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Eur. J. Psychiat. Vol. 29, N.

° 2, (131-134)

Keywords: Schizophrenia; Cognition; Clinical

An abbreviated version of the brief assessment
of cognition in schizophrenia (BACS)
Yasuhiro Kaneda, MD, PhDa,*
Richard S.E. Keefe, PhDb
a Department of Psychiatry, Iwaki Clinic,
Anan, Tokushima 774-0014, Japan
b Department of Psychiatry and Behavioral
Sciences, Duke University Medical Center,
Durham, NC 27710, USA

ABSTRACT – Background and Objectives: A short version of the Brief Assessment of
Cognition in Schizophrenia (BACS) was derived.
Methods: We calculated the corrected item-total correlation (CITC) for each test score
relative to the composite score, and then computed the proportion of variance that each
test shares with the global score excluding that test (Rt2 = CITCt2) and the variance ex-
plained per minute of administration time for each test (Rt2/mint).
Results and Conclusions: The 3 tests with the highest Rt2/mint, Symbol Coding, Digit
Sequencing, and Token Motor, were selected for the Abbreviated BACS.

Received: 24 December 2014
Revised: 31 March 2015
Accepted: 31 March 2015

6). A-BACS) to at P < 0. completed by a trained psychiatrist along with dence that cognitive impairment is a core the BACS. and a mean age at onset of 24. and executive function The assessment of cognitive function is (Tower of London). as well as a key de.0. The Brief Assessment of Cognition in Schizophrenia The data analyses were conducted using (BACS) has been developed as a quick and JMP-8. and the patients had a mean total feature of schizophrenia1. NC. verbal fluency (Verbal Fluency). KEEFE Introduction speed (Token Motor). Digit Sequencing.2. socio-demographic and clinical data. Cary.0001). the variance explained per minute of admin- and is devised for easy administration and istration time for each test (Rt2/mint).55. composite score of the whole BACS (R2 = h batteries6. 1-7 score) was schizophrenia because of the extensive evi. The composite score from improvements. The level of significance was set BACS (Abbreviated BACS. BPRS score of 42. make it more useful for clinical work. attention and processing speed (Symbol Coding). thereby controlling for part-whole cor- the patients had a mean age of 38. Inc.74 with ments of verbal memory (Verbal Memory). using the Japanese BACS recently developed by the authors upon permission4. It is specifi.J for Mac software (SAS Institute efficient tool for measuring cognition in pa. The CITC is the and the subjects consisted of 472 stable pa- correlation between each standardized test tients with a DSM-IV5 diagnosis of chronic score in the BACS with the standardized schizophrenia or schizoaffective disorder. and is as sensitive to cognitive Token Motor tasks correlated 0. and reliability3.0001) and correlated 0.3). The 18-item Brief Psy- an important step in evaluating patients with chiatric Rating Scale (BPRS7. P < 0.05 (two-tailed). The re- mately 30 min with minimal extra time for lationships among measures were determined scoring and training demands. self. The BACS includes brief assess. 213 (45%) were women. . the total battery score excluding these 3 tests working memory (Digit Sequencing). US).93 with the dysfunction in schizophrenia as standard 2.0 (SD = 13. terminant of functional outcome2. We computed the proportion of vari- 13. BACS total score excluding the test score it- Among the patients. composite score (Table). score excluding that test (Rt2 = CITCt2) and The BACS takes approximately 30 min. Descriptive statistics tients with schizophrenia3. tests with the highest Rt2/mint were selected cally designed to measure treatment-related for the A-BACS. The 3 scoring by non-psychologists. Results Methods Based on the previous study8.5.8 (SD = relation.86. P < 0. The author by calculating Pearson correlations (r) among tried to derive an abbreviated version of the the scores.. we calcu- lated the corrected item-total correlation (CITC) for each test score relative to the Data from a previous study were utilized. motor (R2 = 0. The time required were used to report the patients in terms of for the testing with the BACS is approxi.9).132 YASUHIRO KANEDA AND RICHARD S. 0.E.7 years ance that each test shares with the global (SD = 7. The BACS has high test-retest the Symbol Coding.

