WHO NCTB

The first consensus test battery designed to detect deficits suggestive of neurotoxic exposures was the Neurobehavioral Core Test Battery (NCTB), developed by an expert panel convened by the World Health Organization (WHO) with leadership from the National Institute for Occupational Safety and Health (NIOSH). The NCTB was selected to provide an instrument for population screening and research, and to foster the development of a database of common tests shown sensitive to neurotoxic disorders (Johnson et al., 1987).

NCTB tests

Digit Symbol *
Digit Span *
Pursuit Aiming II *
Benton Visual Retention Test *
Simple Reaction Time
Santa Ana
Profile of Mood States (POMS) *

This page is posted by NwETA for the field of Behavioral Neurotoxicology and because NwETA’s BARS system was developed to provide a computer-based alternative to the NCTB. One goal was to overcome certain shortcomings of individually-administered tests such as those in the NCTB. Information about the NCTB is available from: anger@ohsu.edu.

There are 7 tests in the NCTB (above) which met three criteria: (a) they had detected statistically significant differences between exposed and control groups in workplace research; (b) technicians could, following minimal training, reliably administer the NCTB tests; and, (c) materials and equipment were inexpensive and could be administered in remote settings (Johnson et al., 1987). In a 10-country cross-cultural study of the NCTB in unexposed control populations administered in 9 different languages, mean test performance among the 9 countries with similar education levels was within approximately 1 standard deviation (SD) between the high and low scores. Participants from the other country had a mean education level of 3 years, while the mean education level in the remaining countries exceeded 9 years (Anger et al., 1993). This suggests that the NCTB can be administered to a broad range of populations with at least 10 years of education. There is an NCTB Operational Guide (obtainable from anger@ohsu.edu) which allows administration of this battery following a standardized procedure.

The NCTB tests are widely used in neurotoxicology research (see Table 3 in Anger, 1990), and the NCTB has been used in several studies (see references/research articles, below). Prof. You-xin Liang of China identifies 130 studies published primarily in Chinese that used the WHO NCTB. The picture below is of the June, 1999 symposium held to discuss the NCTB: Lessons learned in 15 years since its recommendation (Anger et al., 2000).

* The Digit Symbol, Digit Span, Pursuit Aiming II, some forms of the Benton Visual Retention Test, and the Profile of Mood States are copyrighted tests or tests drawn from copyrighted testing systems, requiring purchase from the copyright holder.

For further information about Behavioral Neurotoxicology
The following conferences provide ways to connect with the researchers in this field.

International Neurotoxicology Association – INA
INA presentations range from the molecular to the whole animal. The society meets in non-even years (eg, 1997, 1999) in Europe, or occasionally in the United States. See http://www.neurotoxicology.org.

International Symposia on Neurobehavioral Methods and Effects in Occupational and Environmental Health
This continuing series of symposia on neurobehavioral methods is supported by a committee of the International Congress on Occupational Health and it is primarily aimed at discussing methods used in human neurobehavioral research on neurotoxic chemicals, and findings in this field of research. This conference met every third year through the Capetown meeting in 2013, now convening for individual presentations at ICOH meetings.

Organized by Renato Gilioli, the first publication was titled, “Neurobehavioral Methods in Occupational Health,” which was probably the name of the conference and it was intended to continue every three years. The second was in Copenhagen, August 6-9, 1985, organized by Philippe Grandjean. The third meeting was held in Washington meeting, December 14-18, 1988. Organized by Barry Johnson, he and Charlie Xintaras were the US leaders in the early meetings. NwETA President Kent Anger played a prominent role in that meeting, as well. The fourth meeting occurred in Tokyo (July 8-11, 1991) and the fifth was in Egypt (July 8-11, 1991).

Neurotoxicology Specialty Section of the Society for Toxicology
NTSS presentations range from molecular neurotoxicology to studies of the whole animal, including humans. The society meets annually in the United States as a section of the Society for Toxicology (SOT). Contact: http://www.toxicology.org

