Determining impairment in the Swedish, Polish and German ECAS: the importance of adjusting for age and education

Abstract

Objective: Age and years of education are strong predictors of cognitive performance in several versions of the Edinburgh Cognitive and Behavioral ALS Screen (ECAS) and cutoffs for the Swedish and Polish versions are not established yet. Here we evaluated the performance of healthy subjects on the national versions of the Swedish and Polish ECAS and compared cognitive performance on three European translations of the ECAS. Methods: The ECAS performances of healthy subjects from Sweden (n = 111), Poland (n = 124) and Germany (n = 86) were compared. Based on the test results on the national versions of ECAS, age- and education-adjusted cutoffs were compared for the German, Swedish and Polish versions, respectively. Results: Age and years of education correlated with performance in the ECAS. Swedish subjects under the age of 60 years and Swedish subjects with low education level scored significantly higher in memory than the respective German and Polish subgroups. German and Polish subjects over 60 years of age performed significantly better in language than the respective Swedish subgroup. The Polish cohort in total had lower executive scores compared to the Swedish cohort, and lower than the German subjects in the higher education subgroup. Conclusions: The results highlight the importance of establishing age- and education-adjusted ECAS cutoffs not only in general, but also for seemingly similar populations of different origins. The results should be taken into account when comparing cognition data across patient populations including in drug trials where an ECAS test result is being used as an inclusion criterium or outcome measure.

Keywords:

• ALS
• FTD
• ECAS
• cognition test
• population differences

Acknowledgements

We thank the many individuals who participated in this study. We thank Professor Thomas H. Bak from the University of Edinburgh for his help in translating the Polish version of ECAS. We also thank Dr. Lillian Carlsson Pähn from the Eksjö Community Hospital for participating in the validation of the Swedish version of ECAS in 2016.

Declaration of interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article.

Data availability statement

Respecting the privacy of the participants and adhering to the European Union General Data Protection Regulation (EU) 2016/679 (GDPR), the data underlying the findings of this study are available from the authors (email). The national versions of ECAS used in this study are freely available for noncommercial use at the ECAS website.

Correction Statement

This article has been corrected with minor changes. These changes do not impact the academic content of the article.

Additional information

Funding

This is an EU Joint Programme – Neurodegenerative Disease Research (JPND) project (“NEEDSinALS” 01ED1405). The project is supported through the following organizations under the egis of JPND—www.jpnd.eu e.g. Germany, Bundesministerium für Bildung und Forschung (BMBF, FKZ); Sweden, Vetenskapsrådet Sverige; Poland, Narodowe Centrum Badan’ i Rozwoju (NCBR). This work was additionally funded by Bundesministerium für Bildung und Forschung (FTLDc O1GI1007A, MND-Net 01GM1103A; PaCeMed 01DS18031), the Kompetenznetzwerk Präventivmedizin Baden-Württemberg (K.N.K.B.008.04), the Deutsches Zentrum für Neurodegenerative Erkrankungen (DZNE), the Swedish Brain Foundation [grants no. 2013-0279, 2016-0303, 2018-0310], the Swedish Research Council [grants no. 2012-3167, 2017-03100], the Knut and Alice Wallenberg Foundation [grants no. 2012.0091, 2014.0305], the Västerbotten County Council [grant no. 2013-7590]. The funding sources played no role in the preparation of this manuscript.