAIS-IV) Woodcock-Johnson Revised (WJ-R) Wechsler Memory Scale (WMS) Clock Drawing Test from Boston Diagnostic Aphasia Examination (BDAE) Verbal Fluency (FAS & Animals) Boston Naming Test (BNT) Trailmaking Tests A & B Reading subtest from Wide Range Achievement Test 3 rd Edition (WRAT-3) Finger Tapping Test (FTT) Hooper Visual Organization Test (HVOT) Cookie Theft Writing Sample (from BDAE) 2

90 «Id» «LName», «FName» «E_yr» NP Battery, Long Form (v. 09/19/2014) Education What is the highest degree or level of school you have completed? Get as much detail as possible in order to accurately score according to the categories below. Examples of additional prompts include: *Did you graduate? *What did you do after High School? *Did you earn a certificate or degree? *Was it a 4-year college? *What did you study? <key text> 0 = none 1 = 4 th grade or less 2 = 5 th, 6 th, or 7 th grades 3 = grade school graduate; no high school 4 = high school, did not graduate 5 = high school diploma 6 = GED 7 = some college course-work for credit (no certificate or degree) 8 = Junior college earned certificate or degree (e.g., AD): 9 = Business college, nursing school, music school, art school 10 = Technical /Trade School (post-hs) earned certificate: 11 = Four Year College, partial 12 = Four Year College, graduate 13 = Graduate School, partial (no Masters degree) 14 = Graduate School (Masters) 15 = Graduate School (Doctorate) 16 = Unknown Occupation What kind of work do (did) you do? ** (get as much detail as possible) Additional prompts include: *Did you work outside the home for pay? *What would you say was your highest status job? *What was your last job before you retired? *What tasks/responsibilities did your job entail? Where did you work? <key text> What was your job title? <key text> **Enter code from occupation list (Bureau of Labor Statistics (BLS) Occupational Classification System Manual, 2001) What is your Current employment status? 3 0 = Works full-time (>30 hrs/wk) 1 = Works part-time (<30 hrs/wk) 2 = Not working due to disability 3 = Retired, no longer works 4 = Unemployed (expects to return to work) 5 = Never worked for pay outside home or only did so briefly; not life-long or to support family 6 = Volunteer 7 = Other 9 = Unknown 10= Full-time Student 11= Homemaker, expects to return to work Sensory Impairments PLEASE NOTE: CODE YES ONLY IF IMPAIRMENT MAY AFFECT TESTING Hearing problems, not fully corrected (i.e., even with hearing aid, hearing is impaired) If yes, please describe: PLEASE NOTE: CODE YES ONLY IF IMPAIRMENT MAY AFFECT TESTING Vision problems, not fully corrected (i.e., even with vision aid, sight is impaired) If yes, please describe: 0 NO 0 NO 1 YES 1 YES 9 Unknown 9 Unknown NP002

91 «Id» «LName», «FName» «E_yr» NP Battery, Long Form (v. 09/19/2014) Testing Priorities High Priority Tests: (do these first; Memory is most important, followed by Trails, etc.) Memory Trails Clocks WRAT reading (if never seen before) Similarities Coding Tests to skip: (Balance is least important, followed by Finger Tapping, etc.) Balance/phys function Finger Tapping WRAT reading if given before Cookie Theft Information Block Design Digital Pen Instructions: This is a special pen for recording your drawings. Hold and write with the pen as you do naturally. We have found that if the pen is held too far horizontally (demonstrate this) it sometimes buzzes. The buzzing is not in any way harmful. If you feel it buzz as you are working, just hold the pen a little more vertically and continue with what you were doing. 4

92 «Id» «LName», «FName» «E_yr» NP Battery, Long Form (v. 09/19/2014) Have you ever been told by a doctor that you have a seizure disorder or epilepsy? A. Are you currently taking any medication for your seizure disorder or epilepsy? History of seizure disorder 0 = No* 1 = Yes 7 = Don t know/not Sure 9 = Refused/Unknown *If No, leave A-D blank and go to History of Learning Difficulty below. 0 = No 1 = Yes** 7 = Don t know/not Sure 9 = Refused/Unknown **If yes, name of med(s): 0 = None 1 = One 2 = More than one 3 = No longer have epilepsy or seizure disorder 7 = Don t know/not sure 9 = Refused/Unknown B. How many seizures of any type have you had in the last three months? C. In the past year, have you seen a neurologist or epilepsy specialist for your epilepsy or seizure disorder? D. During the past 30 days, to what extent has epilepsy or its treatment interfered with your normal activities like working, school, or socializing with family or friends? 0 = No 1 = Yes 7 = Don t know/not sure 9 = Refused/Unknown 1 = Not at all 2 = Slightly 3 = Moderately 4 = Quite a bit 5 = Extremely 7 = Don t know/not sure 9 = Refused/Unknown NP003 5

93 6 «Id» «LName», «FName» «E_yr» NP Battery, Long Form (v. 09/19/2014)

94 «Id» «LName», «FName» «E_yr» NP Battery, Long Form (v. 09/19/2014) Did you have any significant trouble learning in school? Have you ever been diagnosed with a learning or attention disability? *If yes: Diagnosis: Year of Diagnosis: Interventions: Did you ever have any significant head injuries INCLUDING when you were a child? **If yes: Would you be willing to speak to someone about more details about your injury? Cohort/Offspring: Do you have any concerns about your memory or thinking? If yes: Do you think this is normal for your age? History of learning difficulty 0 = No 1 = Yes 9 = Unknown 0 = No 1 = Yes* 2 = No dx; self-reported disability 7 = Don t know/not sure 9 = Refused/Unknown History of head injury 0 = No 1 = Yes** 7 = Don t know/not sure 9 = Refused/Unknown 0 = No 1 = Yes 7 = Don t know/not sure 9 = Refused/Unknown Concerns about memory or thinking 0 = No 1 = Yes, but normal 2 = Yes 8 = N/A; Gen 3 9 = Unknown If yes, describe Gen3: Do you have any concerns about your memory or thinking? If yes: Is this a change? 0 = No 1 = Yes, not a change 2 = Yes 8 = N/A; Cohort/Offspring 9 = Unknown If yes, describe NP003B 7

95 «Id» «LName», «FName» «E_yr» NP Battery, Long Form (v. 09/19/2014) LOGICAL MEMORY (WMS), Immediate Recall I am going to read you a little story of about 4 or 5 lines. Listen carefully because when I am through, I want you to tell me everything I read to you. Are you ready? READ STORY, then say: Tell me everything you remember IF THE PARTICIPANT DOES NOT RECALL THE STORY, YOU CAN PROVIDE THE PROMPT. HOWEVER, DO NOT GIVE PROMPT TOO QUICKLY; ONLY AFTER IT IS CLEAR THAT S/HE WILL NOT PRODUCE ANYTHING WITHOUT IT. PROMPT: It was a story about a woman. WHEN PARTICIPANT STOPS TALKING, ASK: Are there any other details you remember? Anna Thompson, of South Boston, employed as a scrub woman in an office building, reported at the City Hall Station that she had been held up, on State Street, the night before, and robbed of fifteen dollars. She had four little children, the rent was due, and they had not eaten for two days. The officers, touched by the woman s story, made up a purse for her. 8

96 «Id» «LName», «FName» «E_yr» NP Battery, Long Form (v. 09/19/2014) Check here if test NOT completed (record reason in Factors Affecting Testing section) Logical Memory: Immediate Recall (WMS) Cue given? (Cue = It was a story about a woman. ) 0 = No 1 = Yes Circle 2 for verbatim (V) credit and 1 for paraphrase (P) credit (see Scoring Manual) V P Story Short # PSV (freq) before after hand query query Record Story Verbatim: 2 1 Anna Thompson AT 2 1 of South SB or S 2 1 Boston B 2 1 employed e 2 1 as a scrub woman 2 1 in an office building SW or Scr. OB or off bld 2 1 reported rpt 2 1 at the City Hall CH 2 1 Station Stn 2 1 That she had been held up Sh d bn h.up 2 1 on State Street St. St. 2 1 the night before ngt. b/f 2 1 and robbed 2 1 of fifteen dollars. 15 $ 2 1 She had four sh d little children LCh or lt.ch. 2 1 the rent Rwd 2 1 was due, due 2 1 and they had not eaten hn eatn 2 1 for two days. 2 days 2 1 The officers (Off) Total (pre- and post-query) Number of: 2 1 touched by the woman s story tchd by story 2 1 made up a purse md up P 2 1 for her. 4 her Other Perseveration: Clinical Judgment of Perseverations (circle) 0 No 1 Yes 8 N/A 9 Unknown Confabulations Related to story details Unrelated to story details Post-Query Response Only: 1 = no ; 2 = yes, gave response New correct details (freq) New incorrect details (freq) Intrusions NP004 9

97 «Id» «LName», «FName» «E_yr» NP Battery, Long Form (v. 09/19/2014) VISUAL REPRODUCTION (WMS), Immediate Before Card A: I am going to show you a drawing. You will have just 10 seconds to look at it. Then I will take it away and let you draw it from memory. Don t begin to draw until I say go. Ready? Now draw it here EXPOSE DRAWING FOR 10 SECONDS. Before Card B: You will draw the next one here EXPOSE DRAWING FOR 10 SECONDS. Now draw it here Before Card C1-C2: Here is one that is a little harder. This next one has 2 drawings on it. I want you to look at both of them carefully again you have only 10 seconds to look at them and then I will take it away and let you make both drawings; the one on the left side---here (point to space) and the right one---here (point). Ready? EXPOSE DRAWING FOR 10 SECONDS. Now draw it here 10

