Neurobehavioral core test battery (NCTB)
Category: consensus recommendation
Developer: WHO designated committee8
Availability: responsibility of investigator
Instructions, sources of the tests, and operational guide are available from author | Least expensive choice for testing a small group of participants or where equipment is more expensive than trainable labour (examiners). Has been a popular choice in developing countries9,17,46–48,w23
Validity: Based on independent studies by different investigators using NCTB-recommended tests, though not necessarily using the NCTB tests as a unit or battery3
Key references10,1746–53,w23, w49–69 | Not suitable for people with limited education Not a commercially available testing system. The digit symbol, digit span, pursuit aiming II (which is difficult to score reliably), profile of mood states (which uses dated emotional terms), and Benton tests must be purchased from four different sources. The Santa Ana must be manufactured |
Adult environmental neurobehavioral test battery (AENTB)
Category: consensus recommendation
Developer: ATSDR; Atlanta, Georgia, USA29,54
Availability: responsibility of investigator | The AENTB includes more tests than the NCTB and thus assesses more nervous system functions
Validity: based on independent studies by different investigators using AENTB recommended tests, though not necessarily using the AENTB tests as a unit or battery3
Key reference: user manual available from ATSDR54 | Not suitable for people with limited education
Not a commercially available system, although it can be assembled from commercial sources54
Limited use, and there are no peer reviewed publications in exposed populations |
Behavioral assessment and research system (BARS)
Category: computer based testing system Developers: Kent Anger (author of this article), Diane Rohlman, Dan Storzbach, Oregon Health & Science University; Portland, Oregon, USA35,36,w41
Availability: Collaborate with developers; 9BUTTON can be purchased from developers | Large graphics, simple instructions integrated with the test during practice,36 and a 9BUTTON response unit (fig 2) that is a better alternative to a keyboard.35 BARS is thus a preferred choice for marginal populations such as those with limited education
Available with English, Spanish, Portuguese, Korean, Ukranian, and Arabic instructions
Validity: based on implementation of valid tests and discrimination of Parkinson patients from controls.w74
Sensitivity for cross sectional comparisons established by detecting effects of neurotoxic agents and differences in occupational populations
Key references35,36,4546,w13, w22, w41, w42, w48, w70–77 | Available only for limited computer operating systems
9BUTTON is required, tying collaborators to developers |
Neurobehavioral evaluation system 2 (NES2)
Category: computer based testing system
Developer: Richard Letz Emory University Atlanta, Georgia, USA6,14
Availability: purchase from developer | Has been used far more extensively than any other battery by professionals in this field (see “NES” above)
Validity: based on implementation of valid tests and discrimination between neurological patients.26 Sensitivity for cross sectional comparisons established by detecting effects of neurotoxic agents
A large database is available for comparison on three tests20
NES-C is a Chinese language adaptation of the NESw32
Key references16,14–28,55,w26–33, w51, w78–81 | Not suitable for people with limited education
Small graphics and lengthy instructions that are complicated
Requires specialised joystick
The two button response unit may lack durability and long term reliability |
Neurobehavioral evaluation system 3 (NES3)
Category: computer based testing system
Developer: Richard Letz Emory University; Atlanta, Georgia, USA23
Availability: collaborate with developer | Implements a wide range of neuropsychological tests to focus the battery on detection of clinical cases in addition to neurotoxicity
Validity: based on NES2 for some tests and other validated neuropsychological tests, correlations between test performance and cases with solvent encephalopathy, and ability to detect cognitive impairment
Key references23,26,56,57 | Tests have fixed parameters (e.g. type of stimulus, number of trials) that must be changed by the developer
NES3 requires a stylus for response and so may not be suitable for some people with limited education (e.g. those who do not practise writing or holding stylus shaped instruments in their hand) |
Swedish performance evaluation system (SPES)
Category: computer based testing system
Developers: Anders Iregren, Francesco Gamberale, Anders Kjellberg, National Institute of Occupational Health (NIOH), Solna, Sweden13
Availability: purchase from NIOH | Valuable option for Swedish speakers; instructions are also in English
Validity: based on implementation of valid tests. Sensitivity for cross sectional comparisons established by detecting effects of neurotoxic agents
Key references13,30,58–60,w82–86 | May not be suitable for people with limited education
Requires specialised joystick |
Performance and information processing systems test battery (PIPS)
Category: computer based testing system
Developer: Ann Williamson, University of New South Wales, Australia61
Availability: collaborate with developer | Theory based test selection to provide a categorisation of deficits based on that theory
Validity: tests were selected to reflect nervous system functions based on information processing theory, so the PIPS must be judged on the basis of the viability of that theory
Sensitive to effects of exposure to mercury and stress
Key references61–64,w87–91 | Limited research with exposed populations |
Automated cognitive test (ACT)
Category: computer based testing system
Developer: Brian Stollery, University of Bristol, Bristol, UK65
Availability: collaborate with developer | Provides a very broad range of cognitive tests
Validity: based on established relationship between valid tests of nervous system function, and studies of lead and solvent exposed workersw92, w93
Key references65,w92, w93 | Very limited research with exposed populations |
CATSYS
Category: computer based testing system
Developer: Danish Product Development, Snekkersten, Denmarkw94
Availability: purchase from Danish Product Development | Assesses motor function (e.g. tremor, tapping, reaction time) that involves some sensory function
Validity: extensive data on 150 normal controls, with evidence of sensitivity to effects of mercuryw95
Key referencesw94, w95 | Assessment limited primarily to motor functions
Very limited research with exposed populations |