ANAM4™

– There's only one ANAM

What is ANAM4™?

ANAM4™ - The Automated Neuropsychological Assessment Metrics, Version 4 – is a library of computer-based assessments of cognitive domains including attention, concentration, reaction time, memory, processing speed, and decision-making. ANAM4™ provides clinicians and researchers with data to evaluate an individual’s neurocognitive status at a point-in-time and changes in cognitive status over time.

ANAM4™ includes all research and development from previous versions of ANAM initially developed in the Department of Defense and licensed exclusively through the U.S. Army Technology Transfer program for development into a reliable, repeatable and broadly-available assessment technology.[i]

ANAM4™ now includes thirty-five test modules that can be grouped into flexible or standardized batteries that are highly sensitive to cognitive change associated with injury (e.g., trauma, blast) illness (e.g., degenerative disease), exposure (e.g., toxin), risk factors (e.g., heat/cold, sleep loss, fatigue), and intervention (e.g., medication, rehabilitation). Scientists working in varied fields of healthcare and human factors research have identified ANAM4™ batteries most useful in their topic-specific research.

Why use automated assessment?

In the 1980s researchers and scientists began to use personal computers to automate cognitive assessments that historically had been presented by electro-mechanical devices or by clinicians using paper-and-pencil and a stopwatch. When carefully programmed, personal computers can measure an individual’s responses with sub-second accuracy. ANAM was able implement many tests in a highly precise, sensitive, and repeatable fashion. The Department of Defense, FAA, and NASA were among the earliest government agencies to use automated assessment, including ANAM.

What assessments modules does ANAM4™ include?

ANAM4™ does not measure intelligence, but provides an assessment of neurocognitive functions or "cognitive domains." Assessment modules include:

Demographics/ Participant Info
Mood Scale II –Revised
Simple Reaction Time
Procedural Reaction Time
2-Choice Reaction Time
Symbolic Reaction Time
Modified Stanford Sleepiness Scale
Code Substitution (Learning, Immediate, and Delayed)
Matching to Sample
Matching Grids
Mathematical Processing
Running Memory Continuous Performance Task
Standard Continuous Performance Test
Logical Relations
Grammatical Reasoning
Spatial Processing
Memory Search
Tap Left/Tap Right
Pursuit Tracking
Tower Puzzle
Go/No-Go

Does ANAM4™ measure mood and depression?

The ANAM Mood Scale is a brief adjective checklist-type test including: Vigor, Happiness, Depression, Anger, Fatigue, Restlessness, and Anxiety. In a published construct validity study, the ANAM mood scale was found to be highly correlated with common measures of anxiety and depression.[ii]

How is ANAM4™ data accessed by clinicians and researchers?

ANAM4™ includes the ANAM4™ Performance Report (APR), which provides the clinician with full reports on current neurocognitive status for the assessment battery and comparisons to previous assessment sessions, as well as to various reference/norm groups. ANAM4™ also includes the ANAM4™ Data Extraction and Presentation Tool (ADEPT), which provides clinicians and researchers the ability to easily select, organize, and display, ANAM4™ data in spreadsheet form and transfer ANAM4™ data to common statistical and graphics packages.

Who interprets ANAM4™ results?

In clinical applications, the interpretation of ANAM4™ assessment results should be conducted by qualified medical professionals, such as a clinical psychologists, neuropsychologist, or physicians with training in psychological testing principles, test administration procedures, and clinical test interpretation. ANAM4™ does not provide a diagnostic assessment. It provides information to clinician regarding neurocognitive functioning that should be considered together with other clinically-relevant information to assist in medical decision-making.

What is the role of ANAM4™ in DoD pre-deployment neurocognitive assessment?

ANAM4™ was selected as the measure of choice among several technologies evaluated by the Department of Defense in a 2008 "Assessment of Alternatives". ANAM4™ has been used to collect more than 600,000 pre-deployment neurocognitive assessments by the Department of Defense.

ANAM4™ meets the requirements of the 2008 National Defense Authorization Act requiring that DoD have a system for pre-deployment and post-deployment cognitive assessment.

ANAM4™ is the only neurocognitive instrument chosen for two DoD-funded foundational studies of blast-related head injury, a major in-theater study of Traumatic Brain Injury, and a pre-post deployment analysis of neurocognitive function including over 10,000 cases.

How are baseline assessments used in healthcare and performance readiness?

Baseline cognitive assessment can be compared with assessments made at a later time to identify cognitive changes. Clinicians in many fields of medicine and human performance measurement use baseline and follow-up assessments as one element of information in an overall assessment of health or performance status.

What if no baseline assessment results are available?

Comparison of cognitive assessment results to appropriate normative data is valuable, but the most valuable comparison is to baseline data. ANAM4™ has the largest military normative dataset of any automated neuropsychological assessment system available. This normative dataset is based on over 100,000 assessment records. In a very large military database study, an analysis of more than 10,000 assessment records showed baselines to be significantly more accurate than use of normative data alone.

How long does an ANAM4™ assessment take?

The length of the test depends on the number of assessment modules included in the battery. As an example, the ANAM4™ battery used by the DoD for pre-deployment baseline assessment takes approximately 20-25 minutes to administer to 95% of test takers. The cognitive domain measures in this battery have been refined over a decade to identify those most sensitive and specific to brain injury.

How is ANAM4™ administered?