98 «Id» «LName», «FName» «E_yr» NP Battery, Long Form (v. 09/19/2014) Visual Reproductions Immediate Recall (WMS): Examiner s page IR C2 IR C1 If using VR Scoring Examples to determine score, write Examples in the spaces for points rather than individual points. Points Points Criterion Criterion Circle here if 1 point deduction -1 (not keyed) Circle here if 1 point deduction -1 IR-B IR-A Points Points Criterion Criterion Circle here if 2 point deduction -2 (not keyed) Circle here if 1 point deduction -1 top of participant s page 11

99 12 «Id» «LName», «FName» «E_yr» NP Battery, Long Form (v. 09/19/2014)

100 «Id» «LName», «FName» «E_yr» NP Battery, Long Form (v. 09/19/2014) Visual Reproductions: Immediate Recall (WMS) Check here if test NOT completed (record reason in Factors Affecting Testing section) Design (max possible points) A (3) B (5) C1 (3) C2 (3) Total number of points scored Qualitative findings A B C1 C2 Draws right to left Contamination from another VR design Perseveration Micrographia Tremors Confabulation Starts to draw before told to begin No attempt to produce drawing If no attempt to produce drawing, participant reports I do not remember and indicates a specific location for the design. Pt lacks obvious awareness that there should be four drawings (circle) Are there qualitative findings? (circle) 0 No 0 No (leave Qual findings section blank) 1 Yes 1 Yes (fill in Qual findings section) NP005 13

101 «Id» «LName», «FName» «E_yr» NP Battery, Long Form (v. 09/19/2014) VERBAL PAIRED ASSOCIATES (WMS), Learning Trials I m going to read a list of words, two at a time. When I m through, I will tell you one of the words, and I want you to tell me which word went with it. For example, if the words were East, West.. Gold, Walk, then when I said, East, you would say, and when I said, Gold, you would say. Right. IF INCORRECT: No, Gold goes with Walk. (If necessary, explain directions again) Trial 1 Trial 2 Trial 3 Now, we will do the same thing we just did. Please listen carefully as I read through the list of word pairs. Now please listen carefully as I read the list Again we will do the same thing. Please listen carefully as I read through the list of word pairs Metal-Iron Baby-Cries Crush-Dark North-South School-Grocery Rose-Flower Up-Down Obey-Inch Fruit-Apple Cabbage-Pen Which word went with? Rose-Flower Obey-Inch North-South Cabbage-Pen Up-Down Fruit-Apple School-Grocery Metal-Iron Crush-Dark Baby-Cries Baby-Cries Obey-Inch North-South School-Grocery Rose-Flower Cabbage-Pen Up-Down Fruit-Apple Crush-Dark Metal-Iron BE SURE TO GIVE FEEDBACK AFTER EACH RESPONSE, EITHER: Right OR No, that one was 14

102 «Id» «LName», «FName» «E_yr» NP Battery, Long Form (v. 09/19/2014) RECALL Write any wrong answers verbatim: + or if correct SCORE 0 = incorrect 1 = correct 6 = no guess Paired Associates (WMS) INCORRECT ASSOCIATES 2 = PAL interference (another word from the list) 3 = Related (response is related to first word of pair) 4 = Unrelated (response is NOT related to first word) Check here if test NOT completed (record reason in Factors Affecting Testing section) PERSEVERATION Place 1 in the box if incorrect response was given for a prior word in the same trial, else leave blank REPEAT Place 1 in the box if the same incorrect association was made in a prior trial; else leave blank. First Recall Score Incorrect Associates Persev Second Recall Score Incorrect Associates Persev Repeat Third Recall Score Incorrect Associates Persev Repeat North South Fruit Apple Obey Inch Rose Flower Baby Cries Up Down Cabbage Pen Metal Iron School Grocery Crush Dark Cabbage Pen Baby Cries Metal Iron School Grocery Up Down Rose Flower Obey Inch Fruit Apple Crush Dark North South Obey Inch Fruit Apple Baby Cries Metal Iron Crush Dark School Grocery Rose Flower North South Cabbage Pen Up Down Presence of Perseverations (circle): 0 = No (leave all persev columns blank) 1 = Yes (fill in persev columns) Presence of Repeated Pairs (circle): 0 = No (leave all repeat columns blank) 1 = Yes (fill in repeat columns) NP006 15

103 «Id» «LName», «FName» «E_yr» NP Battery, Long Form (v. 09/19/2014) DIGIT SPAN (WAIS) Digits Forward I am going to say some numbers. Listen carefully, and when I am through say them right after me. 16

104 «Id» «LName», «FName» «E_yr» NP Battery, Long Form (v. 09/19/2014) Digit Span (Forward) (WAIS) Score: 0 = incorrect 1 = incorrect, sequencing error only 2 = correct 8 = not administered Check here if test NOT completed (record reason in Factors Affecting Testing section) Span Lengths: Circle the longest correct span length Underline the longest span scored 1 or 2 AFTER the official discontinue Span = Span = Span = Span = Span = Span = Span = 9 Is qualitative score valid? 0 = No 1 = Yes NP007 17

105 «Id» «LName», «FName» «E_yr» NP Battery, Long Form (v. 09/19/2014) DIGIT SPAN (WAIS) Digits Backward Now I am going to say some more numbers, but this time when I stop I want you to say them backwards. For example, if I say what would you say? CORRECT (9-1-7) Here are some others INCORRECT No, that one is I said 7-1-9, so you should say Try this one, and remember you are to say them backwards: START AT 3 span SERIES CORRECT (8-4-3) Here are some others START AT INCORRECT Here are some others START AT 3 span SERIES 2 span SERIES Pass Go ahead to 4 span Fail Go back to 2 span TESTING THE LIMITS: CONTINUE ADMINISTERING ITEMS UNTIL BOTH FAILURES ARE DUE TO ERRORS OTHER THAN SEQUENCING ALONE. 18

106 «Id» «LName», «FName» «E_yr» NP Battery, Long Form (v. 09/19/2014) Score: Digit Span (Backward) (WAIS) 0 = incorrect 1 = incorrect, sequencing error only 2 = correct 8 = not administered Check here if test NOT completed (record reason in Factors Affecting Testing section) Span Lengths: Circle the longest correct span length Underline the longest span scored 1 or 2 AFTER the official discontinue. # of cues: Cue pt each time they say the sequence in forward order and record the number of cues given. Example 1: # of cues: Example 2: # of cues: Span = # of cues: # of cues: Span = # of cues: # of cues: Span = # of cues: # of cues: Span = # of cues: # of cues: Span = # of cues: # of cues: # of cues: # of cues: Span = 7 Span = 8 Is qualitative score valid? 0 = No 1 = Yes Cues given? 0 = No 1 = Yes (leave # cues boxes blank) (fill in # of cues) NP008 19

107 «Id» «LName», «FName» «E_yr» NP Battery, Long Form (v. 09/19/2014) LOGICAL MEMORY (WMS), Delayed Recall At the beginning of the test, I read a story to you. Tell me that story again. IF THE PARTICIPANT DOES NOT RECALL THE STORY, YOU CAN PROVIDE THE PROMPT. HOWEVER, DO NOT GIVE PROMPT TOO QUICKLY; ONLY AFTER IT IS CLEAR THAT S/HE WILL NOT PRODUCE ANYTHING WITHOUT IT. PROMPT: It was a story about a woman. (WHEN THE PARTICIPANT STOPS TALKING, ASK) Are there any other details you remember? 20

108 «Id» «LName», «FName» «E_yr» NP Battery, Long Form (v. 09/19/2014) Check here if test NOT completed (record reason in Factors Affecting Testing section) Logical Memory: Delayed Recall (WMS) Cue given? (Cue = It was a story about a woman. ) 0 = No 1 = Yes Circle 2 for verbatim (V) credit and 1 for paraphrase (P) credit (see Scoring Manual) V P Story Short # PSV (freq) before after hand query query Record Story Verbatim: 2 1 Anna Thompson AT 2 1 of South SB or S 2 1 Boston B 2 1 employed e 2 1 as a scrub woman 2 1 in an office building SW or Scr. OB or off bld 2 1 reported rpt 2 1 at the City Hall CH 2 1 Station Stn 2 1 That she had been held up Sh d bn h.up 2 1 on State Street St. St. 2 1 the night before ngt. b/f 2 1 and robbed 2 1 of fifteen dollars. 15 $ 2 1 She had four sh d little children LCh or lt.ch. 2 1 the rent Rwd Total (pre- and post-query) # of REPEATED from IR: 2 1 was due, due Confabulations Intrusions 2 1 and they had not eaten hn eatn 2 1 for two days. 2 days Related to story details Unrelated to story details 2 1 The officers (Off) Total (pre- and post-query) # of NEW: 2 1 touched by the woman s story tchd by story 2 1 made up a purse md up P 2 1 for her. 4 her Other Perseveration: Clinical Judgment of Perseverations (circle) 0 No 1 Yes 8 N/A 9 Unknown Related to story details Unrelated to story details Post-Query Response Only: 1 = no ; 2 = yes, gave response New correct details (freq) New incorrect details (freq) Confabulations Intrusions NP009 21

109 «Id» «LName», «FName» «E_yr» NP Battery, Long Form (v. 09/19/2014) LOGICAL MEMORY (WMS), Recognition I m going to ask you some questions about that story. I d like you to tell me which one, of the three choices in each question, is correct. 22