References/Reviews

Anger, W. K. and W. K. Boyes (2012). “A brief history of INA and ICOH SCNP: International Neurotoxicology Association and International Congress on Occupational Health Scientific Committee on Neurotoxicology and Psychophysiology.” Neurotoxicology 33(4): 631-640.
Anger WK. Worksite behavioral research: Results, sensitive methods, test batteries and the transition from laboratory data to human health. Neurotoxicology. 1990;11:629–720.
Gilioli R, Cassitto MG, Foa V, (eds.). Neurobehavioral Methods in Occupational Health. Oxford: Pergamon Press, 1983.
Anger WK. Human neurobehavioral toxicology testing: current perspectives. Toxicology and Industrial Health 1989; 5: 165-180.
Anger WK. Assessment of neurotoxicity in humans (pp. 363-386). In: Neurotoxicology/Target Organ Toxicology Series (H. Tilson and C. Mitchell, Eds.) New York: Raven Press, 1992.
Anger WK, Cassitto MG. Individual-administered human behavioral test batteries to identify neurotoxic chemicals. Environmental Research, 1993, 61: 93-106.
Williamson AM. Historical overview of computerized behavioral testing of humans in neurotoxicology. Neurotoxicology and Teratology 1996; 18: 351-357.
Anger WK, Storzbach D, Amler RW, Sizemore OJ. Human behavioral neurotoxicology: Workplace and community assessments (pp. 709-731). In: Environmental and Occupational Medicine (third edition) (W Rom, Ed.) Lippencott-Raven Publishers, Philadelphia. 1998.
Anger WK. Neurobehavioural tests and systems to assess neurotoxic exposures in the workplace and community (invited). Occupational and Environmental Medicine, 2003, 60: 531-538.

