Abstract
The German socio-demographic estimation scale was developed by Jahn et al. (1) to quickly predict premorbid global cognitive functioning in patients. So far, it has been validated in healthy adults and has shown a good correlation with the full and verbal IQ of the Wechsler Adult Intelligence Scale (WAIS) in this group. However, there are no data regarding its use as a bedside test in epilepsy patients. Forty native German speaking adult patients with refractory epilepsy were included. They completed a neuropsychological assessment, including a nine scale short form of the German version of the WAIS-III and the German socio-demographic estimation scale by Jahn et al. (1) during their presurgical diagnostic stay in our center. We calculated means, correlations, and the rate of concordance (range ±5 and ±7.5 IQ score points) between these two measures for the whole group, and a subsample of 19 patients with a global cognitive functioning level within 1 SD of the mean (IQ score range 85-115) and who had completed their formal education before epilepsy onset. The German demographic estimation scale by Jahn et al. (1) showed a significant mean overestimation of the global cognitive functioning level of eight points in the epilepsy patient sample compared with the short form WAIS-III score. The accuracy within a range of ±5 or ±7.5 IQ score points for each patient was similar to that of the healthy controls reported by Jahn et al. (1) in our subsample, but not in our whole sample. Our results show that the socio-demographic scale by Jahn et al. (1) is not sufficiently reliable as an estimation tool of global cognitive functioning in epilepsy patients. It can be used to estimate global cognitive functioning in a subset of patients with a normal global cognitive functioning level who have completed their formal education before epilepsy onset, but it does not reliably predict global cognitive functioning in epilepsy patients in general, who often do not fulfill these criteria. It is therefore not a useful tool to be applied in the general neuropsychological presurgical evaluation of epilepsy patients.
Highlights
The precise assessment of individual cognitive resources and deficits is important for the comprehensive care of epilepsy patients, especially when epilepsy surgery is a feasible therapeutic approach
As the socio-demographic estimation scale tends to represent the premorbid global cognitive functioning within the normal range and uses mainly educational items, we examined a subsample of 19 patients, who fulfilled the following two criteria: first, global cognitive functioning scores of the Wechsler Adult Intelligence Scale (WAIS)-III short form were within 1 SD of the distribution (IQ score = 85 ≤ X ≥ 115) and, second, the onset of epilepsy occurred after completion of the patients’ formal education
The mean socio-demographic estimation score was significantly higher than the mean WAIS-III short form score (Figure 1)
Summary
The precise assessment of individual cognitive resources and deficits is important for the comprehensive care of epilepsy patients, especially when epilepsy surgery is a feasible therapeutic approach. A different and even less time consuming approach is to estimate the level of global cognitive functioning by means of socio-demographic variables, such as educational attainment and occupational status (7). Studies with healthy controls showed good estimation rates for individuals whose global cognitive functioning level is within 1 SD of the mean (mean IQ range 85–115) (8). These scales may be useful to estimate premorbid cognitive functioning in patients (9, 10). These socio-demographic instruments are subject to cultural limitations and may only be applicable in the country in which they have been developed. The usefulness of this scale has not been investigated in patients with epilepsy
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