Artemiadis Artemios, Bakirtzis Christos, Chatzittofis Andreas, Christodoulides Constantinos, Nikolaou George, Boziki Marina Kleopatra, Grigoriadis Nikolaos
Medical School, University of Cyprus, Old Road Nikosia-Limmasol 215/6, 2029 Aglantzia, Nicosia, Cyprus; Department of Neurology, Army Share Fund Hospital (NIMTS), Monis Petraki 10, 11521, Athens, Greece.
Multiple Sclerosis Center, B' Department of Neurology, Aristotle University of Thessaloniki, Kiriakidi 1, 54621, Thessaloniki, Greece.
Mult Scler Relat Disord. 2021 Apr;49:102751. doi: 10.1016/j.msard.2021.102751. Epub 2021 Jan 12.
Cognitive impairment (CI) affects 35-65% of multiple sclerosis (MS) patients. The Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) has been proposed as a highly feasible and cost-effective tool for cognitive impairment (CI) screening in MS. The tool yields scores that should, ideally, readily convey patients' cognitive status to the clinicians.
To this aim, this study sought for cut-off scores of the three BICAMS test in a sample of 960 MS patients. We used three definitions for CI: 1.5, 1,65 and 2 standard deviations below the mean. Receiver operating characteristic (ROC) statistics helped us determine the capacity of BICAMS to diagnose CI. Optimal cut-offs were determined by the delta distance. Positive and negative predictive values, along with overall accuracy were also calculated.
Symbol Digit Modalities Test (SDMT) and California Verbal Learning Test-II (CVLT-II) showed a diagnostic accuracy ranging from 74.6 to 77.4%, across the three CI definitions. The accuracy of Brief Visuospatial Memory Test-Revised (BVMT-R) was over 88%. SDMT had a balanced sensitivity, while CVLT-II and BVMT-R had higher specificities than sensitivities at detecting CI. More specifically, BVMT-R showed 100% specificity for all CI definitions. Raw cut-off scores for BICAMS tests are also provided within the manuscript, along with the diagnostic calculations.
In this study, we confirmed that BICAMS is a good screening tool for CI and that simple cut-offs can be used in the everyday neurological practice.
认知障碍（CI）影响35%至65%的多发性硬化症（MS）患者。简短国际多发性硬化症认知评估（BICAMS）已被提议作为一种在MS中筛查认知障碍（CI）的高度可行且具有成本效益的工具。该工具得出的分数，理想情况下，应能轻松地将患者的认知状态传达给临床医生。
为此，本研究在960名MS患者的样本中寻找BICAMS三项测试的临界分数。我们对CI使用了三种定义：低于均值1.5、1.65和2个标准差。受试者工作特征（ROC）统计帮助我们确定BICAMS诊断CI的能力。通过delta距离确定最佳临界值。还计算了阳性和阴性预测值以及总体准确性。
符号数字模式测验（SDMT）和加利福尼亚言语学习测验第二版（CVLT-II）在三种CI定义下的诊断准确率在74.6%至77.4%之间。简短视觉空间记忆测验修订版（BVMT-R）的准确率超过88%。SDMT具有平衡的敏感性，而CVLT-II和BVMT-R在检测CI时具有比敏感性更高的特异性。更具体地说，BVMT-R对所有CI定义均显示出100%的特异性。手稿中还提供了BICAMS测试的原始临界分数以及诊断计算结果。
在本研究中，我们证实BICAMS是一种用于CI的良好筛查工具，并且简单的临界值可用于日常神经科实践。
