Sensitivity and specificity of the ECAS in identifying executive function and social cognition deficits in MND

Figures & data

Table 1 Descriptive characteristics, neuropsychology tests, and the Hayling and Mini-SEA test scores for healthy controls and patient groups: mean and standard deviation.

	Controls (n = 45)	MND (n = 64)
	M (SD)	M (SD)	% <2 SDs
Sex (M:F)	24:20	50:14	–
Age	60.07 (8.68)	59.64 (10.01)	–
Education	13.29 (3.22)	12.35 (2.80)	–
Premorbid IQ^a	106.63 (10.28)	104.89 (12.27)	–
RAVLT^b T1-5	50.04 (9.94)	42.96 (9.14)**	6%
RAVLT^b T6	9.65 (3.30)	8.51 (3.17)	8%
RAVLT^b T7	9.70 (3.56)	7.98 (3.50)	8%
RAVLT^b recognition	13.26 (1.54)	12.38 (2.43)	18%
RMT topography^c	25.15 (2.79)	24.98 (3.38)	0%
SydBat Naming^g	27.32 (2.15)	26.14 (2.57)	9%
Digit Span Forwards^d	11.78 (2.62)	10.83 (2.11)	2%
Digit Span Backwards^d	8.56 (2.31)	8.35 (2.21)	3%
Trail Making Test A^e	26.37 (8.81)	30.29 (9.99)	0%
Trail Making Test B^e	60.15 (24.74)	75.98 (34.27)*	8%
Stroop color naming^f	234.14 (49.03)	212.63 (36.38)	0%
Stroop interference^f	106.50 (19.26)	103.09 (23.20)	0%
Stroop errors^f	1.20 (1.67)	1.79 (1.69)	9%
Stroop difference^f	130.50 (43.34)	109.39 (38.29)	0%
Verbal fluency ‘F’^h	13.55 (5.02)	11.12 (4.06)	5%
Hayling Test^i			–
Scaled Score#			–
Overall	5.37 (1.57)	5.02 (1.82)	8%
Initiation RT	5.67 (1.04)	5.39 (1.03)*	0%
Inhibition RT	5.42 (1.24)	5.25 (1.39)	5%
Inhibition Errors	5.67 (2.02)	5.27 (2.22)	8%
Response Time (seconds)			–
Initiation	8.54 (13.06)	10.57 (11.38)*	–
Inhibition	43.61 (41.57)	47.27 (40.21)	–
Inhibition – Initiation	35.07 (34.18)	35.70 (36.60)	–
Response categories			–
Initiation correct/15	14.75 (.51)	14.70 (0.56)	–
Inhibition			–
A Errors	1.02 (1.21)	1.10 (1.35)	–
B Errors	3.00 (2.26)	3.34 (2.64)	–
Total correct/15	10.88 (3.12)	10.51 (3.44)	–
Correct w strategy	4.66 (3.44)	6.07 (4.46)	–
Mini-SEA^j			–
Emotion recognition/35	29.73 (2.64)	27.24 (3.16)**	13%
Faux pas stories/40	36.26 (2.49)	32.46 (6.05)*	25%
Total/30	26.14 (1.21)	23.78 (3.32)**	29%
ECAS	–	n = 64	%<2 SDs
Overall/136	–	110.64 (10.69)	28%
ALS-specific/100	–	83.31 (8.63)	23%
Language/28	–	26.56 (1.63)	34%
Naming/8	–	7.64 (0.65)	–
Comprehension/8	–	7.98 (0.13)	–
Spelling/12	–	10.94 (1.55)	–
Verbal fluency/24	–	16.25 (5.24)	27%
S/12	–	8.19 (2.51)	–
T/12	–	8.03 (3.50)	–
Executive (48)	–	40.66 (4.17)	8%
Sentence completion/12	–	10.59 (1.70)	–
Social cognition/12	–	11.58 (1.59)	–
Digit span/12	–	7.22 (2.02)	–
Alternation/12	–	11.27 (1.76)	–
ALS nonspecific/36	–	27.17 (3.84)	25%
Memory/24	–	15.20 (3.95)	36%
Immediate recall/10	–	5.31 (1.70)	–
Delayed recall/10	–	8.08 (2.13)	–
Delayed recognition/4	–	1.81 (1.47)	–
Visuospatial/12	–	11.84 (0.41)	2%
Dot/4	–	3.94 (0.24)	–
Cube/4	–	3.94 (0.24)	–
Number/4	–	3.97 (0.18)	–

Cutoffs for Stroop based on healthy mean and standard deviation; ∼ Scaled Score is 1–10, 6 is average; * = p < 0.05, ** = p < 0.01, compared to Healthy Controls (HC); Not all participants completed all tests (N: HC/MND): ^aNelson and Willison (35) (N: 40/35); ^bIvnik et al. (43) (N: 23/53); ^cWarrington (44) (N: 41/59); ^dWechsler (45) (N: 41/60); ^eArmy Individual Test Battery (46) (N: 23/56); ^fTrenerry et al. (47) (N: 21/24); ^gSavage et al. (48) (N: 22/57); ^hBenton et al. (49) (N: 22/60); ⁱBurgess and Shallice (29) (N: 45/59); ^jBertoux et al. (27) (N: 22/38).

Table 2 Correlations between ECAS subtests and standard neuropsychology tests.

