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BACKGROUND: The added value of patient-reported outcome measures (PROMs) in addition to standard clinical outcome tools in the assessment of relapsing-remitting multiple sclerosis (RRMS) patients' status is increasingly recognized. PROMs facilitate the detection of hidden aspects of MS and help to integrate the patient's subjective experience of health-related quality of life (HRQoL) status and treatment satisfaction in a holistic way. However, the relationship between PROMs and clinical and cognitive status has been scarcely investigated up to now. OBJECTIVE: To investigate the association of PROMs with physical and cognitive disability in a cohort of RRMS patients at initiation of a new disease-modifying treatment. METHODS: In this cross-sectional bicenter study, 59 consecutive RRMS patients underwent neurological examination with EDSS assessment, comprehensive cognitive tests (BVMT-R, SDMT, CVLT-II) and a set of self-reported questionnaires. Lesion and brain volumes were analyzed and processed by the automated MSmetrix® software (Icometrix®, Leuven, Belgium). Spearman's correlation coefficient was used to evaluate the association of collected variables. A cross-sectional logistic regression analysis was performed to find baseline correlates of cognitive impairment. RESULTS: Of the 59 RRMS patients (mean age 39 ± 9.8 years, 79.7% female, median EDSS 2.0), 33 (56%) had cognitive impairment. While almost all dimensions of health, explored by PROMs, were impacted in the overall sample, no significant difference was observed in patients with and without cognitive impairment. All PROMs were significantly associated with EDSS (R = 0.37-0.55; p < 0.05), except for the psychological component of MSIS-29, BDI and DEX-Q scores. No significant correlation was found between PROMs and cognitive performances. The cross-sectional logistic regression analysis included age, gender (female), education, EDSS, hippocampus and FLAIR lesion volumes as significant predictors of cognitive impairment. CONCLUSIONS: The data highlight that PROMs provide valuable information on the well-being of PwMS closely paralleling the extent of MS-related disability, as measured by the EDSS. Additional research should determine the relevance of PROMs as longitudinal outcome measures.

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OBJECTIVE: Cognitive impairment is consistently reported in bipolar disorder (BD), but few studies have characterised which memory component processes are affected. Further, it is unknown whether the component processes underlying memory impairment are moderated by sex. The present study examined diagnosis and sex differences in both verbal and visual memory/learning domains in patients with BD and psychiatrically healthy controls. METHOD: Verbal and visual memory/learning were measured using the Hopkins Verbal Learning Test-Revised (HVLT-R) and Brief Visuospatial Memory Test-Revised (BVMT-R). 114 patients with BD (n = 50 males, n = 64 females), were compared to 105 psychiatrically healthy controls (n = 42 males, n = 63 females). RESULTS: Patients with BD had worse performance in verbal and visual immediate and total recall, verbal and visual delayed free recall, and verbal recognition discrimination scores, but there were no group differences in learning slopes and cumulative learning index scores. There were trends for BD females to outperform BD males in visual memory/learning free recall and cumulative learning, but these results did not survive multiple testing correction. These findings did not change in a secondary sensitivity analysis comparing only strictly euthymic BD patients to controls (n = 64). CONCLUSION: The present study found trait-like verbal and visual memory/learning impairment in BD that was attributable to deficient encoding and/or consolidation processes rather than deficits in learning. We did not find marked sex differences in either visual or verbal memory/learning measures, although some trend level effects were apparent and deserve exploration in future studies.

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Objective: To provide normative data and examine form equivalency of the Brief Visuospatial Memory Test-Revised (BVMT-R) in a sample of 9th decade adults. Method: The sample was comprised of 90 healthy individuals ages 80-84 (n = 42) and 85-89 (n = 48). The average years of education was 14.8 (2.4). The BVMT-R Forms 1 and 4 were administered in a counterbalanced order, one week apart. Form equivalency was conducted utilizing Analysis of Variance (ANOVA). Results: There were no significant gender, education, or MMSE differences between the two age groups or between the counterbalanced subgroups. There were no significant differences between Forms 1 and 4 for the 80-84 age group. However, BVMT-R Form 1 Trial 1 and Total Recall raw scores were significantly higher than those for Form 4 in the 85-89 age group. Conclusions: Individuals in their early 80s obtained comparable scores on Forms 1 and 4 of the BVMT-R; however, individuals in their late 80 s showed more difficulty learning and recalling information presented in Form 4 compared to Form 1. It is recommended that clinicians consider form-specific normative data with this population.

