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 file http://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 Assessment Batteries in Multiple Sclerosis Robert L. Kane, Ph.D. ABPPCn Assoc. Director Communications VA MSCE East Brief NP AssessmentKane 2 History of Cognitive Studies in MS Since MS is a CNS disorder is there a cognitive component What is the severity With what frequency does it occur Is there a particular pattern or presentation Does the pattern or severity vary with subtype of course Brief NP AssessmentKane
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Brief NP AssessmentKane
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The Use of Brief AssessmentBatteries in Multiple Sclerosis
Robert L. Kane, Ph.D. ABPPCn
Assoc. Director Communications
VA MSCE East
Brief NP AssessmentKane
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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
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
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?
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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)
behavioral problemsRepeatabilityUtility as change measure not establishedSensitivity/Specificity (Informant)1Sensitivity: .83Specificity: .97
[1] Benedict R et al (2003) Mult Sclr. V9 95101
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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.
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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
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
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ANAM Automated Neuropsychological Assessment Metrics
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
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)
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Number of Significant Changes toRCIBrief NP AssessmentKane
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