References/Research articles

Kang, S. K. (2000). “The applicability of WHO-NCTB in Korea.” Neurotoxicology 21(5): 697-701.
Cao, Z., J. Liu, S. Li and X. Zhao (2000). “[Effects of electromagnetic radiation from handsets of cellular telephone on neurobehavioral function].” Wei Sheng Yan Jiu 29(2): 102-103.
Anger WK, Liang Y-X, Nell V, Kang S-K, Cole D, Bazylewicz-Walczak B, Rohlman DS , Sizemore OJ. Lessons Learned: 15 years of the WHO-NCTB. NeuroToxicology, 2000, 21:837-846.
Acuna MC, Diaz V, Tapia R, Cumsille MA. [Assessment of neurotoxic effects of methyl bromide in exposed workers] [Article in Spanish]. Rev Med Chil 1997; 125: 36-42.
Chia SE, Chia HP, Ong CN, Jeyaratnam J. Cumulative blood lead levels and neurobehavioral test performance.Neurotoxicology 1997; 18: 793-803.
Liang YX, Chen ZQ, Wang C, Tang HW, Yang HG. The development of neurobehavioral toxicology in China: the 1994 Hanninen Lecture. Environmental Research 1997; 73(1-2):9-17.
Mergler D, Huel G, Belanger S, Bowler RM, Truchon G, Drolet D, Ostiguy C. Surveillance of early neurotoxic dysfunction. Neurotoxicology 1996; 17: 803-812.
Cole DC, Carpio F, Julian J, Leon N, Carbotte R, De Almeida H. Neurobehavioral outcomes among farm and nonfarm rural Ecuadorians. Neurotoxicology and Teratology. 1997; 19: 277-286.
Maizlish NA, Parra G, Feo O. Neurobehavioural evaluation of Venezuelan workers exposed to inorganic lead. Occupational and Environmental Medicine 1995; 52: 408-414.
London L, Myers JE, Nell V, Taylor T, Thompson ML. An investigation into neurologic and neurobehavioral effects of long-term agrichemical use among deciduous fruit farm workers in the Western Cape, South Africa. Environmental Research 1997;73(1-2):132-145.
Cordeiro R, Lima Filho EC, Salgado PE, Santos CO, Constantino L, Malatesta ML. [Neurological disorders in workers with low levels of lead in the blood. II–Neuropsychological disorders] [Article in Portugese]. Rev Saude Publica 1996 Aug;30(4):358-363.
Escalona E, Yanes L, Feo O, Maizlish N. Neurobehavioral evaluation of Venezuelan workers exposed to organic solvent mixtures. American Journal of Industrial Medicine. 1995; 27:15-27.
Ohnishi A, Mori K, Fujishiro K, Kohriyama K, Miyata M, Murai Y, Ikeda M. [Application of neurobehavioral tests in a manufacturing automotive parts factory] [Article in Japanese]. Sangyo Ika Daigaku Zasshi 1995;17: 165-172.
Tang HW, Liang YX, Hu XH, Yang HG. Alterations of monoamine metabolites and neurobehavioral function in lead-exposed workers. Biomed Environ Sci 1995; 8: 23-29.
Xu H, Zhang X, Xue B [Studies on comprehensive evaluation of toxic hazard in low-concentration benzene pollution] [Article in Chinese]. Chung Hua Yu Fang I Hsueh Tsa Chih 1995 Sep;29(5):264-266.
Chia SE, Jeyaratnam J, Ong CN, Ng TP, Lee HS. Impairment of color vision among workers exposed to low concentrations of styrene. American Journal of Industrial Medicine. 1994; 26: 481-488.
Yang HG, Liang YX, Tang HW. [Neuropsychological effects of lead exposure] [Article in Chinese]. Chung Hua Yu Fang I Hsueh Tsa Chih 1994 Jan; 28(1): 9-12.
Anger, W.K., Cassitto, M.G., Liang, Y-x., Amador, R., Hooisma, J., Chrislip, D.W., Mergler, D., Keifer, M., Hartnagl, J., Fournier, L., Dudek, B., Zsogon, E. 1993. Comparison of performance from three continents on the WHO-recommended neurobehavioral core test battery. Environmental Research 62:125-147.
Chia SE, Foo SC, Gan SL, Jeyaratnam J, Tian CS. Neurobehavioral functions among workers exposed to manganese ore. Scand J Work Environ Health 1993 Aug;19(4):264-270.
Lee SH, Lee SH A study on the neurobehavioral effects of occupational exposure to organic solvents in Korean workers. Environmental Research 1993; 60: 227-232.
Dudek B. Adaptation of the WHO NCTB for use in Poland for detection of effects of exposure to neurotoxic agents. Environmental Research. 1993;61:349-356.
Reif JS, Tsongas TA, Anger WK, Mitchell J, Metzger L, Keefe TJ, Tessari JD, Amler R. Two-stage evaluation of exposure to mercury and biomarkers of neurotoxicity at a hazardous wastesite. Toxicology and Environmental Health 1993; 40: 413-422.
Colvin, M., Myers, J., Nell, V., Rees, D., Cronje, R. 1993. A cross-sectional survey of neurobehavioral effects of chronic solvent exposure on workers in a paint manufacturing plant. Environmental Research 63:122-132.
Nell V, Myers J, Colvin M, Rees D. Neuropsychological assessment of organic solvent effects in South Africa: test selection, adaptation, scoring, and validation issues. Environmental Research 1993; 63: 301-318.
Fallas C, Fallas J, Maslard P, Dally S. Subclinical impairment of colour vision among workers exposed to styrene. British Journal of Industrial Medicine 1992 Oct;49(10):679-682.
Waszkowska M, Bazylewicz-Walczak B. [Psychological evaluation of the effects of chronic occupational exposure of paint shop workers to the mixture of organic solvents] [Article in Polish]. Med Pr 1992; 43(1): 35-39.
Bazylewicz-Walczak B, Walenczak J, Wesolowski W, Jakubowski M. [Neurobehavioral effects of chronic occupational exposure to mixtures of solvents used in furniture varnishing. Part I–Psychological examination] [Article in Polish]. Med Pr 1992; 43: 363-370.
Liang Y-X, Chen Z-q, Sun R-k, Fang Y-f, Yu J-h. Application of the WHO Neurobehavioral Core Test Battery and other neurobehavioral screening methods. In: Johnson BL, Anger WK, Durao A, Xintaras C, eds. Advances in Neurobehavioral Toxicology: Applications in Environmental and Occupational Health. Chelsea, MI: Lewis Publishers; 1990; 225–243.
Cassitto, M.G., Camerino, D., Hanninen, H., Anger, W.K. 1990. International Collaboration to Evaluate the WHO Neurobehavioral Core Test Battery. In Advances in Neurobehavioral Toxicology: Applications in Environmental and Occupational Health (B.L. Johnson, W.K. Anger, A. Durao, C. Xintaras, eds.) pp 203-223. Lewis Publishers, Chelsea, MI.
Chen ZQ, Yu JH, Cao SH. Reference values of indicators for WHO neurobehavioral core test battery. Chin Med Journal (Engl) 1990; 103(1): 61-65.
Yokoyama K, Araki S, Osuga J, Karita T, Kurokawa M, Koda K. [Development of Japanese edition of Neurobehavioral Evaluation System (NES) and WHONeurobehavioral Core Test Battery (NCTB): with assessment of reliability]. [Article in Japanese] Sangyo Igaku 1990; Sep;32(5): 354-355.
Cassitto MG, Gilioli R, Camerino D. Experiences with the Milan Automated Neurobehavioral System (MANS) in occupational neurotoxic exposure. Neurotoxicology and Teratology. 1989; 11: 571-574.