ECAS subtest	Standard neuropsychology test	N	τ	p
Language
Naming/8	Sydbat naming/30	57	0.40	<0.001
Comprehension/8	Sydbat comprehension/30	55	n/a^	n/a^
Spelling/12	NART IQ	35	0.41	0.002
Fluency
S/12	F wpm	60	0.45	<0.001
T/12	F wpm	60	0.39	<0.001
Executive
Sentence completion/12	Hayling inhibition correct/15	59	0.51	<0.001
	Hayling inhibition Err SS	59	0.50	<0.001
	Hayling inhibition RT	59	−0.42	<0.001
	Stroop interference	23	0.26	0.113
Social cognition/12	Mini-SEA emotion recognition/35	38	0.34	0.014
	Mini-SEA faux pas stories/40	28	0.02	0.922
	Mini-SEA total/30	28	0.14	0.360
Digit Span/12	WAIS III Digit Span Backwards /14	60	0.74	<0.001
	TMT B RT	37	−0.22	0.079
Alternation/12	TMT B RT	37	−0.18	0.163
	WAIS III Digit Span Backwards /14	60	0.22	0.045
Memory
Immediate recall/10	RAVLT T1-5	53	0.16	0.125
	RAVLT T6/15	53	0.14	0.179
Delayed recall/10	RAVLT T7/15	53	0.36	<0.001
Delayed recognition/4	RAVLT Recognition /15	50	−0.03	0.800
Visuospatial
Dot/4	Judgment of Line Orientation	33	−0.18	0.250
Cube/4	Judgment of Line Orientation	33	−0.31	0.049
Number/4	Judgment of Line Orientation	33	−0.18	0.250

Note. ^ - correlation not appropriate for comprehension due to ceiling effects on both tasks.

Table 3 Sensitivity and specificity of ECAS ALS-specific score, and executive function total and subtest scores in detecting impairments on standard neuropsychology assessments.

	ECAS ALS-specific		ECAS exec. functions		ECAS social cognition
Mini-SEA	Specificity	Sensitivity	Specificity	Sensitivity	Specificity			Sensitivity
Emotion recognition	85%	80%	91%	20%	91%			60%
Faux pas stories	95%	43%	90%	14%	86%			14%
Mini-SEA overall	95%	38%	90%	13%	90%			25%
	ECAS ALS-specific		ECAS exec. functions		ECAS sentence completion
Hayling	Specificity	Sensitivity	Specificity	Sensitivity	Cutoff	Specificity		Sensitivity
Inhibition Error SS	80%	38%	91%	8%	≤11	54%		85%
	–	–	–	–	≤10	76%		85%
	–	–	–	–	≤9	95%		69%
Stroop Interference	91%	–	96%	–	≤11	35%		–
	–	–	–	–	≤10	43%		–
	–	–	–	–	≤9	65%		–
	ECAS ALS-specific		ECAS exec. functions		ECAS digit span
	Specificity	Sensitivity	Specificity	Sensitivity	Cutoff		Specificity	Sensitivity
WAIS-III Digit Span Backwards SS	76%	50%	93%	50%	≤6		66%	100%
	–	–	–	–	≤5		85%	100%
	–	–	–	–	≤4		93%	100%
	ECAS ALS-specific		ECAS exec. functions		ECAS alternation
	Specificity	Sensitivity	Specificity	Sensitivity	Cutoff	Specificity			Sensitivity
WAIS-III Digit Span Backwards	76%	50%	93%	50%	≤11	64%			50%
	–	–	–	–	≤10	88%			50%
Trail Making Test B	82%	100%	91%	33%	≤11	71%			100%
	–	–	–	–	≤10	94%			100%

Note. Standard neuropsychology cutoffs based on 2SD below normative mean.

Nelson HE, Willison J. National adult reading test (NART). Windsor, UK: Nfer-Nelson; 1991:1–26.

 Google Scholar

Ivnik RJ, Malec JF, Tangalos EG, Petersen RC, Kokmen E, Kurland LT. The Auditory-Verbal Learning Test (AVLT): norms for ages 55 years and older. Psychological Assess: J Consult Clin Psychol 1990;2:304.

 Google Scholar

Warrington EK. The Camden memory tests manual (Vol. 1). London, UK: Psychology Press; 1996.

 Google Scholar

Wechsler D. Wechsler adult intelligence scale–Fourth Edition (WAIS–IV). San Antonio, TX: NCS Pearson; 2008.

 Google Scholar

Army, U. S. Army individual test battery. Manual of directions and scoring. Washington, D.C.: War Department, Adjunct General’s Office; 1944.

 Google Scholar

Trenerry MR, Crosson BA, DeBoe J, Leber WR. Stroop neuropsychological screening test. Lutz: Psychological Assessment Resources; 1989.

 Google Scholar

Savage S, Hsieh S, Leslie F, Foxe D, Piguet O, Hodges JR. Distinguishing subtypes in primary progressive aphasia: application of the Sydney language battery. Dement Geriatr Cogn Disord. 2013;35:208–18.

 PubMed Web of Science ®Google Scholar

Benton AL. Differential behavioural effects in frontal lobe disease. Neuropsychologia 1968;6:53–60.

 Web of Science ®Google Scholar

Burgess PW, Shallice T. (1997). The Hayling and Brixton tests: test manual. Bury St Edmunds, UK: Thames Valley Test Company.

 Google Scholar

Bertoux M, Delavest M, de Souza LC, Funkiewiez A, Lépine J-P, Fossati P, Sarazin M. Social cognition and emotional assessment differentiates frontotemporal dementia from depression. J Neurol Neurosurg Psychiatry. 2012;83:411–6.

 PubMed Web of Science ®Google Scholar