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BACKGROUND: Visuospatial abilities are an important component of technical skill acquisition. Targeted visuospatial ability training may have positive implications for training programs. The development of such interventions requires an adequate understanding of the visuospatial ability processes necessary for surgical and nonsurgical tasks. This scoping review aims to identify the components of visuospatial ability that have been reported in surgical and nonsurgical trainees and determine if there is consensus regarding the language and psychometric measures used, clarifying the elements that may be required to develop interventions that enhance visuospatial ability. METHODS: A scoping review was designed to identify relevant records from EMBASE and Medline until January 13, 2020. Data were extracted on visuospatial ability terminology, dimensions, instruments, and interventions with results stratified by specialty (surgical, nonsurgical, or mixed). Conference abstracts, opinion pieces, and review studies were excluded. RESULTS: Out of 882 total records, 26 were identified that met criteria for inclusion. Surgical specialities were represented in > 90% of results. A total of 16 unique terms were used to describe visuospatial ability and were measured using 34 instruments, of which eight were used more than once. Eighteen different dimensions were identified. A single study explored the effects of a targeted visuospatial ability intervention. CONCLUSION: A wide range of visuospatial ability terms, instruments, and dimensions were identified, suggesting an incomplete understanding of the components most relevant to surgical and nonsurgical tasks. This confusion may be hindering the development of visuospatial ability targeted interventions during residency training. A rigorous methodological model is proposed to help unify the field and guide future research.

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Introducción: El test breve de memoria visuoespacial-revisado (BVMT-R) evalúa el aprendizaje y la memoria visuoespacial en población adulta. Este test cuenta con versiones paralelas que permiten su readministración.Objetivo: Obtener datos normativos y estandarizados para el BVMT-R adecuados a las características sociodemográficas de la población española.Sujetos y métodos: El estudio se enmarca dentro del proyecto Normacog. Se evaluó a 903 participantes (rango de edad: 18-93 años) con el BVMT-R (versión 1). Se analizaron el efecto de la edad, el nivel educativo y el sexo sobre el BVMT-R, y se crearon los percentiles y las puntuaciones escalares ajustadas por edad y nivel educativo. Resultados: Se observó un efecto significativo de la edad y el nivel educativo sobre todas las variables analizadas (ensayo 1, recuerdo total, ensayo 4 e índice de discriminación), que explica entre el 12 y el 40% de la varianza. Los participantes más mayores y con menor nivel educativo obtuvieron un menor rendimiento en el BVMT-R. El sexo no presentó un efecto significativo en las variables analizadas. Conclusión: Este estudio aporta baremos estandarizados y normalizados para el BVMT-R, teniendo en cuenta las características sociodemográficas de la población española. Los resultados confirman la influencia de la edad y la educación en el rendimiento del test, por lo que aportamos datos que permiten corregir el BVMT-R teniendo en cuenta dichas características.(AU)

Introduction: The brief visuospatial memory test-revised (BVMT-R) assesses visuospatial learning and memory in adults. It has equivalent forms that allow reassessing patients. Aim: To obtain normative and standardized data for the BVMT-R taking into account the sociodemographic characteristics of the Spanish population.Subjects and methods: The present study is part of the Normacog Project. Nine hundred three participants (18 to 93 years old) were assessed using the BVMT-R (form 1). The effect of age, level of education and gender was analyzed on the BVMT-R, and percentiles and scalar scores adjusted by age and level of education were created.Results: A significant effect of age and educational level on the analyzed variables was observed (trial 1; total recall; trial 4; discrimination index), explaining from 12% to 40% of the variance. The older and less educated participants obtained lower performance in all the analyzed variables of the BVMT-R. Gender had not a significant effect in the analyzed variables.Conclusion: The study provides standardized and normalized data for the BVMT-R taking into account the Spanish sociodemographic characteristics. The results confirm the influence of age and level of education in the performance of the test, so normative data are provided to correct the BVMT-R taking into account these characteristics.(AU)

