Standardized Screening Tools Research Articles

Validation of the UK English Oxford cognitive screen-plus in sub-acute and chronic stroke survivors.

Stroke survivors are routinely screened for cognitive impairment with tools that often fail to detect subtle impairments. The Oxford Cognitive Screen-Plus (OCS-Plus) is a brief tablet-based screen designed to detect subtle post-stroke cognitive impairments. We examined its psychometric properties in two UK English-speaking stroke cohorts (subacute: <3 months post-stroke, chronic: >6 months post-stroke) cross-sectionally. This study included 347 stroke survivors (mean age = 73 years; mean education = 13 years; 43.06% female; 74.42% ischaemic stroke). The OCS-Plus was completed by 181 sub-acute stroke survivors and 166 chronic stroke survivors. All participants also completed the Oxford Cognitive Screen (OCS) and a subset completed the Montreal Cognitive Assessment (MoCA) and further neuropsychological tests. First, convergent construct validity of OCS-Plus tasks to task-matched standardized neuropsychological tests was confirmed (r > 0.30). Second, we evaluated divergent construct validity of all OCS-Plus subtasks (r < 0.19). Third, we report the sensitivity and specificity of each OCS-Plus subtask compared to neuropsychological test performance. Fourth, we found that OCS-Plus detected cognitive impairments in a large proportion of those classed as unimpaired on MoCA (100%) and OCS (98.50%). The OCS-Plus provides a valid screening tool for sensitive detection of subtle cognitive impairment in stroke patients. Indeed, the OCS-Plus detected subtle cognitive impairment at a similar level to validated neuropsychological assessments and exceeded detection of cognitive impairment compared to standard clinical screening tools.

Recognition of Unhealthy Alcohol Use in Older Adults

The older adult population is at risk for adverse consequences of unhealthy alcohol use. Unhealthy alcohol use describes several alcohol-related behaviors, such as harmful alcohol use, abuse, or dependence. Unfortunately, this population is less likely to be screened or assessed for unhealthy alcohol use, and standard screening tools may not address the unique issues associated with aging. Primary, secondary, and tertiary prevention actions help bring awareness to this patient population, assess for unhealthy alcohol use, and provide age-appropriate interventions.

Addressing Methamphetamine Use in Primary Care: Provider Perspectives.

The opioid epidemic has evolved into a combined stimulant epidemic, with escalating stimulant and fentanyl-related overdose deaths. Primary care providers are on the frontlines grappling with patients' methamphetamine use. Although effective models exist for treating opioid use disorder in primary care, little is known about current clinical practices for methamphetamine use. Six semistructured group interviews were conducted with 38 primary care providers. Interviews focused on provider perceptions of patients with methamphetamine use problems and their care. Data were analyzed using inductive and thematic analysis and summarized along the following dimensions: (1) problem identification, (2) clinical management, (3) barriers and facilitators to care, and (4) perceived needs to improve services. Primary care providers varied in their approach to identifying and treating patient methamphetamine use. Unlike opioid use disorders, providers reported lacking standardized screening measures and evidence-based treatments, particularly medications, to address methamphetamine use. They seek more standardized screening tools, Food and Drug Administration-approved medications, reliable connections to addiction medicine specialists, and more training. Interest in novel behavioral health interventions suitable for primary care settings was also noteworthy. The findings from this qualitative analysis revealed that primary care providers are using a wide range of tools to screen and treat methamphetamine use, but with little perceived effectiveness. Primary care faces multiple challenges in effectively addressing methamphetamine use among patients singularly or comorbid with opioid use disorders, including the lack of Food and Drug Administration-approved medications, limited patient retention, referral opportunities, funding, and training for methamphetamine use. Focusing on patients' medical issues using a harm reduction, motivational interviewing approach, and linkage with addiction medicine specialists may be the most reasonable options to support primary care in compassionately and effectively managing patients who use methamphetamines.

