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      Klinische Umsetzbarkeit der kognitiven Screeningbatterie BICAMS bei Patienten mit Multipler Sklerose: Ergebnisse der Machbarkeitsstudie in Deutschland Translated title: Clinical practicability of the cognitive screening battery BICAMS in patients with multiple sclerosis: results of the feasibility study in Germany

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          Abstract

          Hintergrund

          Patienten mit Multipler Sklerose (MS) leiden in 40–70 % der Fälle unter kognitiven Störungen. Der kognitive Status gilt erwiesenermaßen als Prädiktor für Berufsfähigkeit und frühzeitige Berentung. Eine regelmäßige Erfassung der kognitiven Leistungsfähigkeit ist somit dringend indiziert.

          Zielsetzung

          Die deutsche Fassung der international empfohlenen BICAMS (Brief International Cognitive Assessment for Multiple Sclerosis) -Batterie wurde auf Praktikabilität in der klinischen Routine neurologischer Praxen in Deutschland multizentrisch überprüft.

          Material und Methoden

          Medizinische Fachangestellte (MFAs) wurden hinsichtlich der Durchführung und Auswertung von BICAMS geschult. Alle ausgewerteten Testbögen wurden von unabhängigen neuropsychologischen Experten überprüft.

          Ergebnisse

          Insgesamt 1606 BICAMS-Datensätze wurden in 65 Zentren erhoben. Von diesen konnten 1573 analysiert werden. 49,7 % der erhobenen Datensätze wurden inklusive aller Auswerteschritte korrekt durchgeführt. Bei den anderen 50,3 % fanden sich Durchführungs‑, Auswerte- oder Transformationsfehler. Nach Bereinigung der Stichprobe durch fehlerbehaftete Fälle ergaben sich Werte der Interrater-Reliabilität pro Testverfahren in Höhe von ICC \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\geq$$\end{document} 0,953.

          Diskussion

          Grundsätzlich ist BICAMS für den Einsatz im klinischen Alltag sehr zu empfehlen. Es bleibt allerdings zu betonen, dass obgleich die Interrater-Reliabilität für die final bereinigte Stichprobe sehr hoch war, im Gesamtdatensatz 50,3 % Durchführungs‑, Auswerte- oder Transformationsfehler gefunden wurden. Daraus lässt sich die Notwendigkeit ableiten, nichtpsychologisches Personal noch eingehender in der Anwendung und Auswertung von BICAMS durch Experten zu schulen und zu supervidieren.

          Translated abstract

          Background

          Patients with multiple sclerosis (MS) suffer from cognitive impairment in 40–70% of the cases. There is evidence that the cognitive status is predictive for working ability and early retirement. Regular assessment of cognitive functionality is therefore urgently needed.

          Purpose

          The German validation of the Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) battery was evaluated in a multicentric way with respect to its feasibility in private neurological centers across Germany.

          Methods

          Physician assistants were trained with respect to application and scoring of BICAMS. All scored test materials were evaluated by independent neuropsychological experts.

          Results

          A total of 1606 BICAMS datasets were collected from 65 neurological centers. Of these 1573 datasets were analyzed of which 49.7% were correctly applied and scored while mistakes in application, scoring and transformation were found in 50.3%. Interrater reliability for each subtest was found to be ICC \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\geq$$\end{document} 0.953 when datasets containing mistakes were excluded.

          Discussion

          In general, BICAMS is highly recommended to be applied in standard clinical care; however, it should be emphasized that although the interrater reliability in the final sample was high, serious mistakes were found in 50.3% of cases. From these findings we conclude that nonpsychological staff have to be even more intensively trained and supervised by experts in the application and scoring of BICAMS.

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          Most cited references29

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          Rating neurologic impairment in multiple sclerosis: an expanded disability status scale (EDSS).

          J. Kurtzke (1983)
          One method of evaluating the degree of neurologic impairment in MS has been the combination of grades (0 = normal to 5 or 6 = maximal impairment) within 8 Functional Systems (FS) and an overall Disability Status Scale (DSS) that had steps from 0 (normal) to 10 (death due to MS). A new Expanded Disability Status Scale (EDSS) is presented, with each of the former steps (1,2,3 . . . 9) now divided into two (1.0, 1.5, 2.0 . . . 9.5). The lower portion is obligatorily defined by Functional System grades. The FS are Pyramidal, Cerebellar, Brain Stem, Sensory, Bowel & Bladder, Visual, Cerebral, and Other; the Sensory and Bowel & Bladder Systems have been revised. Patterns of FS and relations of FS by type and grade to the DSS are demonstrated.
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            Cognitive impairment in multiple sclerosis.