110 «Id» «LName», «FName» «E_yr» NP Battery, Long Form (v. 09/19/2014) Logical Memory: Recognition (WMS) Check here if test NOT completed (record reason in Factors Affecting Testing section) Circle the participant s response. No Guess = 6; however, strongly encourage participant to make a guess. Response 1 Response 2 Response 3 No Guess Was the story about: a woman 1 a man 2 or an animal 3 6 Was her name: Annie Thomas 1 Anna Thompson 2 or Annie Hall 3 6 Was she from the: Southwest 1 South Boston 2 or Cape Cod 3 6 Was she: a secretary 1 a housekeeper 2 or a scrub woman 3 6 Did she work in: a private home 1 a railroad station 2 or an office building 3 6 Was she: beaten 1 robbed 2 or did she win a prize 3 6 Was she held up on: Main Street 1 Beacon Street 2 or State Street 3 6 Did it happen: that morning 1 the night before 2 or the week before 3 6 Was she robbed: of $ $ or $ Did she have: no children 1 two children 2 or four children 3 6 Did the police: arrest her 1 arrest the robber 2 or give her money 3 6 Had they not eaten for: 2 hours 1 2 days 2 or 1 week 3 6 NP010 23

111 «Id» «LName», «FName» «E_yr» NP Battery, Long Form (v. 09/19/2014) VISUAL REPRODUCTION (WMS), Delayed Now I want to see how well you remember those drawings that I showed you. Try to draw as many as you can remember and you don t have to draw them in the same order that I showed them to you. 24

112 «Id» «LName», «FName» «E_yr» NP Battery, Long Form (v. 09/19/2014) Visual Reproductions Delayed Recall (WMS): Examiner s page DR C2 DR C1 If drawing is in the wrong location, indicate in box D which stimulus drawing is being scored. Box D Box D Points Points Criterion (not keyed) Criterion Circle here if 1 point deduction -1 (not keyed) Circle here if 1 point deduction -1 DR-B DR-A Box D Box D Points Points Criterion Criterion Circle here if 2 point deduction -2 (not keyed) Circle here if 1 point deduction -1 top of participant s page 25

113 26 «Id» «LName», «FName» «E_yr» NP Battery, Long Form (v. 09/19/2014)

114 «Id» «LName», «FName» «E_yr» NP Battery, Long Form (v. 09/19/2014) Visual Reproductions: Delayed Recall (WMS) Check here if test NOT completed (record reason in Factors Affecting Testing section) Design (max possible points) A (3) B (5) C1 (3) C2 (3) Total number of points scored Qualitative findings A B C1 C2 Draws right to left Contamination from another VR design Perseveration Micrographia Tremors Confabulation Starts to draw before told to begin No attempt to produce drawing If no attempt to produce drawing, participant reports I do not remember and indicates a specific location for the design. Pt lacks obvious awareness that there should be four drawings (circle) Are there qualitative findings? (circle) 0 No 0 No (leave Qual findings section blank) 1 Yes 1 Yes (fill in Qual findings section) A B C1 C2 Incorrect productions on Immediate Recall (IR) that were repeated on Delayed Recall (DR) Complete (exact) reproduction(s) (0=no, not complete reproduction; 1=yes, complete reproduction; 8=N/A (if full credit or no attempt on IR or DR)) Partial reproduction(s) (0=no, not partial reproduction; 1=yes, partial reproduction; 8=N/A (if full credit or no attempt on IR or DR)) Correct details recalled on DR that were not produced on IR Correct details (frequency count) NP011A 27

115 «Id» «LName», «FName» «E_yr» NP Battery, Long Form (v. 09/19/2014) VISUAL REPRODUCTION (WMS), Recognition Which one of these drawings did I show you at the beginning? REPEAT FOR ALL DESIGNS. 28

116 «Id» «LName», «FName» «E_yr» NP Battery, Long Form (v. 09/19/2014) Check here if test NOT completed (record reason in Factors Affecting Testing section) Circle participant s response. 6 =no guess; however, strongly encourage a guess. Visual Reproductions: Recognition (WMS) Participant s chosen design Design A Design B Design C Design C No guess 6 No guess 6 No guess 6 No guess Same as design drawn by participant in VR Delayed? 0 no 0 no 0 no 0 no 1 yes 1 yes 1 yes 1 yes 8 N/A 8 N/A 8 N/A 8 N/A NP011B 29

117 «Id» «LName», «FName» «E_yr» NP Battery, Long Form (v. 09/19/2014) VERBAL PAIRED ASSOCIATES (WMS), Recall Now I want to see how well you remember the word pairs. What word went with.? 30

118 «Id» «LName», «FName» «E_yr» NP Battery, Long Form (v. 09/19/2014) Paired Associate Learning: Delayed Recall (WMS) Check here if test NOT completed (record reason in Factors Affecting Testing section) Response Write any incorrect responses verbatim Write a + or a if response is correct Score Incorrect = 0 Correct = 1 No guess = Write the appropriate code for each response in the unshaded box Errors PAL = incorrect word is another word on the list Related = incorrect response is related to the first word Not Related = incorrect response is NOT related to the first word Place a 1 in the appropriate column for each incorrect response 1 if incorr. response was given on prior word pair [within test] 1 if incorr. assoc. was used on any prior trial Metal Iron Baby Cries Crush Dark North South School Grocery Rose Flower Up Down Obey Inch Fruit Apple Cabbage Pen Easy Hard PAL Related XX XX XX XX XX XX XX XX XX XX Not Related Psv Repeat Presence of Perseverations: 0 = No (leave persev column blank) 1 = Yes (fill in persev column) Presence of Repeated Pairs: 0 = No (leave repeat column blank) 1 = Yes (fill in repeat column) NP012 31

119 «Id» «LName», «FName» «E_yr» NP Battery, Long Form (v. 09/19/2014) VERBAL PAIRED ASSOCIATES (WMS), Recognition I m going to give you some multiple choice options for those word pairs. Which word went with, was It,,, or? 32

120 «Id» «LName», «FName» «E_yr» NP Battery, Long Form (v. 09/19/2014) Paired Associate Learning: Recognition (WMS) Check here if test NOT completed (record reason in Factors Affecting Testing section) Circle participant s response. No Guess = 6; however, strongly encourage a guess. Stimulus Option 1 Option 2 Option 3 Option 4 No guess Metal Zinc 1 Head 2 Iron 3 Copper 4 6 Baby Crib 1 Cries 2 Rattle 3 Crawl 4 6 Crush Stamp 1 Dark 2 Park 3 Cramp 4 6 North South 1 Pole 2 West 3 Wise 4 6 School Bus 1 Learn 2 Drugstore 3 Grocery 4 6 Rose Bud 1 Inch 2 Flower 3 Apple 4 6 Up Stair 1 Before 2 Under 3 Down 4 6 Obey Inch 1 Command 2 Order 3 Stitch 4 6 Fruit Apple 1 Peach 2 Grocery 3 Stand 4 6 Cabbage Leaf 1 Pond 2 Soup 3 Pen 4 6 NP013 33

