Elsevier

Schizophrenia Research

Volume 195, May 2018, Pages 327-333
Schizophrenia Research

A 10-minute measure of global cognition: Validation of the Brief Cognitive Assessment Tool for Schizophrenia (B-CATS)

https://doi.org/10.1016/j.schres.2017.08.033Get rights and content

Abstract

Introduction

Schizophrenia is marked by a global cognitive impairment that contributes significantly to chronic disability and unemployment. As new treatments are developed for cognition in schizophrenia, clinicians require easily administered instruments to assess cognition. We previously developed a very brief cognitive battery (Bell et al., 2005). The Brief Cognitive Assessment Tool for Schizophrenia (B-CATS) was developed specifically to provide clinicians with a way to assess cognition in their patients with schizophrenia. Here, we report the results of a validity study comparing B-CATS to a larger neurocognitive battery, the Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) battery.

Methods

Outpatients with schizophrenia (N = 91) were administered the B-CATS and the non-overlapping tests of the MATRICS battery at two time points separated by 1 month. They were also administered the UCSD Performance-based Skills Assessment-Brief (UPSA-B), a measure of functional capacity.

Result

The B-CATS has an administration time of approximately 10 min. It demonstrates good test-retest reliability and internal consistency. It correlates 0.76 (p < 0.01) with the MATRICS battery. The shorter B-CATS and the MATRICS battery correlate with the UPSA-B at 0.50 and 0.58 respectively.

Conclusion

A 10-minute version of the B-CATS correlates highly with the “gold standard” neurocognitive battery that has an administration time of over 60 min. Both measures correlate moderately with a measure of functional capacity. This brief battery was designed to allow clinicians to monitor cognitive change and better inform treatment decisions.

Introduction

Cognition in schizophrenia is severely impaired, on average up to 1–1.5 standard deviations (SD) below control subjects on measures of global cognition (Bokat and Goldberg, 2003). Cognitive deficits also significantly affect functional capacity and outcome in schizophrenia (Bowie et al., 2008). The areas most impacted by schizophrenia are domains such as verbal memory, attention, speed of processing, and executive function (Bokat and Goldberg, 2003). Research into cognitive rehabilitation and remediation has resulted in promising new strategies for improving cognition in schizophrenia (Bratti and Bilder, 2006, Brebion et al., 2004, Crowe, 1998, Dickinson and Coursey, 2002). However, there remains a serious obstacle to clinical cognitive assessment; clinicians do not have a brief and well-validated instrument to measure cognition that is easily administrable and interpretable in a clinical setting. Typical clinical interviews do not capture cognitive functioning and clinicians have been shown to be poor at accurately evaluating cognition and often underestimate the degree of deficit (Dickinson et al., 2004). As a result, clinicians in office or hospital practice cannot reliably measure cognitive deficits in their patients, thereby limiting their ability to offer cognitive treatments. There are brief cognitive assessments that have been developed and adapted for populations with schizophrenia, such as the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) (Dickinson et al., 2006), or that were originally developed specifically for schizophrenia populations, such as the Brief Assessment of Cognition in Schizophrenia (BACS) (Dickinson et al., 2007) and the Brief Cognitive Assessment (BCA) (Dickinson et al., 2008). However the RBANS and BACS take 25–35 min to administer. Given that traditional medication management appointment times vary from 15 to 30 min, it would seem that administration times of 25–30 min would be too long for a clinician during a typical office visit. Furthermore, these batteries require specialized training in administration. The BCA takes 15 min to administer, but with many medication management appointments averaging 15 min, even 15 min may exceed the time a clinician can devote to cognitive testing. A newer instrument has recently been developed, the Brief Neurocognitive Assessment (BNA) (Fervaha et al., 2014, Fervaha et al., 2015), which also takes 10 min and is derived from a larger battery. The BNA and its validation data demonstrate that very brief batteries can have both psychometric and clinical utility.

