Egyptian adaptation and validation of the Edinburgh Cognitive and Behavioral Amyotrophic Lateral Sclerosis Screen (ECAS-EG)

Radwa Soliman; Hebatallah R Rashed; Ramez R Moustafa; Nabila Hamdi; Mahmoud S Swelam; Ahmad Osman; Nagia Fahmy

doi:10.1007/s10072-023-06639-6

Egyptian adaptation and validation of the Edinburgh Cognitive and Behavioral Amyotrophic Lateral Sclerosis Screen (ECAS-EG)

Neurol Sci. 2023 Jun;44(6):1871-1880. doi: 10.1007/s10072-023-06639-6. Epub 2023 Feb 8.

Authors

Radwa Soliman¹, Hebatallah R Rashed², Ramez R Moustafa², Nabila Hamdi³, Mahmoud S Swelam², Ahmad Osman^{4

5}, Nagia Fahmy⁶

Affiliations

¹ Neuromuscular Unit, Neurology and Psychiatry Department, Faculty of Medicine, Ain Shams University, Cairo, 11566, Egypt. radwasoliman@med.asu.edu.eg.
² Neuromuscular Unit, Neurology and Psychiatry Department, Faculty of Medicine, Ain Shams University, Cairo, 11566, Egypt.
³ Molecular Pathology Unit, German University in Cairo (GUC), Cairo, Egypt.
⁴ Biotechnology Department, Basic and Applied Sciences Institute, Egypt-Japan University of Science and Technology, Borg Al Arab, 21934, Egypt.
⁵ Biochemistry Department, Faculty of Science, Ain Shams University, Cairo, 11566, Egypt.
⁶ Neuromuscular Unit, Neurology and Psychiatry Department, Faculty of Medicine, Ain Shams University, Cairo, 11566, Egypt. dr.nagiafahmy@med.asu.edu.eg.

Abstract

Background: Amyotrophic lateral sclerosis (ALS) is the most common, fatal adult neuromuscular disease. It is a multi-system disorder characterized primarily by motor manifestations, but there is established evidence for cognitive and behavioral impairment, which is associated with poor prognosis, hence, the importance of tools for its assessment. The Edinburgh Cognitive and Behavioral Assessment Screen (ECAS) is an invaluable assessment tool for cognition in ALS-front temporal spectrum dementia (FTSD), as it accommodates physical challenges that usually confound traditional neuropsychological testing in those patients.

Objective and methods: To validate the Egyptian Arabic version of ECAS (ECAS-EG) based on the original English scale. This is a prospective study. The ECAS was adapted and administered to 62 Egyptian ALS patients and 60 healthy controls. Patients were recruited from the Neuromuscular Unit, Ain Shams University Hospital. The ECAS was adapted to Egyptian Arabic after being translated using the back translation method. Internal consistency of the test, inter-rater reliability, and construct validity were assessed.

Results: The Egyptian Arabic version of ECAS (ECAS-EG) showed good internal consistency using Cronbach's alpha of 0.84. Inter-rater reliability was tested, values for all variables were compared, and no statistically significant differences were found (ICC = .997). ECAS-EG discriminated significantly between the patients from the control subjects (p-value of 0.001). There was a strong positive correlation between the ECAS-EG total score and the MoCA total score with a p-value of 0.001, thus indicating convergent validity. The test showed that 63% of Egyptian ALS patients were cognitively affected; most affected domains were executive functions and verbal fluency.

Conclusion: The current study proves that the Egyptian version of the ECAS (ECAS-EG) is valid and reliable among Egyptian ALS patients and it would be applicable to the general Arabic-speaking population.

Keywords: ALS; ALSFTD; Amyotrophic lateral sclerosis; Cognitive; ECAS.

Publication types

Review

MeSH terms

Adult
Amyotrophic Lateral Sclerosis* / complications
Amyotrophic Lateral Sclerosis* / diagnosis
Amyotrophic Lateral Sclerosis* / psychology
Cognition / physiology
Cognition Disorders* / complications
Cognition Disorders* / etiology
Egypt
Humans
Neuropsychological Tests
Prospective Studies
Reproducibility of Results