Findings from the implementation of a novel needs assessment survey in children and youth with epilepsy; The impact of social determinants of health on utilization of medical services

ObjectiveThis study aimed to characterize the relationship between social determinants of health (SDOH) and epilepsy-specific outcomes. MethodsThis was an observational, cross-sectional, quality improvement study. We developed a novel screening survey (The Epilepsy Needs Assessment Survey), which was administered to patients with epilepsy at a large urban hospital. We assessed the prevalence of various SDOH and the association with independence in activities of daily living, verbal status, prevalence of intractable epilepsy, missed school/work days, missed neurology appointments and emergency department visits related to seizure. ResultsForty-nine percent of participants reported at least one insecurity. While disease burden did not appear to differ significantly between families with and without hardships, families who reported any hardship had almost twice the percentage of missed neurology appointments and were significantly more likely to have an ED visit related to seizure (RR = 5.44, CI 2.82–10.48). SignificanceSeveral studies have suggested that social determinants of health (SDOH) impact various patient health outcomes such as developmental concerns, functional limitations and higher healthcare utilization. The majority of studies have been performed in general pediatric clinics and the impact of SDOH on patients with complex medical conditions in subspecialty clinics has not been well documented. This is one of the first studies to assess the effects of SDOH on patient-centered, epilepsy specific outcomes using a low cost, novel standardized screening tool.

The Development and Evaluation of the Nutritional Risk Screening Tool for Preterm Infants from Birth to Corrected Age Four Months Old: A Pilot Study

Introduction: Premature infants are exceptionally vulnerable to nutrition-related diseases, and the utilization of standardized feeding guidelines may reduce nutritional practice variation, which can promote growth. Nutritional risk screening is the first step for standardized nutrition advice. However, risk screening tools specific for following up preterm infants are scarce. Hence, our study aimed to develop and evaluate a standardized Nutritional Risk Screening Tool for Preterm Infants (NRSP subscale 1) from birth to corrected age four months old . Methods: This study was a two-phase (the development phase and evaluation phase) study. Initially, we used the Delphi expert consultation method to create NRSP subscale 1. Then, a professional panel interviewed the participated preterm infants using the screening tool, measured anthropometric parameters, and conducted an intellectual development test on the interview day and remeasured anthropometric parameters 2 weeks or 1 month after the first interview. In the development phase, we cross-tabulated the responses to the screening tool with the classifications of z-scores of the body weight, length, or head circumference to identify significant predictors of underweight, stunting, or microcephaly. We then combined significant predictors to produce models for predicting underweight, stunting, or microcephaly by multivariate logistic regression analysis. In the evaluation phase, the area under the curve (AUC), sensitivity, specificity, and correlation coefficient by Spearman’s correlation analysis (r_s) between the risk classifications by NRSP subscale 1 and the classifications of the z-scores of the body weight, length, or head circumference were calculated to assess the validity of the screening tool. Intellectual development levels between high and low nutritional risk infants were statistically compared. Results: A total of 219 and 244 preterm infants were included to two phases, respectively. AUC was 0.936 (95% CI: 0.860–1.000, p < 0.001), sensitivity was 0.667, specificity was 0.941, r_s = 0.407 (p < 0.001); AUC was 0.794 (95% CI: 0.638–0.951, p = 0.002), sensitivity was 0.500, specificity was 0.953, r_s = 0.339 (p < 0.001); AUC was 0.831 (95% CI: 0.737–0.925, p = 0.001), sensitivity was 0.889, specificity was 0.643, r_s = 0.215 (p = 0.001) in predicting underweight, stunting, and microcephaly on the interview day, respectively. AUC was 0.905 (95% CI: 0.826–0.984, p = 0.006), sensitivity was 0.500, specificity was 0.905, r_s = 0.504 (p < 0.001); AUC was 0.738 (95% CI: 0.515–0.960, p = 0.034), sensitivity was 0.429, specificity was 0.848, r_s = 0.382 (p < 0.001); AUC was 0.664 (95% CI: 0.472–0.856, p = 0.071), sensitivity was 0.455, specificity was 0.809, r_s = 0.169 (p = 0.037) in predicting underweight, stunting, and microcephaly 2 weeks or 1 month after the first interview, respectively. Gross motor development quotients (DQs) (95.85 [32.87] vs. 86.29 [17.19], p = 0.022), fine motor DQs (115.77 [46.03] vs. 102.12 [20.27], p = 0.010), and verbal DQs (110.73 [35.27] vs. 100.63 [21.28], p = 0.042) were higher in low nutritional risk infants than high-risk ones. Conclusion: NRSP subscale 1 was acceptable and reliable in predicting underweight, but the validity in predicting stunting or microcephaly was slightly mild. Further investigations are required to authenticate NRSP subscale 1’s effectiveness.

