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Didcote L, Vitoratou S, Al-Chalabi A, Goldstein LH. What is the extent of reliability and validity evidence for screening tools for cognitive and behavioral change in people with ALS? A systematic review. Amyotroph Lateral Scler Frontotemporal Degener 2024; 25:437-451. [PMID: 38415696 PMCID: PMC10972547 DOI: 10.1080/21678421.2024.2314063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 01/12/2024] [Accepted: 01/28/2024] [Indexed: 02/29/2024]
Abstract
OBJECTIVE This systematic review provides an updated summary of the existing literature on the validity of screening tools for cognitive and behavioral impairment in people with Amyotrophic Lateral Sclerosis (pwALS), and also focuses on their reliability. METHOD The following cognitive and behavioral screening tools were assessed in this review: the Edinburgh Cognitive and Behavioral ALS Screen (ECAS); the ALS Cognitive Behavioral Screen (ALS-CBS), the Mini Addenbrooke's Cognitive Examination (Mini-ACE), the Beaumont Behavioral Interview (BBI); the MND Behavior Scale (MiND-B); and the ALS-FTD Questionnaire (ALS-FTD-Q). A search, using Medline, PsychINFO and Embase (21/09/2023), generated 37 results after exclusion criteria were applied. Evidence of internal consistency, item-total correlations, inter-rater reliability, clinical validity, convergent validity, and structural validity were extracted and assessed and risk of bias was evaluated. RESULTS The cognitive component of the ECAS was the tool with most evidence of reliability and validity for the assessment of cognitive impairment in ALS. It is well-suited to accommodate physical symptoms of ALS. For behavioral assessment, the BBI or ALS-FTD-Q had the most evidence of reliability and validity. The BBI is more thorough, but the ALS-FTD-Q is briefer. CONCLUSIONS There is good but limited evidence for the reliability and validity of cognitive and behavioral screens. Further evidence of clinical and convergent validity would increase confidence in their clinical and research use.
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Affiliation(s)
- Lyndsay Didcote
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Silia Vitoratou
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Ammar Al-Chalabi
- Department of Basic and Clinical Neuroscience, Maurice Wohl Clinical Neuroscience Institute, King’s College London, London, UK, and
- Department of Neurology, King’s College Hospital NHS Foundation Trust, London, UK
| | - Laura H. Goldstein
- Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
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2
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Aiello EN, Torre S, Solca F, Curti B, De Luca G, Gendarini C, Cocuzza A, Colombo E, Maranzano A, Verde F, Morelli C, Messina S, Doretti A, Silani V, Ticozzi N, Poletti B. Ecological validity of performance-based cognitive screeners in amyotrophic lateral sclerosis: preliminary evidence. Neurol Sci 2024:10.1007/s10072-024-07660-z. [PMID: 38904901 DOI: 10.1007/s10072-024-07660-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2024] [Accepted: 06/14/2024] [Indexed: 06/22/2024]
Abstract
BACKGROUND This study aimed at preliminarily assessing, in a cohort of non-demented amyotrophic lateral sclerosis (ALS) patients, the ecological validity, and more specifically the veridicality, of the Edinburgh Cognitive and Behavioural ALS Screen (ECAS) and the ALS Cognitive Behavioral Screen (ALS-CBS™), by relating their scores to caregiver-report ratings of cognitive changes. METHODS N = 147 patient-caregiver dyads were recruited. Patients were administered the ECAS and ALS-CBS™, whilst caregiver the Caregiver Behavioral Questionnaire (CBQ) and Beaumont Behavioural Inventory (BBI). An Ecological Cognitive Functioning Index (ECFI) was derived from those items of the CBQ and BBI that tap on executive and language changes. Ecological validity was assessed via both correlational and predictive analyses net of caregiver-rated behavioural changes (as assessed by the ECAS-Carer Interview). RESULTS The ECFI was associated with the total scores on both the ECAS (p = .014) and ALS-CBS™ (p = .017). When looking at ECAS and ALS-CBS™ subscales, those assessing verbal fluency were selectively associated with the ECFI. The ECFI was higher in patients performing defectively on the ECAS (p = .004) and on the ALS-CBS™ (p = .027). DISCUSSION This study suggests that both the ECAS and the ALS-CBS™ represent a valid estimate of non-demented ALS patients' cognitive status in the real world, also highlighting the clinical relevance of cognitive changes reported by caregivers.
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Affiliation(s)
- Edoardo Nicolò Aiello
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Piazzale Brescia 20, 20149, Milano, MI, Italy
| | - Silvia Torre
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Piazzale Brescia 20, 20149, Milano, MI, Italy
| | - Federica Solca
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Piazzale Brescia 20, 20149, Milano, MI, Italy
| | - Beatrice Curti
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Piazzale Brescia 20, 20149, Milano, MI, Italy
| | - Giulia De Luca
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Piazzale Brescia 20, 20149, Milano, MI, Italy
| | - Claudia Gendarini
- Neurology Residency Program, Università degli Studi di Milano, Milano, Italy
| | - Alessandro Cocuzza
- Neurology Residency Program, Università degli Studi di Milano, Milano, Italy
| | - Eleonora Colombo
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Piazzale Brescia 20, 20149, Milano, MI, Italy
| | - Alessio Maranzano
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Piazzale Brescia 20, 20149, Milano, MI, Italy
| | - Federico Verde
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Piazzale Brescia 20, 20149, Milano, MI, Italy
- Department of Pathophysiology and Transplantation, "Dino Ferrari" Center, Università degli Studi di Milano, Milano, Italy
| | - Claudia Morelli
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Piazzale Brescia 20, 20149, Milano, MI, Italy
| | - Stefano Messina
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Piazzale Brescia 20, 20149, Milano, MI, Italy
| | - Alberto Doretti
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Piazzale Brescia 20, 20149, Milano, MI, Italy
| | - Vincenzo Silani
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Piazzale Brescia 20, 20149, Milano, MI, Italy
- Department of Pathophysiology and Transplantation, "Dino Ferrari" Center, Università degli Studi di Milano, Milano, Italy
| | - Nicola Ticozzi
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Piazzale Brescia 20, 20149, Milano, MI, Italy
- Department of Pathophysiology and Transplantation, "Dino Ferrari" Center, Università degli Studi di Milano, Milano, Italy
| | - Barbara Poletti
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Piazzale Brescia 20, 20149, Milano, MI, Italy.
- Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, Milano, Italy.
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Huynh A, Adams K, Barnett-Tapia C, Kalra S, Zinman L, Yunusova Y. Accessing and Receiving Speech-Language Pathology Services at the Multidisciplinary Amyotrophic Lateral Sclerosis Clinic: An Exploratory Qualitative Study of Patient Experiences and Needs. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2023:1-13. [PMID: 37678221 DOI: 10.1044/2023_jslhr-23-00087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
PURPOSE This study sought to explore how patients with amyotrophic lateral sclerosis (ALS) presenting with coexisting bulbar and cognitive impairments and their caregivers experienced the speech-language pathologist (SLP) services provided in multidisciplinary ALS clinics in Canada and identified their perceived needs for bulbar symptom management. METHOD This qualitative study was informed by interpretive description. Seven interviews were conducted with patients with severe bulbar dysfunction or severe bulbar and cognitive dysfunction due to ALS or ALS-frontotemporal dementia, respectively, and/or their caregivers. Purposive sampling was used to recruit individuals with severe bulbar or bulbar and cognitive disease. Thematic analysis was used to analyze interview data. RESULTS Patients and caregivers reported difficulties with accessing and receiving SLP services at the multidisciplinary ALS clinic. These difficulties were further exacerbated in those with severe cognitive disease. Participants expressed a need for more specific (i.e., disease and service-related) information and personalized care to address their changing needs and preferences. Engaging caregivers earlier in SLP appointments was perceived as vital to support care planning and provide in-time caregiver education. CONCLUSIONS This study highlighted the challenges experienced by patients and caregivers in accessing and receiving SLP services. There is a pressing need for a more person-centered approach to ALS care and a continuing need for education of SLPs on care provision in cases of complex multisymptom diseases within a multidisciplinary ALS clinic. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.24069222.
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Affiliation(s)
- Anna Huynh
- Department of Speech-Language Pathology, University of Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto, Ontario, Canada
- Sunnybrook Research Institute, Toronto, Ontario, Canada
- KITE-Toronto Rehabilitation Institute, University Health Network, Ontario, Canada
| | | | | | - Sanjay Kalra
- Department of Medicine (Neurology), University of Alberta, Edmonton, Canada
| | - Lorne Zinman
- Rehabilitation Sciences Institute, University of Toronto, Ontario, Canada
- Sunnybrook Research Institute, Toronto, Ontario, Canada
| | - Yana Yunusova
- Department of Speech-Language Pathology, University of Toronto, Ontario, Canada
- Rehabilitation Sciences Institute, University of Toronto, Ontario, Canada
- Sunnybrook Research Institute, Toronto, Ontario, Canada
- KITE-Toronto Rehabilitation Institute, University Health Network, Ontario, Canada
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Aiello EN, Greco LC, La Tona A, Solca F, Torre S, Carelli L, Pain D, Radici A, Lizio A, Casiraghi J, Cerri F, Brugnera A, Compare A, Woolley S, Murphy J, Tremolizzo L, Appollonio I, Verde F, Silani V, Ticozzi N, Lunetta C, Sansone VA, Poletti B. Clinimetrics of the cognitive section of the Italian ALS Cognitive Behavioral Screen (ALS-CBS™). Neurol Sci 2023; 44:1243-1249. [PMID: 36547779 DOI: 10.1007/s10072-022-06569-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND The present study aimed at (1) providing further validity and reliability evidence for the Italian version of the cognitive section of the ALS Cognitive Behavioral Screen (ALS-CBS™) and (2) testing its diagnostics within an Italian ALS cohort, as well as at (3) exploring its capability to discriminate patients from healthy controls (HCs). METHODS N = 293 non-demented ALS patients were administered the cognitive sections of the ALS-CBS™ and Edinburgh Cognitive and Behavioural ALS Screen (ECAS). N = 96 HCs demographically matched with N = 96 patients were also administered the cognitive section of the ALS-CBS™. In patients, factorial and construct validity, internal reliability, and diagnostics against a defective score on the cognitive section of the ECAS were tested. Case-control discrimination was assessed via a logistic regression. RESULTS ALS-CBS™ cognitive subscales were underpinned by a simple, unidimensional structure, internally reliable (McDonald's ω = 0.74), and mostly related with ECAS executive and fluency scores (rs = 0.54-0.71). Both raw and age- and education-adjusted scores on the cognitive section of the ALS-CBS™ accurately detected ECAS-defined cognitive impairment (AUC = 0.80 and .88, respectively), yielding optimal error-based, information-based and unitary diagnostics. A cut-off of < 15.374 was identified on adjusted scores. The test was able to discriminate patients from HCs (p < 0.001). DISCUSSION The cognitive section of the Italian ALS-CBS™ is a valid, reliable, and diagnostically sound ALS-specific screener for detecting frontotemporal, executive-/attentive-based cognitive inefficiency in non-demented ALS patients, being also able to discriminate them from normotypical individuals.
