Repeatable Battery for the Assessment of Neuropsychological Status (RBANS): Clinical Validation in Greece
1Lambros Messinis,1,2 Amaryllis Malegiannaki, 1Epameinondas Lyros, 1Thanos Papathanasiou, 1Panagiotis Papathanasopoulos
1Department of Neurology, Neuropsychology Section, University of Patras Medical School
2Department of Psychology, Cognitive and Neuropsychology Division, University of Thessaloniki
Introduction
· The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) was developed for the dual purposes of identifying and characterizing abnormal cognitive decline in the elderly and as a screening battery for younger patients with possible cognitive impairment. The entire battery requires 30 minutes administration time and yields scores for five cognitive domains (immediate memory, visuospatial/constructional, language, attention, delayed memory).
· The RBANS has gained wide acceptance as a useful instrument in neuropsychological assessment and is frequently used in clinical and research projects requiring a meaningful and rapid examination of a range of cognitive domains. In addition it has been translated into several different languages apart from the original English version (Randolph, 1998), French (Chianetta, Lefebvre LeBlanc and Grignon, 2008), Japanese (Yamashima, Yoshida, Kumahashi, Matsui, Koshino, Higashima, et al., 2002), Spanish (Sanz, Vargas and Marín, 2009) and other informal versions including Italy, Russia, Hungary and Norway (Groth-Marnat, 2009).
· Although originally constructed as a dementia screening battery, it was expanded to assess cognitive functioning throughout adulthood as a screening tool within various populations, including multiple sclerosis (Beatty, 2004; Aupperle, Beatty, Shelton & Gontkovsky, 2003) and cerebrovascular disorders (Larson et al., 2003; Larson, Kirschner, Bode, Heinemann, & Goodman, 2005).
· It has also been reliable in its ability to differentiate Alzheimer’s dementia (Beatty, Mold & Gontkovsky, 2003; Randolph, Tierney, Mohr & Chase, 1998) from vascular dementia (Randolph, 1997), and has been utilized in Parkinson’s disease (Beatty et al. 2003) and Huntington’s disease (Randolph, Tierney, Mohr & Chase, 1998; Beglinger, Duff, Allison, Theriault, O'Rourke, Leserman, Paulsen, 2009), stroke (Larson et al., 2003; Larson, Kirshcner, Bode, Heinemann & Goodman, 2005), concussion (Moser & Schatz, 2002), schizophrenia (Dickerson et al., 2004; Gogos, Joshua and Rossell, 2010; Gold, Queern, Iannone & Buchanan, 1999; Weber, 2003; Wilk et al., 2002;2004), bipolar disorder (Dickerson et al., 2004; Gogos et al., 2010; Hobart et al., 1999), personality disorders (Seres, Unoka, Bódi, Aspán, Kéri, 2009), traumatic brain injury (McKay et al., 2007) and substance abuse (Green, Garrick, Sheedy, Blake, Shores, Harper, 2010).
Methods
· In the present study we report clinical validation data with the RBANS, comparing patients with Amnesic mild cognitive impairment (AMCI) (n=35) (aMCI) (Petersen, 2007), to patients with Relapsing Remitting Multiple sclerosis (n =38) (mean EDSS = 3.5., mean duration of illness 7.8 years). All patients were recruited from the outpatient Neuropsychology Unit, Department of Neurology, University of Patras Medical School. We excluded participants from this group who suffered from any other medical condition that might affect neuropsychological performance, and non-native speakers of the Greek language.
· Participants were assessed using the original RBANS Kit and instructions (Randolph, 1998) however, a Greek adapted list based partly on the original list of words for the list learning, list recall and list recognition trials was developed. For the story memory and story recall trials a Greek adapted version of the story was developed. For the list learning and story memory trial, the original English words and story were initially translated without change to the Greek language. From this original English word list we retained 6 of the original words. The remaining words used for the development of the Greek list were new words adapted for the Greek language.
· The word items on the newly formed Greek list were evaluated for consistency on the following dimensions: all words were two or three syllable concrete nouns, there were no obvious semantic or phonetic associations or similarities between words in the same list, all were common words that are normally acquired in Greek speaking persons with relatively low levels of education, all words had frequent occurrence in the Greek language. The probability of the occurrence of the word in common usage in the Greek language was ascertained using the ILSP Greek Corpus (Hatzigeorgiu et al., 2000).
Results
RBANS (Index Scores) / Normal subjects(n= 28) / AMCI
(n= 35) / RRMS
(n= 38) / P
Immediate Memory / 101.2 (9.2) / 96.8 (10.6) / 95.2 (9.4) / n.s (AMCI vs. RRMS)
Visuospatial/Constructional / 105.2(11.8) / 98.2 (11.4) / 97.4 (10.2) / n.s (AMCI vs. RRMS)
Language / 99.7 (9.8) / 90.2 (8.0) / 94.2 (6.0) / < .001 (AMCI vs. RRMS)
Attention / 94.5 (6.8) / 99.4 (10.2) / 96.6 (4.6) / < .001 (AMCI vs. RRMS)
Delayed Memory / 102.4 (12.2) / 90.8 (8.5) / 92.5 (6.0) / < .001 (AMCI vs. RRMS)
Performance of Normal Subjects, AMCI and MS patients on RBANS indexes
Ø Both patient groups showed impaired performance when compared to healthy (age and education matched control groups).
Ø In addition the patient groups exhibited different cognitive profiles, differing significantly on the various subscales.
Ø The AMCI patients performed more poorly on language and delayed memory, while the MS patients had lower performances on the attention/speed of processing variants.
Conclusions
These data provide initial evidence in Greek patients that the RBANS is effective at both detecting and characterizing cognitive impairment of different etiology.