Identification of Anxiety and Depression Among Adolescent Kidney Transplant Recipients: A Cross-Sectional Observational Study.

Studies demonstrate an association between mental health disorders and organ transplantation, with adolescents five times more likely to experience anxiety and depression than their nontransplant peers. The purpose of this study is to describe the prevalence of anxiety and depression in adolescent kidney transplant recipients using standardized mental health screening tools. The standardized screening tools, generalized anxiety disorder-7 for anxiety and Patient Health Questionnaire-9 for depression, were administered over 6 months to kidney transplant recipients aged 12-21 years during the transplant clinic visit. Mental health screening increased by 74.0%. Patients reported mild to moderate anxiety at 46.4% and depression at 35.7%. Routine screening for mental health disorders in the transplant clinic allows for early identification of anxiety and depression, prompt referrals to a mental health professional, and improved health outcomes in adolescent kidney transplant recipients.

Association between headache and suicidality: An analysis of universal suicide screening data at a large urban county hospital

Identifying individuals at increased risk of suicide is important, particularly those who present for treatment for nonpsychiatric chief complaints who may go undetected. It has been found that pain symptoms, such as headache, are associated with suicide, although this association requires further characterization. This study examined specific components of suicidality in relation to headache subtypes. This study retrospectively reviewed 2,832,835 nonpsychiatric adult clinical encounters at a large county hospital, where a standardized suicide risk screening tool, the Columbia-Suicide Severity Rating Scale (C-SSRS), was universally implemented. The C-SSRS assesses specific components of suicidality: wish to be dead and suicidal ideation, method, intent, plan, and action. Multivariate logistic regressions were performed to assess the association between headache, as well as headache subtype (migraine, tension, or cluster), and each component of suicidality. There were significant positive associations between presenting with a headache and 2 specific components of suicidality: wish to be dead and suicidal action. Individuals with tension headache may have a lower risk of wishing to be dead compared to those with migraine and cluster headaches. The association of headaches with specific elements of sui-cidality demonstrates the potential yield of identification of suicide risk among individuals with nonpsychiatric presentations.

Comorbidity of Lifetime History of Abuse and Trauma With Opioid Use Disorder: Implications for Nursing Assessment and Care.

Opioid use disorder (OUD) is a public health crisis and is challenging to treat. Previous research has shown correlations between OUD, abuse/trauma, and chronic pain. The purpose of this study was to investigate history of lifetime sexual, physical, and/or emotional abuse among participants in a medication-assisted treatment (MAT) program for OUD, and to investigate associations between abuse history and chronic pain. This is a secondary analysis of intake data from a 2-year, nonexperimental cohort treatment program of patients with OUD in rural Colorado. De-identified data were provided by 476 adult MAT patients using the Adult Addiction Severity Index (ASI-6). The ASI-6 includes three yes/no questions about history of abuse (emotional, physical, and sexual), with separate scoring for "past 30 days" and "lifetime" abuse. Lifetime history among MAT program for OUD patients was 23% for sexual abuse, 43% for physical abuse, and 58% for emotional abuse. History of physical abuse was significantly associated with having a chronic pain diagnosis, χ2 = 4.49, p = .03, and also with higher reported pain levels, t(460) = 2.71, p = .007. Lifetime history of physical abuse was associated with OUD and chronic pain, yet standard pain assessments do not assess these factors. In health care settings, the implementation of standardized trauma-informed screening tools, prompt recognition of abuse/trauma history, and adjunct psychological interventions may reduce stigma, reduce opioid use escalation, and help patients overcome OUD.

