The Use of Brief Assessment Batteries in Multiple Sclerosis · 2019. 1. 5. · 5/14/2014 The Use of...

5/14/2014 The Use of Brief Assessment Batteries

http://webcache.googleusercontent.com/search?q=cache:E7wbQMgktcQJ:www.va.gov/ms/library/managing/robert_kane_brief_assessment_batteries_in_ms.ppt… 1/23

This is the html version of the filehttp://www.va.gov/ms/library/managing/robert_kane_brief_assessment_batteries_in_ms.ppt.Google automatically generates html versions of documents as we crawl the web.

Brief NP AssessmentKane

1

The Use of Brief AssessmentBatteries in Multiple Sclerosis

Robert L. Kane, Ph.D. ABPPCn

Assoc. Director Communications

VA MSCE East


2

History of Cognitive Studies inMS

Since MS is a CNS disorder is there acognitive componentWhat is the severityWith what frequency does it occurIs there a particular pattern or presentationDoes the pattern or severity vary withsubtype of course




3

Clinical Questions

Who needs to be assessedWhat cognitive domains need to be coveredWith what frequency should theassessments take placeStrategies for assessment related topurposeComprehensive: Assessment forrehabilitation, benefits, vocational planningDetection: Identification of individualsshowing deficitsMonitoring: Assessing cognitive changes asa treatment outcome


4

Neurocognitive Assessment as Review of Systems

NeurologicMusculoskeletalCardiovascularRespiratory



GIGUIntegumentary (skin)

(Pain)

AttentionImmediate memorySustained focusedWorking memorydividedMemoryLearningRecallRecognitionLanguageFluencyComprehensionRepetitionProblem SolvingExecutive FunctioningProcessing Speed


5

Strategy

If you have a population where ~50% of thepatients may have problems does it make



sense to screen first before embarking on acomprehensive exam?Is there sufficient consistency in deficits topermit short screening approaches?Can short batteries be used to monitortreatment progression and outcome?


6

Characteristics of a ScreeningExamination

BriefInexpensiveSample pertinent disease parameters(domains, constructs, predictability) Balance Sensitivity and SpecificitySensitivity: ability to make correctidentification(detect true positives)Specificity: ability to not identify everythingelse in the process(minimize false positives)


7



Characteristics of a ScreeningExamination: for sequentialmonitoring

BriefInexpensiveSample pertinent disease parametersBalance Sensitivity and SpecificityRepeatable with methods of identifyingmeaningful change


8

Screening Approaches

MSNQ (MS Neuropsychological ScreeningQuestionnaire)MMSE (Mini Mental Status Examination)BRBN (Brief Repeatable BatteryNeuropsychologicalBNPB (Brief Neuropsychological Battery)SEFCI (Screening Examination for CognitiveImpairment)RBANS (Repeatable Battery for the



Assessment of Neuropsychological Status)BSB (Basso Screening Battery)MACFIMS (Minimal Assessment ofCognitive Function in MS)ANAM (Automated NeuropsychologicalAssessment Metrics)


9

Dimensions for Battery Review

TimeYield

Repeatability

Sensitivity/Specificity


10

MSNQ MS Neuropsychological Screening Questionnaire

Time5 min (patient and informant)YieldReported symptoms of cognitive and



behavioral problemsRepeatabilityUtility as change measure not establishedSensitivity/Specificity (Informant)1Sensitivity: .83Specificity: .97

[1] Benedict R et al (2003) Mult Sclr. V9 95101


11

MMSE Mini Mental Status Examination

Time510 minutesYieldGlobal summary scoreRepeatabilitySingle formSensitivity/Specificity1Sensitivity: 2136% MSGenerally poor with specific or subcorticallesionsSpecificity: 89100%



[1] Fischer JS (2001) in SD Cook (Ed) Handbook of MS 3rd ed.


12

BRBN Brief Repeatable BatteryNeuropsychological

Time3035 minutesYieldSelective Reminding, 10/36 Spatial Recall,PASAT, Digit Symbol Modalities, COWARepeatabilitySome measures have alternative formsNot all alternate forms are equivalent


13

BRBN Brief Repeatable BatteryNeuropsychological

Sensitivity/Specificity (memory)Sensitivity: 93%1



Specificity: 48%Sensitivity1+ impaired tests:41.9%2

2+ impaired tests: 16.2%Performance and performance changescorrelated with MRI findings3

[1] Dent A & Lincoln NB (2000) Br J Clin Psychol v39 p. 3115

[2] Solari A. et al. (2002) Mult Scler v8 p. 16976

[3] Hohol MJ et al (1997) Arch Neurol v54 p. 101825


14

BNPB Brief Neuropsychological Battery

Time20 minYieldSelective Reminding, 7/24 Spatial Recall, PASAT, COWARepeatabilityAlternate forms available for most measures

Sensitivity/Specificity

Sensitivity: 71%1 Specificity: 94%

Sensitivity: 68%2 Specificity: 85%



[1] Rao SM et al. (1991) Neurology v41 p.68591

[2] Fischer JS (2001) in SD Cook (Ed) Handbook of MS 3rd ed.