121 «Id» «LName», «FName» «E_yr» NP Battery, Long Form (v. 09/19/2014) SIMILARITIES Now we will be doing something completely different. I am going to name two things, and I would like you to tell me how they are alike, how they are the same. In what way are an ORANGE and a BANANA alike? **IF FRUIT OR FOOD, SAY Good **IF ANOTHER ACCEPTABLE ANSWER, SAY, That s correct, they are also both fruit.. **IF NO CREDIT RESPONSE, SAY: They are alike in that they are both fruit, you eat both, both have skins. Similarities Scoring 2 points 1 point No Credit Orange- Fruit Food, to eat, have peels, same color, grow, contain Round, same shape, contain calories Banana vitamins Coat- Dress Garments, wearing apparel, clothing Made of cloth, keep you warm, to wear, cover the body, things to put on Coat is warmer than dress, made of same material, you put coat on top of dress, have buttons Axe-Saw Tools, cutting implements Used by carpenters, to cut, hardware, sharp, implement Made of metal, people are afraid of them, have handles, for sawing and chopping Dog-Lion Animals, mammals Legs, fur, tails, belong to same species, teeth Look alike, lion growls, dog barks, dangerous North- West Directions, compass points Tell you where you re going, Places on a map Distance, go either way, geography Eye-Ear Air- Water Table- Chair Egg-Seed Poem- Statue Wood- Alcohol Praise- Punish ment Fly- Tree Senses, sense or perception organs, receptors of stimuli Necessary for life, have to have air to live and must have water to live, necessary for functioning of human body, can t live without them, needed to survive, Furniture, articles of furniture, furnishings Beginnings of life, first stages of life, reproduce what they come from, beginning of a species, embryonic substances/stages/forms of life/beginnings, beginning of growth, young come from both, create/start life, prebirth units, root of life, precursor to life, generate living organisms Works of art, artistic creation, expression of artistic feeling Organic substances, have carbon, contain hydrogen and carbon Means of discipline/teaching, method of criticism, critiques, evaluation of actions, means of socialization, means of reinforcement, forms of reward, means of influencing behavior of others, methods of motivation/ control/correction, appraisal of behavior, shape someone s character, behavior modifiers Living things, have life, forms of life, both alive, biological forms, organisms, both can reproduce, organic, both live outdoors Organs, parts of the body/face, anatomy, you know from them, you get knowledge through them, for communication Elements, have oxygen, help us to live, means of transportation, you need both, fluids, necessary Household objects, kitchen/dining set, found in kitchens and restaurants, used when you eat a meal, associated with eating, to support or hold things Things grow from both, produce, give life (incompletely explained), can create, have shells, something grows from both, means of reproduction (not further explained), beginning (not further explained), embryos, zygotes, potential for life/growth, dormant forms of life, reproductive units, both procreate, form of birth, life forms come from both, offspring, produce, are products of something else, make things, can be fertilized, fertilization Man-made, composed, symbolic, beautiful things, stir feelings, are memorial make you remember, commemorate something/someone, tell stories, express an emotion or idea, method/form of expression, have meaning, both represent something, both describe/express something Burn, used in manufacturing, used as fuel For training people, to express your attitude, used on people to get them in a certain emotional state, means of getting things done, responses to behavior, rewards (no elaboration), reinforcers, feedback or forms of feedback, reinforcement for behavior, to teach (right from wrong), to help one do better, earned through behavior, what you receive when you are good or bad, expression of feelings, consequences of actions, forms of treatment Breathe, grow, need food, created by nature/environment/god, part of nature, need sunlight, need air/water/nourishment to live, both will die Necessary to man, see with eye, hear with ear, both have an opening, can tell what you are saying, you read lips and ear hears what you say, you need both Everywhere on earth, nature s products, contain water, nature s gift, breathe air and drink water, water is a substance and air is a substance, keeps on going, so does water keep on going, in clouds, atmosphere, environment Table to eat on chair to sit on; have four legs, wooden objects Grow, mature, develop, food, one comes from other, you can eat both, have a yolk, are round, hatched, an egg comes from a chicken and a seed comes from a plant Poem describes statue, by famous people, lifeless, you read a poem and look at a statue, people like them, last a long time if good, are decorative, nice, unique, things that are looked at, you read both, found in museums, represent history, culture, by famous people, are timeless, old, lifeless, inanimate objects Tree products, alcohol comes from wood, useful, knock you out Benefit a person, things you inflict on people, something given to you, administered by authority, parents use them on children, learning experiences, behavior, actions doing things, done by another person Up in air, outdoors, fly has wings & tree has leaves, fly is small & tree is big, useful to humans, carry germs, neither are mammals, both (move in wind/flutter/fly/ blow), both are free, support environment, fly would land on a tree ** Give appropriate credit for response if they say, Different or Opposite. For example, for North and South, Different Directions would be a 2- point response because directions is a 2-point response. 34

122 «Id» «LName», «FName» «E_yr» NP Battery, Long Form (v. 09/19/2014) Similarities (WAIS) Check here if test NOT completed (record reason in Factors Affecting Testing section) Orange Banana Coat Dress Axe Saw Dog Lion North West Eye Ear Air Water Table Chair Egg Seed Poem Statue Wood Alcohol Praise Punishment Fly Tree DISCONTINUE: After 4 consecutive failures Response Score (see Scoring Manual) Error Type 1 Place a 1 if the Record response verbatim 0 1 = 0 point response 6 = no guess response is a loss of set (LOS), 1 = 1 point response 8 = d/c criterion met concrete thinking (Con), 2 = 2 point response perseveration (psv); or other Response Score LOS Con 1 Psv Other Fruit Clothes Clothing Garments Tools Animals Directions Senses Necessary for life Furniture Beginnings of life Art Works of art Have carbon Discipline Living things 1 Record Error Type only if score = 0. (If score = 1, concrete will be assumed) NP014 35

123 «Id» «LName», «FName» «E_yr» NP Battery, Long Form (v. 09/19/2014) Odd ID number back-to-back clocks Even ID number split clocks Clock Drawing Test: Command Condition I d like you to draw a clock. Put in all the numbers, and set the hands to ten after eleven. Remember to time the drawing! 36

124 «Id» «LName», «FName» «E_yr» NP Battery, Long Form (v. 09/19/2014) Clock Drawing Test: Command Condition (Examiner s Page) Check here if test NOT completed (record reason in Factors Affecting Testing section) Top of Participant s Clock (circle one). Top Top. Rotated paper while placing numerals/numeral substitutes Attempt to self-correct significant error Time to completion: : (min:sec) 0 No 0 No 1 Yes, result correct 0 1 Yes 2 Yes, result NOT correct 8 N/A 3 No Errors 8 9 Unknown 9 Unknown 9 Unknown 1 Requested reminder of time for hand-setting No Yes N/A Describe Other Observations: NOTE: If dcdt data is not acquired, use full command clock scoring pages. NO016 37

125 «Id» «LName», «FName» «E_yr» NP Battery, Long Form (v. 09/19/2014) VERBAL FLUENCY (FAS) I will say a letter of the alphabet. Then I want you to give me as many words that begin with that letter as quickly as you can. For instance, if I say B, you might give me bad, bottle, bed. However, I do not want you to use words that are proper names such as Boston or Brian. Also, I do not want you to use the same word again with a different ending, such as bake, baking, baked. Any questions? The first letter is F. Give me as many words as you can that begin with F. The next letter is A. Begin The next letter is S. Begin. IF THE PARTICIPANT MAKES TWO OF THE SAME ERRORS CONSECUTIVELY, CUE HIM/HER: Remember we want words that start with the letter F or Remember, no proper names or Remember, don t use the same word with different endings. 38

126 «Id» «LName», «FName» «E_yr» NP Battery, Long Form (v. 09/19/2014) Check here if test NOT completed Verbal Fluency (FAS) (record reason in Factors Affecting Testing section) 0-15 (sec) (sec) (sec) (sec) Write all words produced by participant in order Wrong 1 st Letter Broken Rule Perseveration Other Error Self-correction Write all words produced by participant in order Wrong 1 st Letter Broken Rule Perseveration Other Error Self-correction Write all words produced by participant in order Wrong 1 st Letter Broken Rule Perseveration Other Error Self-correction Write all words produced by participant in order Wrong 1 st Letter Broken Rule Perseveration Other Error Self-correction #errors: #errors: #errors: #errors: F #correct words: #correct words: #correct words: #correct words: #errors: #errors: #errors: #errors: A #correct words: #correct words: #correct words: #correct words: NP019A 39

127 «Id» «LName», «FName» «E_yr» NP Battery, Long Form (v. 09/19/2014) VERBAL FLUENCY (ANIMALS) This time I d like you to tell me the names of as many animals as you can, as quickly as you can. It does NOT matter what letter the words begin with; I just want you to name animals. Ready? Begin. IF THE PARTICIPANT MAKES TWO OF THE SAME ERRORS CONSECUTIVELY, CUE HIM/HER: Remember, it does not matter which letter it starts with or Remember, we want names of animals. 40

128 «Id» «LName», «FName» «E_yr» NP Battery, Long Form (v. 09/19/2014) Verbal Fluency (FAS) 0-15 (sec) (sec) (sec) (sec) Write all words produced by participant in order Wrong 1 st Letter Broken Rule Perseveration Other Error Self-correction Write all words produced by participant in order Wrong 1 st Letter Broken Rule Perseveration Other Error Self-correction Write all words produced by participant in order Wrong 1 st Letter Broken Rule Perseveration Other Error Self-correction Write all words produced by participant in order Wrong 1 st Letter Broken Rule Perseveration Other Error Self-correction #errors: #errors: #errors: #errors: S #correct words: #correct words: Verbal Fluency (Animals) #correct words: #correct words: Check here if test NOT completed (record reason in Factors Affecting Testing section) #errors: #errors: #errors: #errors: Animals #correct words: #correct words: #correct words: #correct words: NP019B 41

129 «Id» «LName», «FName» «E_yr» NP Battery, Long Form (v. 09/19/2014) BOSTON NAMING TEST I m going to show you some pictures, and I d like you to tell me the one word that best names the object in each picture. IF PERSON GIVES AN ANSWER THAT IS CLOSE, BUT NOT CORRECT (E.G., HARNESS FOR YOKE ), SAY, Can you tell me another word for that? Can you be more specific? (E.G., BOAT FOR CANOE ) The following words are acceptable; however, if the phonemic cue is given, it should be for the word that is written on the answer sheet: spyglass in place of telescope settee in place of bench toadstool in place of mushroom spigot for faucet Semantic cue is given at 10 seconds. Phonemic cue is given at 20 seconds. TIME LIMIT for response is 40 seconds 42

130 «Id» «LName», «FName» «E_yr» NP Battery, Long Form (v. 09/19/2014) Boston Naming Test Check here if test NOT completed (record reason in Factors Affecting Testing section) Record all participant responses verbatim in the appropriate column (e.g., if the phonemic cue is given, subsequent verbalizations should be written in the Phonemic Cue column for that item). Circle the appropriate score for each item. Circle all errors that were present for a particular item in the lower (shaded) portion of that item s row. Record in seconds the time of FINAL response. See Scoring Manual for complete scoring instructions. No Cue Circle 0 if incorrect Circle 1 if correct with no cues Circle 2 if correct immediately upon presentation; leave Time blank. Semantic Cue Circle 0 if incorrect Circle 1 if correct with Semantic cue Leave blank if Semantic cue not given Phonemic Cue Circle 0 if incorrect Circle 1 if correct with Phonemic cue Leave blank if Phonemic cue not given 1. Tree Something that grows 0 1 Tr 0 1 Errors: Circle all that apply No Error Circumloc. Perseveration Semantic Para. Phonemic Par. Perceptual 2. House A kind of building 0 1 Hou 0 1 TIME (seconds) Errors: Circle all that apply No Error Circumloc. Perseveration Semantic Para. Phonemic Par. Perceptual 3. Scissors Used for cutting 0 1 Sci 0 1 TIME (seconds) Errors: Circle all that apply No Error Circumloc. Perseveration Semantic Para Phonemic Para Perceptual 4. Comb Used for fixing hair 0 1 Co 0 1 TIME (seconds) Errors: Circle all that apply No Error Circumloc. Perseveration Semantic Para. Phonemic Par. Perceptual 5. Flower Grows in the garden 0 1 Fl 0 1 TIME (seconds) Errors: Circle all that apply No Error Circumloc. Perseveration Semantic Para. Phonemic Par. Perceptual 6. Saw Used by a carpenter 0 1 S 0 1 TIME (seconds) Errors: Circle all that apply 43 No Error Circumloc. Perseveration Semantic Para. Phonemic Par. Perceptual TIME (seconds) NP020

