Neuropsychology Research Unit, School of Psychology, The University of Queensland, Brisbane, Australia.
Neurology, Royal Brisbane and Women's Hospital, Brisbane, Australia.
Amyotroph Lateral Scler Frontotemporal Degener. 2023 Aug;24(5-6):466-474. doi: 10.1080/21678421.2023.2188053. Epub 2023 Mar 27.
Motor neurone disease [MND] encompasses broad cognitive impairments, which are not fully captured by most screening tools. This study evaluated the specificity and sensitivity of the Edinburgh Cognitive and Behavioral ALS Screen [ECAS] in detecting impairments in executive function and social cognition. Participants (MND = 64; Healthy Controls = 45) completed the ECAS and standard neuropsychology tests of executive function and social cognition. Sensitivity and specificity of the ECAS were assessed at three levels (ALS-Specific score, executive function domain score, individual subtests: social cognition, inhibition, working memory, alternation). MND patients were impaired on standard social cognition, initiation, visuomotor alternation, and verbal learning tests but not on inhibition or working memory tests, relative to controls. ECAS results revealed that the ALS-Specific score was high in specificity but low-to-moderately sensitive in identifying social cognition, inhibition, and working memory deficits, and that both sensitivity and specificity were high for identifying alternation deficits. The ECAS executive function domain score was high in specificity but poor in sensitivity for all four executive function domain subtests. The individual ECAS subtests were highly specific with good sensitivity, but the social cognition subtest lacked sensitivity. Impairments in social cognition may go undetected when using the ECAS as a screening tool. Thus, social cognition may need to be considered as a standalone component, distinct from the other executive functions. In addition, the test itself may need to be adjusted to encompass other aspects of social cognition that are affected in MND.Key messagesCognitive screening tools are key to detect cognitive changes in MND, with the domains most affected being executive functions, language, and social cognition.The ECAS measure, developed for MND, has good specificity but lacks sensitivity to impairments in social cognition.Clinical implications are that cognitive impairments in social cognition may not be identified in MND patients by the ECAS.Adjustment to the ECAS cognitive screening tool widely-used in MND is suggested.
运动神经元病[MND]包括广泛的认知障碍，这些障碍不能被大多数筛查工具完全捕捉到。本研究评估了爱丁堡认知和行为 ALS 筛查[ECAS]在检测执行功能和社会认知障碍方面的特异性和敏感性。参与者（MND=64；健康对照组=45）完成了 ECAS 和执行功能和社会认知的标准神经心理学测试。在三个水平（ALS 特异性评分、执行功能域评分、个体子测试：社会认知、抑制、工作记忆、交替）评估了 ECAS 的敏感性和特异性。与对照组相比，MND 患者在标准社会认知、启动、视动交替和言语学习测试中受损，但在抑制或工作记忆测试中不受损。ECAS 结果表明，ALS 特异性评分在识别社会认知、抑制和工作记忆缺陷方面具有高特异性但低至中度敏感性，而在识别交替缺陷方面敏感性和特异性均较高。ECAS 执行功能域评分在识别所有四个执行功能域子测试的缺陷时具有高特异性但敏感性差。个别 ECAS 子测试特异性高，敏感性好，但社会认知子测试敏感性差。当使用 ECAS 作为筛查工具时，社会认知障碍可能无法被发现。因此，社会认知可能需要被视为一个独立的组成部分，与其他执行功能区分开来。此外，该测试本身可能需要进行调整，以涵盖 MND 中受影响的其他社会认知方面。
关键信息
认知筛查工具是检测 MND 认知变化的关键，受影响最大的领域是执行功能、语言和社会认知。
专为 MND 开发的 ECAS 测量方法具有良好的特异性，但对社会认知障碍的敏感性较低。
临床意义是，ECAS 可能无法识别 MND 患者的社会认知障碍。
建议对广泛用于 MND 的 ECAS 认知筛查工具进行调整。