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Affiliation(s)
- Edoardo Nicolò Aiello
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Piazzale Brescia 20, 20149, Milan, Italy
- PhD Program in Neuroscience, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Lucia Catherine Greco
- Neuromuscular Omnicentre (NEMO), Fondazione Serena Onlus, Milan, Italy
- NeMO Lab, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Antonino La Tona
- Department of Human and Social Sciences, University of Bergamo, Bergamo, Italy
| | - Federica Solca
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Piazzale Brescia 20, 20149, Milan, Italy
| | - Silvia Torre
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Piazzale Brescia 20, 20149, Milan, Italy
| | - Laura Carelli
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Piazzale Brescia 20, 20149, Milan, Italy
| | - Debora Pain
- Istituti Clinici Scientifici Maugeri IRCCS, Neurorehabilitation Department of Milan Institute, Milan, Italy
| | - Alice Radici
- Istituti Clinici Scientifici Maugeri IRCCS, Neurorehabilitation Department of Milan Institute, Milan, Italy
| | - Andrea Lizio
- Neuromuscular Omnicentre (NEMO), Fondazione Serena Onlus, Milan, Italy
| | - Jacopo Casiraghi
- Neuromuscular Omnicentre (NEMO), Fondazione Serena Onlus, Milan, Italy
| | - Federica Cerri
- Neuromuscular Omnicentre (NEMO), Fondazione Serena Onlus, Milan, Italy
| | - Agostino Brugnera
- Department of Human and Social Sciences, University of Bergamo, Bergamo, Italy
| | - Angelo Compare
- Department of Human and Social Sciences, University of Bergamo, Bergamo, Italy
| | | | | | - Lucio Tremolizzo
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | | | - Federico Verde
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Piazzale Brescia 20, 20149, Milan, Italy
- Department of Pathophysiology and Transplantation, Dino Ferrari Center", Università degli Studi di Milano, Milan, Italy
| | - Vincenzo Silani
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Piazzale Brescia 20, 20149, Milan, Italy
- Department of Pathophysiology and Transplantation, Dino Ferrari Center", Università degli Studi di Milano, Milan, Italy
| | - Nicola Ticozzi
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Piazzale Brescia 20, 20149, Milan, Italy
- Department of Pathophysiology and Transplantation, Dino Ferrari Center", Università degli Studi di Milano, Milan, Italy
| | - Christian Lunetta
- Istituti Clinici Scientifici Maugeri IRCCS, Neurorehabilitation Department of Milan Institute, Milan, Italy
| | - Valeria Ada Sansone
- PhD Program in Neuroscience, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Department of Biomedical Sciences of Health, University of Milan, Milan, Italy
| | - Barbara Poletti
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Piazzale Brescia 20, 20149, Milan, Italy.
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5
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Taule T, Eide IS, Fjær L, Myrberget MA, Oseland MS, Renså MA, Revheim T, Tysnes OB, Aßmus J, Rekand T. Norwegian version of the Edinburgh cognitive and behavioural ALS screen: Construct validity, internal consistency, inter-rater, and test-retest reliability. PLoS One 2023; 18:e0285307. [PMID: 37141321 PMCID: PMC10159149 DOI: 10.1371/journal.pone.0285307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 04/19/2023] [Indexed: 05/06/2023] Open
Abstract
BACKGROUND Research collaboration highlight a need for validated tests in other languages than English. Translation and culture adjustments may threaten essential features of the original instrument. OBJECTIVE To assess the internal consistency, inter-rater and test-retest reliability, and construct validity of the Norwegian version of the Edinburgh Cognitive and Behavioural Amyotrophic Lateral Sclerosis (ALS) Screen (ECAS-N). METHODS Performance of 71 subjects with ALS, 85 healthy controls (HC) and 6 controls with Alzheimer's disease (AD) were assessed with the ECAS-N. Test-retest interval was four months. Internal consistency was evaluated using Cronbach's alpha; reliability was assessed using intraclass correlation coefficient (ICC), Cohen's kappa, and Bland Altman plot. Five hypothesis, including the Montreal Cognitive Assessment (MoCA) screen, was evaluated for construct validity. RESULTS ECAS-N total score produced a Cronbach's alpha of 0.65, had excellent inter-rater reliability (ICC = 0.99) and acceptable test-retest reliability (ICC = 0.73). Construct validity analysis suggested valid use of the ECAS-N to distinguish people with ALS-specific cognitive impairment from HC (p = 0.001) and those with AD (p = 0.002). The MoCA and ECAS-N were moderately correlated (r = 0.53). CONCLUSION The ECAS-N has potential to be used by different testers in clinical practice and research to screen patients with ALS who speak Norwegian and for documenting cognitive impairment over time.