131 44 «Id» «LName», «FName» «E_yr» NP Battery, Long Form (v. 09/19/2014)

132 «Id» «LName», «FName» «E_yr» NP Battery, Long Form (v. 09/19/2014) Boston Naming Test (continued) No Cue (0=wrong; 1=right; 2=right immed.) Semantic Cue (0=wrong; 1=right) Phonemic Cue (0=wrong; 1=right) 7. Toothbrush Used to clean teeth 0 1 Too 0 1 Errors: Circle all that apply No Error Circumloc. Perseveration Semantic Para. Phonemic Par. Perceptual TIME (seconds) 8. Broom Used for cleaning 0 1 Br 0 1 Errors: Circle all that apply No Error Circumloc. Perseveration Semantic Para. Phonemic Par. Perceptual TIME (seconds) 9. Mushroom Something to eat 0 1 Mu 0 1 (toadstool is acceptable) Errors: Circle all that apply No Error Circumloc. Perseveration Semantic Para. Phonemic Par. Perceptual TIME (seconds) 10. Hanger Found in the closet 0 1 Ha 0 1 Errors: Circle all that apply No Error Circumloc. Perseveration Semantic Para. Phonemic Par. Perceptual TIME (seconds) 11. Wheelchair Found in the hospital 0 1 Whee 0 1 Errors: Circle all that apply No Error Circumloc. Perseveration Semantic Para. Phonemic Par. Perceptual TIME (seconds) 12. Mask Part of a costume 0 1 Ma 0 1 Errors: Circle all that apply No Error Circumloc. Perseveration Semantic Para. Phonemic Par. Perceptual TIME (seconds) NP021 45

133 46 «Id» «LName», «FName» «E_yr» NP Battery, Long Form (v. 09/19/2014)

134 «Id» «LName», «FName» «E_yr» NP Battery, Long Form (v. 09/19/2014) Boston Naming Test (continued) No Cue (0=wrong; 1=right; 2=right immed.) Semantic Cue (0=wrong; 1=right) Phonemic Cue (0=wrong; 1=right) 13. Bench Used for sitting 0 1 Be 0 1 (settee is acceptable) Errors: Circle all that apply No Error Circumloc. Perseveration Semantic Para. Phonemic Par. Perceptual TIME (seconds) 14. Snail An animal 0 1 Sn 0 1 Errors: Circle all that apply No Error Circumloc. Perseveration Semantic Para. Phonemic Par. Perceptual TIME (seconds) 15. Faucet Part of a sink 0 1 Fau 0 1 (spigot is acceptable) Errors: Circle all that apply No Error Circumloc. Perseveration Semantic Para. Phonemic Par. Perceptual TIME (seconds) 16. Telescope Used to look through 0 1 Te 0 1 (spyglass is acceptable) Errors: Circle all that apply No Error Circumloc. Perseveration Semantic Para. Phonemic Par. Perceptual TIME (seconds) 17. Seahorse An ocean animal 0 1 Sea 0 1 Errors: Circle all that apply No Error Circumloc. Perseveration Semantic Para. Phonemic Par. Perceptual TIME (seconds) 18. Canoe Used in water 0 1 Ca 0 1 Errors: Circle all that apply No Error Circumloc. Perseveration Semantic Para. Phonemic Par. Perceptual TIME (seconds) NP022 47

135 48 «Id» «LName», «FName» «E_yr» NP Battery, Long Form (v. 09/19/2014)

136 «Id» «LName», «FName» «E_yr» NP Battery, Long Form (v. 09/19/2014) Boston Naming Test (continued) No Cue (0=wrong; 1=right; 2=right immed.) Semantic Cue (0=wrong; 1=right) Phonemic Cue (0=wrong; 1=right) 19. Wreath A Christmas decoration 0 1 Wrea 0 1 Errors: Circle all that apply No Error Circumloc. Perseveration Semantic Para. Phonemic Par. Perceptual TIME (seconds) 20. Harmonica A musical instrument 0 1 Har 0 1 Errors: Circle all that apply No Error Circumloc. Perseveration Semantic Para. Phonemic Par. Perceptual TIME (seconds) 21. Acorn It comes from a tree 0 1 A 0 1 Errors: Circle all that apply No Error Circumloc. Perseveration Semantic Para. Phonemic Par. Perceptual TIME (seconds) 22. Stilts Used to make you taller 0 1 St 0 1 Errors: Circle all that apply No Error Circumloc. Perseveration Semantic Para. Phonemic Par. Perceptual TIME (seconds) 23. Cactus Something that grows 0 1 Ca 0 1 Errors: Circle all that apply No Error Circumloc. Perseveration Semantic Para. Phonemic Par. Perceptual TIME (seconds) 24. Harp A musical instrument 0 1 Ha 0 1 Errors: Circle all that apply No Error Circumloc. Perseveration Semantic Para. Phonemic Par. Perceptual TIME (seconds) NP023 49

137 50 «Id» «LName», «FName» «E_yr» NP Battery, Long Form (v. 09/19/2014)

138 «Id» «LName», «FName» «E_yr» NP Battery, Long Form (v. 09/19/2014) Boston Naming Test (continued) No Cue (0=wrong; 1=right; 2=right immed.) Semantic Cue (0=wrong; 1=right) Phonemic Cue (0=wrong; 1=right) 25. Knocker Part of a door 0 1 Kno 0 1 Errors: Circle all that apply No Error Circumloc. Perseveration Semantic Para. Phonemic Par. Perceptual TIME (seconds) 26. Stethoscope Used by doctors and nurses 0 1 Ste 0 1 Errors: Circle all that apply No Error Circumloc. Perseveration Semantic Para. Phonemic Par. Perceptual TIME (seconds) 27. Muzzle Used on dogs 0 1 Mu 0 1 Errors: Circle all that apply No Error Circumloc. Perseveration Semantic Para. Phonemic Par. Perceptual TIME (seconds) 28. Funnel Used for pouring 0 1 Fu 0 1 Errors: Circle all that apply No Error Circumloc. Perseveration Semantic Para. Phonemic Par. Perceptual TIME (seconds) 29. Accordian A musical instrument 0 1 Ac 0 1 Errors: Circle all that apply No Error Circumloc. Perseveration Semantic Para. Phonemic Par. Perceptual TIME (seconds) 30. Noose Used for hanging 0 1 Noo 0 1 Errors: Circle all that apply No Error Circumloc. Perseveration Semantic Para. Phonemic Par. Perceptual TIME (seconds) NP024 51

139 52 «Id» «LName», «FName» «E_yr» NP Battery, Long Form (v. 09/19/2014)

140 «Id» «LName», «FName» «E_yr» NP Battery, Long Form (v. 09/19/2014) Boston Naming Test (continued) No Cue (0=wrong; 1=right; 2=right immed.) Semantic Cue (0=wrong; 1=right) Phonemic Cue (0=wrong; 1=right) 31. Compass For drawing 0 1 Co 0 1 Errors: Circle all that apply No Error Circumloc. Perseveration Semantic Para. Phonemic Par. Perceptual TIME (seconds) 32. Tripod Photographers & surveyors use it 0 1 Tri 0 1 Errors: Circle all that apply No Error Circumloc. Perseveration Semantic Para. Phonemic Par. Perceptual TIME (seconds) 33. Tongs A utensil 0 1 To 0 1 Errors: Circle all that apply No Error Circumloc. Perseveration Semantic Para. Phonemic Par. Perceptual TIME (seconds) 34. Yoke Used on farm animals 0 1 Yo 0 1 Errors: Circle all that apply No Error Circumloc. Perseveration Semantic Para. Phonemic Par. Perceptual TIME (seconds) 35. Palette Artists use it 0 1 Pa 0 1 Errors: Circle all that apply No Error Circumloc. Perseveration Semantic Para. Phonemic Par. Perceptual TIME (seconds) 36. Abacus Used for counting 0 1 Ab 0 1 Errors: Circle all that apply No Error Circumloc. Perseveration Semantic Para. Phonemic Par. Perceptual TIME (seconds) NP025 53

141 «Id» «LName», «FName» «E_yr» NP Battery, Long Form (v. 09/19/2014) Clock Drawing Test: Copy Condition Please copy this clock Odd ID number back-to-back clocks Even ID number split clocks Remember to time the drawing! 54

