The Cognitive Behavioral Score Questionnaire (Q‐CBS) in phenotyping minor and major neurocognitive disorder syndromes

Abstract

Background The demand for specialized care in neurocognitive disorders greatly surpasses its availability. Patients have complex needs and specialists are scarce. As a result, there is a gap between the needs of patients and the capacity of health systems to address them. Expert systems help fill this gap working towards early and accurate phenotyping (description) of neurocognitive disorders to better identify and successfully allocate the limited resources. We developed the Cognitive Behavioral Score (CBS), a 51‐item structured self‐administered questionnaire and its caregiver counterpart (cCBS), conducting exploratory analyses on clinical feasibility and diagnostic utility, as well as association to neuropsychological performance. Method We enrolled 29 patients (age: 71.5±11.7; education: 9.6±2.8 years) with minor or major neurocognitive disorder (late age‐of‐onset Alzheimer’s disease with various degrees of vascular comorbidity; MMSE= 26.0±4.3) through the Sleep & Memory Center of the Neurological Institute of Athens. CBS and cCBS were completed by patients and/or their caregivers, covering cognitive, behavior, autonomic, and sleep symptom severity and duration. Patients underwent physical examinations, neuropsychological, biochemical and imaging testing. Statistical analyses were conducted using Pearson ρ or Kendall τ as appropriate, depending on data deviation from normality. Results Both CBS and cCBS were completed in‐clinic or at home within 5 minutes and provided a clinical overview of symptom progression. CBS and cCBS congruence total score was 0.36, certain domain‐specific sub scores were even better (0.46 – 0.67). Correlation to MMSE was better for cCBS (‐0.30), a feature reflective of the patient population. CBS and cCBS sub scores had varying degrees of correlation to domain‐specific neuropsychological tests, with historic symptoms of anomia having most and highest associations (≤ ‐0.76). Non‐cognitive symptoms were correlated to executive function, hinting to possible comorbid synucleinopathies or sleep deprivation. Conclusion The study results suggest that both CBS and cCBS have diagnostic utility for the clinician. They allow faster and more accurate description and identification of syndromic neurocognitive disorders. With better understanding, resources can be allocated in a more directed and better‐planned manner, helping low resource settings. Also these questionnaires minimize the time in history taking, allowing health professionals to dedicate more time to the patients for better and individualized care.