The Ethiopian Cognitive Assessment battery in Schizophrenia (ECAS): a validation study

Yohannes Gebreegziabhere; Kassahun Habatmu; Matteo Cella; Atalay Alem

doi:10.1038/s41537-024-00462-4

The Ethiopian Cognitive Assessment battery in Schizophrenia (ECAS): a validation study

Yohannes Gebreegziabhere, Kassahun Habatmu, Matteo Cella, Atalay Alem

Research output: Contribution to journal › Article › peer-review

Abstract

Cognitive impairment is common in people with schizophrenia (PWS). To detect the presence and its consequences, cognitive measures with sound psychometric properties are needed. However, these are lacking especially in low-income countries. Hence, we developed the Ethiopian Cognitive Assessment battery in Schizophrenia (ECAS). In this study, we evaluated the psychometric properties of the ECAS in a cross-sectional study involving 350 PWS. Confirmatory factor analysis demonstrated a one-factor solution. ECAS score correlated significantly but weakly with a disability measure (r = -0.13, p = 0.02) and symptom dimensions of PANSS (r between -0.12 and -0.29, p < 0.05), except for positive symptoms (r = -0.10, p > 0.05). Years of education (β = 0.12, 95% CI (0.09, 0.14), p < 0.001), male sex (β = 0.22, 95% CI (0.05, 0.39)), age β = -0.02, 95% CI (-0.03, -0.01), and medication side effects (β = -0.03, 95% CI (-0.06, -0.01), p = 0.021) were significantly associated with the composite score of ECAS. The Item Response Theory analysis showed that the tool best functions among participants with moderate cognitive impairment (difficulty coefficient between -1.12 and 0.27). The Differential Item Functioning analyses showed that education had a positive contribution on Digit Symbol Substitution Test (MH OR = 2.64, 95% CI (1.34, 5.20)). The results showed that ECAS is valid in assessing cognition in PWS in low-resource settings.

Original language	English
Article number	42
Pages (from-to)	42
Journal	Schizophrenia
Volume	10
Issue number	1
DOIs	https://doi.org/10.1038/s41537-024-00462-4
Publication status	Published - 6 Apr 2024

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@article{d113f9c4d98c45069056b3fb08986d8b,

title = "The Ethiopian Cognitive Assessment battery in Schizophrenia (ECAS): a validation study",

abstract = "Cognitive impairment is common in people with schizophrenia (PWS). To detect the presence and its consequences, cognitive measures with sound psychometric properties are needed. However, these are lacking especially in low-income countries. Hence, we developed the Ethiopian Cognitive Assessment battery in Schizophrenia (ECAS). In this study, we evaluated the psychometric properties of the ECAS in a cross-sectional study involving 350 PWS. Confirmatory factor analysis demonstrated a one-factor solution. ECAS score correlated significantly but weakly with a disability measure (r = -0.13, p = 0.02) and symptom dimensions of PANSS (r between -0.12 and -0.29, p < 0.05), except for positive symptoms (r = -0.10, p > 0.05). Years of education (β = 0.12, 95% CI (0.09, 0.14), p < 0.001), male sex (β = 0.22, 95% CI (0.05, 0.39)), age β = -0.02, 95% CI (-0.03, -0.01), and medication side effects (β = -0.03, 95% CI (-0.06, -0.01), p = 0.021) were significantly associated with the composite score of ECAS. The Item Response Theory analysis showed that the tool best functions among participants with moderate cognitive impairment (difficulty coefficient between -1.12 and 0.27). The Differential Item Functioning analyses showed that education had a positive contribution on Digit Symbol Substitution Test (MH OR = 2.64, 95% CI (1.34, 5.20)). The results showed that ECAS is valid in assessing cognition in PWS in low-resource settings.",

author = "Yohannes Gebreegziabhere and Kassahun Habatmu and Matteo Cella and Atalay Alem",

note = "Funding Information: First, we would like to thank Addis Ababa University, especially the staff of the Department of Psychiatry, for facilitating data collection activities and providing comments at various steps of the study. We would like to extend our gratitude to all the data collectors and participants (people with schizophrenia and their families): the study\u2019s success was started primarily with the quality of data collected. We also would like to thank Debre Berhan University and the African Mental Health Research Initiative (AMARI) for sponsoring the primary investigator to conduct this study. This work was supported by the DELTAS Africa Initiative [DEL-15-01] through the first author (Y.G.). Finally, we thank Prof. Richard Keefe and his team for allowing us to use the Digit Sequencing Task (DST). DST is part of the BACS, and the copyright belongs to WCG. We also would like to thank Prof Martine Prince and his team for letting us use the Word Learning Test (WLLT) and the Animal Naming Test (ANT), part of a validation study of a cross-cultural measure of Dementia in developing countries. Funding This work was supported by the DELTAS Africa Initiative [DEL-15-01] through the first author (Y.G.). The DELTAS Africa Initiative is an independent funding scheme of the African Academy of Sciences (AAS) Alliance for Accelerating Excellence in Science in Africa (AESA) and supported by the New Partnership for Africa\u2019s Development Planning and Coordinating Agency (NEPAD Agency) with funding from the Wellcome Trust [DEL-15-01] and the UK government. The views expressed in this publication are those of the author(s) and not necessarily those of AAS, NEPAD Agency, Wellcome Trust, or the UK government. The funder has no role in the interpretation of findings and publication decisions. Publisher Copyright: {\textcopyright} The Author(s) 2024.",

year = "2024",

month = apr,

day = "6",

doi = "10.1038/s41537-024-00462-4",

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T1 - The Ethiopian Cognitive Assessment battery in Schizophrenia (ECAS)