142 «Id» «LName», «FName» «E_yr» NP Battery, Long Form (v. 09/19/2014) Clock Drawing Test: Copy Condition (Examiner s Page) Check here if test NOT completed (record reason in Factors Affecting Testing section) Top of Participant s Clock (circle one). Top Top. Rotated paper while placing numerals/numeral substitutes Time to completion: : (min:sec) 0 No 1 Yes, result correct 1 Yes 2 Yes, result NOT correct 8 N/A 3 9 Unknown 0 9 Attempt to self-correct significant error No No Errors Unknown Describe Other Observations: NOTE: If dcdt data is not acquired, use full copy clock scoring pages. NO027 55

143 «Id» «LName», «FName» «E_yr» NP Battery, Long Form (v. 09/19/2014) Blank Page 56

144 «Id» «LName», «FName» «E_yr» NP Battery, Long Form (v. 09/19/2014) Blank Page 57

145 «Id» «LName», «FName» «E_yr» NP Battery, Long Form (v. 09/19/2014) TRAILMAKING TEST: Part A... Sample... On this page (POINT) are some numbers. Begin at number 1 (POINT AS YOU GO ALONG) and draw a line from one to two, two to three, three to four, and so on, in order, until you reach the end. Draw the lines as fast as you can. Do not lift the pen from the paper. Ready, begin. AFTER THE MISTAKE HAS BEEN EXPLAINED, MARK OUT THE WRONG PART AND SAY, Go on from here, POINTING TO THE LAST CORRECT CIRCLE. IF THE SUBJECT CAN T DO SAMPLE A, TAKE HIS/HER HAND AND GUIDE THE PEN (ERASER END DOWN) THROUGH THE TRAIL. THEN SAY, Now you try it. Put your pen, point down. Remember, begin at number one (POINT ALONG THE WAY) and draw a line from one to two, two to three, three to four, and so on, in order until you reach the circle marked END. Do not skip around but go from one number to the next in the proper order. If you make a mistake, mark it out. Remember, work as fast as you can. Ready, Begin! IF RIGHT, SAY, Good! Let s try the next one.... Test... On this page are numbers from 1 to 25. Do this the same way. Begin at number 1 (POINT TO 1 ) and draw a line from one to two, (POINT TO 2 ), two to three (POINT TO 3 ), three to four (POINT TO 4 ), and so on, in order, until you reach the end (POINT TO THE CIRCLE MARKED END ). Remember, work as fast as you can and do not lift the pen from the paper. Ready, Begin! WHEN PART A IS FINISHED, STOP TIMING, TAKE THE PAPER AND SAY, That s fine. Now we ll try another one. ACCEPTABLE ERROR CORRECTIONS for Sample: You started with the wrong circle. This is where you start. You skipped this circle. You should go from number one to two, two to three, and so on until you reach the circle marked END. You only went as far as this circle. You should have gone to this circle marked END. Please keep the pen on the paper, and continue right on to the next circle. 58

146 «Id» «LName», «FName» «E_yr» NP Battery, Long Form (v. 09/19/2014) Examiner Page Do not key Record data on Trail Making Test: Part A scoring page Completion of this page is optional and does not necessarily reflect complete data. # Pen Lifts # Errors #Self-Corrected Errors TIME: : Pt started sample early? Pt started test early? Yes No Yes No 59

147 «Id» «LName», «FName» «E_yr» NP Battery, Long Form (v. 09/19/2014) TRAILMAKING TEST: Part B... Sample... On this page are some numbers and letters. Begin at number one (POINT ALONG THE WAY) and draw a line from one to A, A to two, two to B, B to three, three to C, and so on, in order, until you reach the end. Remember, first you have a number (POINT ALONG THE WAY), then a letter, then a number, then a letter, and so on. Draw the lines as fast as you can, and do not lift the pen from the paper. Ready, Begin!... Test... On this page are some numbers and letters. Do this one the same way. Begin at number one (POINT ALONG THE WAY) and draw a line from one to A, A to two, two to B, B to three, three to C, and so on, in order, until you reach the end. Remember, first you have a number (POINT ALONG THE WAY) then a letter, and so on. Do not skip around, but go from one circle to the next in the proper order. Draw the lines as fast as you can, and do not lift the pen from the paper. Ready, Begin! ACCEPTABLE ERROR CORRECTIONS for Sample: You started with the wrong circle. This is where you start. You skipped this circle. You should go from number one to two, two to three, and so on until you reach the circle marked END. You only went as far as this circle. You should have gone to this circle marked END. Please keep the pen on the paper, and continue right on to the next circle. GUIDELINES FOR ERROR CORRECTIONS for Test 1. Cross out line, point to last correct circle, and say, This is a mistake. Start again from here. 2. If participant does not start, ask, What should come next? 3. If unable to proceed, ask, Do you remember the sequence? 4. If participant does not know, remind by saying, First you have a number, then a letter, then a number, and so on. 5. If participant still cannot proceed, go back three circles and say, First you had a number (point), then a letter (point), then a number (pointing now at the last correct circle). What should come next? <substitute number and letter as appropriate> 60

148 «Id» «LName», «FName» «E_yr» NP Battery, Long Form (v. 09/19/2014) Check here if test NOT completed Trail Making Test: Part A (record reason in Factors Affecting Testing section) *Time to completion: If the test is not completed, record the total time the pt worked on the test. Obvious Time to completion* # self-corrected errors # examiner corrected errors # pen lifts # cues given Tremor (min:sec) Perceptual Other Perceptual Other 0 = No : 1 = Yes Started to draw before told to begin Sample Started to draw before told to begin Test IF test was discontinued, record the number of circles that were completed. 0 = No 1 = Yes 0 = No 1 = Yes Check here if test NOT completed Trail Making Test: Part B (record reason in Factors Affecting Testing section) *Time to completion: If the test is not completed, record the total time the pt worked on the test. Obvious Time to completion* # self-corrected errors # examiner corrected errors # pen lifts # cues given Tremor (min:sec) Perceptual LOS Sequencing Perceptual LOS Sequencing 0 = No : 1 = Yes Started to draw before told to begin Sample Started to draw before told to begin Test IF test was discontinued, record the number of circles that were completed. 0 = No 1 = Yes 0 = No 1 = Yes # pen lifts: (for examiner use only) # cues given: (for examiner use only) NP030 61

149 «Id» «LName», «FName» «E_yr» NP Battery, Long Form (v. 09/19/2014) WRAT-3 READING Please look carefully at the words on this page. I d like you to read them out loud, so I can hear you. Begin here (POINT TO THE FIRST WORD), and go across the page and on to the next line and so on. Go slowly so I can keep up with you. Go ahead. FIRST ERROR ONLY: Will you please say that one again? ANY THAT YOU CANNOT HEAR: Will you please say that again exactly as you just said it? If the subject cannot read five words, have him/her read the letters at the top of the page. SCORING ERROR TYPES: For semantic errors, write out the incorrect word, e.g. Hershey for hearsay. For wrong accent errors, circle the syllable that was accented incorrectly. 62

150 «Id» «LName», «FName» «E_yr» NP Battery, Long Form (v. 09/19/2014) Reading Test (WRAT 3 rd Edition) Circle 0 for incorrect response and indicate error types (2=phonemic, 3=semantic, 4=wrong accent error); 1 for correct responses; 8 if test was discontinued. Check here if test NOT completed (record reason in Factors Affecting Testing section) Discontinue Rule: Ten (10) consecutive failures A B O S E R T H U P I V Z J Q (15) If letters are administered, put score to right; else leave blank. correct incorrect error type no guess d/c d correct incorrect error type no guess d/c d 1 in In 2 cat kat 3 book buuk 4 tree tree 5 how (how) 6 animal an-ĭ-măl 7 even ee-vĕn 8 spell spel 9 finger fing-gĕr 10 size sīz 11 felt felt 12 split split 13 lame laym 14 stretch strech 15 bulk bulk 16 abuse ă-byoos, -byooz 17 contemporary kŏn-tem-pŏ-rer-ee 18 collapse kŏ-laps 19 contagious kŏn-tay-jŭs 20 triumph trī-ŭmf 21 alcove al-kohv n/a n/a n/a n/a n/a n/a n/a n/a n/a n/a bibliography bib-li-og-ră-fee 23 horizon hŏ-rī-zŏn 24 municipal myoo-nis-ĭ-păl 25 unanimous yoo-nan-ĭ-mŭs 26 benign (bi-nīn) 27 discretionary di-skresh-ŏ-ner-ee 28 stratagem strat-ă-jĕm 29 seismograph sīz-mŏ-graf 30 heresy her-ĕ-see 31 itinerary ī-tin-ĕ-rer-ee 32 usurp yoo-surp, -zurp 33 irascible i-ras-ĭ-bĕl 34 pseudonym soo-dŏ-nim 35 oligarchy ol-ĭ-gahr-kee 36 covetousness kuv-ĕ-tŭs-nes 37 heinous hay-nŭs 38 egregious î-gree-jŭs 39 omniscient om-nish-ĕnt 40 assuage ă-swayj 41 disingenuous dis-in-jen-yoo-ŭs 42 terpsichorean turp-sĭ-kŏ-ree-ăn NP031 63

151 «Id» «LName», «FName» «E_yr» NP Battery, Long Form (v. 09/19/2014) FINGER TAPPING This is a test of your finger tapping speed. We are going to do several trials with each hand, always using your index--or pointer--finger. Let me show you, first. [demonstrate how to use the tapper correctly] You need to keep all the rest of your fingers on the board like this. Make sure you go all the way up and all the way down, or the counter will not register your taps, see? [demonstrate that the taps do not register] 64

