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Proposing the short Neurological Evaluation Scale

Published online by Cambridge University Press:  24 October 2016

Akin Ojagbemi ,
Robin Emsley  and
Oye Gureje
Akin Ojagbemi*
Affiliation:
World Health Organization (WHO) Collaborating Centre for Research and Training in Mental Health, Neuroscience, and Substance Abuse, Department of Psychiatry, University of Ibadan, Ibadan, Oyo State, Nigeria
Robin Emsley
Affiliation:
Department of Psychiatry, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, Western Cape, South Africa
Oye Gureje
Affiliation:
World Health Organization (WHO) Collaborating Centre for Research and Training in Mental Health, Neuroscience, and Substance Abuse, Department of Psychiatry, University of Ibadan, Ibadan, Oyo State, Nigeria
*
Akin Ojagbemi, Department of Psychiatry, University of Ibadan, Cape Town, Western Cape,Nigeria. Tel: +234 803 673 7171; E-mail: akin.ojagbemi@kclalumni.net
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Abstract

Objectives

The time required in completing the 26 items of neurological examinations in the standard Neurological Evaluation Scale (NES) may limit its utility in pragmatic clinical situations. We propose the Short Neurological Evaluation Scale (S-NES) for use in busy clinical settings, and in research.

Methods

Using confirmatory factor analyses, we identified 12 items of neurological examination showing significant overlap with previously reported theoretical and empirical categories of neurological soft signs (NSS) in schizophrenia. This provided justification for the development of a shorter version of the NES based on the empirically identified NSS. In the present study, we relied on existing data to present an initial validation of the S-NES against the referent standard 26-item NES. We determined sensitivity, specificity, and likelihood ratios. Posterior-test probability was estimated using a Bayesian nomogram plot.

Results

Using data derived from 84 unmedicated or minimally treated patients with first-episode schizophrenia, 12 empirically determined items of neurological examinations showed high agreement with the 26 items in the standard NES battery (sensitivity=96.3%, specificity=100%, and posterior-test probability=100%).

Conclusions

Within limitations of validity estimates derived from existing data, the present results suggest that the design of the S-NES based on empirically identified 12 items of neurological examination is a logical step. If successful, the S-NES will be useful for rapid screening of NSS in busy clinical settings, and also in research.

Keywords

biological markersendophenotypespsychometric analysesscreening tools
Type
Original Articles
Information
Acta Neuropsychiatrica , Volume 29 , Issue 4 , August 2017 , pp. 236 - 243
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Copyright
© Scandinavian College of Neuropsychopharmacology 2016 

