The Edinburgh cognitive and behavioural ALS screen (ECAS); relationship to age, education, IQ and the ACE-III

Psychology-PPLS, Euan MacDonald Centre for MND research, Anne Rowling Regenerative Neurology Clinic, Centre for Cognitive Ageing & Cognitive Epidemiology

The Edinburgh Cognitive and Behavioural ALS Screen (ECAS) was developed to assess changes in cognition and behaviour related to frontotemporal dementia (FTD) and Motor Neurone Disease (MND)/Amyotrophic Lateral Sclerosis (ALS). The test was designed to assess those functions typically affected in ALS and FTD (executive and language domains, fluency and behaviour) in addition to functions more typically affected in other dementias (memory and visuospatial functions).

Objectives: Our first aim was to investigate the relationship of the ECAS with the Addenbrooke’s Cognitive Examination (ACE-III), a well-validated tool for objective assessment of cognitive deficits in Alzheimer’s disease and FTD. Our second aim was to investigate the effects of age, education, and IQ on the ECAS; and if present, create appropriate cut-off scores to determine abnormality.

Participants and Methods: For the first experiment we assessed 57 healthy participants (age range 35-80) with the ECAS, the Wechsler Abbreviated Scale of Intelligence (WASI-II), and the ACE-III.  For the second experiment we recruited 47 additional participants (age range 51-80). Participants were divided into four groups according to age and education; and were tested with the ECAS and the WASI-II.

Results: Results showed that the ECAS and the ACE-III have a strong convergent validity with a significant correlation. Regression analysis revealed that IQ was the strongest predictor of the score of the ECAS, followed by age. Education was not a significant predictor over and above IQ.

Conclusions: Abnormality cut-off scores adjusted for age (below and above 65 years old) and education (with or without university degree) are presented. The ECAS seems to be less influenced by intelligence and presents less ceiling effects in comparison to the ACE-III. Since the ECAS and the ACE-III have a strong convergent validity, the ECAS could be a better test at assessing changes in cognition of FTD patients because of the inclusion of executive functions.

References

1. Abrahams, S., Newton, J., Niven, E., Foley, J., and Bak, T, (2014). Screening for cognition and behaviour changes in ALS. Amyotrophic Lateral Sclerosis and Frontotemporal Degeneration. 15: 9-14
2. Goldstein, L.H. and Abrahams, S. (2013) Changes in cognition and behaviour in amyotrophic lateral sclerosis: nature of impairment and implications for assessment. Lancet Neurol, 12, 368-380
3. Hsieh, S. et al. (2013) Validation of the Addenbrooke’s Cognitive Examination III in Frontotemporal Dementia and Alzheimer’s Disease. Dementia and Geriatric Cognitive Disorders. 36, 242-250
4. Lulé, D. et al. (2015) The Edinburgh Cognitive and Behavioural Amyotrophic Lateral Sclerosis Screen: A cross-sectional comparison of established screening tools in a German-Swiss population. Amyotrophic Lateral Sclerosis and Frontotemporal Dementia. 16 (1-2): 16-23
5. Niven, E. et al. (2015) Validation of the Edinburgh Cognitive and Behavioural Amyotrophic Lateral Sclerosis Screen (ECAS): A cognitive tool for motor disorders. Amyotrophic Lateral Sclerosis and Frontotemporal Degeneration. 16 (3-4): 172-179

Funded by: Consejo Nacional de Ciencia y Tecnología (CONACYT)

* entered into the PhD student poster competition