In 2008, in collaboration with the FDA, NIMH, and academia, researchers developed a consensus cognitive battery for schizophrenia (the MCCB or MATRICS Consensus Cognitive Battery (Fisher et al., 2015, Gold et al., 1999)) designed to be the “gold standard” assessment battery to standardize pharmacological trials for cognitive enhancing agents in schizophrenia. The battery takes 60–70 min to administer, and includes tests from 10 domains (see Table 2). While research trials may be able to devote over an hour to cognitive testing, clinicians usually cannot. We previously described the construction of a Brief Cognitive Assessment Tool for Schizophrenia (B-CATS) (Bell et al., 2005). Because we aimed for the B-CATS to be a brief and efficient way to measure what is typically measured using longer batteries of tests, we constructed it by examining the performance of different tests that were included in three comprehensive batteries administered in three separate studies to over 1100 subjects. We hoped to identify a battery of tests that would generate scores that correlate highly with longer battery scores, and did so in the shortest time. We therefore selected test scores from each battery that accounted for the most variance in the total battery composite scores, excluding the effects of the test itself, and then computed an index of efficiency we called “variance per minute” (VPM; that is the amount of variance in battery composite scores explained by each individual test divided by the administration time for that test). We then chose the three tests with the highest VPM for the B-CATS, which resulted in a battery conforming to our desired cut-off administration time of under 12 min. This procedure led to the selection of three well-known tests for the B-CATS: the Digit Symbol Substitution/Coding test, the Trail Making Test, and Verbal Fluency. See Bell et al. (2005) for more details. In this paper we further examine the validity of several alternate versions of the B-CATS with respect to the MCCB.

Section snippets

Participants

Subjects with diagnoses of schizophrenia, schizoaffective disorder, or schizophreniform disorder were recruited into this study as part of a larger protocol designed to validate an interview-based measure of cognition (Cognitive Assessment Interview or CAI) in schizophrenia (Goldberg et al., 2007). The subjects in this study formed a subset of the larger sample in the CAI study. In total, 91 subjects completed the first testing session, and 61 subjects completed both testing sessions. As per

Results

Table 1 contains the demographic data of subjects with complete and incomplete neuropsychological data. Those without complete data were younger than those with complete data. There are no other significant differences between the groups.

There was no statistically significant difference between subjects who completed the MCCB in or out of the original order (t =  1.4, df = 119, p = 0.25).

Discussion

The B-CATS is an easily administered battery that takes on average 10 min to complete and correlates at 0.76 with the gold standard cognitive battery in schizophrenia (MCCB). Like the MCCB, the B-CATS correlates moderately with a measure of functional capacity. The B-CATS demonstrates good test-retest reliability and inter-item consistency, and practice effects are small. It provides a means by which non-psychometrically trained clinicians can obtain a global cognitive score in the course of a

Conclusion

The B-CATS is a 10-minute cognitive battery that can be administered by non-psychometrically trained clinicians. It provides a clinically meaningful estimate of global cognition that closely approximates the score of a much longer gold-standard neurocognitive battery. Global cognition is both significantly correlated with functional outcome in schizophrenia, and is a current target of cognitive remediation and other treatments for cognition. The B-CATS provides clinicians with the brief and

Conflicts of interest

Irene M. Hurford: None.

Steven P. Reise: None.

Joseph Ventura: Received research grants from PositScience and Genentech, Inc., and has been a consultant to Boehringer-Ingelheim.

Lumosity, and PositScience, Inc.

Stephen R. Marder: Consulting fees: Allergan, Teva, Lundbeck, Takeda, Neurocrine.

Research Support: Neurocrine.

Stock Holder: MedAvante.

Robert M. Bilder: None.

Contributors

Only the authors contributed to this manuscript.

Role of funding source

This work was fully supported by a Brain and Behavior (formerly NARSAD) Young Investigator Award to I.M.H.

Acknowledgements

The authors would like to thank the research assistants and clinical assessors who helped us complete this project.

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