Detecting Cognitive Decline in Multiple Sclerosis With Shortened BICAMS

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With its 20-minute application time, the BICAMS is one of the few tools available for small centers with only a few staff members who might not be trained in administering neuropsychological tests.

Combined administration of 2 sections of the Brief International Cognitive Assessment for multiple sclerosis (BICAMS), the symbol digit modalities test (SDMT), and brief visuospatial memory test-revised (BVMT-R), reliably detects cognitive impairment in patients with multiple sclerosis (MS) in a more time-efficient manner than administering the whole BICAMS, according to findings presented at the 7th Joint ECTRIMS-ACTRIMS Meeting, held October 25-28, 2017 in Paris.

“The screening tool [BICAMS] was proposed as an international instrument to homogenize cognitive assessment across countries,” the researchers wrote. With its 20-[minute] application time, it is one of the few tools available to be implemented even in small [centers] with only [a] few staff members who might not be particularly trained in administering neuropsychological tests.”

To assess whether a shortened version of the BICAMS can be administered in clinical practice and still accurately detect cognitive impairment in MS, researchers screened 1380 patients from multiple centers using BICAMS (mean age, 43; 73% women). They examined which single tests or combinations of two out of the three tests had results closest to the total BICAMS battery. Cut-off scores for cognitive impairment were set as: Z-scores of SDMT lower than –1.65; percentage scores of verbal learning and memory test (VLMT), and BVMT-R lower than 16%. Patients were classified as having cognitive impairment when at least one out of the three test scores in the total BICAMS battery, or at least one of the two tests in the combinations, were below clinical cut-off scores. Consistency was defined by overall hit rates and correct rejections, respectively. 

When applying the full BICAMS battery, 41.7% of screened patients had cognitive impairment. The combined SDMT and BVMT-R tests (93.0%, P =.002) and the VLMT and BVMT-R (93.6%, P <.001) had a significantly higher consistency with the total BICAMS battery compared with the combined SDMT and VLMT tests (89.5%). All combinations of two tests were more consistent with the full BICAMS battery than single tests alone.

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The VLMT was the weakest single test (77.9%) and detected less cognitively-impaired patients than the BVMT-R (84.5%, P <.001). Although the VLMT detected the same amount of cognitively-impaired patients as the SDMT (77.9%, P =1.000), the VLMT was also not language-independent and took more time to administer.

“We conclude that the combined administration of SDMT and BVMT-R enables [detection of] cognitively impaired MS patients in a more time economic way, but [as reliably] as the whole BICAMS battery,” the researchers concluded. “We therefore recommend this combination for clinical practice.”

Disclosures: C. Lassek has received travel grants, speaker’s honoraria, financial research support, and consultancy fees from Teva, Merck Serono, Genzyme-Sanofi, Novartis, Bayer, and Biogen Idec. I.K. Penner has received honoraria for speaking at scientific meetings, serving at scientific advisory boards, and consulting activities from Adamas Pharma, Almirall, Bayer Pharma, Biogen, Genzyme, Merck Serono, Novartis, and Teva. She has received research support from Merck Serono, Novartis, the German MS Society, and Teva.


Bätge S, Filsner M, Renner A, Ullrich S, Lassek C, Penner IK. Detection of cognitive decline in MS using BICAMS: Is there substantial value in applying the full battery? Presented at: 7th Joint ECTRIMS-ACTRIMS Meeting. October 25-28, 2017; Paris, France. Abstract P1096.