15

SEFCI Screening Examination for Cognitive Impairment

Time2030 minYieldList learning and recall, Symbol DigitModalities, Shipley ILSRepeatabilityAlternate forms not available for allmeasures


16

SEFCI Screening Examination for Cognitive Impairment

Sensitivity/Specificity186% : 1+ cog measure100%: 3+ cog domains



90%: 0 cog domains

Sensitivity/Specificity2Sensitivity: 7486%Specificity: 9091%

Sensitivity31+ impaired tests: 31.5%2+ impaired tests: 18.5%

[1] Beatty WW et al (1995) Neurology v45 p. 71823

[2] Fischer JS (2001) in SD Cook (Ed) Handbook of MS 3rd ed

[3] Solari et al (2002) Mult Sclr v8 p. 16976


17

RBANS Repeatable Battery for the Assessment of Neuropsychological Status

Time25 MinutesYieldIndex scoresIndividual test norms now availableRepeatability2 alternate formsSupplemental release contains changescore informationSensitivity/Specificity1



=MMSE<BNPB<SEFCI

[1] Aupperle RL et al. (2002) Mult Sclr v8 p. 3829


18

BSB Basso Screening Battery

Time20 minYieldLogical Memory, COWA, Seashore Rhythm,graphesthesia, sterognosisRepeatabilityNo alternate form for memory measureSensitivity/Specificity1Sensitivity: 100% (not independent ofcriterion)Specificity: 80% (not independent ofcriterion)

[1] Basso MR et al. (1996) Arch Neurol v53 p. 9804




19

MACFIMS Minimal Assessment of Cognitive Function in MS

Time90 MinYieldWorking Memory, Processing Speed,Learning/Memory, Executive Functioning,Perception/Spatial Processing, WordFluencyRepeatabilityAlternate forms available for most measuresSensitivity/Specificity

Benedict RHB et al (2002) Clin Neuropsyol v16 p. 381397


20

ANAM Automated Neuropsychological Assessment Metrics

Time~25 MinutesYield



Scores related to processing speed/attention, workingmemory, memory, executive fxRepeatabilityMultiple computer produced formsSensitivity/Specificity1Time 1Sensitivity: 87.5%Specificity: 97.5Time 2Sensitivity: 85.7%Specificity: 100%

[1] Wilken J et al. (2003) Mult Sclr v9 p. 11927


21

Sensitivity in Early MS

Classification Agreement MS Patients: Time 1

Computerized Tests

Intact



Impaired

Percent Correct

Traditional Measures

Intact

39

1

97.5

Impaired

1

7

87.5

Overall Rate

95.8



Classification Agreement MS Patients: 6 Month Followup

Computerized Tests

Intact

Impaired

Percent Correct

Traditional Measures

Intact

29

0

100

Impaired

1

6

85.7



Overall Rate

97.2


22

Attention/Processing Construct Validity: Correlation of indicator tests with latent

constructBrief NP AssessmentKane

23

Working Memory Construct Validity: Correlationof indicator tests with latent construct


24

DS Back

LNS Tot

Math

TP



.

85

.

49

.

71

.

76

Arith Tot Note. Arith Tot = Wechsler Adult Intelligence Scale III (WAISIII) arithmetic total score.DS Back = WAISIII digit span backward. LNS Tot = WAISIII letternumber sequencingtotal score. Math TP = ANAM Math TP score.

Working Memory

Construct Validity WorkingMemory

N = 65. c2(2)=1.94, GFI = 0.99, RMSEA=.00Brief NP AssessmentKane

25



DS Back

LNS Tot

RM TP

.

81

.

60

.

56

.

63

Arith Tot Note. Arith Tot = Wechsler Adult Intelligence Scale III (WAISIII) arithmetic total score.DS Back = WAISIII digit span backward. LNS Tot = WAISIII letternumber sequencingtotal score. RM TP = ANAM Running Memory TP score.

Working Memory



Construct Validity WorkingMemory

N = 65. c2(2)=1.31, GFI = 0.99, RMSEA=.00Brief NP AssessmentKane

26

Note. CVLT

Sav = California Verbal Learning Test savings score; HS Loss =

Heaton Story percentage loss

Tscore; HF Loss =

Heaton Figure percentage loss Tscore; MTS

TP =

WinSCAT Matching to sample

thtroughput.

CVLT

Sav

HS Loss

HF Loss

MTS

TP

Memory



.

52

.

.47

.

42

.

51

n = 66 c2(2)=1.15, GFI = .99. RMSEA=.00

Memory Construct in a ClinicalSample Matching to Sample

ThroughputBrief NP AssessmentKane

27

Remote ANAMBrief NP AssessmentKane

28



Reliable Change Index (RCI)

RCI = (postest – baseline) / SEmeasWhere SEmeas = sdbaseline * sqrt(1-rxx)rxx is the reliability of the measureBaseline = sd of last three trials prior toobservations of interestAssumption: Once stable baseline has beenattained, differences among an individual’sscores are due to measurement errorChanges significantly greater thanmeasurement error reflect true change (<=95% confidence interval)


29

Number of Significant Changes toRCIBrief NP AssessmentKane

30

Summary



Compelling reasons to make neurocognitiveassessment more obtainableData support the focus on using briefscreens to identify individuals in need offurther assessmentFocus should also be on patient monitoringSelecting measures that are repeatableDeveloping good procedures for assessingchange

The Use of Brief Assessment Batteries in Multiple Sclerosis · 2019. 1. 5. · 5/14/2014 The Use of...

Documents

Transcript of The Use of Brief Assessment Batteries in Multiple Sclerosis · 2019. 1. 5. · 5/14/2014 The Use of...