title: A preliminary validation of the brief international cognitive assessment for multiple sclerosis (BICAMS) tool in an Irish population with multiple sclerosis (MS).
abstract: BACKGROUND
  Cognitive impairment is common in multiple sclerosis (MS) irrespective of disease stage or subtype. It is typically underreported and neuropsychological testing can be required to detect more subtle evidence of cognitive impairment. The Brief International Cognitive Assessment in Multiple Sclerosis (BICAMS) was an initiative undertaken by a panel of experts with the primary objective of identifying a brief cognitive assessment tool that could be administered by healthcare professionals without formal neuropsychological training to identify early or subtle cognitive impairment among MS patients.
  
  
  OBJECTIVE
  To validate BICAMS in Irish patients with MS and healthy controls.
  
  
  METHODS
  Consecutive patients attending the MS outpatient department from January to April 2014 were recruited. Age, gender, education, handedness, MS subtype, expanded disability status scale (EDSS) and disease duration were recorded. They were administered BICAMS composed of Symbol Digit Modalities Test (SDMT), California Verbal Learning Test (CVLT-II) and Brief Visuospatial Memory Test (BVMT-R). Depression and anxiety were assessed using the Hospital Anxiety and Depression Scale (HADS). Control participants were composed of unaffected relatives, spouses or carers attending the clinic with a patient and were matched by age, gender and years of education. Impairment on individual tests was defined as -1.5 SD below reference group means.
  
  
  RESULTS
  67 patients [73% women; mean age: 43.9 yrs (12.1); mean years of education: 13.6 yrs (2.7)] and 66 controls [68% women; mean age 42.7 yrs (12.7); mean years of education: 14.1 yrs (3.2)] were recruited. Of the MS patient group: 70% were classified as having relapsing remitting MS, 28% secondary progressive MS and 2% primary progressive MS (PPMS). Mean EDSS scores were 1.8 (SD: 0.9), 5.7 (SD: 1.4) and 7.0 in each group respectively with mean disease duration of 10.2 (SD: 8.4) years, 20.6 (10.2) and 17 years. Mean scores and standard deviations for patients and control participants respectively were 46 (12.9) and 55.9 (10.9), p < 0.001; d = 0.83 for SDMT; 45.3 (10.2) and 52.8 (8.8), p < 0.001; d = 0.79 for CVLT-II and 17.9 (7.1) and 20.7 (6.6), p = 0.02; d = 0.41 for BVMT-R. Using regression based norms derived from the control sample only 43% of patients compared to 83% of control participants' results were within the normal range on all three tests. As expected higher rates of unemployment was seen amongst the patient population compared to control participants. Using the HADS 11 patients were classified as depressed and 13 as suffering from anxiety. Neither, these measures or the level of fatigue as measured by the MFIS was significantly associated with any of the three outcome measures (Pearson r < ± 0.3).
  
  
  CONCLUSIONS
  This study demonstrates that BICAMS is an easy test to administer and should be used as a basic tool to identify patients with cognitive impairment who may benefit from further neuropsychological assessment. Cognitive impairment can put patients at risk of poor self-management of disease including poor mediation adherence, and negatively impact on employment. Once identified appropriate support and monitoring can be put in place. BICAMS may also be used to help guide treatment decisions and rehabilitation. Further studies will be needed to assess its reliability over time and ability to detect meaningful changes.
authors.affiliation: Department of Neurology, St. Vincent's University Hospital, Dublin 4, Ireland; School of Medicine and Medical Sciences, University College Dublin, Ireland. Electronic address: k.oconnell@svuh.ie.
authors.forename: K
authors.initials: K
authors.lastname: O'Connell
authors.affiliation: Department of Psychology, Royal Holloway, University of London, Surrey, UK.
authors.forename: D
authors.initials: D
authors.lastname: Langdon
authors.affiliation: Department of Neurology, St. Vincent's University Hospital, Dublin 4, Ireland; School of Medicine and Medical Sciences, University College Dublin, Ireland.
authors.forename: N
authors.initials: N
authors.lastname: Tubridy
authors.affiliation: Department of Neurology, St. Vincent's University Hospital, Dublin 4, Ireland; School of Medicine and Medical Sciences, University College Dublin, Ireland.
authors.forename: M
authors.initials: M
authors.lastname: Hutchinson
authors.affiliation: Department of Neurology, St. Vincent's University Hospital, Dublin 4, Ireland; School of Medicine and Medical Sciences, University College Dublin, Ireland.
authors.forename: C
authors.initials: C
authors.lastname: McGuigan
mesh_terms: D000328:Adult; D003071:Cognition; D003072:Cognition Disorders / Q000150:complications* / Q000175:diagnosis*; D005260:Female; D006801:Humans; D007494:Ireland; D008297:Male; D009103:Multiple Sclerosis / Q000150:complications* / Q000175:diagnosis* / Q000523:psychology; D009483:Neuropsychological Tests; D012044:Regression Analysis
keywords: Brief International Cognitive Assessment in MS (BICAMS); Cognition; Cognitive impairment; Multiple sclerosis; Neuropsychological assessment