Brief Cognitive Assessment based
on Consensus Standards in the US
and Abroad
Dawn Langdon PhD
MS care providers needs
• Most interested in receiving consultation on
cognition (31.0%)
• Most interested in CME relating to cognition
(40.1%)
• Highest preference for live conference
Turner et al., JRRD 2006;43:25-34
MS patients’ information needs
• All those questions recommended information
about cognition in MS for all patients
• And on average to be given earlier than they
had received it
Heesen et al., Acta Neurol Scand 2006;114:268-272
Assessment of Cognition
MSNQ
Screening tests
Routine in the office
BRB
SEFCI
Brief Batteries
Routine NP exam.
MACFIMS
Intermediate length Batteries
Differential diagnosis
Disability questions
Rehabilitation programs
Ad hoc
Comprehensive Batteries
4
Cognitive assessment for MS
• Requires specialist training
• Time-consuming
• Not routinely available outside specialist
centres
• Not comparable across countries
BICAMS
Brief International Cognitive Assessment for MS
• Identify a brief assessment tool for cognition in MS
– can be used by health care professionals who are not
cognitive specialists
– has international validation
• Specify an international validation protocol that can
be implemented in any country
• Agree guidelines on test-retest timing and clinically
significant change
BICAMS committee meetings and website are sponsored by Bayer Healthcare
6
BICAMS committee meetings and website are sponsored by Bayer Healthcare
BICAMS
Brief International Cognitive Assessment for MS
•
•
•
Identify a brief assessment tool for cognition in MS
80 key scientific articles identified
Each article rated by two committee members
– Psychometric standards
• Reliability
• Validity
• Sensitivity
– Pragmatic standards
• International applicability
• Ease of administration
• Feasibility in the specified context
• Acceptability to patients
BICAMS committee meetings and website are sponsored by Bayer Healthcare
8
BICAMS
Brief International Cognitive Assessment for MS
• No materials required beyond papers, pencil
and stopwatch
BICAMS committee meetings and website are sponsored by Bayer Healthcare
Benedict et al. Clin Neuropsychol 2002; 16: 381-97
Neuropsychological Evaluations
California Verbal Learning Test-II (CVLT II)
Truck
Spinach
Giraffe
Bookcase
Onion
Motorcycle
Cabinet
Zebra
Coach
Lamp
Celery
Cow
Desk
Boat
Squirrel
Cabbage
Benedict et al. Clin Neuropsychol 2002; 16: 381-97
11
Brief Visuospatial Memory Test
(Revised)
RHB Benedict (Clin Neuropsych 1994; Psychol Assess 1996;
Psychol Assess Resources 1997).
Benedict et al. Clin Neuropsychol 2002; 16: 381-97
12
BICAMS
Brief International Cognitive Assessment for MS
Battery:
SDMT
CVLT-II, first recall trials
BVMTR, first recall trials
BICAMS committee meetings and website are sponsored by Bayer Healthcare
13
MS patients compared to healthy
controls on BICAMS
Parmenter et al., JINS 2010;16:6-16
MS
(n=395)
Mean
SD
Controls
(n=100)
Mean
SD
P value
d’
Age
46.28
8.99
44.79
9.43
ns
0.16
Education
14.28
2.34
14.47
1.72
ns
0.09
BDI-FS
3.39
3.40
0.90
1.40
<.001
0.96
SDMT
49.53
13.20
61.40
9.31
<.001
1.04
CVLT-II TL
48.80
10.56
55.79
9.35
<.001
0.70
7.17
26.68
5.56
<.001
0.90
BVMTR TL 20.92
Raw score to scaled score conversion
Parmenter et al., JINS 2010;16:6-16
Scaled score
SDMT
CVLT-II (learning trials)
2
BVMTR (learning trials)
<13
3
<43
<32
13
4
43-35
32-35
14-15
5
46
36-43
16
6
47-50
44-46
17-19
7
51-54
47-48
20-22
8
55-56
49-51
23-24
9
57-59
52-53
25-26
10
60-63
54-57
27-28
11
64-66
58-60
29-30
12
67-69
61-63
31
13
70-72
64-66
32
14
73-74
67-70
33
15
75-78
71-73
34-35
16
79
74
17
80-87
18
>87
>74
36
BICAMS committee meetings and website are sponsored by Bayer Healthcare
BICAMS
Brief International Cognitive Assessment for MS
• Identify a brief assessment tool for cognition in
MS
– can be used by health care professionals who are not
cognitive specialists
– has international validation
• Specify an international validation protocol that
can be implemented in any country
BICAMS committee meetings and website are sponsored by Bayer Healthcare
17
BICAMS
Brief International Cognitive Assessment for MS
international validation protocol
• Step 1, Standardization and Translation of Test
Stimuli.
• Step 2, Standardization and Translation of Test
Instructions
• Step 3, Normalization
• Step 4, Test-Retest Reliability
• Step 5, Criterion-Related Validity
Benedict et al., BMC Neurology (submitted)
BICAMS committee meetings and website are sponsored by Bayer Healthcare
BICAMS
Brief International Cognitive Assessment for MS:
National
Country
NC n Validations
MS n Data
Data
Analysis Analysis
collection
started
collection
completed
started
completed
Publication
BICAMS
support
Argentina
TBD
TBD
Pending
Pending
Pending
Pending
Pending
RHB
Benedict
Czech
Repub
92
130
Mar 2010
Ongoing
Pending
Pending
Pending
RHB
Benedict
Iran
158
90
Mar 2010
Sep 2011
Oct 2011
Nov 2011
Submitted
RHB
Benedict
Argentina
TBD
TBD
Pending
Pending
Pending
Pending
Pending
RHB
Benedict
UK
60
60
Pending
Pending
Pending
Pending
Pending
DW
Langdon
Egypt
TBD
TBD
Pending
Pending
Pending
Pending
Pending
DW
Langdon
Estonia
TBD
TBD
Pending
Pending
Pending
Pending
Pending
Italy
TBD
TBD
Pending
Pending
Pending
Pending
Pending
DW
Langdon
MP
Amato
19
BICAMS
Brief International Cognitive Assessment for MS
• Identify a brief assessment tool for cognition in MS
– can be used by health care professionals who are not
cognitive specialists
– has international validation
• Specify an international validation protocol that can
be implemented in any country
• Agree guidelines on test-retest timing and clinically
significant change
BICAMS committee meetings and website are sponsored by Bayer Healthcare
20
Assessment of Cognition
Routine in the office
Routine in the clinic
Screening tests
0 mins
BICAMS
15 mins
Brief Batteries
Batteries
Brief
45 mins
Routine NP exam
Intermediate length Batteries
Differential diagnosis
Disability questions
Rehabilitation programs
Comprehensive Batteries
90 mins
120 mins
21