# Cognitive Impairment & Detection — Resources

Curated, high-trust sources. Knowledge in lessons is drawn from here, not from guesses.

## Knowledge — Cognitive domains & how they're measured

- [Classifying Neurocognitive Disorders: The DSM-5 Approach — Sachdev et al., *Nature Reviews Neurology* (2014)](https://escholarship.org/content/qt77g8t63q/qt77g8t63q_noSplash_59d7fbd60fc063e6dba5c393fe7ea300.pdf)
  Defines the canonical six DSM-5 neurocognitive domains and subdomains. Use for: the authoritative taxonomy of what your tasks should cover.
- [The Cognition Battery of the NIH Toolbox: Validation in an Adult Sample — Weintraub et al., *JINS* (2014)](https://pmc.ncbi.nlm.nih.gov/articles/PMC4103959/)
  Government-backed, free domain→task→reliability blueprint (Flanker, DCCS, List Sorting, Pattern Comparison, etc.). Use for: a ready-made battery model.
- [NIH Toolbox — Cognition Assessments (official)](https://nihtoolbox.org/domain/cognition/)
  Quick canonical task→subdomain reference. Use for: looking up which test targets which subdomain.
- [Reliability & Validity of NIH Toolbox Composite Scores — Akshoomoff et al. (2014)](https://pmc.ncbi.nlm.nih.gov/articles/PMC4103963/)
  Concrete psychometric benchmarks (test-retest r ≈ 0.86–0.92). Use for: targets your app should aim to beat or match.
- [CANTAB — cognitive test domains — Cambridge Cognition](https://www.cambridgecognition.com/cantab/cognitive-tests/executive-function/)
  Leading computerized battery's domain map and signature tasks. Use for: industry-standard task design references.
- [The Unity and Diversity of Executive Functions — Miyake et al., *Cognitive Psychology* (2000)](https://www.sciencedirect.com/science/article/abs/pii/S001002859990734X)
  The field-standard model: executive function = Shifting + Updating + Inhibition. Use for: why "executive function" needs multiple tasks, not one.
- [Unity and Diversity of EF (update) — Friedman & Miyake, *Cortex* (2017)](https://pmc.ncbi.nlm.nih.gov/articles/PMC5104682/)
  Current consensus with a "common EF" factor. Use for: the up-to-date EF structure.
- [Digit Symbol Substitution Test: Sensitivity Over Specificity — Jaeger (2018)](https://pmc.ncbi.nlm.nih.gov/articles/PMC6291255/)
  Why DSST is broadly sensitive to dysfunction but not specific. Use for: justifying a digit-symbol-style general screen.
- [Trail Making Test — what it actually measures — Varjacic et al., *Scientific Reports* (2022)](https://www.nature.com/articles/s41598-022-16431-9)
  Decomposes TMT into scanning, speed, set-shifting, working memory. Use for: designing/interpreting a connect-the-dots task.

## Knowledge — Substance & state impairment fingerprints

- [Fatigue, alcohol and performance impairment — Dawson & Reid, *Nature* (1997)](https://www.nature.com/articles/40775)
  The classic equivalence: ~17h awake ≈ 0.05% BAC, ~24h ≈ 0.10%. Use for: anchoring fatigue severity to a familiar scale.
- [The cumulative cost of additional wakefulness — Van Dongen et al., *Sleep* (2003)](https://www.med.upenn.edu/uep/assets/user-content/documents/Van_Dongen_Dinges_Sleep_26_3_2003.pdf)
  Chronic 4–6h/night accrues PVT-lapse deficits like total sleep deprivation. Use for: why vigilance/lapses are the fatigue signal.
- [Sleep deprivation: Impact on cognitive performance — Alhola & Polo-Kantola (2007)](https://www.tandfonline.com/doi/full/10.2147/ndt.s12160203)
  Review: sleep loss hits sustained attention first ("wake-state instability"). Use for: the fatigue fingerprint.
- [Dose-Related Effects of Alcohol on Cognitive Functioning — *PLOS ONE* (2013)](https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0050977)
  Which domains degrade by BAC; divided attention fails first at low doses. Use for: the alcohol fingerprint and dose-coupling.
- [Cannabis and Cognitive Functioning: Acute to Residual — Figueiredo et al., *Frontiers in Psychiatry* (2021)](https://www.frontiersin.org/journals/psychiatry/articles/10.3389/fpsyt.2021.596601/full)
  Acute THC: working memory, attention, EF, reaction time, + time-perception distortion. Use for: the cannabis fingerprint.
- [Duration of Neurocognitive Impairment With Cannabis — McCartney et al., *Frontiers in Psychiatry* (2021)](https://www.frontiersin.org/journals/psychiatry/articles/10.3389/fpsyt.2021.638962/full)
  Time course: onset 30–60 min, peak ~90 min–2h, resolves ~4–5h; shorter in frequent users. Use for: timing/recovery design.
- [Cannabis and Driving (alcohol contrast) — Pearlson et al. (2021)](https://pmc.ncbi.nlm.nih.gov/articles/PMC8499672/)
  Cannabis users overestimate & compensate; alcohol users underestimate & act impulsively. Use for: behavioral tells.
- [Benzodiazepines & Cognition: meta-analysis — Crowe & Stranks, *Frontiers in Psychiatry* (2020)](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7527532/)
  Depressant profile overlapping alcohol. Use for: why some agents are hard to tell apart from cognition alone.
- [Marijuana-Impaired Driving: Report to Congress — NHTSA (2017)](https://www.nhtsa.gov/sites/nhtsa.gov/files/documents/812440-marijuana-impaired-driving-report-to-congress.pdf)
  High-trust government anchor on THC dose-impairment dissociation. Use for: defensible non-academic citation.

