Open Access Highly Accessed Correspondence

Brief International Cognitive Assessment for MS (BICAMS): international standards for validation

Ralph HB Benedict*, Maria Pia Amato, Jan Boringa, Bruno Brochet, Fred Foley, Stan Fredrikson, Paivi Hamalainen, Hans Hartung, Lauren Krupp, Iris Penner, Anthony T Reder and Dawn Langdon

Author Affiliations

Buffalo General Medical Center, Department of Neurology, Suite E2, 100 High Street, Buffalo, NY 14203

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BMC Neurology 2012, 12:55  doi:10.1186/1471-2377-12-55

Published: 16 July 2012

Abstract

An international expert consensus committee recently recommended a brief battery of tests for cognitive evaluation in multiple sclerosis. The Brief International Cognitive Assessment for MS (BICAMS) battery includes tests of mental processing speed and memory. Recognizing that resources for validation will vary internationally, the committee identified validation priorities, to facilitate international acceptance of BICAMS. Practical matters pertaining to implementation across different languages and countries were discussed. Five steps to achieve optimal psychometric validation were proposed. In Step 1, test stimuli should be standardized for the target culture or language under consideration. In Step 2, examiner instructions must be standardized and translated, including all information from manuals necessary for administration and interpretation. In Step 3, samples of at least 65 healthy persons should be studied for normalization, matched to patients on demographics such as age, gender and education. The objective of Step 4 is test-retest reliability, which can be investigated in a small sample of MS and/or healthy volunteers over 1–3 weeks. Finally, in Step 5, criterion validity should be established by comparing MS and healthy controls. At this time, preliminary studies are underway in a number of countries as we move forward with this international assessment tool for cognition in MS.