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Affiliation(s)
- Tina Taule
- Department of Occupational Therapy, Orthopedic Clinic, Haukeland University Hospital, Bergen, Norway
| | - Irmelin Smith Eide
- Department of Rehabilitation Services, Haraldsplass Deaconess Hospital, Bergen, Norway
| | - Line Fjær
- Department of Physio and Occupational Therapy, Namsos hospital, Nord-Trøndelag Hospital Trust, Namsos, Norway
| | - Mari-Anne Myrberget
- Department of Clinical Services, St. Olav's University Hospital, Trondheim, Norway
| | - Marit Sofie Oseland
- Department of Social Work, Occupational Therapy and Physiotherapy, Hospital of Southern Norway, Kristiansand, Norway
| | - Marit Arnevik Renså
- Department of Neurology, Neurologic Clinic, Haukeland University Hospital, Bergen, Norway
| | - Tone Revheim
- Department of Occupational Therapy, Orthopedic Clinic, Haukeland University Hospital, Bergen, Norway
| | - Ole-Bjørn Tysnes
- Department of Neurology, Neurologic Clinic, Haukeland University Hospital, Bergen, Norway
| | - Jörg Aßmus
- Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway
| | - Tiina Rekand
- Department of Neurology, Neurologic Clinic, Haukeland University Hospital, Bergen, Norway
- Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Aiello EN, Solca F, Torre S, Carelli L, Ferrucci R, Priori A, Verde F, Ticozzi N, Silani V, Poletti B. Feasibility and diagnostics of the Frontal Assessment Battery (FAB) in amyotrophic lateral sclerosis. Neurol Sci 2023; 44:587-592. [PMID: 36201126 PMCID: PMC9842552 DOI: 10.1007/s10072-022-06438-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 09/28/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND The present study aimed at evaluating the diagnostic properties of the Frontal Assessment Battery (FAB) in non-demented ALS patients by addressing the Edinburgh Cognitive Behavioural ALS Screen (ECAS) as the gold standard, as well as by examining the association between its administrability and scores with motor-functional measures. MATERIALS N = 348 consecutive patients were administered the ECAS and FAB. Disease severity (ALSFRS-R), duration, progression rate (ΔFS), and stages (via King's and Milano-Torino systems) were considered. Administrability rates and prevalence of below-cut-off FAB scores were compared across clinical stages; regression models allowed to test whether, net of the ECAS-Total, motor features predicted the probability of the FAB not being administrable and of a defective FAB score. Intrinsic and post-test diagnostics were explored against a combined defective ECAS-Executive and ECAS-Fluency scores. RESULTS 85.3% of patients managed to complete the FAB. FAB administrability rates decreased with advanced clinical stages, whereas the prevalence of below-cut-off FAB scores did not. The probability of the FAB not being administrable was predicted only by lower ALSFRS-R-bulbar and ALSFRS-R-upper-limb scores; no motor features, but the ECAS-Total, predicted a below-cut-off performance on the FAB. Raw and adjusted FAB scores showed high accuracy (AUC = .85 and .81, respectively) and good intrinsic and post-test properties. DISCUSSION The FAB is featured by optimal diagnostics for detecting executive deficits in ALS, provided that it can be administered according to its original, standardized procedure, and thus that patients have sufficiently spared motor abilities to complete the test.
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Affiliation(s)
- Edoardo Nicolò Aiello
- IRCCS Istituto Auxologico Italiano, Department of Neurology and Laboratory of Neuroscience, Piazzale Brescia 20, Milano, 20149 Italy
- PhD Program in Neuroscience, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Federica Solca
- IRCCS Istituto Auxologico Italiano, Department of Neurology and Laboratory of Neuroscience, Piazzale Brescia 20, Milano, 20149 Italy
| | - Silvia Torre
- IRCCS Istituto Auxologico Italiano, Department of Neurology and Laboratory of Neuroscience, Piazzale Brescia 20, Milano, 20149 Italy
| | - Laura Carelli
- IRCCS Istituto Auxologico Italiano, Department of Neurology and Laboratory of Neuroscience, Piazzale Brescia 20, Milano, 20149 Italy
| | - Roberta Ferrucci
- Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics, Department of Health Sciences, International Medical School, University of Milan, Milan, Italy
- ASST Santi Paolo E Carlo, San Paolo University Hospital, Milan, Italy
- IRCCS Ca’ Granda Foundation Maggiore Policlinico Hospital, Milan, Italy
| | - Alberto Priori
- Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics, Department of Health Sciences, International Medical School, University of Milan, Milan, Italy
- ASST Santi Paolo E Carlo, San Paolo University Hospital, Milan, Italy
| | - Federico Verde
- IRCCS Istituto Auxologico Italiano, Department of Neurology and Laboratory of Neuroscience, Piazzale Brescia 20, Milano, 20149 Italy
- Department of Pathophysiology and Transplantation, “Dino Ferrari Center”, Università Degli Studi di Milano, Milan, Italy
| | - Nicola Ticozzi
- IRCCS Istituto Auxologico Italiano, Department of Neurology and Laboratory of Neuroscience, Piazzale Brescia 20, Milano, 20149 Italy
- Department of Pathophysiology and Transplantation, “Dino Ferrari Center”, Università Degli Studi di Milano, Milan, Italy
| | - Vincenzo Silani
- IRCCS Istituto Auxologico Italiano, Department of Neurology and Laboratory of Neuroscience, Piazzale Brescia 20, Milano, 20149 Italy
