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

Comprehensive BatteriesComprehensive Batteries

Intermediate length BatteriesIntermediate length Batteries

Brief BatteriesBrief Batteries

Screening testsScreening tests

MSNQ

BRBSEFCI

MACFIMS

Ad hoc

Routine in the office

Routine NP exam.

Differential diagnosisDisability questionsRehabilitation programs

4

Cognitive assessment for MS

• Requires specialist training• Time-consuming• Not routinely available outside specialist

centres• Not comparable across countries

BICAMSBrief 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

6

BICAMS committee meetings and website are sponsored by Bayer Healthcare

BICAMS committee meetings and website are sponsored by Bayer Healthcare

BICAMSBrief 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

8

BICAMS committee meetings and website are sponsored by Bayer Healthcare

BICAMSBrief 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

11

Neuropsychological EvaluationsCalifornia Verbal Learning Test-II (CVLT II)

Truck SpinachGiraffe

BookcaseOnion

MotorcycleCabinetZebraCoachLampCeleryCowDeskBoat

SquirrelCabbage

Benedict et al. Clin Neuropsychol 2002; 16: 381-97

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

BICAMSBrief International Cognitive Assessment for MS

Battery:SDMT

CVLT-II, first recall trialsBVMTR, first recall trials

13BICAMS committee meetings and website are sponsored by Bayer Healthcare

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 1.04CVLT-II TL 48.80 10.56 55.79 9.35 <.001 0.70BVMTR TL 20.92 7.17 26.68 5.56 <.001 0.90

Scaled score SDMT CVLT-II (learning trials) BVMTR (learning trials)2 <133 <43 <32 134 43-35 32-35 14-155 46 36-43 166 47-50 44-46 17-197 51-54 47-48 20-228 55-56 49-51 23-249 57-59 52-53 25-2610 60-63 54-57 27-2811 64-66 58-60 29-3012 67-69 61-63 3113 70-72 64-66 32

14 73-74 67-70 3315 75-78 71-73 34-3516 79 7417 80-8718 >87 >74 36

BICAMS committee meetings and website are sponsored by Bayer Healthcare

BICAMSBrief 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

17

BICAMS committee meetings and website are sponsored by Bayer Healthcare

BICAMSBrief 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

BICAMSBrief International Cognitive Assessment for MS:National Validations

Country NC n MS n Data collection started

Data collection completed

Analysis started

Analysis completed

Publi-cation

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 D W Langdon

Estonia TBD TBD Pending Pending Pending Pending Pending DW Langdon

Italy TBD TBD Pending Pending Pending Pending Pending MPAmato

19

BICAMSBrief 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

20

BICAMS committee meetings and website are sponsored by Bayer Healthcare

Assessment of Cognition

Comprehensive BatteriesComprehensive Batteries

Intermediate length BatteriesIntermediate length Batteries

Brief BatteriesBrief Batteries

Screening testsScreening testsScreening testsScreening tests

Brief BatteriesBrief Batteries

Routine in the office

Routine NP exam

Differential diagnosisDisability questionsRehabilitation programs

21

BICAMSBICAMSRoutine in the clinic

0 mins

15 mins

45 mins

90 mins

120 mins