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

Figures & data

Table 1 Performance on the ECAS and age- and education-adjusted cut-offs of the German language cohort (as previously reported by Loose et al. (19)).

	All participants	Age- and education adjusted groups
	Mean (SD)	Cutoffs(19)
		Age <60, education ≤12 years	Age <60, education >12 years	Age ≥60, education ≤12 years	Age ≥60, education >12 years
	N = 86	n = 20	n = 26	n = 20	n = 20
ECAS total	111.80 (10.57)	93.5	99.7	78.8	98.2
ECAS ALS specific	82.55 (9.66)	56.3	84.5	56.4	73.9
ECAS ALS nonspecific	28.64 (3.50)	22.4	22.6	20.1	22.6
memory	16.89 (3.41)	11.0	10.8	8.8	10.6
visuospatial	11.76 (0.51)	10.2	11.4	10.4	11.5
language	26.65 (2.10)	23.1	26.3	18.6	25.3
fluency	19.09 (3.39)	11.4	9.9	13.6	17.1
executive function	38.78 (4.66)	32.5	34.9	24.8	30.0

ECAS: Edinburgh Cognitive and Behavioural ALS Screen.

ECAS ALS specific score includes language, fluency and executive functions.

ECAS ALS non-specific score includes memory and visuospatial functions.

Table 2 Changes made to the ECAS to adapt to the Polish and Swedish cultures and languages.

	English version	Swedish version	Polish version
Memory – recall	Primrose Woods	Granskogen	Las Kabacki
	Douglas Watt	Anders Larsson	Tomasz Bąk
	Woodland project	N/A	przedsiębiorstwo Lasy Państwowe (national woods company)
	…impressed and especially proud…	N/A	…mile zaskoczony i dumny… (…positively surprised and proud..)
Language – spelling	Skateboard	Rullskridskor (roller skates)	N/A
	Biscuit	Choklad (chocolate)	N/A
	Brought	Definiera (to define)	N/A
Free fluency	Letter S	N/A	Letter K
Restricted fluency	Letter T	Letter P	Letter M
Executive – sentence completion	When she got up in the morning the sun was…(Instruction)	Dagen efter festen var lägenheten… (The day after the party, the apartment was…)	N/A
	John cut his hand with the sharp…orange (Instruction)	N/A	Adam przeciął sobie rękę ostrym…pomidorem (Adam cut his hand with the sharp…tomato)
	Sally spread her toast with butter and…	Sara bredde sin smörgås med… (On her toast, Sara spread…)	Hania…
	John…	Johan…	Zygmunt…
	She dived into the swimming…	Hon åkte till flygplatsen för att… (She went to the airport in order to…)	Zanurzyła się w ciepłej… (She dived in warm….)
	…to a local cafe…	…in på restaurangen… (…in the restaurant…)	…do miejscowego baru… (…to a local bar…)
Memory – delayed recall	Was he from the local council?	Pratade han med lokala fotografer? (Did he speak with local photographers?)	N/A
	Was his first name “Thomas”?	Var hans förnamn Göran? (Was his first name Göran?)	Czy na imię miał Stefan? (Was his first name Stefan?)

Table 3 Cut-offs for the Swedish ECAS for the total cohort and stratified for age and education.

	All participants		Age- and education adjusted groups
			Cutoffs
	Mean (SD)	Cutoffs	Age ≤65, education ≤12 years	Age ≤65, education >12 years	Age >65, education ≤12 years	Age >65, education >12 years
	N = 111		n = 13	n = 44	n = 21	n = 33
ECAS total	115.23 (9.35)	96.53	96.43	103.60	89.44	94.96
ECAS ALS specific	84.50 (7.22)	70.07	66.62	74.18	66.78	69.64
ECAS ALS nonspecific	30.74 (3.82)	23.10	27.28	26.77	19.49	21.25
Memory	18.84 (3.76)	11.33	15.60	15.07	7.32	9.69
Visuospatial	11.80 (0.44)	10.91	11.10	11.24	10.59	10.69
Language	26.30 (1.98)	22.34	22.34	23.45	22.07	21.35
Fluency	19.60 (2.39)	14.82	12.22	17.14	11.86	15.76
Executive function	38.59 (5.46)	27.68	24.38	30.38	25.45	27.34

ECAS: Edinburgh Cognitive and Behavioral ALS Screen.