- Department of Pathophysiology and Transplantation, “Dino Ferrari Center”, Università Degli Studi di Milano, Milan, Italy
| | - Barbara Poletti
- IRCCS Istituto Auxologico Italiano, Department of Neurology and Laboratory of Neuroscience, Piazzale Brescia 20, Milano, 20149 Italy
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7
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Ball LJ, Geske JA, Burton E, Pattee GL. A clinical bulbar assessment scale (CBAS) for amyotrophic lateral sclerosis. Muscle Nerve 2022; 66:694-701. [PMID: 36217681 DOI: 10.1002/mus.27738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 09/30/2022] [Accepted: 10/03/2022] [Indexed: 12/14/2022]
Abstract
INTRODUCTION/AIMS Comprehensive and valid bulbar assessment scales for use within amyotrophic lateral sclerosis (ALS) clinics are critically needed. The aims of this study are to develop the Clinical Bulbar Assessment Scale (CBAS) and complete preliminary validation. METHODS The authors selected CBAS items from among the literature and expert opinion, and content validity ratio (CVR) was calculated. Following consent, the CBAS was administered to a pilot sample of English-speaking adults with El Escorial defined ALS (N = 54) from a multidisciplinary clinic, characterizing speech, swallowing, and extrabulbar features. Criterion validity was assessed by correlating CBAS scores with commonly used ALS scales, and internal consistency reliability was obtained. RESULTS Expert raters reported strong agreement for the CBAS items (CVR = 1.00; 100% agreement). CBAS scores yielded a moderate, significant, negative correlation with ALS Functional Rating Scale-Revised (ALSFRS-R) total scores (r = -0.652, p < .001), and a strong, significant, negative correlation with ALSFRS-R bulbar subscale scores (r = -0.795, p < .001). There was a strong, significant, positive correlation with Center for Neurologic Studies Bulbar Function Scale (CNS-BFS) scores (r = 0.819, p < .001). CBAS scores were significantly higher for bulbar onset (mean = 38.9% of total possible points, SD = 22.6) than spinal onset (mean = 18.7%, SD = 15.8; p = .004). Internal consistency reliability (Cronbach's alpha) values were: (a) total CBAS, α = 0.889; (b) Speech subscale, α = 0.903; and (c) Swallowing subscale, α = 0.801. DISCUSSION The CBAS represents a novel means of standardized bulbar data collection using measures of speech, swallowing, respiratory, and cognitive-linguistic skills. Preliminary evidence suggests the CBAS is a valid, reliable scale for clinical assessment of bulbar dysfunction.
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Affiliation(s)
- Laura J Ball
- Speech-Language Pathology, Mississippi University for Women, Columbus, Mississippi, USA
| | - Jenenne A Geske
- Department of Family Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA
| | - Elizabeth Burton
- Speech-Language Pathology, Madonna Rehabilitation Institute, Lincoln, Nebraska, USA
| | - Gary L Pattee
- University of Nebraska Medical Center, Neurology Associates, PC, Lincoln, Nebraska, USA
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8
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Aiello EN, Carelli L, Solca F, Torre S, Ferrucci R, Priori A, Verde F, Silani V, Ticozzi N, Poletti B. Validity and diagnostics of the Reading the Mind in the Eyes Test (RMET) in non-demented amyotrophic lateral sclerosis (ALS) patients. Front Psychol 2022; 13:1031841. [PMID: 36405135 PMCID: PMC9670302 DOI: 10.3389/fpsyg.2022.1031841] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Accepted: 10/12/2022] [Indexed: 11/07/2022] Open
Abstract
Background The aim of this study was to explore the construct validity and diagnostic properties of the Reading the Mind in the Eyes Test (RMET) in non-demented patients with amyotrophic lateral sclerosis (ALS). Materials A total of 61 consecutive patients and 50 healthy controls (HCs) were administered the 36-item RMET. Additionally, patients underwent a comprehensive assessment of social cognition via the Story-Based Empathy Task (SET), which encompasses three subtests targeting Causal Inference, Emotion Attribution (SET-EA), and Intention Attribution (SET-IA), as well as global cognitive [the Edinburgh Cognitive and Behavioral ALS Screen (ECAS)] and behavioral screening [the Frontal Behavioral Inventory (FBI); the Dimensional Apathy Scale (DAS); the Beck Depression Inventory (BDI); and the State and Trait Anxiety Inventory-Y]. The construct validity of the RMET was tested by regressing it within a stepwise model that encompassed as predictors the abovementioned cognitive and behavioral measures, covarying for demographic and motor confounders. Receiver-operating characteristics (ROC) analyses allowed exploring intrinsic and post-test properties of the RMET both in discriminating patients from HCs and in identifying patients with a defective SET-EA performance. Results The RMET was solely predicted by the SET-EA (p = 0.003) and SET-IA (p = 0.005). RMET scores showed high accuracy both in discriminating patients from HCs (AUC = 0.81) and in identifying patients with a defective SET-EA score (AUC = 0.82), with adequate-to-optimal both intrinsic and post-test properties. Discussion The RMET is a convergently and divergently valid measure of affective social cognition in non-demented ALS patients, also featuring optimal intrinsic and post-test diagnostic properties in both case-control and case-finding scenarios.
