EPICOG-SCH: A brief battery to screen cognitive impact of schizophrenia in stable outpatients

Abstract

Brief batteries in schizophrenia, are needed to screen for the cognitive impact of schizophrenia. We aimed to validate and co-norm the Epidemiological Study of Cognitive Impairment in Schizophrenia (EPICOG-SCH) derived brief cognitive battery. A cross-sectional outpatient evaluation was conducted of six-hundred-seventy-two patients recruited from 234 centers. The brief battery included well-known subtests available worldwide that cover cognitive domains related to functional outcomes: WAIS-III-Letter-Number-Sequencing-LNS, Category Fluency Test-CFT, Logical-Memory Immediate Recall-LM, and Digit-Symbol-Coding-DSC. CGI-SCH Severity and WHO-DAS-S were used to assess clinical severity and functional impairment, respectively. Unit Composite Score (UCS) and functional regression-weighted Composite Scores (FWCS) were obtained; discriminant properties of FWCS to identify patients with different levels of functional disability were analyzed using receiver-operating characteristic (ROC) technique. The battery showed good internal consistency, Cronbach's alpha = 0.78. The differences between cognitive performance across CGI-SCH severity level subscales ranged from 0.5 to 1 SD. Discriminant capacity of the battery in identifying patients with up to moderate disability levels showed fair discriminant accuracy with areas under the curve (AUC) > 0.70, p < 0.0001. An FWCS mean cut-off score ≥ 100 showed likelihood ratios (LR) up to 4.7, with an LR + of 2.3 and a LR − of 0.5. An FWCS cut-off ≥ 96 provided the best balance between sensitivity (0.74) and specificity (0.62).The EPICOG-SCH proved to be a useful brief tool to screen for the cognitive impact of schizophrenia, and its regression-weighted Composite Score was an efficient complement to clinical interviews for confirming patients' potential functional outcomes and can be useful for monitoring cognition during routine outpatient follow-up visits.

Neurocognitive Impairment in Severe Mental Illness. Comparative study with Spanish Speaking Patients

“…This problem also affects to neuropsychological assessment of Spanish speaking population in the United States [ 12 ]. However, some neuropsychological instruments exist that—although they were developed to evaluate other conditions such as dementia—may represent a valid and helpful tool in the detection of cognitive impairment in SMI patients and they have been adapted to Spanish: The Screen for Cognitive Impairment in Psychiatry (SCIP) [ 13 ], the Epidemiological Study of Cognitive Impairment in Schizophrenia Battery (EPICOG-SCH) [ 14 ] and the Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) developed by National Institute of Mental Health (NIMH) and adapted and standardized in Spain by Rodriguez-Jimenez, Bagney, Garcia-Navarro, Aparicio, Lopez-Anton, Moreno-Ortega and Green [ 15 ]. However, all of them have in common that they are brief screening tests while the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) represents a more comprehensive assessment tool, already tested in many different pathologies and adapted worldwide.…”