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Brief Cognitive Assessment Tool in MS Good for Everyday Use


The Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) is an effective tool in everyday clinical practice for the identification of cognitive impairment (CI) in patients with MS, an Italian study has confirmed.

The study also highlighted the good psychometric properties of the symbol digit modalities test (SDMT), Maria P. Amato, MD, of the University of Florence, Italy, and colleagues reported online in BMC Neurology.

"It seems important to stress that, in optimal clinical conditions, where a neuropsychologist can take care of the cognitive assessment, it is preferable to achieve a more thorough cognitive evaluation using tools including neuropsychological tests that investigate several cognitive domains impaired in MS," said the investigators. "The implementation of BICAMS is still in its infancy," they noted.

The study showed that when BICAMS was compared with other commonly used neuropsychological batteries used in MS, such as the Brief Repeatable Battery (BRB), neither BICAMS nor BRB were equivalent to SDMT in the assessment of CI in MS. This is in keeping with the recent literature, pointed out the investigators.

"On the basis of our results, the agreement between the BICAMS and the BRB is fair to moderate and mainly dependent on the inclusion of the SDMT, which is the only common test between the two batteries," they reported. "We can hypothesize that the BICAMS and the BRB cannot be considered as equivalent in the assessment of CI in MS."

The study showed that the BRB provides a more comprehensive cognitive profile, including wider assessment than the BICAMS, said the investigators. "Therefore, we can consider the BRB a brief neuropsychological battery more complete than the BICAMS and more suitable to identify change over time, they concluded.

On the other hand, in settings where resources are scare, the BICAMS represents a valid alternative to a more comprehensive test, said Amato and colleagues. They added that since cognitive evaluations in their study were performed by neuropsychologists, further analyses are needed to confirm the external validity of their findings.

While the BRB remains the most commonly used instrument to assess cognitive dysfunction in MS and has good psychometric properties, it is not suited to everyday clinical practice, noted the investigators. Among other considerations, it takes 45 minutes to administer and results require expert interpretation. "There has been considerable effort over the past decade to streamline the neuropsychological assessment in MS by developing brief assessment tools that can be incorporated into everyday patient assessment," wrote Amato and colleagues.

The BICAMS, developed as an CI assessment tool that can be used routinely, has been recommended as an international, validated, and standardized brief cognitive test, noted the investigators.

It can be performed in 15 minutes using a pen, paper, and stopwatch by healthcare professionals without cognitive expertise. BICAMS has recently been validated in populations in the U.S., Czechoslovakia, Iran, and Italy.

Until now, little was known about BICAMS performance in comparison with other neuropsychological tests. In the study, a total of 192 MS patients (142 women; 50 men) were recruited from consecutive admissions to 11 major Italian MS centers. All participants had a diagnosis of relapsing-remitting (RR) MS. Mean age was 41.4 ± 10.8 years. All patients received both the BRB and the BICAMS.

Cognitive impairment, which affects 40%-60% of patients with MS, 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, said the investigators, who added that they calculated the sizes of effects for each test of the two batteries using Cohen's d (the difference between means divided by pooled SD).

Results showed that patients' mean scores in all cognitive measures examined were lower than those of healthy subjects, a finding in accordance with the typical cognitive profile in MS patients, noted the investigators.

Story Source: The above story is based on materials provided by MEDPAGETODAY
Note: Materials may be edited for content and length


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