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The Chinese (Cantonese) brief international cognitive assessment for multiple sclerosis (BICAMS): A validation study
C Y Lee1, K H Chan1, C Y Chau2
1Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong; Neuroimmunology and Neuroinflammation Research Laboratory, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong.
Background:
The Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) is a widely used tool to detect cognitive impairment in multiple sclerosis (MS) patients across different populations. However, a validated version for Cantonese-speaking Chinese MS patients is lacking.
Objective:
To develop and validate a Chinese (Cantonese) version of BICAMS for Cantonese-speaking Chinese MS patients in Hong Kong.
Method:
Thirty Cantonese-speaking Chinese MS patients and twenty healthy control (HC) subjects were recruited for cognitive function assessment using a Chinese (Cantonese) version of BICAMS, which consists of the Symbol Digit Modalities Test (SDMT), a Brief Visuospatial Memory Test-Revised (BVMT-R), and a Cantonese version of the California Verbal Learning Test-II (CVLT-II). Repeat testing was performed 14-21 days after baseline testing to assess test-retest reliability. Scoring was performed by a single investigator according to the criteria of the original BICAMS. Cognitive impairment was defined as having a score of 1.5 standard deviations below the mean of the control group in one or more tests.
Results:
The HC and MS groups were well-matched in terms of mean age (37.0 vs. 40.7 years), sex distribution (female 60 % vs. 73.3 %), and mean duration of education (18.2 vs. 17.3 years). MS patients had significantly lower mean z-scores in all three tests compared to HC subjects (SDMT p < 0.01, BVMT-R p < 0.01, and CVLT-II p < 0.05). Good correlation between baseline test and retest was confirmed by both Pearson's correlation and intraclass correlation, suggesting high test-retest reliability. Nineteen of 30 (63.3 %) MS patients had cognitive impairment, detected in 50.0 % by SDMT, 53.3 % by BVMT-R, and 30.0 % by CVLT-II. More severe cognitive impairment was associated with higher disability as measured by the Expanded Disability Status Scale (EDSS). SDMT was found to be an independent predictor of unemployment in MS patients.
Conclusion:
The Chinese (Cantonese) version of BICAMS demonstrated good validity and reliability as an assessment tool for detecting cognitive impairment in Cantonese-speaking Chinese MS patients in Hong Kong. Future research should focus on the responsiveness of this version of BICAMS to treatment interventions and its utility in longitudinal assessments of cognitive function in MS patients.