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References

1. Kong, L, Herold, CJ, Lasser, MM et al. Association of cortical thickness and neurological soft signs in patients with chronic schizophrenia and healthy controls. Neuropsychobiology 2015;71:225–233.Google Scholar
2. Gay, O, Plaze, M, Oppenheim, C et al. Cortex morphology in first-episode psychosis patients with neurological soft signs. Schizophr Bull 2013;39:820–829.CrossRefGoogle ScholarPubMed
3. Dazzan, P, Morgan, KD, Chitnis, X et al. The structural brain correlates of neurological soft signs in healthy individuals. Cereb Cortex 2006;16:1225–1231.CrossRefGoogle ScholarPubMed
4. Thomann, PA, Wustenberg, T, Santos, VD, Bachmann, S, Essig, M, Schroder, J. Neurological soft signs and brain morphology in first-episode schizophrenia. Psychol Med 2009;39:371–379.Google Scholar
5. Hirjak, D, Wolf, RC, Stieltjes, B et al. Cortical signature of neurological soft signs in recent onset schizophrenia. Brain Topogr 2014;27:296–306.Google Scholar
6. Mouchet-Mages, S, Rodrigo, S, Cachia, A et al. Correlations of cerebello-thalamo-prefrontal structure and neurological soft signs in patients with first-episode psychosis. Acta Psychiatr Scand 2011;123:451–458.CrossRefGoogle ScholarPubMed
7. Zhao, Q, Li, Z, Huang, J et al. Neurological soft signs are not ‘soft’ in brain structure and functional networks: evidence from ALE meta-analysis. Schizophr Bull 2014;40:626–641.Google Scholar
8. Ojagbemi, A, Esan, O, Emsley, R, Gureje, O. Motor sequencing abnormalities are the trait marking neurological soft signs of schizophrenia. Neurosci Lett 2015;600:226–231.CrossRefGoogle ScholarPubMed
9. Xu, T, Wang, Y, Li, Z et al. Heritability and familiality of neurological soft signs: evidence from healthy twins, patients with schizophrenia and non-psychotic first-degree relatives. Psychol Med 2016;46:117–123.Google Scholar
10. Chan, RC, Xie, W, Geng, FL et al. Clinical utility and lifespan profiling of neurological soft signs in schizophrenia spectrum disorders. Schizophr Bull 2016;42:560–570.CrossRefGoogle ScholarPubMed
11. Ivleva, EI, Morris, DW, Moates, AF, Suppes, T, Thaker, GK, Tamminga, CA. Genetics and intermediate phenotypes of the schizophrenia – bipolar disorder boundary. Neurosci Biobehav Rev 2010;34:897–921.Google Scholar
12. Peng, ZW, Xu, T, Miao, GD et al. Neurological soft signs in obsessive-compulsive disorder: the effect of co-morbid psychosis and evidence for familiality. Prog Neuropsychopharmacol Biol Psychiatry 2012;39:200–205.Google Scholar
13 Urbanowitsch, N, Degen, C, Toro, P, Schroder, J. Neurological soft signs in aging, mild cognitive impairment, and Alzheimer’s disease – the impact of cognitive decline and cognitive reserve. Front Psychiatry 2015;6:12.Google Scholar
14. Prikryl, R, Ceskova, E, Tronerova, S et al. Dynamics of neurological soft signs and its relationship to clinical course in patients with first-episode schizophrenia. Psychiatry Res 2012;200:67–72.Google Scholar
15. Greenberg, MS, Wood, NE, Spring, JD et al. Pilot study of neurological soft signs and depressive and postconcussive symptoms during recovery from Mild Traumatic Brain Injury (mTBI). J Neuropsychiatry Clin Neurosci 2015;27:199–205.Google Scholar
16. Mechri, A, Bourdel, MC, Slama, H, Gourion, D, Gaha, L, Krebs, MO. Neurological soft signs in patients with schizophrenia and their unaffected siblings: frequency and correlates in two ethnic and socioeconomic distinct populations. Eur Arch Psychiatry Clin Neurosci 2009;259:218–226.CrossRefGoogle ScholarPubMed
17. Neelam, K, Garg, D, Marshall, M. A systematic review and meta-analysis of neurological soft signs in relatives of people with schizophrenia. BMC Psychiatry 2011;11:139.Google Scholar
18. Chan, RC, Wang, Y, Zhao, Q et al. Neurological soft signs in individuals with schizotypal personality features. Aust N Z J Psychiatry 2010;44:800–804.CrossRefGoogle Scholar
19. Braff, DL, Freedman, R, Schork, NJ, Gottesman, II. Deconstructing schizophrenia: an overview of the use of endophenotypes in order to understand a complex disorder. Schizophr Bull 2007;33:21–32.Google Scholar
20. Buchanan, RW, Heinrichs, DW. The Neurological Evaluation Scale (NES): a structured instrument for the assessment of neurological signs in schizophrenia. Psychiatry Res 1989;27:335–350.Google Scholar
21. Convit, A, Volavka, J, Czobor, P, de Asis, J, Evangelista, C. Effect of subtle neurological dysfunction on response to haloperidol treatment in schizophrenia. Am J Psychiatry 1994;151:49–56.Google Scholar
22. Schroder, J, Niethammer, R, Geider, FJ et al. Neurological soft signs in schizophrenia. Schizophr Res 1991;6:25–30.Google Scholar
