Table 4.

Test batteries

Author	Battery name—designed for…	Informant reports contained in battery	Ability tested	Direct tests contained in battery	Ability tested	Ppts, age, and group	Type of ID	Outcome and comments
Burt et al. (2000) [69]—United States	Working Groups Battery—designed for dementia diagnosis in ID.	-DMR [56] -The Dementia Scale for Downs Syndrome (DSDS—[68]) -Reiss Screen for maladaptive behavior [63] -Scales of Independent Behaviour—revised (SIB-R) [74] -AAMR Adaptive Behaviour Scale: Residential and Community [43] -Stress Index	-Dementia status -Dementia status -Emotional/motivational changes -Behavior -Behavior -Differential diagnostics (stress)	-Test for Severe Impairment modified (TSI [20], [70]) -Stanford Binet sentences [71] -Flud modified [72] -Spatial Recognition Span [75] -Autobiographical memory -Orientation [77] -Boston Naming Test [78] -McCarthy Verbal Fluency [79] -Simple commands (modified from Haxby [41]) -Purdue Pegboard modified [80] -Developmental Test of Visual Motor Integration [81]	-Memory and Other Cognitive decline -Immediate recall -Immediate and delayed recall -Immediate spatial recognition -Autobiographical memory -Orientation to time and place -Expressive vocabulary -Language fluency -Receptive language -Fine motor speed -Perceptual motor skills	None reported in first study – reliability studies did follow… -Pyo et al. [28] showed good reliability on the Autobiographical memory and Orientation tests. -Pyo et al. [73] only looks at orientation and shows significant differences between DAT group and controls but Orientation tests alone are not reliable for diagnosis. -Pyo et al. [76] showed autobiographical memory tests to be reliable.		1–1.5 hours to administer. Longitudinal administration is crucial to observing clinical change.
Palmer (2006) [82] - USA	Not given—designed for dementia assessment in individuals with Mental Retardation.	-The early signs of dementia checklist [83]	-Dementia status	-The Color Trials Test [84] -The Boston Naming Test [78] -The Controlled Oral Word Association Test (COWAT—Spreen et al. [85]) -The Fuld Object Memory Evaluation [86]	-Visual Attention and Concentration -Expressive Vocabulary (Agnosia) -Language: sematic fluency -Memory and Learning	22 ppts Aged: 33–66 years Groups: Cases = Dementia Controls = matched for IQ, age, presence of DS and sex but no dementia present.	Mild or Moderate ID.	2–2.5 hours to administer. Cases < Controls in all areas assessed.
Van der Wardt et al. (2011) [87]—UK, applied setting	Cognitive computerized test battery for individual's with intellectual disabilities (CCIID)—designed to assess IQ in individuals with ID.	N/A	N/A	-Corsi Block Tapping Test [88] -Series -Odd one out -Jigsaw	-Visual/spatial working memory -Inductive Reasoning -Inductive Reasoning -Visual/Spatial Abilities	Reliability and validity studies were conducted in various ID populations and showed the CCIID to be a valid and reliable instrument for testing IQ.	ID all levels	30 minutes to administer. Originally designed as an IQ test for verifying eligibility for Paralympic sporting events, but has been suggested for use in dementia assessment – not yet tested however for this purpose.
Silverman et al. (2004) [89]—United States, applied setting (ppts' residence or day program facility)		-Informant interviews conducted based on a clinical record review of the participants medical history. -The Dementia Questionnaire for Mentally Retarded persons [56]. -Part 1 of the American Association on Mental Deficiency Adaptive Behaviour Scale (ABS [91]) -Reiss Screen for Maladaptive Behaviour [63]	-Medical history -Cognitive abilities and social skills -Description of functional abilities -Screening for possible depression, psychosis, and behavior problems.	-IBR evaluation of mental status [90] -Downs syndrome Mental Status Examination [41]—including expanded memory section. -Test of severe impairment (TSI—Albert et al. [29]) -The Peabody Picture Vocabulary Test – Revised (PPVT—Dunn et al. [37]) -Verbal Fluency Test [79] -The Beery Visual Motor Integration Test, long form [92] -Block design subtest of WISC-R [93] -Selective Reminding Test [34]	-Orientation -Overall Cognitive Functioning -Overall cognitive functioning -Receptive vocabulary -Verbal fluency -Construction abilities -Visual spatial memory -Episodic memory	273 ppts Aged: 45+ years After testing grouped into: 1)Not demented 2)Questionable 3)Possible dementia 4)Definite dementia 5)Declines with complications	All levels of ID.	2 hours to administer. 18 month longitudinal analysis presented. Findings suggest that by conducting a full assessment of cognitive abilities like presented here, diagnosis of dementia can be made a lot more rapid and accurate.
