The Philadelphia Brief Assessment of Cognition (PBAC): a validated screening measure for dementia

The Philadelphia Brief Assessment of the Cognition (PBAC) is a brief dementia-screening instrument. The PBAC assesses five cognitive domains: working memory/executive control; lexical retrieval/language; visuospatial/visuoconstructional operations; verbal/visual episodic memory; and behavior/social comportment. A revised version of the PBAC was administered to 198 participants including patients with Alzheimer's disease (AD) (n=46) and four groups of patients with frontotemporal dementia (FTD) syndromes: behavioral-variant FTD (bvFTD; n=65), semantic-variant primary progressive aphasia (PPA) (svPPA; n=22), non-fluent/agrammatic-variant PPA (nfaPPA; n=23), and corticobasal syndrome (CBS; n=42), and a group of normal controls (n=15). The total PBAC score was highly correlated with the MMSE. The criterion validity of the PBAC was assessed relative to standard neuropsychological test performance. Using standard neuropsychological test performance as a criterion, the total PBAC score accurately identified the presence and severity of dementia. Intra-class correlations between PBAC subscales and standard neuropsychological tests were highly significant. PBAC subscales demonstrated good clinical utility in distinguishing AD and FTD subtypes using receiver operating characteristic analysis and standard diagnostic performance statistics to determine optimal subscale cut scores. The PBAC is a valid tool and able to assesses differential patterns neuropsychological/behavioral impairment in a broad range of neurodegenerative conditions.     

The Philadelphia Brief Assessment of Cognition (PBAC): A Validated Screening Measure for Dementia

The Philadelphia Brief Assessment of the Cognition (PBAC) is a brief dementia-screening instrument. The PBAC assesses five cognitive domains: working memory/executive control; lexical retrieval/language; visuospatial/visuoconstructional operations; verbal/visual episodic memory; and behavior/social comportment. A revised version of the PBAC was administered to 198 participants including patients with Alzheimer's disease (AD) (n?=?46) and four groups of patients with frontotemporal dementia (FTD) syndromes: behavioral-variant FTD (bvFTD; n?=?65), semantic-variant primary progressive aphasia (PPA) (svPPA; n?=?22), non-fluent/agrammatic-variant PPA (nfaPPA; n?=?23), and corticobasal syndrome (CBS; n?=?42), and a group of normal controls (n?=?15). The total PBAC score was highly correlated with the MMSE. The criterion validity of the PBAC was assessed relative to standard neuropsychological test performance. Using standard neuropsychological test performance as a criterion, the total PBAC score accurately identified the presence and severity of dementia. Intra-class correlations between PBAC subscales and standard neuropsychological tests were highly significant. PBAC subscales demonstrated good clinical utility in distinguishing AD and FTD subtypes using receiver operating characteristic analysis and standard diagnostic performance statistics to determine optimal subscale cut scores. The PBAC is a valid tool and able to assesses differential patterns neuropsychological/behavioral impairment in a broad range of neurodegenerative conditions.     

Spanish validation of the Brief Assessment in Cognition in Schizophrenia (BACS) in patients with schizophrenia and healthy controls

Neurocognitive impairment is a core feature of schizophrenia and is closely associated with functional outcome. The importance of cognitive assessment is broadly accepted today, and an easy-to-use, internationality validated cognitive assessment tool is needed by researchers and in daily clinical practice. The Brief Assessment of Cognition in Schizophrenia (BACS) has been validated in English, French, Japanese and Italian. It is as sensitive to cognitive dysfunction as a standard test battery, with the advantage of requiring less than 35 minutes to complete. In our study, we tested the psychometric characteristics of a Spanish version of the BACS in 117 patients with schizophrenia-spectrum disorders and 36 healthy controls. All BACS cognitive subtests discriminated between patients and controls (P < .001), and the concurrent validity between the BACS and a traditional neuropsychological test battery was similar to that reported in other languages. We conclude that the BACS can facilitate the comparison of the cognitive performance of patients with schizophrenia in many different countries.     