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Affiliation(s)
- Edoardo Nicolò Aiello
- IRCCS Istituto Auxologico Italiano, Department of Neurology and Laboratory of Neuroscience, Milan, Italy
- Ph.D. Program in Neuroscience, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Laura Carelli
- IRCCS Istituto Auxologico Italiano, Department of Neurology and Laboratory of Neuroscience, Milan, Italy
| | - Federica Solca
- IRCCS Istituto Auxologico Italiano, Department of Neurology and Laboratory of Neuroscience, Milan, Italy
| | - Silvia Torre
- IRCCS Istituto Auxologico Italiano, Department of Neurology and Laboratory of Neuroscience, Milan, Italy
| | - Roberta Ferrucci
- Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics, Department of Health Sciences, International Medical School, University of Milan, Milan, Italy
- ASST Santi Paolo e Carlo, San Paolo University Hospital, Milan, Italy
- IRCCS Ca’ Granda Foundation Maggiore Policlinico Hospital, Milan, Italy
| | - Alberto Priori
- Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics, Department of Health Sciences, International Medical School, University of Milan, Milan, Italy
- ASST Santi Paolo e Carlo, San Paolo University Hospital, Milan, Italy
| | - Federico Verde
- IRCCS Istituto Auxologico Italiano, Department of Neurology and Laboratory of Neuroscience, Milan, Italy
- “Dino Ferrari” Center, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Vincenzo Silani
- IRCCS Istituto Auxologico Italiano, Department of Neurology and Laboratory of Neuroscience, Milan, Italy
- “Dino Ferrari” Center, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Nicola Ticozzi
- IRCCS Istituto Auxologico Italiano, Department of Neurology and Laboratory of Neuroscience, Milan, Italy
- “Dino Ferrari” Center, Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Barbara Poletti
- IRCCS Istituto Auxologico Italiano, Department of Neurology and Laboratory of Neuroscience, Milan, Italy
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Taule T, Morland AS, Aßmus J, Tysnes OB, Rekand T. Translation, cultural adaptation, and validation of a screening test for cognitive and behavioural changes in amyotrophic lateral sclerosis. Disabil Rehabil 2022; 44:7069-7077. [PMID: 34726988 DOI: 10.1080/09638288.2021.1980621] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
PURPOSE To describe challenges of translating and culturally adapting the Edinburgh Cognitive and Behavioural Amyotrophic Lateral Sclerosis (ALS) Screen into Norwegian (ECAS-N), evaluate its content validity; provide age- and education-balanced norms for verbal fluency and cut-off values for abnormal performance. MATERIALS AND METHODS Translation to Norwegian and back-translation to English complied with standard methods. Patients and ALS experts evaluated the relevance, comprehensiveness and comprehensibility of the translated ECAS (ECAS-N). Content validity indexes at the item level (I-CVI), scale level (S-CVI) and inter-rater agreement were calculated. Performance of controls determined norms for written and spoken verbal fluency (n = 559) and cut-off scores for abnormal performance (n = 85). RESULTS High levels of content validity was achieved for all items of the ECAS-N, I-CVI, S-CVI and inter-rater agreement was 87.5%. Age- and education-balanced norms for written and spoken verbal fluency were produced. Cut-off scores of abnormal performance were slightly lower than the original ECAS. CONCLUSIONS The ECAS-N holds promise for detecting cognitive and behavioural impairment in Norwegian patients with ALS. Cut-off scores are situational and could slightly vary between different cultures. The ECAS-N can be used in international research, but researchers should be aware of the differences between the tests applied in the studies.Implications for rehabilitationThe ECAS-N, a Norwegian version of the English-language ECAS was produced for clinical use in Norway.Rigorous translation methods were used, and expert-judged modifications were made for Norwegian-specific culture and language nuances.Determination of ECAS-N cut-off scores for abnormal cognition was guided by a biostatistician, are slightly lower than the original ECAS, and are based on results from an objectively calculated number of healthy Norwegians.A nuanced picture of cognitive impairment in ALS drawn from a well-developed scale as the ECAS-N can contribute to a management process better tailored to patients'- and carers' individual needs.
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Affiliation(s)
- Tina Taule
- Department of Occupational Therapy, Orthopedic Clinic, Haukeland University Hospital, Bergen, Norway
| | - Annbjørg Spilde Morland
- Department of Occupational Therapy, Orthopedic Clinic, Haukeland University Hospital, Bergen, Norway
| | - Jörg Aßmus
- Centre for Clinical Research, Haukeland University Hospital, Bergen, Norway
| | - Ole-Bjørn Tysnes
- Department of Neurology, Neurologic Clinic, Haukeland University Hospital, Bergen, Norway
| | - Tiina Rekand
- Department of Neurology, Neurologic Clinic, Haukeland University Hospital, Bergen, Norway.,Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Aiello EN, Solca F, Torre S, Carelli L, Ferrucci R, Priori A, Verde F, Silani V, Ticozzi N, Poletti B. Diagnostics and clinical usability of the Montreal Cognitive Assessment (MoCA) in amyotrophic lateral sclerosis. Front Psychol 2022; 13:1012632. [PMID: 36211901 PMCID: PMC9540377 DOI: 10.3389/fpsyg.2022.1012632] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 09/05/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundThe present study aimed at (1) assessing the diagnostic properties of the Montreal Cognitive Assessment (MoCA) in non-demented ALS patients and at (2) exploring the MoCA administrability according to motor-functional status.MaterialsN = 348 patients were administered the MoCA and Edinburgh Cognitive and Behavioural ALS Screen (ECAS). Administrability rates and prevalence of defective MoCA scores were compared across King’s and Milano-Torino clinical stages. Regression models were run to test whether the non-administrability of the MoCA and a defective score on it were predicted, net of the ECAS-Total, by disease duration, ALS Functional Rating Scale-Revised (ALSFRS-R) and progression rate, computed as (48: ALSFRS-R)/disease duration. Intrinsic and post-test diagnostics were tested against a below-cut-off ECAS-total score.ResultsThe 79.9% of patients successfully underwent the MoCA, whose administrability rates decreased with advanced clinical stages, at variance with its defective score prevalence. The probability of the FAB not being administrable was predicted only by lower ALSFRS-R-bulbar and-upper-limb scores; no motor features, but the ECAS-Total, predicted a defective MoCA performance. The MoCA showed high accuracy (AUC = 0.82) and good intrinsic and post-test properties—being slightly more specific than sensitive.DiscussionIn non-demented ALS patients, the MoCA is featured by optimal diagnostics as a screener for cognitive impairment, especially for ruling-out its occurrence, as long as patients are in the early stages of the disease and have sufficiently spared bulbar and upper-limb functions.