Strategies to Integrate the Practice of Social Emergency Medicine Into Routine Patient Care.

The Research to Practice column focuses on improving the research critique skills of advanced practice providers and to assist with the translation of research into practice. In this issue, we discuss the findings of a 2-phase, mixed-methods feasibility investigation conducted by A. S. Wallace et al. (2020) that developed and evaluated a screening process to identify social needs/risks for emergency department (ED) patients and connect them to community-based resources upon discharge. The results revealed that patients with identified social needs and referred to community resources tended to utilize the ED more than those without needs. This suggests the need for EDs to implement a standardized screening tool for social determinants of health (SDOH) on all ED patients for improved patient outcomes. Findings also highlighted a need for EDs to provide staff training and competence in the areas of patient communication and SDOH.

Correlating Physician versus Adolescent Self-Rating Using Modified Ferriman-Gallwey (mFG) Hirsutism Scoring to Androgen Levels

Background: Hirsutism affects 5-15% of reproductive-age women and is characterized by excessive terminal hair growth in a male pattern distribution. The gold standard screening tool for quantifying hirsutism is the mFG score. In the absence of specific hormonal markers and preexisting depilation confounding the physical exam for hirsutism, we are the first to study if adolescent vs physician rated hirsutism using mFG correlates to androgen levels.

Depression, anxiety and stress in women with breech pregnancy compared to women with cephalic presentation—a cross-sectional study

PurposeThis study aims to evaluate the level of psychological distress for women with breech compared to cephalic presentation. We hypothesized, that women with breech presentation have higher levels of depression, stress and anxiety. Secondary objectives were to analyze potential demographic risk factors and comorbidity of psychological distress in breech pregnancy.MethodsThe breech study group was formed by 379 women with breech presentation. A sample of 128 women with cephalic presentation was recruited during routine clinical care. Depression, anxiety and stress symptoms were ascertained by means of the Depression–Anxiety–Stress-Score (DASS)-21 questionnaire. Categorial data was analyzed with Chi-square or exact test, continuous data with unpaired t test or Mann–Whitney U test. Demographic risk factors were identified using a binary logistic regression model.ResultsPrevalence of psychological distress among women with breech was not higher compared to those of other pregnant women. Symptomatic depression, anxiety and stress affected 5.8%, 14.5% and 11.9% of women with breech, respectively. Decreasing age was identified as a risk factor for anxiety (p = 0.006). Multiparity increased risk for depression (p = 0.001), for anxiety (p = 0.026) and for perinatal stress (p = 0.010). More than 80% of women with depressive symptoms had comorbidities of psychological distress.ConclusionsBreech presentation compared to cephalic presentation was not associated with higher levels of psychological distress. However, breech pregnancies are affected by symptoms of potential mental disorder. Multiparous women and younger women may need additional support and would benefit from a standardized screening tool for the assessment of perinatal psychological distress.Clinical trial registrationEthical approval (EA2/241/18) was granted by the Ethics Commission of the Charité University Hospital on the 23.01.2019 (ClinicalTrials.gov Identifier: NCT03827226).

Depression, Insomnia and Post-Traumatic Stress Disorder in COVID-19 Survivors: Role of Gender and Impact on Quality of Life.

