A comparison of the brief international cognitive assessment for multiple sclerosis and the brief repeatable battery in multiple sclerosis patients

Abstract

BackgroundRecently, a Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) has been developed as an international and standardized brief cognitive test, which is easily performed in everyday clinical practice for neuropsychological assessment in multiple sclerosis (MS). However, we need to gather more information about this tool compared to other neuropsychological batteries. The aim of our study is to compare the performance of BICAMS and Brief Repeatable Battery (BRB) in MS subjects.MethodsTests of the BRB and BICAMS were administered to MS patients recruited from 11 Italian MS centres. Cognitive impairment (CI) was defined as the failure on at least two tests (scores below the fifth percentile) on the BRB and as the failure on at least one test of the BICAMS. The agreement between the performances on the two batteries was assessed through Cohen’s K statistic. Finally we calculated the effects sizes for each test of the two batteries using Cohen’s d.ResultsThe two batteries were administered to 192 MS patients (142 women, 50 men; mean age 41.4 ± 10.8 years, mean education 12.3 ± 3.5 years). Mean scores of patients were lower compared to those of healthy subjects in all the cognitive measures examined. Forty-six MS patients were identified as impaired and 48 as unimpaired on both of the batteries, when the Symbol Digit Modalities Test (SDMT) was included in the analysis. Cohen’s K statistic was 0.46 which corresponds to a moderate accord. If the SDMT was excluded from the BRB, 37 MS patients were identified as impaired and 57 as unimpaired on both of the batteries. Cohen’s K statistic was 0.3 which corresponds to a poor accord. The SDMT, the Paced Auditory Serial Addition Test (PASAT) 3 and 2 yielded higher d values (SDMT 0.83, PASAT 3 0.65, PASAT 2 0.84).ConclusionsThis study confirms the feasibility of BICAMS in everyday clinical practice for the identification of CI and highlights the good psychometric properties of the SDMT.

The correlation between EDSS and cognitive impairment in MS patients. Assessment of a Brazilian population using a BICAMS version

“…The score obtained by patients with MS in the SDMT in previous publications ranges from 34.9 to 56.3 with a mean of 43.5 (mean SD = 14.1) 3,7,10,13,20,21,22,23,24 , close to our result of 48.5 (SD = 14.9). Importantly, in the study that showed the lower score 7 , the population assessed was of older patients (mean age 61.8 years) and with longer duration of disease (mean 34.5 years) compared to ours, which possibly influenced its results.…”

“…The patients had a mean of 52 points, very close to our 48.2. In other studies, this findings was similar, ranging from 42 to 51.6 points 12,22,23,24,25 . Only one paper 13 showed a significant discrepancy, with a mean in the CVLT of 64 in patients with MS 2 .…”

“…Of course, the use of different assessment tools prevents a simple direct comparison, since the test battery used in the cited studies, the Neuropsychology Brief Repeatable Battery Test (BRB-N) 5 , is much more extensive than BICAMS. The BRB-N and BICAMS have the SDMT 23 as a common test, in which our sample presented a prevalence of abnormality of 42%, with the same parameters for definition of an abnormal test -a very similar rate to other Latin Americans cited papers. Beyond this, the cognitive impairment rates found by these authors are comparable to ours when using 2 SD present in just one NTs as a definition parameter (Table 3).…”

“…This test had lower abnormality rates, with 58% of patients below the average of normal controls previously reported (26.2 points; mean SD = 5.3) 4,11,22,23,24,25 . However, there was a marked inverse correlation with the EDSS, with a coefficient r of -0.54 (95%CI: -0.71 to -0.25), highly significant, p < 0.01 ( Figure 3A), and a coefficient R 2 of 0.29 (Table 2).…”

“…This test showed 73% of patients below the average of healthy controls (58.4 points; mean SD = 8.3) 4,8,13,22,23,24,25 . The coefficient r with the EDSS was negative, -0.40 (95%CI: -0.57 to -0.11), indicative of a moderate 26 correlation, with a p < 0.05 (Figure 2A), and the coefficient R 2 for this association was 0.16 ( Table 2).…”