Abbreviating the MACFIMS: Developing Short-Form Versions of the Brief Visuospatial Memory Test------Revised, Symbol Digit Modalities Test, and Delis-Kaplan Executive

Abstract

Multiple sclerosis (MS) is a demyelinating disease of the central nervous system, in which cognitive dysfunction is a prevalent symptom. Due to the lack of reliable and valid self-reports for cognitive dysfunction in MS, we have concentrated on developing screening tests from full-length neuropsychological tests widely used in MS. In this study, we focused on three tests: the Brief Visuospatial Memory Test---Revised (BVMT-R), a valid test of visual learning and memory; the Symbol Digit Modalities Test (SDMT), a valid test of processing speed and working memory; and the Delis-Kaplan Executive Function System (D-KEFS) Sorting Test, a valid test of executive functioning. We hypothesized that we could reduce the BVMT-R to one to two trials, the SDMT to 30 to 60 seconds, and the D-KEFS Sorting Test to one free card sort to create accurate screeners in their respective domains. Using BVMT-R data from two cohorts, we performed ROC analyses of Trial 1, Trial 2, and Trial 1 and 2 raw data combined (N = 287) compared to standardized total scores, choosing both 1.5 and 2 standard deviations (SD) below the mean as cut-offs for impairment. We chose the same statistical method and cut-offs for 30-second and 60-second data from the SDMT ( N = 321) and Free Card Sort 1 of the D-KEFS Sorting (N = 120). For the BVMT-R, Trial 1 was 92.0% accurate at 1.5 SD and 90.1% at 2 SD. The first 30-second data of the SDMT was 94.0% accurate at 1.5 SD and 94.3% at 2 SD. Free Card Sort 1 was 93.3% accurate at 1.5 SD and 89.8% accurate at 2 SD. The results show that administration of the first trial of the BVMT-R, 30 seconds of the SDMT, and Free Card Sort 1 can detect cognitive dysfunction in their respective domains.