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Introduction: The Brief Visual Memory Test-Revised (BVMT-R) is a frequently used visuospatial declarative memory test, but normative data in the Czech population are lacking. Moreover, the BVMT-R includes promising learning indexes that can be used to detect learning deficits in Parkinson's disease (PD). However, its clinical usefulness has not yet been thoroughly examined. Early detection of memory impairment in PD is essential for effective treatment. Therefore, this study aimed to provide BVMT-R Czech normative data for clinical use and to find the detection potential of the principal BVMT-R scores, including new learning indices, to capture the cognitive deficit in PD. Method: The BVMT-R were administered to a normative sample of 920 participants aged 17 to 95 years and to a clinical sample of 60 PD patients; 25 with mild cognitive impairment (PD-MCI) and 35 with normal cognition (PD-NC). In order to provide normative values, multiple regression analyses were employed, and to compare the clinical and control sample, Bayesian Hierarchical Linear Models were used. Results: The best model for regression-based norms showed to be with age + age2 + education + sex as predictors. From all learning indexes, L6 (sum of trials 1-3), followed by, L4 (sum of trials 1-3 multiplied by the difference between the highest and the lowest score) best differentiated between controls or PD-NC and PD-MCI. Conclusions: We provide regression-based normative values for BVMT-R that could be used in clinical settings and meta-analytic efforts. Furthermore, we revealed visuospatial learning and memory deficit in PD-MCI. We have also identified the most discriminative learning index adapted to BVMT-R.

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The disease multiple sclerosis (MS) is characterized by various neurological symptoms. This paper deals with a novel tool to assess cognitive dysfunction. The Brief Visuospatial Memory Test-Revised (BVMT-R) is a recognized method to measure optical recognition deficits and their progression. Typically, the test is carried out on paper. We present a way to make this process more efficient, without losing quality by having the patients using a tablet App and having the drawings rated with the use of a machine learning (ML) algorithm. A dataset of 1'525 drawings were digitalized and then randomly split in a training dataset and in a test dataset. In addition to the training dataset the already trained drawings from a preliminary paper were added to the training dataset. The ratings done by two neuropsychologists matched for 81% of the test dataset. The ratings done automatically with the ML algorithm matched 72% with the ones of the first neuropsychologist and 79% of the ones of the second neuropsychologist. For a semi-automated rating we defined a threshold value for the reliability of the rating of 78.8%, under which the drawing is routed for manual rating. With this threshold value the ML algorithm matched 80.3% and 86.6% of the ratings of the first and second neuropsychologists. The neuropsychologists have in that case to manually check 17.4% of the drawings. With our results is it possible to execute the BVMT-R Test in a digital way. We found out, that our ML algorithms have with the semi-automated method the similar matching as the two professional raters.

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Post-mortem studies consistently show evidence of reduced synaptic protein levels in patients with schizophrenia. Clinically high-risk subjects show a steeper decrease in grey matter thickness and in vitro modeling using patient-derived cells implicate excessive synaptic pruning during neurodevelopment as a part of the schizophrenia pathophysiology. However, it is unclear to what extent synapse elimination is present during various stages of the disease, which is of clinical importance as in a real-world setting most subjects received their first-episode psychosis (FEP) diagnosis not until their mid-twenties. In the present study, we measured cerebrospinal fluid (CSF) concentrations of the two pre-synaptic proteins synaptosomal-associated protein 25 (SNAP-25) and synaptotagmin-1 (SYT-1), both of which are increased in conditions of ongoing synaptic degeneration, in 44 FEP subjects (mean age 29.9 years) and 21 healthy controls (25.9 years) using immunoprecipitation mass spectrometry. Neither protein was found to differ between healthy controls and patients, and they showed no correlation with symptom ratings, cognitive performance or antipsychotic medication. Additional studies in high-risk subjects in the early prodromal phase will be needed to address if excessive synapse destruction occurs before the development of overt psychotic symptoms.

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This work concerns methods for automated rating of the progression of Multiple Sclerosis (MS). Often, MS patients develop cognitive deficits. The Brief Visuospatial Memory Test-Revised (BVMT-R) is a recognized method to measure optical recognition deficits and their progression. Typically, the test is carried out on paper using geometric figures which the patient should recognize and trace. The results are rated manually by a physician. The goal of this work was to digitize the BVMT-R and to support the interpretation of the test results using a machine learning (ML) algorithm. A convolutional neural network (CNN) was used to rate the drawings of a patient. As a result, the correct point value of the BVMT-R could be determined with an accuracy between 57% and 76% based on a training set of 624 patient drawings obtained from 135 patients. These drawings had been previously physician rated to serve as a gold standard. In our experiment, we obtained reasonable accuracy above 80% when more than 40 drawings were available, but our training sample was too small for more detailed analysis. Conclusion: At the currently achieved classification accuracy, results analysis will remain a physician task, potentially supported with ML based preclassification, but there is hope that ML accuracy can be further improved to enable automated follow-ups.