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Affiliation(s)
- Edoardo Nicolò Aiello
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy
- PhD Program in Neuroscience, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Federica Solca
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Silvia Torre
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Laura Carelli
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy
| | - Roberta Ferrucci
- Department of Health Sciences, International Medical School, Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics, University of Milan, Milan, Italy
- ASST Santi Paolo e Carlo, San Paolo University Hospital, Milan, Italy
- IRCCS Ca’ Granda Foundation Maggiore Policlinico Hospital, Milan, Italy
| | - Alberto Priori
- Department of Health Sciences, International Medical School, Aldo Ravelli Center for Neurotechnology and Experimental Brain Therapeutics, University of Milan, Milan, Italy
- ASST Santi Paolo e Carlo, San Paolo University Hospital, Milan, Italy
| | - Federico Verde
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy
- Department of Pathophysiology and Transplantation, "Dino Ferrari Center", Università degli Studi di Milano, Milan, Italy
| | - Vincenzo Silani
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy
- Department of Pathophysiology and Transplantation, "Dino Ferrari Center", Università degli Studi di Milano, Milan, Italy
| | - Nicola Ticozzi
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy
- Department of Pathophysiology and Transplantation, "Dino Ferrari Center", Università degli Studi di Milano, Milan, Italy
| | - Barbara Poletti
- Department of Neurology and Laboratory of Neuroscience, IRCCS Istituto Auxologico Italiano, Milan, Italy
- *Correspondence: Barbara Poletti,
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Aiello EN, Iazzolino B, Pain D, Peotta L, Palumbo F, Radici A, Canosa A, Moglia C, Calvo A, Mora G, Chiò A. The diagnostic value of the Italian version of the Edinburgh Cognitive and Behavioral ALS Screen (ECAS). Amyotroph Lateral Scler Frontotemporal Degener 2022; 23:527-531. [PMID: 35311435 DOI: 10.1080/21678421.2022.2051552] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Objectives: The diagnostic capabilities of specific cognitive screeners are clinically crucial for an early detection of frontotemporal features in amyotrophic lateral sclerosis (ALS) patients. This study aimed at providing diagnostic properties of the cognitive section of the Edinburgh Cognitive and Behavioral ALS Screen (ECAS) in Italian ALS patients.Methods: Eighty-nine consecutive Italian ALS patients were classified according to Strong et al. (2017) criteria with a comprehensive neuropsychological assessment. The Italian version of ECAS was also administered, and its accuracy, sensitivity (SE), specificity (SP), negative and positive predictive values (PPV; NPV) and likelihood ratios (LR+; LR-) were computed against clinical diagnoses.Results: The ECAS and its subscales yielded moderate-to-high accuracy (AUC = .7-.87). High SP was overall found (81.8%-100%). The most sensitive measures were ALS-specific and Executive (73.9-78.3%) subscales, while the least were the ALS-non-specific subscales (8.7-17.4%). ECAS measures showed good PPVs (60%-100%) and NPVs (75.9%-91.5%). Acceptable LRs were found (LR+: 6.97-4.3; LR-: .29-.91), with total and ALS-specific measures yielding the best estimates.Conclusions: This is the first study demonstrating the diagnostic value of the ECAS against a thorough neuropsychological assessment in Italy. ECAS-total and -ALS-specific scores are diagnostically sound as to both intrinsic and post-test features, whereas ALS-non-specific measures perform slightly worse.
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Affiliation(s)
- Edoardo Nicolò Aiello
- PhD Program in Neuroscience, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
| | - Barbara Iazzolino
- 'Rita Levi Montalcini' Department of Neuroscience, University of Turin, ALS Centre, Turin, Italy
| | - Debora Pain
- Istituti Clinici Scientifici Maugeri, IRCCS Milano, Milan, Italy
| | - Laura Peotta
- 'Rita Levi Montalcini' Department of Neuroscience, University of Turin, ALS Centre, Turin, Italy
| | - Francesca Palumbo
- 'Rita Levi Montalcini' Department of Neuroscience, University of Turin, ALS Centre, Turin, Italy
| | - Alice Radici
- Istituti Clinici Scientifici Maugeri, IRCCS Milano, Milan, Italy
| | - Antonio Canosa
- 'Rita Levi Montalcini' Department of Neuroscience, University of Turin, ALS Centre, Turin, Italy.,Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Neurology Unit 1, Turin, Italy
| | - Cristina Moglia
- 'Rita Levi Montalcini' Department of Neuroscience, University of Turin, ALS Centre, Turin, Italy.,Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Neurology Unit 1, Turin, Italy
| | - Andrea Calvo
- 'Rita Levi Montalcini' Department of Neuroscience, University of Turin, ALS Centre, Turin, Italy.,Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Neurology Unit 1, Turin, Italy.,Neuroscience Institute of Turin (NIT), Turin, Italy and
| | - Gabriele Mora
- Istituti Clinici Scientifici Maugeri, IRCCS Milano, Milan, Italy
| | - Adriano Chiò
- 'Rita Levi Montalcini' Department of Neuroscience, University of Turin, ALS Centre, Turin, Italy.,Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Neurology Unit 1, Turin, Italy.,Neuroscience Institute of Turin (NIT), Turin, Italy and.,Institute of Cognitive Sciences and Technologies, C. N. R. Rome, Italy
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12
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Aiello EN, Rimoldi S, Bolognini N, Appollonio I, Arcara G. Psychometrics and diagnostics of Italian cognitive screening tests: a systematic review. Neurol Sci 2021; 43:821-845. [PMID: 34816316 DOI: 10.1007/s10072-021-05683-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Accepted: 10/17/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Cognitive screening tests (CSTs) are crucial to neuropsychological diagnostics, and thus need to be featured by robust psychometric and diagnostic properties. However, CSTs happen not to meet desirable statistical standards, negatively affecting their level of recommendations and applicability. This study aimed at (a) providing an up-to-date compendium of available CSTs in Italy, (b) report their psychometric and diagnostic properties, and (c) address related limitations. METHODS This review was implemented by consulting Preferred Reporting Items for Systematic Reviews and Meta-Analyses and pre-registered on the International Prospective Register of Systematic Reviews. Standardization and usability studies focusing on norms, validity, reliability, or sensitivity/specificity (and derived metrics) in adults were considered for eligibility. Quality assessment was performed by means of an ad hoc checklist collecting information on sampling, psychometrics/diagnostics, norming, and feasibility. RESULTS Sixty studies were included out of an initial N = 683. Identified CSTs (N = 40) were classified into general, domain-, and disease-specific (N = 17, 7, and 16, respectively), the latter being less statistically robust than remaining categories. Validity and reliability evidence was provided for 29 and 26 CSTs, respectively, sensitivity/specificity for 20 and norms for 33. Prevalence- and post-test-based diagnostic metrics were seldomly represented; factorial structures, ceiling/floor effects, and acceptability rarely investigated; content, face, and ecological validity never assessed. DISCUSSION Although available Italian CSTs overall met basic psychometric/diagnostic requirements, their statistical profile often proved to be poor on several properties that are desirable for clinical applications, with a few exceptions among general and domain-specific ones.
