Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS): Canadian contribution to the international validation project

• BICAMS is a valid tool for identifying cognitive impairment in MS in Canada.
• BICAMS is reliable but practice effects should be considered with serial testing.
• Results in this Canadian study are comparable to results in other countries.

BackgroundGiven the high prevalence of cognitive dysfunction in people with multiple sclerosis (PWMS) and the lack of availability of specialized neuropsychological services in most MS Clinics, there is a need for a brief cognitive monitoring tool that can be easily administered by MS clinic staff.ObjectiveWe aimed to establish the Brief International Cognitive Assessment for Multiple Sclerosis (BICAMS) as a feasible cognitive monitoring tool and provide Canadian data toward the international validation effort. Secondary considerations were to determine if BICAMS correlates with self-reported cognition and predicted vocational status.Methods57 PWMS were matched to 51 healthy controls (age, sex, education). Participants completed the BICAMS battery which includes the Symbol Digit Modalities Test, and the learning trials from the California Verbal Learning Test-II and the Brief Visuospatial Memory Test-Revised. Depression, self-reported cognition, and fatigue were assessed. Participants were re-tested 15.6 (SD 2.0) days later.ResultsWith impairment defined as “one or more abnormal tests,” 57.9% of MS sample was cognitively impaired. Participants were more likely to be impaired on the BVMT-R (43.9%). On the SDMT and CVLT-II, 28.1% and 26.3% of MS participants were impaired. Sensitivity and specificity were highest for the SDMT. The BICAMS was reliable over time (r value range from 0.69 for BVMT-R to 0.87 for SDMT) with the SDMT being most robust. There was no relationship between BICAMS and subjective cognition. The BVMT-R reliably predicted employment.ConclusionsThe BICAMS detected cognitive impairment to a comparable degree to more comprehensive neuropsychological batteries and is a valid measure of cognition in MS. Reliability of components varies, suggesting care be taken when interpreting serial testing results. The BICAMS is a feasible cognitive assessment tool in Canadians and yields comparable results to other cultures.