## Knowledge — Detecting impairment & test validity

- [Fitness-for-Duty Testing — Burns & Hiller-Sturmhöfel, NIAAA (1995)](https://pmc.ncbi.nlm.nih.gov/articles/PMC6875724/)
  The core case: performance tests measure the *effect*, chemical tests only the *cause*. Use for: the why-behavioral-testing argument.
- [Validity & Sensitivity of the Brief PVT (PVT-B) — Basner, Mollicone & Dinges (2011)](https://www.med.upenn.edu/uep/assets/user-content/documents/Basner2011-ValidityandsensitivityofabriefPVT.pdf)
  Validates the 3-minute PVT vs the 10-min gold standard. Use for: justifying a short field task.
- [Maximizing PVT Sensitivity to Sleep Loss — Basner & Dinges, *SLEEP* (2011)](https://pubmed.ncbi.nlm.nih.gov/21532951/)
  Which scoring metrics (lapses, speed) best discriminate. Use for: choosing your scoring.
- [3-Minute Smartphone/Tablet PVTs — *Behavior Research Methods* (2017)](https://link.springer.com/article/10.3758/s13428-016-0763-8)
  Validates touchscreen RT delivery (latency concerns). Use for: phone-implementation evidence.
- [3-Min PVT inadequate convergent validity — *Frontiers in Neuroscience* (2022)](https://www.frontiersin.org/journals/neuroscience/articles/10.3389/fnins.2022.815697/full)
  Counter-evidence: shortening trades off validity. Use for: honest limits of brief tasks.
- [DRUID app — cannabis dose study — Vandrey et al. (2021)](https://www.impairmentscience.com/post/study-proves-isis-druid-app-accurately-detects-impairment-from-cannabis)
  A validated ~3-min divided-attention/balance impairment app. Use for: a direct product precedent.
- [Added Value of Baseline Testing in Computer-Based Cognitive Assessment — PMC (2013)](https://pmc.ncbi.nlm.nih.gov/articles/PMC3716479/)
  Why an individual baseline beats population norms. Use for: the baseline design argument.
- [Reliable Change on Neuropsych Tests (RCI) — PMC (2016)](https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4860819/)
  The statistic for "is this change real or noise?" Use for: your impaired-vs-baseline decision rule.
- [Smartphone/Tablet Cognitive Tools: Scoping Review — *JMIR* (2025)](https://www.jmir.org/2025/1/e65297)
  37 tools; most fail to report reliability/validity. Use for: the bar a credible app must clear.
- [Fatigue Detection Technology guidance — NIOSH/CDC (2021)](https://www.cdc.gov/niosh/bulletin/2021/fatigue.html)
  Government guidance: such tools support, not replace, a safety program. Use for: honest product positioning.

## Wisdom (Communities)

- [r/Neuropsychology](https://www.reddit.com/r/Neuropsychology/) — practitioners and researchers; good for "is this task valid for X?" sanity checks. Moderated, academic-leaning.
- [Human Factors and Ergonomics Society (HFES)](https://www.hfes.org/) — the professional home for fatigue/impairment-in-the-field and applied performance testing. Conferences + journals.
- [Sleep Research Society (SRS)](https://sleepresearchsociety.org/) — the PVT/fatigue research community, if the fatigue path becomes central.

## Gaps

- No source yet on **multi-task score fusion / classification** (how to combine several task outputs into one impairment decision, ML or rule-based). Worth a future search.
- No source yet specifically on **gamification effects on measurement validity** (does making a task a "game" add noise or motivation bias?). Directly relevant to the product — search next.