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Affiliation(s)
- Edoardo Nicolò Aiello
- PhD Program in Neuroscience, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.
| | - Sara Rimoldi
- Department of Psychology, University of Milano-Bicocca, Milano, Italy
| | - Nadia Bolognini
- Department of Psychology, University of Milano-Bicocca, Milano, Italy.,Neuropsychological Laboratory, IRCCS Istituto Auxologico Italiano, Milano, Italy
| | - Ildebrando Appollonio
- Neurology Section, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
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Temp AGM, Dyrba M, Büttner C, Kasper E, Machts J, Kaufmann J, Vielhaber S, Teipel S, Prudlo J. Cognitive Profiles of Amyotrophic Lateral Sclerosis Differ in Resting-State Functional Connectivity: An fMRI Study. Front Neurosci 2021; 15:682100. [PMID: 34248485 PMCID: PMC8261303 DOI: 10.3389/fnins.2021.682100] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 05/17/2021] [Indexed: 11/18/2022] Open
Abstract
Background Half of all amyotrophic lateral sclerosis-frontotemporal spectrum disorder (ALS-FTSD) patients are classified as cognitively impaired, of which 10% have frontotemporal dementia (FTD), and an additional 40% suffer from a frontotemporal syndrome not severe enough to be described as dementia (cognitively impaired/ALSci). As changes in cerebral function measured by resting-state magnet resonance imaging (rs-fMRI) are known in ALS, we investigated whether group differences in resting-state functional connectivity (RSFC) networks could be observed between ALS patients with different cognitive profiles against healthy controls (HC). Furthermore, we correlated cognition and motor functioning with network connectivity. Methods Healthy controls, 69, and 97 ALS patients underwent functional MRI scanning and cognitive assessment. The ALS patients were categorized as non-impaired (ALSni; n = 68), cognitively impaired (ALSci; n = 21), and ALS-FTD (n = 8). Group differences in connectivity of the default mode network (DMN), motor network (MN), and ventral attention network (VAN) were investigated using a full-factorial model; correlations between global cognitive performance, shifting, and motor symptom severity were established using Pearson’s correlation. Results At a liberal alpha level of uncorrected p < 0.005 and a cluster size exceeding 20 voxels, we found widespread decreases in functional connectivity in all three networks when comparing ALS patients to HC. Similar patterns of hypoconnectivity in the bilateral motor cortices and frontotemporal emerged when comparing the ALSci and ALS-FTD patients to those not cognitively impaired. Hyperconnectivity in the DMN temporal gyrus correlated with worse global cognition; moreover, hyperconnectivity in the VAN thalamus, insula, and putamen correlated with worse shifting ability. Better-preserved motor function correlated with higher MN connectivity. Only the motor-related effects prevailed at a more conservative significance level of pFDR< 0.001. Conclusion Resting-state functional connectivity differs between cognitive profiles of ALS and is directly associated with clinical presentation, specifically with motor function, and cognitive shifting.
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Affiliation(s)
- Anna G M Temp
- German Center for Neurodegenerative Diseases (DZNE), Rostock, Germany
| | - Martin Dyrba
- German Center for Neurodegenerative Diseases (DZNE), Rostock, Germany
| | - Charlotte Büttner
- German Center for Neurodegenerative Diseases (DZNE), Rostock, Germany
| | - Elisabeth Kasper
- Department of Neurology, Rostock University Medical Center, Rostock, Germany
| | - Judith Machts
- German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany.,Department of Neurology, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Jörn Kaufmann
- Department of Neurology, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Stefan Vielhaber
- German Center for Neurodegenerative Diseases (DZNE), Magdeburg, Germany.,Department of Neurology, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Stefan Teipel
- German Center for Neurodegenerative Diseases (DZNE), Rostock, Germany.,Department of Psychosomatic Medicine, Rostock University Medical Center, Rostock, Germany
| | - Johannes Prudlo
- German Center for Neurodegenerative Diseases (DZNE), Rostock, Germany.,Department of Neurology, Rostock University Medical Center, Rostock, Germany
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