T2 - a validation study

AU - Gebreegziabhere, Yohannes

AU - Habatmu, Kassahun

AU - Cella, Matteo

AU - Alem, Atalay

N1 - Funding Information: First, we would like to thank Addis Ababa University, especially the staff of the Department of Psychiatry, for facilitating data collection activities and providing comments at various steps of the study. We would like to extend our gratitude to all the data collectors and participants (people with schizophrenia and their families): the study\u2019s success was started primarily with the quality of data collected. We also would like to thank Debre Berhan University and the African Mental Health Research Initiative (AMARI) for sponsoring the primary investigator to conduct this study. This work was supported by the DELTAS Africa Initiative [DEL-15-01] through the first author (Y.G.). Finally, we thank Prof. Richard Keefe and his team for allowing us to use the Digit Sequencing Task (DST). DST is part of the BACS, and the copyright belongs to WCG. We also would like to thank Prof Martine Prince and his team for letting us use the Word Learning Test (WLLT) and the Animal Naming Test (ANT), part of a validation study of a cross-cultural measure of Dementia in developing countries. Funding This work was supported by the DELTAS Africa Initiative [DEL-15-01] through the first author (Y.G.). The DELTAS Africa Initiative is an independent funding scheme of the African Academy of Sciences (AAS) Alliance for Accelerating Excellence in Science in Africa (AESA) and supported by the New Partnership for Africa\u2019s Development Planning and Coordinating Agency (NEPAD Agency) with funding from the Wellcome Trust [DEL-15-01] and the UK government. The views expressed in this publication are those of the author(s) and not necessarily those of AAS, NEPAD Agency, Wellcome Trust, or the UK government. The funder has no role in the interpretation of findings and publication decisions. Publisher Copyright: © The Author(s) 2024.

PY - 2024/4/6

Y1 - 2024/4/6

N2 - Cognitive impairment is common in people with schizophrenia (PWS). To detect the presence and its consequences, cognitive measures with sound psychometric properties are needed. However, these are lacking especially in low-income countries. Hence, we developed the Ethiopian Cognitive Assessment battery in Schizophrenia (ECAS). In this study, we evaluated the psychometric properties of the ECAS in a cross-sectional study involving 350 PWS. Confirmatory factor analysis demonstrated a one-factor solution. ECAS score correlated significantly but weakly with a disability measure (r = -0.13, p = 0.02) and symptom dimensions of PANSS (r between -0.12 and -0.29, p < 0.05), except for positive symptoms (r = -0.10, p > 0.05). Years of education (β = 0.12, 95% CI (0.09, 0.14), p < 0.001), male sex (β = 0.22, 95% CI (0.05, 0.39)), age β = -0.02, 95% CI (-0.03, -0.01), and medication side effects (β = -0.03, 95% CI (-0.06, -0.01), p = 0.021) were significantly associated with the composite score of ECAS. The Item Response Theory analysis showed that the tool best functions among participants with moderate cognitive impairment (difficulty coefficient between -1.12 and 0.27). The Differential Item Functioning analyses showed that education had a positive contribution on Digit Symbol Substitution Test (MH OR = 2.64, 95% CI (1.34, 5.20)). The results showed that ECAS is valid in assessing cognition in PWS in low-resource settings.

AB - Cognitive impairment is common in people with schizophrenia (PWS). To detect the presence and its consequences, cognitive measures with sound psychometric properties are needed. However, these are lacking especially in low-income countries. Hence, we developed the Ethiopian Cognitive Assessment battery in Schizophrenia (ECAS). In this study, we evaluated the psychometric properties of the ECAS in a cross-sectional study involving 350 PWS. Confirmatory factor analysis demonstrated a one-factor solution. ECAS score correlated significantly but weakly with a disability measure (r = -0.13, p = 0.02) and symptom dimensions of PANSS (r between -0.12 and -0.29, p < 0.05), except for positive symptoms (r = -0.10, p > 0.05). Years of education (β = 0.12, 95% CI (0.09, 0.14), p < 0.001), male sex (β = 0.22, 95% CI (0.05, 0.39)), age β = -0.02, 95% CI (-0.03, -0.01), and medication side effects (β = -0.03, 95% CI (-0.06, -0.01), p = 0.021) were significantly associated with the composite score of ECAS. The Item Response Theory analysis showed that the tool best functions among participants with moderate cognitive impairment (difficulty coefficient between -1.12 and 0.27). The Differential Item Functioning analyses showed that education had a positive contribution on Digit Symbol Substitution Test (MH OR = 2.64, 95% CI (1.34, 5.20)). The results showed that ECAS is valid in assessing cognition in PWS in low-resource settings.

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DO - 10.1038/s41537-024-00462-4

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SN - 2754-6993

VL - 10

SP - 42

JO - Schizophrenia

JF - Schizophrenia

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M1 - 42

ER -

The Ethiopian Cognitive Assessment battery in Schizophrenia (ECAS): a validation study

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