Recommended ANAM4™ administration procedures follow the general guidelines of the American Psychological Association (APA) for distribution and administration of psychological tests. In a group testing environment, verbal directions are recommended to supplement written instructions. This assists test takers with varied reading capabilities.

ANAM4™ can be administered by qualified professionals who have training in psychological testing principles and test administration procedures. Training for proctors is offered through Vista LifeSciences.

ANAM4™ runs on most standard IBM-based PCs (as well as Macs with PC emulation) with Windows 2000 through Windows 7 OS. ANAM4™ uses a keyboard, standard monitor, and USB mouse.

Is there a "practice effect" when individuals take the ANAM4™ multiple times?

"Practice effect" is the change in assessment performance that occurs when an assessment is repeated multiple times in succession. While almost any performance-based test will exhibit some "practice effect," ANAM4™ was designed to have minimal "practice effect." ANAMTM was also designed to provide randomized stimuli across tests sessions, creating a near limitless number of alternative forms to facilitate repeated-measures testing.[iii]

Clinical and research protocols for cognitive testing, especially automated testing, differ in their management of "practice effect". Researchers often repeat a test many times to achieve "asymptotic" performance levels on the test prior to administering a treatment and post-treatment test trials. Asymptotic performance is typically defined as performance absent most learning effects. This protocol provides a good method for assessing very subtle changes in function. Clinicians typically do not seek "asymptotic" performance levels. They attempt to obtain a baseline that typically represents a good estimation of "first time exposure" to a test. The baseline represents a "comparative assessment point."

The assumption is that the post-injury assessment will probably not be repeated for period of time so the post-injury assessment will be more like a "first time exposure."

What software language and development standards are used for ANAM4™ development?

ANAM4™ is written in C++ and C# and uses Web Services to utilize IP protocols over the internet. All assessment responses are measured in sub-seconds on computer hardware. The ANAM4™ system development lifecycle is managed according to best industry practices.

ANAM4™ is backward compatible with earlier versions of ANAM assessment modules wherever possible. Appropriate engineering and quality assurance practices are central to ANAM4™ development and have been used to preserve the integrity of ongoing longitudinal studies.

Is ANAM Research Ongoing?

ANAM is unlike other commercial cognitive assessment software in its research history and research approach. ANAM rests on decades of laboratory and clinical research. ANAM is included in more than 300 peer-reviewed independent research studies from some of the world’s most prestigious research institutions such as NASA and the FAA.

ANAM has a long and continuous history of research in the Department of Defense, including sports concussion studies at West Point and TBI assessment during Ft. Bragg Paratrooper training.

Through these programs and more than 600,000 pre-deployment ANAM4™ baseline assessments collected since 2008, ANAM4™ has the most comprehensive military research and clinical application records of any cognitive assessment technology.

The Archives of the National Academy of Neuropsychology, the official journal of the National Academy of Neuropsychology, published a special edition of its journal focused exclusively on ANAM in 2007.

Notes on the History of ANAM Development….

Judgment, memory, mood, and general cognitive status are critical elements in an individual’s performance in simple daily tasks as well complex work.

During his tenure in the 1980s as Director of the Office of Military Performance Assessment Technology (OMPAT) and Director of the Military Operational Medicine Research Program, Dr. Fred Hegge recognized the importance of cognitive health and the need for a consistent and well-developed approach to cognitive assessment. He and his team worked with a diversity of neuropsychological testing tools, including the Walter Reed Performance Assessment Battery, to develop and validate the ANAM, a standardized set of cognitive assessment tools that could effectively be used in diverse conditions including varied climates, altitudes and toxic conditions.[iv]

Dozens of the finest researchers and scientists working for federal agencies or using ANAM with approval from the U.S. Army contributed to ANAM development.

[i] The U.S. Army exclusively licensed all ANAM software code and other intellectual property to the University of Oklahoma through its technology transfer program in 2004. Through over two years of research, development, quality assurance and investment, ANAM became ANAM4™. The OU Center for the Study of Human Operator Performance (C-SHOP) collected ANAM research and code, and with a team test experts and engineers created a stable, enhanced assessment library having backward compatibility with previous versions of ANAM. New assessment and reporting modules were added, and computer engineering quality assurance processes were inserted in the development and review processes to provide an enhanced version of the early ANAM test library.

Vista Partners joined the ANAM team when the University of Oklahoma licensed ANAM4™ to Vista Partners to integrate ANAM4™ with other innovative technologies, interface with the medical community, and collaborate on further ANAM development. Vista Partners and OU work collaboratively to enhance ANAM for research and clinical user.

[ii] ANAM mood scale. Archives of Clinical Neuropsychology 2008, vol. 23, no 1, pp. 73-85. JOHNSON Dan R.; VINCENT Andrea S.; JOHNSON Ashley E.; GILLILAND Kirby; SCHLEGEL Robert.

[iii] Assessing change with the Automated Neuropsychological Assessment Metrics (ANAM): issues and challenges. Journal of American Neuropsychology 2007 Feb; 22 Suppl 1:S79-87. Epub 2006 Nov 2. Roebuck-Spencer T, Sun W, Cernich AN, Farmer K, Bleiberg J.

[iv] Army research needs for automated neuropsychological tests: Monitoring soldier health and performance status. Archives of Clinical Neuropsychology 22S (2007) S7–S14.

Karl E. Friedl, Stephen J. Grate, Susan P. Proctor, James W. Ness, Brian J. Lukey, Robert L. Kane