ALS Cognitive Behavioral Screen-Phone Version (ALS-CBS™-PhV): norms, psychometrics, and diagnostics in an Italian population sample

Edoardo Nicolò Aiello; Antonella Esposito; Ilaria Giannone; Lorenzo Diana; Susan Woolley; Jennifer Murphy; Georgia Christodoulou; Lucio Tremolizzo; Nadia Bolognini; Ildebrando Appollonio

doi:10.1007/s10072-021-05636-x

ALS Cognitive Behavioral Screen-Phone Version (ALS-CBS™-PhV): norms, psychometrics, and diagnostics in an Italian population sample

Neurol Sci. 2022 Apr;43(4):2571-2578. doi: 10.1007/s10072-021-05636-x. Epub 2021 Oct 2.

Authors

Affiliations

¹ PhD Program in Neuroscience, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy. e.aiello5@campus.unimib.it.
² Department of Psychology, University of Milano-Bicocca, Milan, Italy.
³ PhD Program in Neuroscience, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.
⁴ Sutter Pacific Medical Foundation, San Francisco, CA, USA.
⁵ Biogen, Cambridge, MA, USA.
⁶ Institute for Health Promotion and Disease Prevention Research, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.
⁷ Neurology Section, School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy.
⁸ Neuropsychological Laboratory, IRCCS Istituto Auxologico Italiano, Milan, Italy.

^# Contributed equally.

Abstract

Background: Up to 50% of motor neuron disease (MND) patients show neuropsychological deficits which negatively affect prognosis and care. However, disability-related logistical issues and uneven geographical coverage of healthcare services may prevent MND patients from accessing neuropsychological evaluations. This study thus aimed to standardize for the Italian population the ALS Cognitive Behavioral Screen-Phone Version (ALS-CBS™-PhV), an MND-specific, telephone-based screening for frontotemporal dysfunction.

Methods: The cognitive section of the ALS-CBS™-PhV, the Italian telephone-based Mini-Mental State Examination (Itel-MMSE), and the Telephone Interview for Cognitive Status (TICS) was administered to 359 healthy individuals (143 males, 216 females; age, 52.7 ± 15.8; education, 13.1 ± 4.4). Norms were derived through equivalent scores. Validity, factorial structure, reliability, diagnostic accuracy, and item difficulty and discrimination were examined. Statistical equivalence between the telephone-based and in-person versions was tested.

Results: ALS-CBS™-PhV measures were predicted by age and education. The ALS-CBS™-PhV reflected a mono-component structure, converged with Itel-MMSE and TICS scores (r_s = .23-.51) and was equivalent to its in-person format (t = .37; p = .72). Good internal (Cronbach's α = .61), test-retest (ICC = .69), and inter-rater (ICC = .96) reliability was detected. High accuracy was found when tested against both the Itel-MMSE and the TICS (AUC = .82-89). Backward digit span items were the most discriminative.

Discussion: The ALS-CBS™-PhV is a statistically solid screening test for frontotemporal disorders featuring MND. Its standardization allows for (1) improvements in tele-healthcare for MND patients, (2) epidemiological applications, and (3) effective assessments in decentralized clinical trials. The ALS-CBS™-PhV can be also suitable for assessing bedridden and visually impaired patients with motor disorders.

Keywords: Cognitive screening; Frontotemporal degeneration; Motor neuron disease; Normative data; Psychometrics; Telephone-based.

MeSH terms

Adult
Aged
Amyotrophic Lateral Sclerosis* / diagnosis
Cognition
Delivery of Health Care
Female
Humans
Male
Middle Aged
Neuropsychological Tests
Psychometrics
Reproducibility of Results
Telephone