NEW YORK (Reuters Health) – An abbreviated cognitive battery, the Brief Cognitive Assessment Tool for Schizophrenia (B-CATS), allows quick assessment of global cognition in patients with schizophrenia, researchers report.
“I found it surprising that we could really capture so much of the variance of the overall MATRICS Consensus Cognitive Battery (MCCB) score with a 10-minute, easily administered test,” said Dr. Irene M. Hurford from the University of Pennsylvania, in Philadelphia.
“It means that if we are willing to settle for a measure of global cognitive functioning (as opposed to information about specific areas of functioning, like working memory or attention), then a very brief test does a good enough job without needing an hour or a neuropsychologist.” she told Reuters Health by email.
The MCCB was designed to be the gold-standard assessment battery to standardize pharmacological trials for cognitive enhancing agents in schizophrenia. It includes tests from 10 domains and takes 60-70 minutes to administer.
Dr. Hurford and colleagues developed the B-CATS as an alternative and compared its outcomes with those of MCCB and the UCSD Performance-based Skills Assessment-Brief (UPSA-B), a measure of functional capacity, in 91 outpatients with schizophrenia.
The final B-CATS version included the Trail Making Test part A and part B, Digit Symbol Substitution Test, and Animal Fluency.
The B-CATS took a mean of 10.3 minutes to administer by clinical research assistants who were neither psychologists nor psychometricians, though they received training on proper administration of the B-CATS. The mean administration time for the MCCB, in contrast, was 64 minutes.
B-CATS results showed a correlation of 0.76 with MCCB results, the researchers report in Schizophrenia Bulletin, online September 13, and both correlated moderately with UPSA-B results (0.50 and 0.58, respectively).
Symptoms on the Brief Psychiatric Rating Scale correlated with the B-CATS for positive symptoms, negative symptoms and disorganized symptoms – consistent with the correlations with MCCB.
The B-CATS demonstrated good test-retest reliability and acceptable internal consistency.
“With the B-CATS, clinicians could set aside 10 minutes of their appointment time semiannually or annually to track people’s cognitive status and see whether treatment is helping or hurting,” Dr. Hurford said. “We don’t want to do the test too often, or we will get into practice effects.”
“If we really want to be serious about finding treatments for cognitive deficits in schizophrenia, then the clinicians responsible for patient care need a way to measure cognition,” she concluded. “This is a step in that direction that will hopefully start opening doors to more available cognitive treatments.”
Dr. Melisa Rempfer, director of clinical psychology training at the University of Missouri Kansas City, told Reuters Health by email, “It is striking to consider that clinicians could attain similar patient data without extensive testing. This is more efficient not only from a clinical resource point of view, but it is less burdensome to patients as well.”
“The development of valid, and practical, methods for assessing cognition that can be incorporated into daily practice among first-line clinicians is an exciting possibility, because it may ultimately lead to greater awareness of and access to cognitively oriented treatments for patients,” she said.
Dr. Eva Norlin-Bagge from Sahlgrenska University Hospital and the University of Gothenburg, Sweden, a practicing neuropsychologist for more than 30 years in neurology, neurorehabilitation, and psychiatry, said, “The tests suggested in the article inform about processing-speed reduction, but not other aspects of cognitive- and behavioral-capacity reductions important for the understanding and treatment of individuals with schizophrenia-spectrum disorders. Thus, B-CATS cannot be said to be a safe and valid diagnostic instrument for cognitive dysfunction in schizophrenia.”
Instead, she recommended another screening tool. “The Barrow Neurological Institute Screen for Higher Cerebral Functions (BNIS) takes about 20-30 minutes to perform; the items cover a range of cognitive domains and are not speed-dependent. Systematized observational methods of everyday behavior used by nursing staff give valuable information about functioning in everyday life, and their results can be applied in their daily clinical work,” Dr. Norlin-Bagge told Reuters Health by email.
“Comprehensive clinical neuropsychological investigation methods should be reserved for and supervised by psychologists with knowledge about neuropsychological disturbances and methods to investigate these,” she said.
SOURCE: http://bit.ly/2xyWlBO
Schizophr Bull 2017.
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