Clinical Use of the Bicams: Case Studies Illustrating Varied Application to Meet Patient and Clinician Needs

Background: Persons with Multiple Sclerosis (pwMS) manage symptoms for their entire lives. Cognition is one of these symptoms.  The Brief International Assessment for Multiple Sclerosis (BICAMS) is a well validated, repeatable protocol that can be used to monitor the cognitive status in pwMS.

Objectives: In order to improve the quality of patient care…Clinical use of the BICAMS protocol will be examined to determine if there are applications for the protocol beyond clinical monitoring.

Methods:

A medical record review was undertaken to find evidence of repeated use of the BICAMS to manage patient care.  The pattern of use of the BICAMS was examined to determine if clinical monitoring was the only use.

Results: Three case studies showing distinct uses for the BICAMS found.

1. Clinical Monitoring

A 42 years old female diagnosed two years earlier. The initial BICAMS scores (SDMT 74; CVLT2 48; BVMTR unavailable).  Working part time. One year later, the SDMT (74) is stable and the CVLT2 improved (60). Administration of BVMTR yielded a score of 34.  Symptoms of slurred speech and word recall reported.  The patient was on leave from work.

One year later, no change in the SDMT (74), decline in CVLT2 (47) with improvement in BVMTR (46). Difficulty attending in background noise, change in memory.  Now on disability.

After 4 years, the patient reports consistent difficulty attending in background noise,  and unknowingly repeating statements.  The patient reports new eye pain. The score on the SDMT declined by 14 (60). The score on the CVLT2 improved (72), but the BVMTR declined (34). Neuropsych recommended.

2. Outcomes Measure

A 53 year old female diagnosed 20 years earlier.

Initials scores showed objective impairment (SDMT 27; CVLT2 24; BVMTR 7).  After treatment, SDMT improved (49).  Six months later there was no decline in SDMT (50), or CVLT2 (23) but improved BVMTR (34).  After the course of care, the patient showed objective improvement in the CVLT2 (35).  Eighteen months later, the SDMT improved (54), CVLT2 declined (29) as did the BVMTR (31).  The patient is currently completing care.

3. Education

A 51 year old male diagnosed one year earlier.  The patient is employed full time.

At initial evaluation the patient showed objective impairment (SDMT 38; CVLT2 45; BVMTR 37) after a course of care the patient and spouse stated functional improvements. One year later the patient’s spouse reached out to this clinician regarding a change in cognition.  Upon follow - up MRI, a new enhancing lesion was discovered.  Because of the administration of the BICAMS, this patient was successfully proactive in his own care.  

Conclusions:  

Three separate uses for the BICAMS occur in the comprehensive care setting. First, clinical monitoring, where the patient is sent for a status check.  Second, as an outcomes measure, providing an objective indicator of change over the course of treatment.  Third, as a tool to provide education on the nature of cognitive change in pwMS giving the patient a tool to be proactive in their own care.