Evidence to date suggests that a significant proportion of COVID-19 patients experience adverse psychological outcomes and neuropsychiatric complications. The aim of this study was to evaluate the effect of SARS-CoV-2 infection and subsequent hospitalization on the mental health, sleep, and quality of life of COVID-19 survivors. Patients were assessed 1–2 months after hospital discharge using standardized screening tools for depression and anxiety (HADS), post-traumatic stress disorder (IES-R), insomnia (AIS), and quality of life (EQ-5D-5L). Sociodemographic factors, comorbidities, disease severity and type of hospitalization were also collected. Amongst the 143 patients included, mental health symptoms were common (depression—19%; anxiety—27%; traumatic stress—39%; insomnia—33%) and more frequently reported in female than in male patients. Age, smoking status, comorbidities and illness severity were not found to significantly correlate with the presence of mood, sleep, or stress disorders. Finally, quality of life was worse for patients requiring ICU (p = 0.0057) or a longer hospital stay (p < 0.001) but was unaffected by factors such as sex and other measured outcomes. These findings highlight the need for appropriate intervention to properly manage the immediate and enduring mental health complications of COVID-19.

418 Anxiety among polish pregnant women during the COVID-19 pandemic - preliminary results of a cross-sectional study

Introduction and aims of the study: The global COVID-19 pandemic makes people susceptible to severe anxiety. Anxiety in pregnant women can adversely affect both mother and child. The aim of the study was to assess anxiety experienced by pregnant women in the time of the pandemic. Methods: This is a cross-sectional web-based survey study that included 701 women that were pregnant and during the pandemic in Poland. The level of anxiety was examined using a standardized screening tool for generalised anxiety disorder (GAD-7). These results are part of a “Risk factors for anxiety and depression among pregnant women during the COVID-19 pandemic” study registered at clinicaltrials.gov. Results: The total mean GAD-7 score was 5.54, indicating normal anxiety levels. However 32% of pregnant women had a score of more than 6, which signals severe anxiety. Respondents felt the most anxiety in relation to childbirth, especially the presence of a partner in the delivery room. Concerns about being infected with SARS-CoV-2 were not high. More often, women feared the adverse effects of the COVID-19 for family members and the safety of the unborn child. Pregnant women were felt to be most burdened by the constraints associated with recommended or implemented social distancing, and restrictions of leisure activities. Risk factors for increased anxiety were: complications related to pregnancy, previous mental problems, as well as feeling of burdened due to social distancing and by restrictions imposed on labour and delivery. Protective factors were lower age, being a pregnant for the first time, having social support (partner or family), and being financially well-off. Conclusions: Anxiety in pregnant women is related, not to the presence of the epidemic, but to the restrictions associated with it, particularly concerning childbirth. During an outbreak, pregnant women especially need social support to reduce their levels of anxiety.

Determining the appropriate use of Technology Enabled Care Services (TECS) to manage upper-limb trauma injuries during the COVID-19 pandemic: A multicentre retrospective observational study

BackgroundThe COVID-19 pandemic created a unique opportunity to explore the use of Technology Enabled Care Services (TECS), which remains novel for many service providers. This study assesses the factors that affect adaptation to remote monitoring of patients after upper-limb trauma injury. A standardised risk-stratified screening tool is further developed here to support clinical staff in both the determination of appropriate use of TECS and the optimisation of patient care.Objectives1: To explore the patient and injury factors that determine the appropriate use of TECS for patients with upper-limb injury. 2: To use these findings to refine a standardised screening tool for the appropriate choice of follow-up format.MethodsA retrospective review of patient management was undertaken across three NHS upper-limb trauma units during the first UK COVID-19 lockdown. Data were collected, and themes were analysed across a number of predetermined categories. This was underpinned by a review of contemporary policy guidance and literature.ResultsA total of 85% of patients were offered an appropriate format of follow-up; this was defined by the ability to achieve desired patient-clinician goals and lack of complications. Key factors in determining appropriate follow-up included extent of injury, mental health considerations, and the need for face-to-face (F2F) assessment and treatment.ConclusionStudy findings demonstrate consistency between units in the factors determining the appropriate use of TECS. The refined screening tool provides a risk-stratified, standardised approach to the choice of follow-up format, F2F or TECS. It is hoped that this will support future clinical decision-making processes to ensure optimal patient care.