be a good choice to use an A-BACS to assess For assessing cognitive function in schiz. battery should be very brief and account for mainly because verbal fluency in the BACS a large proportion of the variance of the is composed of Semantic Fluency and two global cognitive score of the battery.53 0.09 Token Motor 0. speed of processing measures and one work. These should be necessary to test their sensitivity to NTBs are. Hurford et al.46 5 0.46 7 0. VPM = variance explained per minute of administration time. another A-BACS composed of a nition in patients with schizophrenia could be different subset may be necessary10. we should be aware cally difficult. Still. 133 Table BACS Item.37 5 0. The finding is consis. Rt2/mint were selected for the A-BACS. In addition.18 Digit Sequencing 0. it may valid estimate of general cognitive ability. and thus BACS has been developed.68 0.07 Tower of London 0. .8 described. treatments. The findings in this study therefore schizophrenia9 and A-BACS could be ad- suggested that the A-BACS could provide a ministered approximately in 11 min.05 *Administration times were derived from the administration records from the previous study11. as Hurford et al. is employed. however. a brief fluency was not chosen for this A-BACS.. Verbal cause. BACS = Brief Assessment of Cognition in Schizophrenia. and thus it takes three Since a single generalized cognitive deficit times as long as Semantic Fluency alone has been suggested to best characterizes takes.8 proposed a pointments8.34 7 0. Discussion an extremely useful guide for clinicians mak- The A-BACS is also composed of two ing decisions about potential rehabilitation.55 3 0. CITC = corrected item-total correlation.. and digit symbol. trials of Letter Fluency.09 Verbal Memory 0. Condition CITC Variance Estimated Admin Time (min)* VPM Symbol Coding 0. for prediction of different aspects of a quick and efficient tool for measuring cog.74 0. and costly. typical outpatient psychiatric practice allots tent with the results in the previous reports: about 15min for medication management ap- in their report. a ing memory measure. AN ABBREVIATED VERSION OF THE BRIEF ASSESSMENT OF COGNITION. usually consisting of 8-12 tests tap. outcome. be- category fluency. techni. cognitive function in patients with schizo- ophrenia.61 0. The 3 tests with the highest group of tests composed of trail making B. further studies rocognitive domains. semination of brief neuropsychological as- ping each of several for the putative neu.68 0.28 3 0. The availability of that. Tests Sortied by Variance Explained Per Minute of Administration Time.59 0. time consuming. a neuropsychological test battery phrenia in clinical settings. sessments such as A-BACS.07 Verbal Fluency 0. For broader dis- (NTB).

Harvey PD. Braff DL. Reise SP. 10. Robinson D.: American Psychiatric Association. Schiz- 119-36. 37(3): 538-45. Numata Iwaki Clinic. Keefe receives royalties from the BACS testing bat. Ohmori T. Diagnostic and Sta. 2000. Gold JM. MD. Yasuhiro Kaneda. Arndt S. Bilder RM. Poe MP. 2008. Construction of a tool for clinicians. Facsimile number: +81-884-22-1780 Washington. 61(6): 602-9. 10: 799-812. Keefe RS. Bates JA. The Brief Assessment of Cognition in Schizophrenia: Reliability. tery and the MATRICS Battery (BACS Sym- bol Coding). Mintz J. Ishimoto Y. * Corresponding author: 68(2-3): . Keefe RS. Fourth Edition (DSM-IV). Hamer RM.E. 2004. Harvey PD. 14(2): 209-21. Hurford IM. Psychiatry Clin Tokushima 774-0014 Neurosci. Overall JE. Brief assessment of cognition in schizophre- Gakubara. Kennel C. Efficiency of the CATIE and BACS neu- ropsychological batteries in assessing cognitive effects of an- Dr. Keefe RS. Hill SK. 8. Generalized cognitive deficits in schizophrenia: Bowie CR. Clin Exp Neuropsychol. 2. Gu H. Coughenour L. +81-884-23-5600 tistical Manual of Mental Disorders. 26(1): Assessment of Cognition in Schizophrenia (BACS). Gold JM. E-mail: kaneday-tsh@umin. schizophrenia: Prediction of different aspects of outcome. D. 2009. 11-1 Kamimizuta S. 102(1-3): 108-15. Schizophr Res. 2007. 31(4): 462-71. Keefe RS. 1962. Heaton RK. 3. Psychol Rep. Harvey PD. Bilder RM. 56(8): 749-54. NC. He is also a shareholder in Neu. Reiter G. KEEFE 6. O’Leary D. American Psychiatric Association. Kaneda Y. Perkins Conflict of interest DO. 9. Durham. Goldman RS. 11. Patterson TL. et al. 2008. Goldberg TE. Paulsen JS. Abbreviated neuropsychological assessment in A study of first-episode patients. J Int Neuropsychol Soc. Anan nia: Validation of the Japanese version. Tel. 1. Kern RS. A brief cognitive assessment tool for schizophrenia: roCog Trials. 1994. Arch Gen Psychiatry. dreasen N. et al. Schizophr Bull. 157(4): 549-59. Keefe RS. J 1999. Kaneda is responsible for developing tipsychotic treatments in schizophrenia. ophr Res. Walker tive deficits and functional outcome in schizophrenia: Are TM. Neuropsychology of first-episode schiz- References ophrenia: Initial characterization and clinical correlates. 2011. An. Mohamed S. sensitivity.C. and comparison with a standard neurocognitive battery. Sumiyoshi T. Gorham DR. Marder SR. Keefe R. 7. PhD Department of Psychiatry 4. Norms and standardization of the Brief we measuring the “right stuff”? Schizophr Bull. Green MF.134 YASUHIRO KANEDA AND RICHARD S. Japan 5. Sweeney JA. USA. Am J Psychiatry. Goldberg TE. Dr. the Japanese version of the BACS. The brief psychiatric rating scale. Neurocogni. Bell L. et al.