Brief Cognitive Assessment based on Consensus Standards in the US and Abroad Dawn Langdon PhD

MS care providers needs Most interested in receiving consultation on cognition (31.0%) Most interested in CME relating to cognition (40.1%) Highest preference for live conference Turner et al., JRRD 2006;43:25-34

MS patients’ information needs All those questions recommended information about cognition in MS for all patients And on average to be given earlier than they had received it Heesen et al., Acta Neurol Scand 2006;114:268-272

Assessment of Cognition Comprehensive Batteries Intermediate length Batteries Brief Batteries Screening tests MSNQ BRB SEFCI MACFIMS Ad hoc Routine in the office Routine NP exam. Differential diagnosis Disability questions Rehabilitation programs 4

Cognitive assessment for MS Requires specialist training Time-consuming Not routinely available outside specialist centres Not comparable across countries

BICAMS Brief International Cognitive Assessment for MS Identify a brief assessment tool for cognition in MS can be used by health care professionals who are not cognitive specialists has international validation Specify an international validation protocol that can be implemented in any country Agree guidelines on test-retest timing and clinically significant change BICAMS committee meetings and website are sponsored by Bayer Healthcare

BICAMS committee meetings and website are sponsored by Bayer Healthcare

BICAMS Brief International Cognitive Assessment for MS Identify a brief assessment tool for cognition in MS 80 key scientific articles identified Each article rated by two committee members Psychometric standards Reliability Validity Sensitivity Pragmatic standards International applicability Ease of administration Feasibility in the specified context Acceptability to patients BICAMS committee meetings and website are sponsored by Bayer Healthcare

BICAMS Brief International Cognitive Assessment for MS No materials required beyond papers, pencil and stopwatch BICAMS committee meetings and website are sponsored by Bayer Healthcare

Benedict et al. Clin Neuropsychol 2002; 16: 381-97

Neuropsychological Evaluations California Verbal Learning Test-II (CVLT II) Truck Spinach Giraffe Bookcase Onion Motorcycle Cabinet Zebra Coach Lamp Celery Cow Desk Boat Squirrel Cabbage Benedict et al. Clin Neuropsychol 2002; 16: 381-97

Brief Visuospatial Memory Test (Revised) RHB Benedict (Clin Neuropsych 1994; Psychol Assess 1996; Psychol Assess Resources 1997). Benedict et al. Clin Neuropsychol 2002; 16: 381-97 12

BICAMS Brief International Cognitive Assessment for MS Battery: SDMT CVLT-II, first recall trials BVMTR, first recall trials BICAMS committee meetings and website are sponsored by Bayer Healthcare

MS patients compared to healthy controls on BICAMS Parmenter et al MS patients compared to healthy controls on BICAMS Parmenter et al., JINS 2010;16:6-16 MS (n=395) Mean SD Controls (n=100) P value d’ Age 46.28 8.99 44.79 9.43 ns 0.16 Education 14.28 2.34 14.47 1.72 0.09 BDI-FS 3.39 3.40 0.90 1.40 <.001 0.96 SDMT 49.53 13.20 61.40 9.31 1.04 CVLT-II TL 48.80 10.56 55.79 9.35 0.70 BVMTR TL 20.92 7.17 26.68 5.56

CVLT-II (learning trials) BVMTR (learning trials) Raw score to scaled score conversion Parmenter et al., JINS 2010;16:6-16 Scaled score SDMT CVLT-II (learning trials) BVMTR (learning trials) 2 <13 3 <43 <32 13 4 43-35 32-35 14-15 5 46 36-43 16 6 47-50 44-46 17-19 7 51-54 47-48 20-22 8 55-56 49-51 23-24 9 57-59 52-53 25-26 10 60-63 54-57 27-28 11 64-66 58-60 29-30 12 67-69 61-63 31 70-72 32 14 73-74 67-70 33 15 75-78 71-73 34-35 79 74 17 80-87 18 >87 >74 36

BICAMS committee meetings and website are sponsored by Bayer Healthcare

BICAMS Brief International Cognitive Assessment for MS Identify a brief assessment tool for cognition in MS can be used by health care professionals who are not cognitive specialists has international validation Specify an international validation protocol that can be implemented in any country BICAMS committee meetings and website are sponsored by Bayer Healthcare

Benedict et al., BMC Neurology (submitted) BICAMS Brief International Cognitive Assessment for MS international validation protocol Step 1, Standardization and Translation of Test Stimuli. Step 2, Standardization and Translation of Test Instructions Step 3, Normalization Step 4, Test-Retest Reliability Step 5, Criterion-Related Validity  Benedict et al., BMC Neurology (submitted) BICAMS committee meetings and website are sponsored by Bayer Healthcare

BICAMS Brief International Cognitive Assessment for MS: National Validations Country NC n MS n Data collection started Data collection completed Analysis started Analysis completed Publi-cation BICAMS support Argentina TBD Pending RHB Benedict Czech Repub 92 130 Mar 2010 Ongoing Iran 158 90 Sep 2011 Oct 2011 Nov 2011 Submitted UK 60 DW Langdon Egypt D W Langdon Estonia Italy MP Amato

BICAMS Brief International Cognitive Assessment for MS Identify a brief assessment tool for cognition in MS can be used by health care professionals who are not cognitive specialists has international validation Specify an international validation protocol that can be implemented in any country Agree guidelines on test-retest timing and clinically significant change BICAMS committee meetings and website are sponsored by Bayer Healthcare

Assessment of Cognition Routine in the office Comprehensive Batteries Intermediate length Batteries Brief Batteries Screening tests 0 mins Routine in the clinic BICAMS 15 mins 45 mins Routine NP exam 90 mins Differential diagnosis Disability questions Rehabilitation programs 120 mins 21