Evaluation of a Pilot Intimate Partner Violence Screening Program in a Veterans Health Administration HIV Clinic

ABSTRACT Intimate partner violence (IPV) impacts health and well-being and healthcare settings are important for identifying patients experiencing IPV and providing related education, support, and resources. This study evaluated the expansion of an existing IPV screening program in a Veterans Affairs Medical Center to assess feasibility of screening veterans with HIV diagnoses for past-year experiences of IPV. Clinical staff were trained in screening methods and routine screening using standardized screening tools was implemented for all patients with HIV+ diagnoses in an infectious disease clinic. During the observation period, 79 patients were eligible for the IPV screening. Of the total eligible veterans, 57% completed the IPV screening. Forty-three percent of eligible veterans were not screened, highlighting missed opportunities to identify IPV. Of those screened, all patients identified as men and 11% screened positive for past-year IPV. Findings from this small pilot study suggest feasibility of screening men veteran patients for IPV in an infectious disease clinic and indicate that the population of men veterans with HIV+ diagnoses may have IPV-related service needs.

Commentary on the 2020 update of the KDOQI clinical practice guideline for nutrition in chronic kidney disease.

Commentary on the 2020 update of the KDOQI clinical practice guideline for nutrition in chronic kidney disease.

Incidence and Prevention of Thromboembolic Complications for Sports and Arthroscopic-related Surgery: Evidence-based Recommendations.

The incidence of thromboembolic events following arthroscopic surgery is relatively rare. Despite this, these are important complications to be aware of, as arthroscopic procedures are performed in high frequency each year and can lead to a substantial burden within health care. Over the past several decades, pharmacologic antithrombotic prevention strategies following knee arthroscopy have been extensively studied; however, their efficacy remains controversial, and there is a lack of consensus regarding a standard prevention protocol, with the exception of the established benefits of early mobilization. Several surgical and medical risk factors have been established and are important to consider as they specifically relate to each individual patient's risk of thromboembolic disease. Based on the best available evidence, chemical thromboprophylaxis appears to be unnecessary among healthy patients but may be beneficial for higher risk patients, especially those with a prior history of venous thromboembolism. A standard screening tool for risk factors in arthroscopy patients may be a cost-effective and safe solution for implementing preventative efforts.

Investigation of Play Intervention for Dementia (PID) Activities in Addressing Cognitive Domains Reflected in Hong Kong Montreal Cognitive Assessment (HK-MoCA).

Background/Objectives: Yee Hong Play Intervention for Dementia (PID) is a community program strengthening East Asians >65 years with dementia in their daily functional activities. We analyzed how PID activities align with Hong Kong Montreal Cognitive Assessment. Methods: Utilizing observation sheets procured from documentation notes from the twice-weekly PID sessions, cognitive domains were identified. Mean time duration and activity frequencies were compared between high and low competency client groups. Results: Independent of competency group, activities predominantly targeted attention/concentration (23.8% HC, 16.4% LC), and hand-eye coordination (19.1% HC, 28.7% LC). Less focused domains were delayed recall (3.1–4.7%) and naming (1.3–1.5%). Conclusions: Yee Hong PID tested innovative cognitive domains not currently covered in HK-MoCA screening assessment, emphasizing attention/concentration-oriented activities and none assessing orientation and language domains. Additionally, presence of new domains such as hand-eye coordination and fine motor dexterity suggested that strict adherence with standardized screening tools (e.g., MoCA) may not be ideal. Likely, facilitators have developed innovative measures to assess individual competency to strengthen resilience in our geriatric population.