Establishing the Brief Assessment of Cognition - Short form

The study aims to identify and validate a parsimonious subset of tests in the commonly used Brief Assessment of Cognition in Schizophrenia (BACS) that allows the evaluation of global cognitive ability. Several permutations of subtests from the BACS were examined to identify the best subset of tests to compose the short form measure. The Brief Assessment of Cognition-Short Form (BAC-SF) was evaluated for convergent validity in healthy and psychiatric samples (N = 3718). Verbal Memory, Digit Sequencing, and Symbol Coding subtests were found to best summarize the variance of composite scores in both Asian and US Norming samples (r = 0.91) indicating that BAC-SF is an appropriate approximation of cognitive deficits. Test re-test reliability of the BAC-SF was adequate (Intraclass Correlation Coefficient (ICC) = 0.73) and showed sufficient separation between healthy controls and schizophrenia (Average Predictive Accuracy = 79.9%; replication = 76.5%). Findings indicate that the BAC-SF an could be used as a cognitive screener for large-scale clinical and epidemiological studies. The short form does not replace the need for comprehensive neuropsychological batteries purposed for detailed neuropsychological and clinical investigation of cognitive function. Further replication of the construct might be necessary in other clinical populations.     

Norms and standardization of the Brief Assessment of Cognition in Schizophrenia (BACS)

According to the recommendations of the Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) Neurocognition Committee, one of the desired characteristics of a cognitive battery for assessing cognition in schizophrenia studies and clinical trials is the availability of normative data. This report describes normative data collected on the Brief Assessment of Cognition in Schizophrenia (BACS) from 404 healthy controls with demographic characteristics matching the 2005 United States Census of English-speakers. The six test measures demonstrated the expected pattern of correlations with age, gender, and education. Individual test scores were converted into standardized (T and z) scores and composite scores that were corrected for age and gender. An education-correction factor was calculated and recommended only for non-schizophrenia patients. Eight different verbal memory tests were found to have equivalent levels of difficulty.     

The Brief Assessment of Cognition in Schizophrenia. Normative data for the Italian population

OBJECTIVE: To provide normative values for the Italian population for the Brief Assessment of Cognition in Schizophrenia (BACS), a recent brief neuropsychological instrument for the assessment of cognition in patients with schizophrenia. PARTICIPANTS: Data were collected from 204 healthy adult Italian subjects, stratified by gender, education and age. MEASUREMENTS AND RESULTS: Tests included in the BACS are the following: list learning, digit sequencing, verbal fluency, token motor task, symbol-coding and Tower of London. Normative values were established using the Equivalent Scores method in order to enable comparison with other neuropsychological tasks commonly used in the assessment of the Italian population. Performance on the BACS was influenced by the commonest demographic variables such as age and education. CONCLUSIONS: The availability of normative data for the Italian population will increase the usefulness of this test for both clinical and experimental purposes.     

Assessment of the psychometric performance of the WHOQOL-BREF instrument in a sample of Brazilian older adults

BACKGROUND: There has been increasing interest in the measurement of quality of life in cross-sectional investigations and in the assessment of intervention outcomes in elderly adults. Several instruments used in this measurement have not yet been adequately tested. OBJECTIVE: To describe the psychometric properties of the World Health Organization's Quality of Life Instrument-Short Version (WHOQOL-BREF) in a sample of Brazilian elderly. METHOD: A total of 424 elderly adults selected through convenience sampling completed the instruments WHOQOL-BREF, the Beck Depression Inventory (BDI), the Beck Hopelessness Scale (BHS) and a sociodemographic data form. Discriminant validity, concurrent validity, criterion validity and internal consistency were analyzed. RESULTS: The sample comprised predominantly women (64.2%), community-dwelling subjects (84.4%) and subjects who consider themselves healthy (67.5%). All domains in the instrument showed the ability to discriminate levels of depressive symptoms and hopelessness, as well as different perceptions of health status. The correlation coefficients among the domains and the BDI and BHS scores were statistically significant. The reliability coefficients present scores ranging from 0.614 to 0.925. CONCLUSION: The WHOQOL-BREF instrument shows suitable psychometric performance in a sample of Brazilian older adults, becoming a useful alternative in the measurement of quality of life in this population.     