Das et al. (1995) [36]—United States and Canada, applied setting (quiet rooms in workshops, group or independent living setting)	Das Naglieri Cognitive Assesment System—designed to assess cognitive decline due to aging among individuals with Downs Syndrome.	N/A	N/A	-Planned search [94] -Matching numbers [95] -Number finding [96] -Expressive Attention [96] -Receptive Attention [95] -Simultaneous Verbal -Figure Memory -Word Series -Color ordering -Speech rate	-Visual search and planning -Planning -Attention, Vigilance -Expressive attention -Receptive Attention -Language -Simultaneous processing memory -Recall Memory -Spatial Memory -Speech rate (Verbal Fluency)	63 ppts Aged: 50–62 Groups 1)Young DS (n = 16) 2)Old DS (n = 16) 3)Young Non-DS (n = 16) 4)Old Non-DS (n = 15)	ID with DS or ID without DS with equivalent level of ID.	1.5–4 hours to administer – a lot of variation in time taken. 2 < than all other groups on all tasks. Seen most on tasks requiring planning and attention.
Crayton et al. (1997) [97]—UK	Neuropsychological Assesment of dementia in adults with intellectual disability—designed for dementia assessment in Downs syndrome.	Cognitive test battery was compared to… -Vineland Adaptive Behaviour Scale (VABS—Sparrow et al. [98])	-Adaptive behaviour	-British Picture Vocabulary Scale (BPVS—Dunn, Dunn, Whetton & Pentilie, 1982) [99] -Orientation (taken from Cambridge Mental Disorders of the Elderly Examination—CAMDEX [100]: -Picture Naming (taken from BPVS) -Picture identification (taken from BPVS) -Acting on request -Card Sorting task Computerized tests -Visual memory -Pattern recognition -Spatial recognition -Matching-to-sample -Delayed response -Conditioned associative learning	-Receptive Language -Orientation -Aphasia -Agnosia -Receptive Language -Executive Functions -Visual Memory -Recognition -Spatial Abilities -Object recognition -Delayed response -Conditioned associative learning	70 ppts Aged: 28+ Mean Age: 42.8 Groups 1)under 40 years old 2)between 40 and 49 years 11 months old 3)aged 3 50+ years	DS	1.5 hours to administer. VABS and all neuropsychological tests negatively correlated (sig) – preexisting global cog impairment shown on these tests No difference between age groups (1, 2, and 3) on neuropsychological deficits. – because of screening method used before study. 2 & 3 < 1 performance on memory tests (sig) Results suggest sensitive tests that were used could be useful in dementia diagnostic process.