152 «Id» «LName», «FName» «E_yr» NP Battery, Long Form (v. 09/19/2014) Finger Tapping Test Check here if test NOT completed (record reason in Factors Affecting Testing section) Discontinue rule: Five (5) trials within 5 taps of each other; or, 10 trials if criterion is not met. Discontinue rule applies separately for right and left hands. For any trials not administered, leave data box blank Right Hand Left Hand Trial # of Taps Trial # of Taps Comments: (Will NOT be keyed; transfer comments that should be keyed to Factors Affecting Testing page in the back of the battery.) NP032 65

153 «Id» «LName», «FName» «E_yr» NP Battery, Long Form (v. 09/19/2014) BLOCK DESIGN (WAIS) NOTE: For Designs 1 to 6, the blocks should be placed on the table with two solid red blocks, one solid white block, and one ½ red ½ white block facing up. For Design 7, the blocks should be placed on the table for the participant so that there are three all red blocks, three all white blocks, and three ½ red ½ white blocks. Design #1: You see these blocks. They are all alike. On some sides they are all red; on some, all white; and on some, half red and half white. I m going to put them together to make a design. Watch me. Arrange the four blocks slowly. Do not expose the card. Leave model intact. Give four other blocks to the participant and say, Now make one just like this. If the participant fails: pick up the participant s blocks, leaving the examiner s intact, and say, Watch me again. Demonstrate a second time, then mix them up, still leaving the examiner s model intact, and say, Now you try it and be sure to make it just like mine. Regardless of success or failure, move on to the next design. If the participant is trying to copy the sides as well as the tops, say, You only need to copy the top of the blocks. Design #3 (Second one administered): Now make one like this. Tell me when you have finished. 66

154 DESIGN 1 «Id» «LName», «FName» «E_yr» NP Battery, Long Form (v. 09/19/2014) Check here if test NOT completed Block Design (WAIS) (record reason in Factors Affecting Testing section) DISCONTINUE: If both 1 & 3 are incorrect, OR after three consecutive failures Time Correct? Score : No 0 Yes, in overtime 1 Yes, in time (1 min) 2 Fail 0 Pass Trial 2 (2 nd 1 min) 2 Pass Trial 1 (1 min) 4 Broken Configuration? No 0 Yes 1 Incorrect due to only one block in error (i.e. inattention error) No Yes No Error DESIGN 3 Time Correct? Score : No 0 Yes, in overtime 1 Yes, in time (1 min) 2 Fail 0 Pass 4 Broken Configuration? No 0 Yes 1 Incorrect due to only one block in error (i.e. inattention error) No Yes No Error NP035 67

155 «Id» «LName», «FName» «E_yr» NP Battery, Long Form (v. 09/19/2014) BLOCK DESIGN (WAIS) - continued Designs 4 & 5 Now make one like this. Tell me when you have finished. 68

156 «Id» «LName», «FName» «E_yr» NP Battery, Long Form (v. 09/19/2014) DESIGN 4 Block Design (WAIS) Time Correct? Score : No 0 Yes, in overtime 1 Yes, in time (1 min) 2 Fail 0 Pass 4 D/c d 8 Broken Configuration? No 0 Yes 1 Incorrect due to only one block in error (i.e. inattention error) No Yes No Error DESIGN 5 Time Correct? Score : No 0 Yes, in overtime 1 Yes, in time (1 min) 2 Fail 0 Pass 4 D/c d 8 Broken Configuration? No 0 Yes 1 Incorrect due to only one block in error (i.e. inattention error) No Yes No Error NP036 69

157 «Id» «LName», «FName» «E_yr» NP Battery, Long Form (v. 09/19/2014) BLOCK DESIGN (WAIS) - continued Design #6 Now make one like this. Tell me when you have finished. Design #7 Now make one like this, using nine blocks. Be sure to tell me when you have finished. *Remember to present 3 red blocks, 3 white blocks, and 3 ½ red ½ white blocks. 70

158 DESIGN 6 «Id» «LName», «FName» «E_yr» NP Battery, Long Form (v. 09/19/2014) Block Design (WAIS) Time Correct? Score : No 0 Yes, in overtime 1 Yes, in time (1 min) 2 Fail 0 Pass 4 D/c d 8 Broken Configuration? No 0 Yes 1 Incorrect due to only one block in error (i.e. inattention error) No Yes No Error DESIGN 7 Time Correct? Score : No 0 Yes, in overtime 1 Yes, in time (1:30 min) 2 Fail 0 41s- 1: s s 6 D/c d 8 Broken Configuration? No 0 Yes 1 Incorrect due to only one block in error (i.e. inattention error) No Yes No Error NP037 71

159 «Id» «LName», «FName» «E_yr» NP Battery, Long Form (v. 09/19/2014) INFORMATION (WAIS-R) Now I m going to ask you some general questions. READ EACH QUESTION EXACTLY AS STATED. IF THE RESPONSE TO A QUESTION IS INCOMPLETE OR NOT CLEAR, YOU MAY SAY, Explain what you mean OR Tell me more about it, BUT DO NOT ASK LEADING QUESTIONS OR SPELL THE WORDS. DO NOT ALTER THE WORDING OF ANY QUESTION. NOTE THE FOLLOWING: 1) WHERE DOES THE SUN RISE? IF THE SUBJECT POINTS, SAY, YES, BUT WHAT DIRECTION IS THAT? 2) NAME 4 MEN WHO HAVE BEEN PRESIDENT SINCE IF SUBJECT GIVES MORE THAN 4 RESPONSES, AND AT LEAST ONE IS WRONG, AS HIM/HER TO CHOOSE JUST 4 AS HIS/HER FINAL ANSWER. 8) WHO WAS LOUIS ARMSTRONG? IF SUBJECT GIVES SOME OTHER CORRECT ANSWER SUCH AS SATCHMO, SAY, BUT WHAT IS HE MOST FAMOUS FOR? 14) WHO WAS AMELIA EARHART? ACCEPT FIRST WOMAN PILOT AS CORRECT 15) WHY ARE DARK CLOTHES WARMER THAN LIGHT-COLORED CLOTHES? DO NOT GIVE CREDIT FOR RESPONSE THAT DARK CLOTHES HOLD, ATTRACT, OR DRAW HEAT. 17) WHO WAS MARTIN LUTHER KING? IF THE SUBJECT GIVES SOME OTHER CORRECT ANSWER SUCH AS MINISTER OR BLACK LEADER, SAY, BUT WHAT WAS HE FAMOUS FOR? 21) HOW DOES YEAST CAUSE DOUGH TO RISE? DO NOT GIVE CREDIT FOR CHEMICAL REACTION. 24) NAME THREE KINDS OF BLOOD VESSELS IN THE HUMAN BODY. NAMES OF SPECIFIC VESSELS ARE NOT ACCEPTABLE, BUT GIVE CREDIT FOR VENULES AND ARTERIOLES. 25) AT WHAT TEMPERATURE DOES WATER BOIL? IF SCALE IS NOT SPECIFIED, SAY, WHAT SCALE? 26) WHO WAS MARIE CURIE? DO NOT GIVE CREDIT FOR DISCOVERER OF RADIATION. 72

160 «Id» «LName», «FName» «E_yr» NP Battery, Long Form (v. 09/19/2014) Check here if test NOT completed Information (WAIS-R) (record reason in Factors Affecting Testing section) Discontinue: 5 consecutive incorrect/no guess answers After marking the 5 th 0, circle the 8 in the d/c d column for the next item and draw a line down through the remaining 8s to indicate they were not administered. Record responses verbatim and score according to the Scoring Manual. Question Response Incorrect Correct No guess d/c d 1. What are the colors in the American flag? 2. What is the shape of a ball? 3. How many months are there in a year? 4. What is a thermometer? 5. Where does the sun rise? Red, white, blue Round 12 Measures temp east X X X X X 6. Name four men who have been president of the United States since 1950 Truman, Eisenhower, Kennedy, Johnson, Nixon, Ford, Carter, Reagan, Bush, Clinton, G.W. Bush, Obama NOTE if EITHER 5 OR 6 is incorrect, administer items How many weeks are there in a year? 8. Who was Louis Armstrong? Jazz musician In what direction would you travel if you went from Chicago to Panama? 10. In what month is labor day? 11. On what continent is Brazil? 12. Who wrote Hamlet? 13. Who was President of the United States during the Civil War? 14. Who was Amelia Earhart? South/southeast/southwest Sept South America Shakespeare Lincoln Pilot NP038 73

