Cognitive screening tools in multiple sclerosis revisited: sensitivity and specificity of a short version of Rao’s Brief Repeatable Battery

Abstract

BackgroundCognitive deficits are common in multiple sclerosis (MS) and require continuous monitoring. In routine examinations, screening instruments such as the Brief Repeatable Battery (BRB) may serve this purpose. It was suggested that even a shortened version of the BRB, comprising the Symbol Digit Modalities Test (SDMT), Paced Auditory Serial Addition Test (PASAT) and Selective Reminding Test (SRT), may be feasible.However, an evaluation of sensitivity and specificity of the short BRB in comparison to an independent battery of established tests has not yet occurred. Therefore in the current study, this short version of the BRB was matched against the gold standard of an extensive test battery comprehensively assessing neuropsychological functions.Methods127 MS-patients were tested with a short version of the BRB and an extensive procedure. The latter served as the gold standard for defining sensitivity and specificity.ResultsFor subtests of the short BRB, estimates of sensitivity (38-44 %) and specificity (81-94 %) were obtained. Combining subtests into a single indicator of cognitive deficits yielded increased sensitivity (78 %), while reducing specificity (65 %).ConclusionThe short BRB is reasonably sensitive and specific in detecting cognitive deficits. However, these qualities only emerge, if the short BRB is administered as a whole, whereas sensitivity is considerably lower than suggested by previous work, when relying on subtests separately (SDMT, PASAT, SRT). While the short BRB may not be regarded as conclusive as an extensive test battery, it represents a valid and economic screening instrument.Electronic supplementary materialThe online version of this article (doi:10.1186/s12883-015-0497-8) contains supplementary material, which is available to authorized users.

What is the meaning of PASAT rejection in multiple sclerosis?

“…Furthermore, it is included in several standard batteries such as the Brief Repeatable Battery of Neuropsychological test (BRB-N) 1 and the Minimal Assessment of Cognitive Function In MS 2 It has also been suggested and validated as a screening of neuropsychological performance, 3 although the Symbol Digit Modalities Test is generally preferred and more accepted by the patients. It is considered a reliable tool for the assessment of working memory and sustained attention, and an indirect measure of information processing speed.…”

“…It is considered a reliable tool for the assessment of working memory and sustained attention, and an indirect measure of information processing speed. Furthermore, it is included in several standard batteries such as the Brief Repeatable Battery of Neuropsychological test (BRB-N) 1 and the Minimal Assessment of Cognitive Function In MS 2 It has also been suggested and validated as a screening of neuropsychological performance, 3 although the Symbol Digit Modalities Test is generally preferred and more accepted by the patients. 4 In this regard, the performance below the standards (a "positive" result when used as a screening tool) should give rise to suspect the presence of cognitive dysfunction.…”

Frontal brain activity and cognitive processing speed in multiple sclerosis: An exploration of EEG neurofeedback training

“…Inclusion criteria involved a verified MS diagnosis based on revised McDonald criteria (Polman et al, 2011), subjective reports of cognitive deficits during activities of everyday life, as reported by patients during routine medical visitations, as well as an age range of 18–75 years. Patients who reported subjective cognitive difficulties took part in an established neuropsychological screening procedure during the routine clinical process (Hansen et al, 2015, Hansen et al, 2016). In this context, they were offered to participate in the study.…”

“…Due to a pathologic autoimmune response that leads to demyelinization and axonal loss, multiple sclerosis (MS) patients may display various neurological symptoms, including sensory and motor deficits, as well as autonomic dysfunction (Compston and Coles, 2008; Burschka et al, 2012; Keune et al, 2015a, Keune et al, 2017b). About two thirds of patients also show clinically relevant cognitive deficits (Amato et al, 2006; Langdon, 2011; Hansen et al, 2015). These have been attributed to a disconnection syndrome of the brain, arising from the interplay of focal lesion burden and the disruption of critical white matter connecting fiber tracts (Filippi and Rocca, 2011; Calabrese et al, 2013; Rocca et al, 2014, Rocca et al, 2015).…”

“…In turn, deficits may manifest in various cognitive domains, including attention, executive function and memory (Langdon, 2010). To effectively diagnose and monitor cognitive deficits in routine clinical practice, various tests have been established (Langdon et al, 2012; Hansen et al, 2015), including the Symbol Digit Modalities Test (SDMT; Smith, 1982; Benedict et al, 2017), which addresses information processing speed and attention. SDMT performance partly relies on the integrity of structural connectivity in prefrontal regions and deep gray nuclei (Llufriu et al, 2017).…”