Oliver et al. (1998) [101] – UK	Different test batteries were collated, including the CANTAB and CAMCOG, plus extra tests added for the purpose of this study. (Please see across) – designed to detect age-related cognitive change in DS.	-Vineland Adaptive Behaviour Scale (VABS [98])	-Adaptive behaviour	-Visual memory battery (part of Cambridge Neuropsychological Automated Test Battery—CANTAB, see [103]), only 2 sections analyzed in this study, delayed response and conditioned associative learning tasks. -Orientation section of CAMCOG (part of the Cambridge Assessment for Mental Disorder in the Elderly—CAMDEX) Asked to name 14 pictures of everyday objects and identification following a verbal instruction. Also asked to carry out simple actions on a verbal cue (e.g., clap your hands). -The British Picture Vocabulary Scale (BPVS) (Dunn, Dunn, Whetton & Pentilie, 1982) -Extra verbal memory test added to batteries used. (adapted from the Memory for Sentences Test – [102]) -Extra procedure added at the start of the memory for objects test, involving naming, identification, immediate recall and delayed recall.	-Learning and memory -Aphasia and Agnosia -Apraxia -Receptive language -Verbal memory -Memory	57 ppts Aged: 30+ Groups 1)No cognitive deterioration 2)Cognitive deterioration 3)Moderate cognitive deterioration 4)Severe cognitive deterioration	DS	Does not state how long the battery took to administer. 28.3% of ppts showed severe cognitive deterioration, like apraxia or agnosia. A higher prevalence of these impairments was associated with older age. Rate of cognitive deterioration also ↑ w/age & degree of pre-existing cognitive impairment. Deterioration in memory, learning and orientation preceded the acquisition of aphasia, agnosia and apraxia. Pattern of cognitive deterioration seen with individuals who have DS in this study is comparable to the pattern reported in individuals who have Alzheimer's disease but do not have DS.
Jozsvai et al. (2002) [104]—UK, Clinical Setting	Not given—designed to assess cognitive decline in DS.	-The Dementia Scale for Downs syndrome (DSDS [68])	-Dementia status	-The Peabody Picture Vocabulary test revised (PPVTr – [37]) Battery included: -Information and Orientation Questions (IO) -Block Design Test (BD – from WISC-R: [93]) -Fuld Object Memory Evaluation (FULD—[86], [105]) -Grocery list (GL) -Boston Naming Task (BNT—[78]) -Test of Apraxia (PX)	-Receptive vocabulary, verbal intelligence -Orientation -Visuo-constructional praxis -Immediate and delayed memory -Category fluency -Expressive vocabulary -Apraxia	35 ppts Aged: 28+ years Groups: Cases = diagnosed DAT using DSDS (n = 12) Controls = without DAT (n = 23)	DS -Does not include more severe ID in sample	Doesn't state how long the battery took to administer. FLUD and IO shown to be most useful tests in battery—must be wary of practice effects though. BNT and BD, most effected by aging & had least diagnostic ability.
Johansson et al. (2002) [106]—Sweden	Not given—designed to assess dementia in DS.	Informants were interviewed with questions regarding the ppts abilities in the following aspects and any changes observed in these abilities: 1)Change (global changes in ppt) 2)Support 3)Learning Adaptability		-Spatial tests of memory -Verbal tests of memory including: objects to be remembered, auditive learning, visual learning, supported learning, sensing items inside a bag, Where did I put it? - Other cognitive tests included: - Understanding pictures - Simplified Arithmetic - Telling the time on a clock - Ability to estimate time taken - Understanding of cause and effect - Drawing ability - Proper prepositions - Copying pictures with and without the original - Agnosia: what did you draw? - Word Fluency - Routine Decisions - Understanding reverse order - Arranging a coffee break - Naming (aphasia, agnosia, and apraxia) - Long-term memory questions included: - Biographical questions - Memory of the dys preceding the interview - Past and present friends and staff at residential and occupational settings - Semantic memory - Prospective memory		9 ppts Aged: 26–56 Groups: 1)No Decline 2)Possible Decline 3)Decline	DS	Ppt section took 1.5–2 hours to administer. Advocates a combination of testing and interviewing in order to gain a full clinical picture.
Witts (1998) [107]—UK, applied setting (adult training centers.	Severe Impairment Battery (SIB [108])—designed to assess cognitive functioning of the severely demented client.	-Vineland Adaptive Behaviour Scale (VABS [98])	-Adaptive behavior	Battery tests focus on: -Attention -Orientation -Language -Memory -Visuo-perception -Construction -Praxis -Social interaction Carers provide most of the info for the battery.		33 ppts Mean age = 36 years	DS	20 minutes to administer. Good reliability and validity found. No floor effects encountered. Should be used longitudinally.

Abbreviations: ID, intellectual disabilities; DS, Down syndrome; DAT, dementia Alzheimer's type; ↑, increases; ppts, participants.

NOTE. Tests highlighted in bold indicate repeated use within studies. Age is denoted in years.