The Brief International Cognitive Assessment in Multiple Sclerosis (BICAMS): results from the German validation study
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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).
To validate BICAMS on a sample of German MS patients and healthy controls (HCs).
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).
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.
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.
KeywordsMultiple sclerosis BICAMS Cognition Working ability Validation
Brief International Cognitive Assessment in Multiple Sclerosis
Modified Brief International Cognitive Assessment in Multiple Sclerosis
Brief Repeatable Battery of Neuropsychological tests
Brief Visual Memory Test Revised
California Verbal Learning Test II
Expanded Disability Status Scale
Minimal Assessment of Cognitive Function in Multiple Sclerosis
Probability of an event or outcome in a statistical experiment
Primary progressive multiple sclerosis
Pearson’s r, correlation coefficient
Rey Auditory Verbal Learning Test
Relapsing-remitting multiple sclerosis
Symbol Digit Modalities Test
Secondary progressive multiple sclerosis
Statistical Package for the Social Sciences
Verbaler Lern- und Merkfähigkeitstest
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.
Michael Lang received a research Grant from Merck for this study (at 4 December 2013). Reference number: 4501354695.
Compliance with ethical standards
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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