Artemios Artemiadis1, Christos Bakirtzis2, Andreas Chatzittofis3, Constantinos Christodoulides4, George Nikolaou5, Marina Kleopatra Boziki6, Nikolaos Grigoriadis7. 1. Medical School, University of Cyprus, Old Road Nikosia-Limmasol 215/6, 2029 Aglantzia, Nicosia, Cyprus; Department of Neurology, Army Share Fund Hospital (NIMTS), Monis Petraki 10, 11521, Athens, Greece. Electronic address: artemiadis.artemios@ucy.ac.cy. 2. Multiple Sclerosis Center, B' Department of Neurology, Aristotle University of Thessaloniki, Kiriakidi 1, 54621, Thessaloniki, Greece. Electronic address: bakirtzischristos@yahoo.gr. 3. Medical School, University of Cyprus, Old Road Nikosia-Limmasol 215/6, 2029 Aglantzia, Nicosia, Cyprus. Electronic address: chatzittofis.andreas@ucy.ac.cy. 4. Center for Applied Neuroscience, University of Cyprus, Nicosia, Kallipoleos 75, 1678, Cyprus. Electronic address: constantinos.christodoulides@ucy.ac.cy. 5. Department of Neurology, Army Share Fund Hospital (NIMTS), Monis Petraki 10, 11521, Athens, Greece. Electronic address: gnik1978@yahoo.gr. 6. Multiple Sclerosis Center, B' Department of Neurology, Aristotle University of Thessaloniki, Kiriakidi 1, 54621, Thessaloniki, Greece. Electronic address: bozikim@auth.gr. 7. Multiple Sclerosis Center, B' Department of Neurology, Aristotle University of Thessaloniki, Kiriakidi 1, 54621, Thessaloniki, Greece. Electronic address: grigoria@med.auth.gr.
Abstract
BACKGROUND: Cognitive impairment (CI) affects 35-65% of multiple sclerosis (MS) patients. The Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) has been proposed as a highly feasible and cost-effective tool for cognitive impairment (CI) screening in MS. The tool yields scores that should, ideally, readily convey patients' cognitive status to the clinicians. METHODS: To this aim, this study sought for cut-off scores of the three BICAMS test in a sample of 960 MS patients. We used three definitions for CI: 1.5, 1,65 and 2 standard deviations below the mean. Receiver operating characteristic (ROC) statistics helped us determine the capacity of BICAMS to diagnose CI. Optimal cut-offs were determined by the delta distance. Positive and negative predictive values, along with overall accuracy were also calculated. RESULTS: Symbol Digit Modalities Test (SDMT) and California Verbal Learning Test-II (CVLT-II) showed a diagnostic accuracy ranging from 74.6 to 77.4%, across the three CI definitions. The accuracy of Brief Visuospatial Memory Test-Revised (BVMT-R) was over 88%. SDMT had a balanced sensitivity, while CVLT-II and BVMT-R had higher specificities than sensitivities at detecting CI. More specifically, BVMT-R showed 100% specificity for all CI definitions. Raw cut-off scores for BICAMS tests are also provided within the manuscript, along with the diagnostic calculations. CONCLUSIONS: In this study, we confirmed that BICAMS is a good screening tool for CI and that simple cut-offs can be used in the everyday neurological practice.
BACKGROUND:Cognitive impairment (CI) affects 35-65% of multiple sclerosis (MS) patients. The Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) has been proposed as a highly feasible and cost-effective tool for cognitive impairment (CI) screening in MS. The tool yields scores that should, ideally, readily convey patients' cognitive status to the clinicians. METHODS: To this aim, this study sought for cut-off scores of the three BICAMS test in a sample of 960 MS patients. We used three definitions for CI: 1.5, 1,65 and 2 standard deviations below the mean. Receiver operating characteristic (ROC) statistics helped us determine the capacity of BICAMS to diagnose CI. Optimal cut-offs were determined by the delta distance. Positive and negative predictive values, along with overall accuracy were also calculated. RESULTS: Symbol Digit Modalities Test (SDMT) and California Verbal Learning Test-II (CVLT-II) showed a diagnostic accuracy ranging from 74.6 to 77.4%, across the three CI definitions. The accuracy of Brief Visuospatial Memory Test-Revised (BVMT-R) was over 88%. SDMT had a balanced sensitivity, while CVLT-II and BVMT-R had higher specificities than sensitivities at detecting CI. More specifically, BVMT-R showed 100% specificity for all CI definitions. Raw cut-off scores for BICAMS tests are also provided within the manuscript, along with the diagnostic calculations. CONCLUSIONS: In this study, we confirmed that BICAMS is a good screening tool for CI and that simple cut-offs can be used in the everyday neurological practice.
Authors: K H Lam; P van Oirschot; B den Teuling; H E Hulst; B A de Jong; Bmj Uitdehaag; V de Groot; J Killestein Journal: Mult Scler Date: 2021-05-26 Impact factor: 6.312