Meghan Beier1, Elizabeth S Gromisch2, Abbey J Hughes3, Kevin N Alschuler4, Renee Madathil5, Nancy Chiaravalloti6, Frederick W Foley7. 1. Johns Hopkins University School of Medicine, Department of Physical Medicine and Rehabilitation, Suite 413, Church Professional Building, 98 North Broadway, Baltimore, MD 21231, USA. Electronic address: mbeier1@jhu.edu. 2. Mandell Center for MS, Mount Sinai Rehabilitation Hospital, 490 Blue Hills Avenue, Hartford, CT 06112, USA. Electronic address: elizabeth.gromisch@stfranciscare.org. 3. Johns Hopkins University School of Medicine, Department of Physical Medicine and Rehabilitation, Suite 413, Church Professional Building, 98 North Broadway, Baltimore, MD 21231, USA. Electronic address: abbeyjhughes@jhmi.edu. 4. UW Medicine Multiple Sclerosis Center, Box 358815, Department of Rehabilitation Medicine, University of Washington School of Medicine, 1536 N 115th St, Seattle, WA 98133, USA. Electronic address: kalschul@uw.edu. 5. University of Rochester Medical Center, School of Medicine and Dentistry, Department of Physical Medicine & Rehabilitation, 601 Elmwood Ave, Box 664, Rochester, NY, USA. 6. Rutgers New Jersey Medical School, Department of Physical Medicine and Rehabilitation, USA; Rutgers New Jersey Medical School, Department of Neurosciences, USA; Kessler Foundation Research Center, Neuropsychology and Neuroscience Laboratory, Kessler Foundation, 300 Executive Drive, Suite 70, West Orange, NJ 07052, USA. Electronic address: nchiaravalloti@kesslerfoundation.org. 7. Yeshiva University, Ferkauf Graduate School of Psychology, 1300 Morris Park Ave., Bronx, NY 10468, USA; Holy Name Medical Center Multiple Sclerosis Center, 718 Teaneck Rd., Teaneck, NJ 07666, USA. Electronic address: ffoley1@aol.com.
Abstract
OBJECTIVE: Cognitive impairment (CI) is common in multiple sclerosis (MS). An international consensus committee developed the Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) to screen for CI commonly seen in MS. BICAMS cut scores would allow clinicians to, efficiently and effectively, identify patients with possible CI and could aid in clinical decision-making. The aim of this study was to establish cut scores for the neuropsychological tests of the BICAMS. METHODS: This study utilized data collected from MS Centers in the United States. ROC curve analysis identified cut scores yielding the best balance of sensitivity and specificity. We tested two definitions of impairment: 1.5 and 2 standard deviations (SD) below the normative mean. RESULTS: All cut scores yielded excellent or good sensitivity and specificity for identifying impaired cognitive performance. The following cut scores yielded the best balance between sensitivity and specificity: On the Symbol Digit Modalities Test, 44 for 1.5 SD below the mean and 38 for 2 SD below the mean; on the California Verbal Learning Test - II learning trials, 39 (1.5 SD) and 35 (2 SD); and on the Brief Visuospatial Memory Test-Revised learning trials, 17 (1.5 SD) and 16 (2 SD). CONCLUSIONS: Cut scores can accurately identify cognitive impairment on all subtests of the BICAMS. Use of cut scores may improve the efficiency of screening for cognitive impairment by reducing administrative burden and simplifying interpretation.
OBJECTIVE:Cognitive impairment (CI) is common in multiple sclerosis (MS). An international consensus committee developed the Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) to screen for CI commonly seen in MS. BICAMS cut scores would allow clinicians to, efficiently and effectively, identify patients with possible CI and could aid in clinical decision-making. The aim of this study was to establish cut scores for the neuropsychological tests of the BICAMS. METHODS: This study utilized data collected from MS Centers in the United States. ROC curve analysis identified cut scores yielding the best balance of sensitivity and specificity. We tested two definitions of impairment: 1.5 and 2 standard deviations (SD) below the normative mean. RESULTS: All cut scores yielded excellent or good sensitivity and specificity for identifying impaired cognitive performance. The following cut scores yielded the best balance between sensitivity and specificity: On the Symbol Digit Modalities Test, 44 for 1.5 SD below the mean and 38 for 2 SD below the mean; on the California Verbal Learning Test - II learning trials, 39 (1.5 SD) and 35 (2 SD); and on the Brief Visuospatial Memory Test-Revised learning trials, 17 (1.5 SD) and 16 (2 SD). CONCLUSIONS: Cut scores can accurately identify cognitive impairment on all subtests of the BICAMS. Use of cut scores may improve the efficiency of screening for cognitive impairment by reducing administrative burden and simplifying interpretation.
Authors: Sara Salama; Hazem Marouf; M Ihab Reda; Amal R Mansour; Osama ELKholy; Michael Levy Journal: Clin Neurol Neurosurg Date: 2019-11-25 Impact factor: 1.876