ECAS ALS specific score includes language, fluency and executive functions. ECAS ALS non-specific score includes memory and visuospatial functions.

Table 4 Cutoffs for the Polish ECAS for the total cohort and stratified for age and education.

	All participants		Age- and education adjusted groups
			Cut-offs
	Mean (SD)	Cut-offs	Age ≤61, education ≤12 years	Age ≤61, education >12 years	Age >61, education ≤12 years	Age >61, education >12 years
	N = 124		n = 19	n = 43	n = 32	n = 37
ECAS total	111.58 (10.70)	90.18	92.87	99.55	82.27	91.34
ECAS ALS specific	82.72 (8.55)	65.62	69.72	73.15	58.52	66.58
ECAS ALS non-specific	28.86 (3.99)	20.88	18.65	22.61	19.95	20.17
Memory	17.54 (3.47)	10.60	8.73	12.50	11.14	8.92
Visuospatial	11.32 (1.28)	8.76	7.81	10.31	7.55	9.26
Language	26.98 (1.55)	23.88	25.04	25.47	21.75	24.55
Fluency	19.95 (2.64)	14.67	14.08	16.29	13.90	14.38
Executive function	35.79 (6.85)	22.09	25.96	27.42	16.84	22.19

Figure 1 Comparison of performance on the ECAS of healthy cohorts in Sweden (n = 111), Germany (n = 86) and Poland (n = 124). Box plots illustrate the median and interquartile range (IQR), whiskers represent the minimum and maximum values that are not outliers. Circles represent mild outliers (1.5 × IQR below first quartile or above third quartile), stars represent extreme outliers (3.0 × IQR below first quartile or above third quartile). p-Values refer to post-hoc comparisons between language cohorts and are Bonferroni–Holm corrected.

Table 5 Overview of cut-offs for different national versions of ECAS.

Language	ECAS total score	ECAS ALS-specific score	ECAS non-specific score	n
English (original) (5)	105	77	24	40
English (revised British) (19)	(100, 98, 110, 108)	N/A	N/A	80
Italian (17)	(92, 89, 108, 107)	(71, 64, 79, 79)	(24, 22, 27, 26)	248
Dutch (18)	(97, 89, 107, 102)	(71, 64, 78, 75)	(23, 22, 26, 23)	690
Swedish (this report)	(96, 89, 104, 95)	(66, 67, 74, 69)	(27, 20, 26, 21)	111
Polish (this report)	(93, 82, 96, 91)	(69, 59, 73, 67)	(19, 20, 23, 20)	124
Greek (9)	93	68	23	52
Norwegian (10)	92	65	24	85
German (16)	(93, 78, 99, 98)	(56, 56, 84, 73)	(22, 20, 22, 22)	86
English (Ireland) (20)	(96, 76, 100, 95)	(70, 57, 73, 68)	(23, 15, 24, 25)	82
Afrikaans (21)	(90, 78, 100, 85)	(65, 57, 74, 63)	(20, 18, 24, 20)	108
Persian (11)	88	61	23	31
English (South Africa) (21)	(95, 74, 95, 84)	(66, 50, 69, 68)	(18, 19, 22, 14)	53
Japanese (12)	86	65	16	28
Czech (13)	86	61	23	102
isiXhosa (21)	(76, 72, 91, 87)	(59, 54, 69, 63)	(14, 12, 18, 20)	100
Chinese (14)	81	58	19	84
Spanish (15)	73	53	19	40

Parentheses designate subgroup cut-offs, the order is: younger and less education, older and less education, younger and high education, older and high education.

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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.