Standardization of the Italian ALS-CBS™ Caregiver Behavioral Questionnaire

Abstract

BackgroundThe present investigation aimed at testing the psychometrics and diagnostics of the Italian version of the Caregiver Behavioral Questionnaire (CBQ) from the ALS Cognitive Behavioral Screen (ALS-CBS™), as well as its case–control discrimination, in a cohort of non-demented patients with ALS.MethodsThe caregivers of N = 265 non-demented patients with ALS and N = 99 healthy controls (HCs) were administered the CBQ and the Edinburgh Cognitive and Behavioural ALS Screen-Carer Interview (ECAS-CI). For N = 98 patients, an in-depth behavioural/psychopathological assessment via the Frontal Behavioural Inventory (FBI), the Dimensional Apathy Scale (DAS), the State and Trait Anxiety Inventory-Form Y (STAI-Y), and the Beck Depression Inventory (BDI) was also available. Factorial and construct validity, internal reliability, and diagnostics against an abnormal ECAS-CI score were tested in patients. Case–control discrimination was explored through logistic regression.ResultsThe CBQ was internally reliable (McDonald’s ω = 0.90) and underpinned by a simple, unidimensional structure; it converged with ECAS-CI, FBI, and DAS scores and diverged from STAI-Y and BDI ones. A cutoff of ≤ 33 accurately detected abnormal ECAS-CI scores (AUC = 0.85), yielding optimal error- and information-based diagnostics. The CBQ was independent of demographic and disease-related variables and discriminated patients from HCs (p < 0.001).DiscussionThe Italian version of the CBQ from the ALS-CBS™ is a valid, reliable, diagnostically sound, and feasible screener for detecting frontotemporal-like behavioural changes in non-demented patients with ALS. Its adoption is thus recommended within clinical practice and research in the view of providing preliminary information on whether the administration of more extensive behavioural instruments is needed.

What is the extent of reliability and validity evidence for screening tools for cognitive and behavioral change in people with ALS? A systematic review

“…The internal consistency of the ECASb was questionable as it was only assessed by one study ( 25 ) that found its internal consistency to be statistically unacceptable. While inter-rater reliability and test-retest reliability for the ALS-CBSb were not reported in any of the studies included here, one study suggested that the ALS-CBSb had acceptable internal consistency ( 34 ).…”

“…There was evidence of convergent validity between the ECASb and ALS-CBSb ( 25 , 26 , 34 ) ( Table 7 ) and between the ALS-CBSb and the other behavioral measures ( 34 , 45 , 48 ).…”

“…Six papers reported ALS-CBSb validity data ( 10 , 26 , 34 , 45 , 47 , 48 ) ( Table 7 ). Two studies supported the clinical validity of the ALS-CBSb ( 10 , 47 ).…”

“…One study ( 34 ), using Principal Components Analysis (PCA), reported that the ALS-CBSb has a single component structure. For the BBI, another study ( 35 ) reported that five items loaded weakly on the component of behavioral impairment when using PCA but reported a clear single factor structure.…”

“…The methodological quality of behavioral screen studies was generally high. Reliability and validity statistics were presented for the ECASb by only four studies ( 23 , 25 , 26 , 34 ) ( Tables 6 and 7 ). The internal consistency of the ECASb was questionable as it was only assessed by one study ( 25 ) that found its internal consistency to be statistically unacceptable.…”