Clinical Pearls

Almost one-third of deaths in the United States take place in intensive care units. Critical care health providers report high levels of stress and burnout when working with end-of-life (EOL) care. Although various EOL care interventions have been developed, little evidence is available on their use in practice.Palma and colleagues conducted focus groups with physicians, nurses, and nursing assistants in Chile to explore their perceptions of EOL care. The major themes include The findings show the need for interprofessional collaborative strategies to support all critical care staff. The authors suggest communication training to build care providers’ confidence in EOL care.See Article, pp 24-32. Delirium affects up to 80% of all patients in intensive care units (ICUs). This costly complication (&gt;$182 billion nationally) has been associated with long-term cognitive and functional deterioration. Standardized screening tools, such as the Confusion Assessment Method for the ICU (CAM-ICU), are widely used in practice by highly trained delirium experts and ICU providers. However, when used by bedside practitioners, the sensitivity of the tool for detecting delirium drops significantly.Sinvani and colleagues explored the feasibility of using a telehealth training program with a remotely located delirium specialist. They found Although further research is needed to examine the impact of telehealth on patient outcomes, the authors suggest use of tele-ICU platforms to share expertise from one remote location to numerous other sites.See Article, pp 73-76. Visitation of family members during the COVID-19 pandemic was not permitted in most hospitals, greatly affecting communication between the patient’s provider and the surrogate decision maker (SDM). Although many intensive care units instituted a daily telephone call between a senior physician and the SDM to provide patient-related information, perceptions of this practice are unknown.Fritz and colleagues surveyed SDMs, physicians, family members, and other health care providers to assess their experience with this practice. They found The practice was satisfactory for most physicians and SDMs; however, the authors suggest improvement with more frequent calls and use of videoconferencing.See Article, pp 77-81. Infants born with a congenital heart defect (CHD) are at risk for neurodevelopmental abnormalities such as cognitive disabilities, mental health problems, and gross motor deficits. Individualized family-centered developmental care (IFDC) interventions such as cue-based care and parent participation have been successfully used with premature infants to prevent neurodevelopmental problems; however, the practice with infants with a CHD varies.LaRonde and colleagues surveyed nurses from 25 cardiovascular programs to describe the current state of IFDC practice. They found Although most respondents described competence with IFDC, practice varied widely. The authors state that next steps should include development of guidelines for infants with CHD and then implementation and evaluation across pediatric critical care settings.See Article, pp e10-e19.

VALIDATION OF THE BRIEF INTERNATIONAL COGNITIVE ASSESSMENT FOR MULTIPLE SCLEROSIS (BICAMS) IN A LARGE COHORT OF RELAPSING-REMITTING MS PATIENTS.

Cognitive impairment is one of the most frequently reported symptoms in persons with multiple sclerosis (MS). The Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) has been recommended as a standardized international screening and monitoring tool for brief cognitive assessment. The aim of our study was to assess the reliability and validity of the Serbian version of the BICAMS. A total of 500 relapsing-remitting MS (RRMS) patients and 69 age-, gender- and education-matched healthy control (HC) subjects were examined. All participants performed the BICAMS test battery, which includes the oral version of the Symbol Digit Modalities Test (SDMT), California Verbal Learning Test second edition (CVLT-II), and Brief Visuospatial Memory Test Revised (BVMTR). A randomly selected subset of patients were retested one to three weeks after baseline. Statistically significant differences between patients and HCs were evident on the SDMT and BVMTR (p<0.001). HCs had higher CVLT-II scores but this difference did not reach statistical significance (p=0.063). Cognitive impairment, defined as an abnormal test score on ≥1 subtest, was found in 62.9% of MS patients. There were statistically significant correlations between BICAMS scores and age, education, EDSS and disease duration in patient sample. Test-retest reliability was confirmed with Pearson correlation coefficient of 0.70 in all measures. This study supported the reliability and validity of the Serbian BICAMS, although the CVLT-II version tested here lacked sensitivity to detect MS compared to healthy volunteers.