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OBJECTIVE: This study investigated whether indices within the Brief Visuospatial Memory Test - Revised (BVMT-R) could function as embedded performance validity measures in an outpatient clinical sample. METHOD: A sample of 138 neuropsychological outpatients was utilized; approximately 45% had a known or suspected external incentive. Patients were determined to be valid performers if they passed all criterion performance validity tests (PVTs) and determined to be invalid performers if they failed two or more PVTs. BVMT-R indices met criteria for optimal embedded PVTs if they were not significantly correlated with genuine cognitive dysfunction and if they adequately differentiated the validly from invalidly performing patient groups. Classification accuracy statistics for the indices were then calculated. Supplementary analyses were also calculated for a separate dementia sample. RESULTS: Recognition Hits and Recognition Discrimination were identified as two optimal embedded PVTs for patients without dementia. Recognition Hits showed a sensitivity rate of 41% and a specificity rate of 95%. Recognition Discrimination showed a sensitivity rate of 54% and a specificity rate of 93%. CONCLUSION: Embedded BVMT-R PVTs are discussed in relation to previous research findings, which were obtained from veteran samples. Recognition Hits and Recognition Discrimination are now validated in a non-veteran clinical sample.

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Cognitive Impairment (CI) is a common and distressing problem in Multiple Sclerosis (MS). Its identification is complicated and sometimes omitted in the routine evaluation by neurologists. The BICAMS (Brief International Cognitive Assessment for Multiple Sclerosis) is a promising tool to overcome this difficulty. However, there is some concern regarding the subjectivity in scoring of the BVMT-R (Brief Visuospatial Memory Test - Revised), one of its components. OBJECTIVE: To evaluate the reliability of the BVMT-R in a sample of Brazilian MS patients, with the measure being administered and scored by neurologists. METHODS: BICAMS was applied to seventy subjects comprising forty patients diagnosed with MS and thirty healthy controls. In the MS patients group, the coefficients of agreement between three different raters, using the same protocols, and the internal consistency of the BVMT-R were assessed. Also, the coefficients of correlation of the BVMT-R with the other tests of the BICAMS, CVLT II (California Verbal Learning Test II) and SDMT (Symbol Digit Modalities Test), and their respective effect sizes were calculated. RESULTS: the BVMT-R presented a moderate inter-rater coefficient of agreement (k=0.62), an excellent Intraclass Correlation Coefficient (ICC=0.85), and high internal consistency (α=0.92). The correlation between the BVMT-R and CVLT II was moderate (ρ=0.36; p<0.025), but strong with the SDMT (ρ=0.60; p<0.01), with a large effect size. CONCLUSION: The BVMT-R is a reliable instrument for assessing CI in patients with MS, having a significant association with information processing speed, an aspect which should be considered when evaluating its score.

O declínio cognitivo (DC) é um problema comum na esclerose múltipla (EM), mas sua identificação é complexa, por vezes sendo omitida na avaliação de rotina pelos neurologistas. O BICAMS é uma bateria breve de testes neuropsicológicos que visa superar tais dificuldades. No entanto, uma possível subjetividade no sistema de pontuação do BVMT-R, um dos seus componentes, é um ponto frágil desta ferramenta. OBJETIVO: Avaliar a confiabilidade do BVMT-R em pacientes portadores de EM, aplicado e aferido por neurologistas. MÉTODOS: Os testes do BICAMS foram administrados a setenta indivíduos, quarenta pacientes portadores de EM e trinta controles saudáveis. No grupo de pacientes com EM foram calculados os coeficientes de concordância dos resultados entre três diferentes avaliadores e a consistência interna do BVMT-R. Também foram calculados os coeficientes de correlação do BVMT-R com os demais testes componentes do BICAMS e seus respectivos tamanhos de efeito. RESULTADOS: O BVMT-R apresentou um coeficiente de concordância entre examinadores moderado (k=0,62), um excelente Coeficiente de Correlação Intraclasse (ICC=0,85) e uma alta consistência interna (α=0,92). A correlação entre o BVMT-R foi moderada (CVLT II: ρ=0,36; p<0,025) ou forte (SDMT: ρ=0,60; p<0,01), com grande tamanho de efeito. CONCLUSÃO: O BVMT-R é um instrumento confiável para avaliar o DC na EM, apresentando uma associação significativa com a velocidade de processamento da informação, o que deve ser considerado na interpretação de seus resultados.