23. Chen, EY, Shapleske, J, Luque, R et al. The Cambridge Neurological Inventory: a clinical instrument for assessment of soft neurological signs in psychiatric patients. Psychiatry Res 1995;56:183–204.CrossRefGoogle ScholarPubMed
24. Jahn, T, Cohen, R, Hubmann, W et al. The Brief Motor Scale (BMS) for the assessment of motor soft signs in schizophrenic psychoses and other psychiatric disorders. Psychiatry Res 2006;142:177–189.Google Scholar
25. Ojagbemi, A, Emsley, R, Gureje, O. Exploratory factor structure of the Neurological Evaluation Scale in black Africans with first episode schizophrenia. Data Brief 2016;6:471–475.Google Scholar
26. Ojagbemi, A, Akpa, O, Esan, O, Emsley, R, Gureje, O. The confirmatory factor structure of neurological soft signs in Nigerians with first episode schizophrenia. Neurosci Lett 2015;589:110–114.CrossRefGoogle ScholarPubMed
27. Heinrichs, DW, Buchanan, RW. Significance and meaning of neurological signs in schizophrenia. Am J Psychiatry 1988;145:11–18.Google ScholarPubMed
28. Sanders, RD, Allen, DN, D Forman, S, Tarpey, T, Keshavan, MS, Goldstein, G. Confirmatory factor analysis of the Neurological Evaluation Scale in unmedicated schizophrenia. Psychiatry Res 2005;133:65–71.Google Scholar
29. Sanders, RD, Keshavan, MS, Forman, SD et al. Factor structure of neurologic examination abnormalities in unmedicated schizophrenia. Psychiatry Res 2000;95:237–243.Google Scholar
30. Keshavan, MS, Sanders, RD, Sweeney, JA et al. Diagnostic specificity and neuroanatomical validity of neurological abnormalities in first-episode psychoses. Am J Psychiatry 2003;160:1298–1304.Google Scholar
31. Goldstein, G, Sanders, RD, Forman, SD et al. The effects of antipsychotic medication on factor and cluster structure of neurologic examination abnormalities in schizophrenia. Schizophr Res 2005;75:55–64.Google Scholar
32. Prasad, KM, Sanders, R, Sweeney, J et al. Neurological abnormalities among offspring of persons with schizophrenia: relation to premorbid psychopathology. Schizophr Res 2009;108:163–169.Google Scholar
33. First, MB, Spitzer, RL, Gibbon, M, Williams, JB. Structured Clinical Interview for DSM-IV Axis I Disorders, Clinician Version (SCID-IV). Washington, DC: American Psychiatric Press Inc., 1996.Google Scholar
34. American Psychiatric Association. Diagnostic and Statistical Manual of Mental disorders: 4th Edition, (DSM IV) Text Revision. Washington, DC: American Psychiatric Association, 1994.Google Scholar
35. Sewell, RA, Perry, EB Jr., Karper, LP et al. Clinical significance of neurological soft signs in schizophrenia: factor analysis of the Neurological Evaluation Scale. Schizophr Res 2010;124:1–12.Google Scholar
36. Hooper, D, Coughlan, J, Mullen, M. Structural Equation Modelling: guidelines determining model fit. J Bus Res Methods 2008;6:53–60.Google Scholar
37. Ojagbemi, AA. A Prospective Study of Neurological Abnormalities in a Cohort of Nigerian Patients with Schizophrenia. Stellenbosch: Stellenbosch University, 2014; 291pp.Google Scholar
38. Bombin, I, Arango, C, Buchanan, RW. Significance and meaning of neurological signs in schizophrenia: two decades later. Schizophr Bull 2005;31:962–977.CrossRefGoogle ScholarPubMed
39. Chan, RC, Gottesman, II. Neurological soft signs as candidate endophenotypes for schizophrenia: a shooting star or a Northern star? Neurosci Biobehav Rev 2008;32:957–971.Google Scholar
40. Compton, MT, Bercu, Z, Bollini, A, Walker, EF. Factor structure of the Neurological Evaluation Scale in a predominantly African American sample of patients with schizophrenia, unaffected relatives, and non-psychiatric controls. Schizophr Res 2006;84:365–377.Google Scholar
41. Emsley, R, Turner, HJ, Oosthuizen, PP, Carr, J. Neurological abnormalities in first-episode schizophrenia: temporal stability and clinical and outcome correlates. Schizophr Res 2005;75:35–44.Google Scholar
42. Krebs, MO, Gut-Fayand, A, Bourdel, M, Dischamp, J, Olie, J. Validation and factorial structure of a standardized neurological examination assessing neurological soft signs in schizophrenia. Schizophr Res 2000;45:245–260.Google Scholar
43. Malla, AK, Norman, RM, Aguilar, O, Cortese, L. Relationship between neurological ‘soft signs’ and syndromes of schizophrenia. Acta Psychiatr Scand 1997;96:274–280.CrossRefGoogle ScholarPubMed
44. Mohr, F, Hubmann, W, Cohen, R et al. Neurological soft signs in schizophrenia: assessment and correlates. Eur Arch Psychiatry Clin Neurosci 1996;246:240–248.Google Scholar
45. Schroder, J, Geider, FJ, Binkert, M, Reitz, C, Jauss, M, Sauer, H. Subsyndromes in chronic schizophrenia: do their psychopathological characteristics correspond to cerebral alterations? Psychiatry Res 1992;42:209–220.Google Scholar
46. Sanders, RD, Joo, YH, Almasy, L et al. Are neurologic examination abnormalities heritable? A preliminary study. Schizophr Res 2006;86:172–180.CrossRefGoogle ScholarPubMed