161 «Id» «LName», «FName» «E_yr» NP Battery, Long Form (v. 09/19/2014) INFORMATION SCORING Question Acceptable Responses 1. Colors of flag Red, white blue 2. Shape of ball Round, sphere, spherical, circular (if circular gesture is given) 3. Months in year Thermometer Instrument (thing, etc.) for measuring temperature (degrees, Fahrenheit, etc.), it takes temperature, it measures heat and cold, it measures the heat inside your body 5. Sun rise In the East. East to West. (If the subject points, say, Yes, but what direction is that? ) 6. Four presidents since 1950 Truman, Eisenhower, Kennedy, Johnson, Nixon, Ford, Carter, Reagan, Bush, Clinton, Bush 7. Weeks in year Louis Armstrong Musician, trumpet player, singer, entertainer, band leader. (If subject gives some other correct answer such as Satchmo, say, But what is he most famous for?) 9. Chicago to Panama South, southeast, southwest 10. Labor day month September 11. Continent of Brazil South America 12. Hamlet William Shakespeare, Shakespeare 13. President during Civil War Abraham Lincoln, Lincoln 14. Amelia Earhart Aviator, flyer, pilot (Accept first woman pilot as correct) 15. Dark clothes warmer Dark clothes absorb heat from the sun, light clothes reflect (repel) heat from the sun. (Do NOT give credit for response that dark clothes hold, attract, or draw heat.) 16. Capital of Italy Rome 17. Martin Luther King Civil right leader, worker for poor people, helped blacks stand up for their rights, A minister (pastor, preacher) who believed in nonviolence, a preacher who believed in all colors (equality for everyone), black preacher who fought to end segregation, he gave the I have a dream speech, Nobel Peace Prize winner (If the subject gives some other correct answer such as Minister or Black leader, say, But what was he famous for? ) 18. Theme of Genesis Creation, beginning of the world (humanity, life, man), early Hebrew history, Adam and Eve 19. Continent of Sahara Desert Africa, African continent 20. Theory of relativity Albert Einstein, Einstein 21. Yeast It causes fermentation which produces carbon dioxide bubbles and makes the dough swell, gases are formed, it ferments, it expands, it forms air bubbles, bacterial action. (Do NOT give credit for Chemical reaction. ) 22. Senators in US Senate Paris to New York Any answer between 3000 and 4000 miles (or between 4800 and 6500 kilometers) 24. Three kinds of blood vessels Arteries, veins, and capillaries (Names of specific vessels are not acceptable, but give credit for venules and arterioles.) 25. Water boil 212 F, 100 C, 373K (If scale is not specified, say, What scale? ) 26. Marie Curie Chemist, physicist, scientist, discoverer of radium, discovered radioactivity (Do NOT give credit for Discoverer of radiation ). 27. Population of US 244 million to 366 million /// 305 million+- 20% (updated 3/09) 28. Koran Mohammedan scriptures, Mohammedan sacred writings, Mohammedan Bible (Moslem or Islamic in place of Mohammedan is acceptable.) 29. Faust Goethe (pronounced GER-tah ), Gounod (\gü-ˈnō; ˈgü-ˌnō\) 74

162 «Id» «LName», «FName» «E_yr» NP Battery, Long Form (v. 09/19/2014) Information (WAIS-R) (continued) Question Response Incorrect Correct No guess d/c d 15. Why are dark clothes warmer than light colored clothes? 16. What is the capital of Italy? 17. Who was Martin Luther King? 18. What is the main theme of the book of Genesis? 19. On what continent is the Sahara Desert? 20. Whose name is usually associated with the theory of relativity? 21. How does yeast cause dough to rise? 22. How many senators are there in the United States Senate? 23. How far is it from Paris to New York? 24. Name three kinds of blood vessels in the human body? 25. At what temperature does water boil? 26. What was Marie Curie famous for? 27. What is the population of the United States? 28. What is the Koran? 29. Who wrote Faust? Absorb heat from sun Rome Civil rights leader Creation Africa Einstein fermentation to 4000 miles Arteries veins capillaries 212 F 100 C 373K radium 252 M to 378 M Mohammedan/Moslem/Islamic scriptures Goethe / Gounod NP039 75

163 «Id» «LName», «FName» «E_yr» NP Battery, Long Form (v. 09/19/2014) COOKIE THEFT Here is a picture for you to look at. Write down everything that is happening in the picture. Please use complete sentences. Go ahead and tell me when you are finished. 76

164 «Id» «LName», «FName» «E_yr» NP Battery, Long Form (v. 09/19/2014) Check here if test NOT completed (record reason in Factors Affecting Testing section) Cookie Theft Writing Sample Time to completion: (from go ahead to finish) in minutes and seconds Type of writing: Syntactic complexity of writing: 0 No relevant writing (If no relevant writing, leave rest of page blank) NOTE: Do NOT consider the omission of the in reference to a character as an incomplete sentence; e.g. Boy is reaching 1 Print 0 Incomplete sentences : 2 Cursive 1 Syntactically simple sentences 3 Combined print and cursive 2 Syntactically complex sentences Inclusion of major events Absent Present Woman (mother) washing/drying dishes 0 1 Woman (mother) daydreaming/not paying attention Girl reaching/shushing (or other appropriate description Sink overflowing 0 1 Stool tipping 0 1 Boy reaching (or appropriate substitute) 0 1 Other notable findings Absent Present N/A Unusual spatial clumping of words? Incorrect use of capital letters? Incorrect use of punctuation? Rotated paper (to portrait orientation)? NP040 77

165 «Id» «LName», «FName» «E_yr» NP Battery, Long Form (v. 09/19/2014) HOOPER VISUAL ORGANIZATION TEST This is a test of your ability to recognize pictures of objects when the pictures have been cut up and rearranged. Look at each picture and decide what it might be if it were put together. For example, look at the first picture. [present item 1.] What would it be if it were put together? IF CORRECT: That s right, it s a fish. IF INCORRECT: The correct answer is fish. (POINT AS YOU GO ALONG) You see here is the head, the fins, and the tail. If it were put together correctly, it would be a fish. WHETHER CORRECT OR INCORRECT: Now do the other pictures in the same way. Toward the end they become rather hard. Try to give an answer even if you are not sure of it. 78

166 «Id» «LName», «FName» «E_yr» NP Battery, Long Form (v. 09/19/2014) Hooper Visual Organization Test Check here if test NOT completed (record reason in Factors Affecting Testing section) RESPONSE: Record verbatim the participant s response. SCORE: Circle the appropriate score for each response. ERROR TYPE: Place a 1 in the appropriate error type column if an error was made by the pt; else leave blank. RESPONSE SCORE ERROR TYPE 1. Fish Incorrect.5 pt Correct No Guess Isolate Percept. Psv. LOS Other 0 n/a Saw 3. Table/Bench 4. Airplane 5. Baseball/ball 6. Hammer 0 n/a n/a n/a football n/a Dog/Sheep 0 animal Truck 0 auto, car Cup 10. Hand 11. Apple, Peach, etc. 12. Basket (e.g. net) 0 vase, jar 0.5 glove 0.5 fruit n/a Scissors 0 n/a Cane, Hockey stick (e.g. pencil) 0 n/a Sailboat, boat 0 n/a 1 6 NP033 79

167 80 «Id» «LName», «FName» «E_yr» NP Battery, Long Form (v. 09/19/2014)

168 «Id» «LName», «FName» «E_yr» NP Battery, Long Form (v. 09/19/2014) Hooper Visual Organization Test (continued) RESPONSE SCORE ERROR TYPE Incorrect.5 pt Correct No Guess Isolate Percept. Psv. LOS Other 16. Teakettle 0 n/a Chair 18. Candle 0 sofa n/a Teapot, Cream Pitcher 0 n/a Cat 0 animal Flower, Pansy, etc. (e.g. tree, island) Mouse, Guinea Pig, etc Book n/a 1 6 animal n/a Rabbit 25. Block 0 animal n/a Lighthouse 27. Shoe 0 (e.g. iron) 0 tower/ castle n/a Key 0 n/a Ring 30. Broom (e.g. lock) 0 (e.g. mop) 0 n/a 1 6 n/a 1 6 NP034 81

169 «Id» «LName», «FName» «E_yr» NP Battery, Long Form (v. 09/19/2014) DIGIT SYMBOL-CODING Example: <Point to the key at the top of the page > Look at these boxes. Each box has a number in the top part <point across the numbers from 1 to 9> and a special mark in the bottom part <point across the symbols> Each number has its own mark. <Point to 1 and its mark in the key, then 2 and its mark. Then point to the seven squares located to the left of the heavy black line> Down here, the boxes have numbers in the top parts but are empty in the bottom parts. You are to draw the marks that belong in the empty boxes, like this. <Point to the first Sample Item, then point back to the key to show its corresponding mark> Here is a 6; the 6 has this mark. So I put it in this empty square, like this. <write in the symbol, point to the second sample item> <REPEAT FOR EXAMPLES 1 to 3> Sample: Now you do these. Stop when you get to this line. <point to the heavy line> NOTE: If the participant makes an error on any of the Sample Items, correct the error immediately and review use of the key. Continue to provide help if needed. DO NOT PROCEED until the participant clearly understands the task. Test: Begin here and fill in as many squares as you can, one after the other without skipping any. Keep working until I tell you to stop. Work as quickly as you can without making any mistakes. When you finish this line <point to first row> go on to this one. <Point to first square in second row> Go ahead. <begin timing> If participant omits an item or starts to do only one type: Do them in order. Don t skip any. <point to omitted item> do this one next Provide no further assistance except to remind the participant to continue until instructed to stop. After 120 seconds (2 minutes) say STOP. 82

170 «Id» «LName», «FName» «E_yr» NP Battery, Long Form (v. 09/19/2014) Check here if test NOT completed (record reason in Factors Affecting Testing section) Discontinue at 2:00 minutes (120 seconds) or at the completion of 3 rows (45 squares), whichever is longer Digit Symbol: Coding (WAIS-IV) Total time to complete task (min:sec) : Number of squares completed by the end of each time range (cumulative) 00:00-00:15 00:16-00:30 00:31-00:45 00:46-1:00 1:01-1:15 1:16-1:30 1:31-1:45 1:46-2:00 Total number CORRECT: Total number INCORRECT: Qualitative Observations (frequency across first two minutes) Error Frequency Self Corrections Frequency Wrong Mark: another mark in code Wrong Mark (Total): confabulation Skipped item: Number instead of mark: Poorly formed mark: A Result is correct Result is incorrect Rotation (Total): U L V = T NP040A 83