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The Brief International Cognitive Assessment in Multiple Sclerosis (BICAMS): results from the German validation study

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Abstract

Background

Recent research has convincingly shown that the ability to work mainly depends on the cognitive status in multiple sclerosis (MS). An international committee of experts recommended a brief neuropsychological battery to evaluate cognitive performance in MS. BICAMS comprises three tests, the Symbol Digit Modalities Test (SDMT), the learning trials of the California Verbal Learning Test II (CVLT-II), and the Brief Visuospatial Memory Test-Revised (BVMT-R).

Objective

To validate BICAMS on a sample of German MS patients and healthy controls (HCs).

Methods

According to the international guidelines for validation, examiner’s instructions were standardized and translated into German. Due to the availability of better normative data for future applications in routine clinical care and classification of individual performance degree, the Rey Auditory Verbal Learning Test (RAVLT) (German version: Verbaler Lern- und Merkfähigkeits-Test, VLMT) was chosen instead of CVLT-II. 172 MS patients and 100 HCs entered the study. BICAMS was administered at baseline and retest (after 3–4 weeks).

Results

The groups did not differ in age, gender or education. Mean age of MS patients was 43.33 years (SD 11.64); 68% were female and 86.9% had relapsing-remitting MS. Patients performed significantly worse than HCs on the SDMT (p < 0.01) and on BVMT-R (p < 0.05) but not on VLMT. In addition, BICAMS was shown to be reliable over time: r = 0.71 for BVMT-R, r = 0.72 for VLMT and r = 0.85 for SDMT. SDMT z-score proved to be a good predictor for the ability to work in a full-time (p < 0.001) as well as in a part-time job (p < 0.001). VLMT z-score turned out to be a significant predictor only for the ability to work in a part-time job, while BVMT-R z-score showed no significant predictive value.

Conclusion

In this German validation study with the VLMT, the modified BICAMS (BICAMS-M) turned out to reliably detect cognitive problems in MS patients and to monitor cognitive performance over time. SDMT revealed the best predictive value for working ability. Moreover, only the SDMT was able to predict the ability to work in a part-time or full-time job. Following these results, application of the SDMT is recommended for medical statements on working ability of MS patients.

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Abbreviations

BICAMS:

Brief International Cognitive Assessment in Multiple Sclerosis

BICAMS-M:

Modified Brief International Cognitive Assessment in Multiple Sclerosis

BL:

Baseline

BRB-N:

Brief Repeatable Battery of Neuropsychological tests

BVMT-R:

Brief Visual Memory Test Revised

CVLT-II:

California Verbal Learning Test II

EDSS:

Expanded Disability Status Scale

HCs:

Healthy controls

LÄK:

Landesärztekammer

MACFIMS:

Minimal Assessment of Cognitive Function in Multiple Sclerosis

MS:

Multiple sclerosis

N :

Population size

p :

Probability of an event or outcome in a statistical experiment

PPMS:

Primary progressive multiple sclerosis

r :

Pearson’s r, correlation coefficient

RAVLT:

Rey Auditory Verbal Learning Test

RRMS:

Relapsing-remitting multiple sclerosis

RT:

Retest

SD:

Standard deviations

SDMT:

Symbol Digit Modalities Test

SPMS:

Secondary progressive multiple sclerosis

SPSS:

Statistical Package for the Social Sciences

VLMT:

Verbaler Lern- und Merkfähigkeitstest

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Funding

Michael Lang received a research Grant from Merck for this study (at 4 December 2013). Reference number: 4501354695.

Author information

Authors and Affiliations

  1. Cogito Center for Applied Neurocognition and Neuropsychological Research, Düsseldorf, Germany

    M. Filser & I. K. Penner

  2. Neurological Practice and Neuropoint Academy, Ulm, Germany

    H. Schreiber & M. Lang

  3. Institut für Neuroimmunologie und Multiple Sklerose, Universitätsklinikum Hamburg-Eppendorf, Hamburg, Germany

    J. Pöttgen

  4. .05 Statistikberatung, Düsseldorf, Germany

    S. Ullrich

  5. Department of Neurology, Medical Faculty, Heinrich Heine University Düsseldorf, Düsseldorf, Germany

    I. K. Penner

Authors
  1. M. Filser
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  2. H. Schreiber
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Contributions

MF: statistical data analysis, data interpretation, manuscript preparation. HS: Co-PI of study, study conceptualization, data collection, data interpretation, manuscript preparation. JP: data collection, data interpretation, manuscript preparation. SU: support of statistical analysis, data interpretation, review of manuscript. ML: data collection, study coordination. IKP: PI of study, study conceptualization, data collection, data interpretation, manuscript preparation.

Corresponding author

Correspondence to I. K. Penner.

Ethics declarations

Ethics approval and consent to participate

The study was performed in accordance with the Declaration of Helsinki. It was approved in October 2014 by the ethical committee of the University of Hamburg, committee’s reference number is PV4770, and in June 2014 by the Landesärztekammer (LÄK) Baden-Württemberg, Stuttgart, committee’s reference number is F-2014-048. All participants were informed of the full details of the study and to give their confirmation to participate.

Consent for publication

Not applicable. There are no details, images, or videos relating to an individual person included in this manuscript.

Availability of data and materials

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

Conflicts of interest

MF has nothing to disclose. HS has received travel Grants and honoraria for speaking at scientific meetings, participating in scientific advisory boards and consulting activities from Almirall, Bayer Healthcare, Biogen GmbH, Genzyme, Merck, Novartis and Teva. JP has received travel cost compensation from Bayer Pharma and honoria for speaking at scientific meetings from Novartis Pharma GmbH. SU has nothing to disclose. ML has received travel Grants, speaker’s honoraria, financial research support, consultancy fees from Teva, Merck Serono, Genzyme -Sanofi, Novartis, Bayer, Biogen. IKP has received honoraria for speaking at scientific meetings, serving at scientific advisory boards and consulting activities from Adamas Pharma, Almiral, Bayer Pharma, Biogen GmbH, Desitin, Genzyme, Merck Serono, Novartis Pharma GmbH, Roche and Teva.

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Filser, M., Schreiber, H., Pöttgen, J. et al. The Brief International Cognitive Assessment in Multiple Sclerosis (BICAMS): results from the German validation study. J Neurol 265, 2587–2593 (2018). https://doi.org/10.1007/s00415-018-9034-1

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  • DOI: https://doi.org/10.1007/s00415-018-9034-1

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