精神分裂症认知功能简明成套测评量表（中文版,BACS）信度、效度研究

目的对精神分裂症认知功能简明成套测评量表（中文版,BACS）的信度、效度进行测试。方法选取56例符合CCMD-3诊断标准的新近住院精神分裂症和分裂样精神障碍患者进行精神分裂症认知功能简明成套测评量表（中文版,BACS）评测,并对所获资料进行因子分析和信度分析法。结果①因子分析法显示KMO统计量为0.820,Bartlett球形检验,χ^2=102.430,P〈0.01,主成分分析可将其分为3因子。②各个分测验评分之间的相关系数在0.126～0.582之间,除了伦敦塔和语义流畅性之外,其他均具有显著相关性。③标准化Cronbach α=0.81。④A、B版本亚表之间的相关性在0.736～0.968之间,均具有显著性。结论精神分裂症认知功能简明成套测评量表（中文版,BACS）具有较好的信度、效度,是一种较好的精神分裂症认知功能评测工具,适合汉语地区临床应用。     

Progressive supranuclear palsy in a sample of Brazilian population: clinical features of 16 patients

Progressive supranuclear palsy (PSP) is an uncommon disorder characterized by marked postural instability, vertical gaze abnormalities and axial rigidity. The purpose of this study is to report the clinical features of 16 consecutive subjects seen over a 10-year period at a Movement Disorders Clinic. These subjects fulfilled criteria for probable PSP namely those of the National Institute of Neurologic Disorders and Stroke (NINDS) and the Society for PSP (SPSP). This patient-group represented 2.1% of all degenerative parkinsonians observed and the mean age of onset of the disease was 64.7 years (sd = +/- 7.2). Postural instability with falls was the most frequent initial feature presented in PSP patients (62.5%). The hallmark of the disease, the supranuclear vertical gaze palsy, appeared after 2.3 years of disease onset, and only 12.5% had such manifestation at the first evaluation. Transient tremor was observed with a relatively high frequency in this group (44%), but only 19% had rest tremor. Chronic dacryocystitis, probably related to a paucity of blinking, was observed in two patients as an inaugural manifestation. In the first evaluation, only 19% of the 16 patients were diagnosed as probable PSP. The mean interval prior to the final diagnosis was 2.4 years.     

Dementia in Parkinson's disease: a Brazilian sample

To determine the prevalence of dementia associated with Parkinson's disease (PD-D) in a Brazilian sample adopting clinical and diagnostic procedures recommended by the Movement Disorders Society (MDS). Sixty-seven patients were consecutively submitted to neurological, neuropsychological and functional examinations. PD-D was established according to MDS clinical criteria (Level II) and clinical procedures for PD-D (Level I) and prevalence rate was compared between the levels adopted. Ten patients (14.9%) were diagnosed as demented by Level I criteria whereas sixteen (23.8%) were diagnosed based on Level II criteria. Level I criteria had low sensitivity in detecting PD-D (31.25%), but greater specificity (90.19). The PD-D group had significantly worse performance on all neuropsychological tests, were older (p<0.001), had an older age of onset of disease (p<0.01), had lower educational level (p<0.02) and had higher scores on functional scales. Current age (p=0.046) and Hoehn & Yahr score (p=0.048) were predictors for developing PD-D.     

The Brief Assessment of Cognition in Schizophrenia: reliability, sensitivity, and comparison with a standard neurocognitive battery

Studies of neurocognitive function in patients with schizophrenia use widely variable assessment techniques. Clinical trials assessing the cognitive enhancing effect of new medications have used neurocognitive assessment batteries that differed in content, length and administration procedures. The Brief Assessment of Cognition in Schizophrenia (BACS) is a newly developed instrument that assesses the aspects of cognition found to be most impaired and most strongly correlated with outcome in patients with schizophrenia. The BACS requires less than 35 min to complete in patients with schizophrenia, yields a high completion rate in these patients, and has high reliability. The BACS was found to be as sensitive to cognitive impairment in patients with schizophrenia as a standard battery of tests that required over 2 h to administer. Compared to healthy controls matched for age and parental education, patients with schizophrenia performed 1.49 standard deviations lower on a composite score calculated from the BACS and 1.61 standard deviations lower on a composite score calculated from the standard battery. The BACS composite scores were highly correlated with the standard battery composite scores in patients (r=0.76) and healthy controls (r=0.90). These psychometric properties make the BACS a promising tool for assessing cognition repeatedly in patients with schizophrenia, especially in clinical trials of cognitive enhancement.     