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ABSTRACT: Cognitive Impairment (CI) is a common and distressing problem in Multiple Sclerosis (MS). Its identification is complicated and sometimes omitted in the routine evaluation by neurologists. The BICAMS (Brief International Cognitive Assessment for Multiple Sclerosis) is a promising tool to overcome this difficulty. However, there is some concern regarding the subjectivity in scoring of the BVMT-R (Brief Visuospatial Memory Test - Revised), one of its components. Objective: To evaluate the reliability of the BVMT-R in a sample of Brazilian MS patients, with the measure being administered and scored by neurologists. Methods: BICAMS was applied to seventy subjects comprising forty patients diagnosed with MS and thirty healthy controls. In the MS patients group, the coefficients of agreement between three different raters, using the same protocols, and the internal consistency of the BVMT-R were assessed. Also, the coefficients of correlation of the BVMT-R with the other tests of the BICAMS, CVLT II (California Verbal Learning Test II) and SDMT (Symbol Digit Modalities Test), and their respective effect sizes were calculated. Results: the BVMT-R presented a moderate inter-rater coefficient of agreement (k=0.62), an excellent Intraclass Correlation Coefficient (ICC=0.85), and high internal consistency (α=0.92). The correlation between the BVMT-R and CVLT II was moderate (ρ=0.36; p<0.025), but strong with the SDMT (ρ=0.60; p<0.01), with a large effect size. Conclusion: The BVMT-R is a reliable instrument for assessing CI in patients with MS, having a significant association with information processing speed, an aspect which should be considered when evaluating its score.

RESUMO: O declínio cognitivo (DC) é um problema comum na esclerose múltipla (EM), mas sua identificação é complexa, por vezes sendo omitida na avaliação de rotina pelos neurologistas. O BICAMS é uma bateria breve de testes neuropsicológicos que visa superar tais dificuldades. No entanto, uma possível subjetividade no sistema de pontuação do BVMT-R, um dos seus componentes, é um ponto frágil desta ferramenta. Objetivo: Avaliar a confiabilidade do BVMT-R em pacientes portadores de EM, aplicado e aferido por neurologistas. Métodos: Os testes do BICAMS foram administrados a setenta indivíduos, quarenta pacientes portadores de EM e trinta controles saudáveis. No grupo de pacientes com EM foram calculados os coeficientes de concordância dos resultados entre três diferentes avaliadores e a consistência interna do BVMT-R. Também foram calculados os coeficientes de correlação do BVMT-R com os demais testes componentes do BICAMS e seus respectivos tamanhos de efeito. Resultados: O BVMT-R apresentou um coeficiente de concordância entre examinadores moderado (k=0,62), um excelente Coeficiente de Correlação Intraclasse (ICC=0,85) e uma alta consistência interna (α=0,92). A correlação entre o BVMT-R foi moderada (CVLT II: ρ=0,36; p<0,025) ou forte (SDMT: ρ=0,60; p<0,01), com grande tamanho de efeito. Conclusão: O BVMT-R é um instrumento confiável para avaliar o DC na EM, apresentando uma associação significativa com a velocidade de processamento da informação, o que deve ser considerado na interpretação de seus resultados.

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OBJECTIVE: The Brief Visuospatial Memory Test-Revised (BVMT-R) is one of the most widely used tests for the assessment of learning and memory in the visual/spatial domain. The aim of this study was to use multiple regression to derive normative data for the use of BVMT-R in an Italian population. METHOD: We employed a regression-based norms procedure to maximally utilize a relatively small sample while controlling for a variety of demographic factors in addition to age. Additionally, we used these norms to compare the performance of Italian healthy controls with patients diagnosed with multiple sclerosis (MS), thereby providing evidence of the method's validity. RESULTS: A total of 200 healthy volunteers and 70 MS patients participated in this study and completed the BVMT-R according to the published procedures. Regression-based norms were generated for the Italian sample and are presented herein. CONCLUSIONS: Using these norms, the performance of the MS patients was found to be significantly worse than that of the controls.

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PURPOSE: This study examined the construct validity of a visual memory test (Brief Visuospatial Memory Test, Revised [BVMT-R]) in a sample of older adults and provided normative data for adults aged 80+ years. METHOD: The sample included 109 community-dwelling individuals (mean [M] age = 74.9 years, M education = 15.0 years, 62.4% female, and 97.2% European American). PROCEDURES: Measures administered included the BVMT-R, California Verbal Learning Test, 2nd edition, and subtests of the Delis-Kaplan Executive Function System and Neuropsychological Assessment Battery. RESULTS: The BVMT-R correlated highly with another measure of memory and less so with unrelated measures (e.g., verbal fluency). Age and education were significantly correlated with BVMT-R Total and Delayed Recall scores, with education as the strongest predictor. No significant differences were found for sex. Normative data were provided for adults aged 80 to 88 years (n = 29). CONCLUSIONS: Adequate evidence was found for convergent validity and only partial support for discriminant validity. Normative data should continue to be stratified by age and also by formal education level.

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