ECAS A-B-C: alternate forms of the Edinburgh Cognitive and Behavioural ALS Screen

Christopher J Crockford, Michaela Kleynhans, Evelyn Wilton, Ratko Radakovic, Judith Newton, Elaine H Niven, Ammar Al-Chalabi, Orla Hardiman, Thomas H Bak, Sharon Abrahams

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BACKGROUND: The Edinburgh Cognitive and Behavioural ALS Screen (ECAS) is a short assessment by which neuropsychological symptoms can be detected and quantified in people with ALS. To avoid potential practice effects with repeated administration, here we present alternative versions of the ECAS suitable for measuring change over time. 

OBJECTIVE: To develop two alternate versions of the ECAS: ECAS-B and ECAS-C. 

METHOD: One hundred and forty-nine healthy adult participants were recruited. Thirty participants completed a pilot study in developing the alternate versions. Two groups of 40 participants were administered the ECAS-B or ECAS-C and compared to published data of the original ECAS (ECAS-A) to determine equivalence. An additional 39 participants were administered the ECAS consecutively, either repeating the original version (ECAS-A-A-A) serially or the different versions (ECAS-A-B-C) to determine potential practice effects. Recordings of assessments were scored by a second researcher to determine inter-rater reliability. 

RESULTS: No significant differences were found between versions (A, B, C) of the composite performance measures of ALS Specific, ALS Non-Specific, and ECAS Total scores. Repeated serial administration of ECAS-A (A-A-A) produced some practice effects for composite scores, whereas no such effects were found when alternate versions were administered serially (A-B-C). Exceptionally high intra-class correlations were found for all three versions of the ECAS suggesting a high degree of rater agreement. 

CONCLUSION: The newly developed alternate forms of the ECAS are both highly equitable to the original ECAS-A and enable avoidance of practice effects, thus supporting their use in measuring cognition and behaviour over time.

Original languageEnglish
Pages (from-to)57-64
Number of pages8
JournalAmyotrophic Lateral Sclerosis and Frontotemporal Degeneration
Issue number1-2
Early online date5 Dec 2017
Publication statusPublished - 2018
Externally publishedYes


  • Cognition
  • behaviour
  • screen
  • ECAS
  • alternate forms
  • reliability

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