The Edinburgh cognitive and behavioral amyotrophic lateral sclerosis screen (ECAS): sensitivity in differentiating between ALS and Alzheimer’s disease in a Greek population

Abstract

Objectives: (1) Adapt the ECAS into Greek, validate it in ALS patients and compare with the ALS-CBS. (2) Determine the sensitivity and specificity of ECAS in the differentiation between AD and non-demented ALS patients as compared with the ACE-III and mini-ACE. Methods: ALS patients (n = 28) were recruited and AD patients (n = 26) were matched in age, sex, and education with ALS patients (n = 24). The normative data were derived from a random sample of controls (n = 52). Bayes correlation analysis was conducted to examine convergent validity. Bayes t-test was performed to assess between groups’ differences. Receiver operating characteristics (ROC) curve analyses and area under the curve (AUC) were implemented to appraise the sensitivity and specificity in the differentiation between the AD and non-demented ALS patients. Results: The ECAS and its sub-scores in addition to the behavior interview demonstrated robust correlations with the ALS-CBS. Impairment in language and verbal fluency were the most prominent deficits in the ALS patients. The most frequently reported change was apathy. The ROC analysis demonstrated that the ECAS-ALS nonspecific score (comprising memory and visuospatial domains) is the most sensitive and specific in differentiating the AD from ALS patients. The other measures expressed high sensitivity, yet a poor specificity. Conclusions: The ECAS is a multi-purpose screening tool. The ECAS-ALS specific appraises the whole spectrum of the highly prevalent cognitive impairments in ALS. The ECAS-ALS nonspecific (memory and visuospatial) is a sensitive score to detect AD related deficits and is able to differentiate the AD from the non-demented ALS patients better than the ACE-III and mini-ACE.

Keywords:

• Greek
• ECAS
• ALS
• Alzheimer’s disease
• ACE-III

Acknowledgements

The official adaptation of ECAS in Greek was performed with the permission of Sharon Abrahams, Thomas Bak and Judy Newton. The official Greek version of ECAS can be downloaded from https://ecas.psy.ed.ac.uk/ecas-international/#Greek. The official adaptations of ACE-III and M-ACE in Greek were performed with the permission of J.R. Hodges. We deeply thank J.R. Hodges and the Brain and Mind Center of University of Sydney for allowing us to adapt ACE-III and M-ACE in Greek. The official Greek versions of ACE-III and M-ACE can be downloaded from https://sydney.edu.au/brain-mind/resources-for-clinicians/dementia-test.html. We would like to thank all the patients, their caregivers, and healthy controls for their willingness to participate in the present study.

Declaration of interest

The authors declare no conflicts of interest and that this study is their own work.

Additional information

Funding

F.C. Foteini Christidi is supported by the State Scholarships Foundation [I.K.Y.; Postdoctoral Support; EP ANADEDBM/ESPA 2014–2020].