Project Summary This proposal aims to continue the National Neuropsychology Network (NNN, R01MH118514). The NNN has exceeded its original ambitious recruitment goals, already has enrolled more than 9,400 individuals, and is on track to include more than 12,000 participants during the current funding period. With core infrastructure in place, the NNN has gathered item-level data on representative neuropsychological (NP) instruments and deposited these data in the NIMH Data Archive (NDA). We created digital history forms and the System for Acquisition of Item-Level Observations and Responses (SAILOR) and an application programming interface with Pearson’s Q-interactive platform to enable point-of-testing data acquisition for more than 50 NP tests using iPads, along with automated scoring and enhanced score reporting features. Data analyses already have tested measurement invariance between NNN and the original standardization samples, specifying the core latent constructs that are identified across tests, and generated computerized adaptive test models to show how some tests can be dramatically shortened without loss of key information. The NNN has further harmonized history- taking and self-report methods across sites by creating the Structured History Protocol for Neuropsychology (SHiP-NP) that is now freely available nationwide. Following aspirations as stated in the original application, the NNN now aims to expand from the four original clinical research sites in California, Florida, Georgia, and Wisconsin to add a new site in Texas, to include both English and Spanish speaking (bilingual and monolingual) participants, and to add widely used Spanish language NP tests. This continuation project further enhances recruitment of participants who report Black or African American ancestry. The proposed expansion is critically needed to address current disparities in understanding NP function in racial and ethnic groups that have been underrepresented in biomedical research despite representing increasingly large proportions of the U.S. population. To increase the scalability of the NNN and increase integration with healthcare informatics research, the proposal further aims to synchronize data across electronic medical record (EMR) and NNN databases, thereby automating retrieval of important common data elements (CDEs) and establishing standards for CDEs that are most important for NP assessment. The data acquired during the continuation phase will enable analyses to: (a) test measurement invariance across diverse groups defined by individual, cultural and linguistic differences; (b) create regression-based predictions of NP performance in clinically-relevant groups based on demographic and social determinants of health (SDOH) that go beyond race- and ethnicity stratified norms; (c) develop proposals for new more efficient adaptive tests and test batteries; and (d) create a scalable network structure that can dynamically incorporate novel test content...