            Multiple sclerosis (MS) is a progressive disease of the CNS that is characterised by widespread lesions in the brain and spinal cord. MS results in motor, cognitive, and neuropsychiatric symptoms, all of which can occur independently of one another. The common cognitive symptoms include deficits in complex attention, efficiency of information processing, executive functioning, processing speed, and long-term memory. These deficits detrimentally affect many aspects of daily life, such as the ability to run a household, participate fully in society, and maintain employment--factors that can all affect the overall quality of life of the patient. The increased use of neuroimaging techniques in patients with MS has advanced our understanding of structural and functional changes in the brain that are characteristic of this disease, although much remains to be learned. Moreover, examination of efforts to treat the cognitive deficits in MS is still in the early stages.
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              Recommendations for a Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS)

              Background: Cognitive impairment in MS impacts negatively on many patients at all disease stages and in all subtypes. Full clinical cognitive assessment is expensive, requiring expert staff and special equipment. Test versions and normative data are not available for all languages and cultures. Objective: To recommend a brief cognitive assessment for multiple sclerosis (MS) that is optimized for small centers, with one or few staff members, who may not have neuropsychological training and constructed to maximize international use. Methods: An expert committee of twelve members representing the main cultural groups that have so far contributed considerable data about MS cognitive dysfunction was convened. Following exhaustive literature review, peer-reviewed articles were selected to cover a broad spectrum of cultures and scales that targeted cognitive domains vulnerable to MS. Each was rated by two committee members and candidates scales were rated on psychometric qualities (reliability, validity, and sensitivity), international application, ease of administration, feasibility in the specified context, and acceptability to patients. Results: The committee recommended the Symbol Digit Modalities Test, if only 5 minutes was available, with the addition of the California Verbal Learning Test – Second Edition and the Brief Visuospatial Memory Test – Revised learning trials if a further 10 minutes could be allocated for testing. Conclusions: A brief cognitive assessment for MS has been recommended. A validation protocol has been prepared for language groups and validation studies have commenced.
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                Author and article information

                Contributors
                iris-katharina.penner@uni-duesseldorf.de
                Journal
                Nervenarzt
                Nervenarzt
                Der Nervenarzt
                Springer Medizin (Heidelberg )
                0028-2804
                1433-0407
                17 February 2021
                17 February 2021
                2021
                : 92
                : 10
                : 1031-1041
                Affiliations
                [1 ]COGITO Zentrum für Angewandte Neurokognition und Neuropsychologische Forschung, Düsseldorf, Deutschland
                [2 ]GRID grid.411327.2, ISNI 0000 0001 2176 9917, Medizinische Fakultät, Klinik für Neurologie, , Heinrich-Heine-Universität, ; Düsseldorf, Deutschland
                [3 ]GRID grid.411327.2, ISNI 0000 0001 2176 9917, Institut für Experimentelle Psychologie, , Heinrich-Heine-Universität, ; Düsseldorf, Deutschland
                [4 ]GRID grid.461736.1, ISNI 0000 0001 2183 2023, .05 Statistikberatung, Life Science Center, ; Düsseldorf, Deutschland
                [5 ]Neurologische Gemeinschaftspraxis, Kassel/Vellmar, Deutschland
                Article
                1073
                10.1007/s00115-021-01073-5
                8484165
                33598773
                dfc7e9ca-b8c6-4b6d-b1e2-b6a6b0d60583
                © The Author(s) 2021

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                History
                : 4 January 2021
                Funding
                Funded by: Universitätsklinikum Düsseldorf. Anstalt öffentlichen Rechts (8911)
                Categories
                Originalien
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                © Springer Medizin Verlag GmbH, ein Teil von Springer Nature 2021

                Neurology
                kognition,erfassen kognitiver störungen,chronisch entzündliche erkrankung,kognitive neurologie,neuropsychologie,cognition,assessment of cognitive impairment,chronic inflammatory disease,cognitive neurology,neuropsychology

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