Evaluation of cognitive function in bipolar disorder using the Brief Assessment of Cognition in Affective Disorders (BAC-A)

BackgroundAlthough cognitive impairment is a core feature of bipolar disorder (BD) there is no instrument of choice for the assessment of bipolar patients. The aim of this study is to assess cognitive performance using the Brief Assessment of Cognition in Affective Disorders (BAC-A), a comprehensive test battery developed specifically for BD, and determine its suitability to estimate global functioning.MethodsThe BAC-A was administered to 93 BD patients (M ± S.E: 35.18 ± 1.39 years) and 56 healthy controls (HC – M ± S.E: 36.17 ± 1.91 years). The scores of the BAC-A were combined in eight summary scores: visuomotor, immediate affective and non-affective memory, verbal fluency, delayed affective and non-affective memory, inhibition, and problem solving. Post hoc analyses were performed on subtests of the summary scores found to be significantly different between BD patients and HC. Correlational analyses explored the association between the Global Assessment of Functioning (GAF) score and cognitive functioning.ResultsCompared to HC, BD patients showed a significant impairment in short-term non-affective memory and verbal fluency. Poorer performance in verbal memory and verbal fluency summary scores correlated positively with reduced GAF.ConclusionsOur results are consistent with previous reports of verbal memory and verbal fluency impairment in BD. The deficits in short-term memory and semantic fluency may indicate inefficient learning strategies and/or difficulties in retrieving information. The BAC-A could be used to estimate global functioning in BD patients.     

The relationship of the Brief Assessment of Cognition in Schizophrenia (BACS) to functional capacity and real-world functional outcome

The Brief Assessment of Cognition in Schizophrenia (BACS) assesses five different domains of cognitive function with six tests, and takes about 30-35 minutes to complete in patients with schizophrenia. Previous work has demonstrated the reliability of this measure, and its sensitivity to the deficits of schizophrenia. However, the relationship of this brief cognitive measure to functional outcome has not been determined. Further, future registration trials for potentially cognitive enhancing compounds may not only assess efficacy with cognitive performance measures, but with assessments of real-world functional outcome and functional capacity. The purpose of this study was to determine the relationship between the BACS and a potential co-primary measure for treatment studies of cognition in schizophrenia, and to determine if such a measure accounts for significant variance in functioning beyond that provided by cognitive function. The current study assessed 60 patients with schizophrenia over the course of six months. Cognitive functions were measured with the BACS. Functional capacity was measured with the UCSD Performance-based Skills Assessment (UPSA). Real-world functional outcome was measured with the Independent Living Skills Inventory (ILSI). BACS composite scores were significantly correlated with functional capacity as measured by the UPSA (r = .65, df = 55, p < .001), and real-world functional outcome as assessed by the ILSI (r = .37, df = 56, p = .005). In multiple regression analyses, UPSA scores did not account for additional variance in real-world functioning beyond that accounted for by the BACS. These data suggest that brief cognitive assessments such as the BACS are able to assess aspects of cognition that are related to important functional measures in clinical trials of cognitive enhancement. They also suggest that the measures being considered as potential co-primary indicators of cognitive function for registration trials are significantly correlated with cognition as assessed by brief cognitive assessments.     

Assessment of Snaith-Hamilton Pleasure Scale (SHAPS): the dimension of anhedonia in Italian healthy sample

The Snaith-Hamilton Pleasure Scale (SHAPS) is a rapid screening battery created for assessing the presence of anhedonia, namely the inability to experience pleasure. Although, this symptom has widely been investigated in clinical settings, individual differences in anhedonia are also present in healthy population. The aim of present study was to validate the translated Italian version of this test. One thousand six hundred ninety-seven consecutive healthy subjects (55% female) of different ages (age 18–82 years) underwent SHAPS. Participants who showed mild level of anhedonia also completed the Apathy Evaluation Scale (AES), Beck Depression Inventory (BDI), Toronto Alexithymia Scale-20 (TAS), Mood Disorders Insight Scale (MDIS), and Beck Hopelessness Scale (BHS). The SHAPS showed good internal consistency and discriminant validity; moreover, the factorial analysis highlighted that SHAPS had a three-factor structure for explaining the anhedonic construct. 14.9% showed a significant reduction of hedonic tone (SHAPS ≥?3). Finally, the degree of anhedonia was significantly correlated with BDI and BHS scores, but not with age or gender. Although anhedonia is a prominent feature of many psychiatric and neurological disorders, the presence of this symptom in the healthy population highlighted the importance to develop reliable tool. SHAPS shows good psychometric properties to assess multidimensional anhedonia symptoms also in Italian healthy population.