Examining Cognitive Decline Over Time in Iranian Als Patients: Adapting Successive Versions B and C of the Edinburgh Cognitive and Behavioral Screen to Persian Publisher



Z Shaka ZOHA ; H Mojtabavi HELIA ; M Taebi MORVARID ; B Mahmoodibakhtiari BEHROOZ ; P Sarraf PAYAM
Source: Amyotrophic Lateral Sclerosis and Frontotemporal Degeneration Published:2025

Abstract

Objective: To adapt successive versions B and C of the Edinburgh Cognitive and Behavioral Screen (ECAS) into Persian and evaluate cognitive and behavioral changes over time in Iranian ALS patients. Methods: This study included 38 ALS patients in the ECAS-B group and 29 in the ECAS-C group, diagnosed between May 2021 and February 2023 at the Iranian Center of Neurological Research, Imam Khomeini Hospital, Tehran, Iran. Additionally, 59 age- and education-matched healthy controls were enrolled (30 for ECAS-B and 29 for ECAS-C). The Montreal Cognitive Assessment (MoCA) was used to validate the ECAS versions. Results: The Persian versions of ECAS-B and ECAS-C demonstrated strong internal consistency (Cronbach’s alpha: 0.88 for ECAS-B and 0.89 for ECAS-C) and a positive correlation with MoCA and ALS-FRS-r scores. The area under the ROC curve was 0.851 for ECAS-B and 0.861 for ECAS-C. ECAS-C scores were significantly lower than ECAS-B scores, suggesting a faster cognitive decline over time. Optimal cutoff values of 72 for ECAS-B and 78 for ECAS-C were identified for detecting cognitive impairment. Cognitive impairment was observed in 10 patients (26.31%) in the ECAS-B group and 15 patients (51.72%) in the ECAS-C group. Conclusions: The Persian versions of ECAS-B and ECAS-C demonstrate good validity and reliability for detecting cognitive impairment and tracking cognitive decline in ALS patients. © 2025 Elsevier B.V., All rights reserved.