Validation Of Chinese Cerebellar Cognitive Affective Syndrome Scale In Cerebellar Infarction Cohort

The cerebellar cognitive affective syndrome(CCAS)is a group of clinical syndromes manifested as executive dysfunction,visual spatial disorder,speech defect,impaired memory and emotional change post cerebellar injuries as described by Schmahmann and Sherman.Objective: To convert the English CCAS scale(CCAS-s)into a Chinese CCAS-s,and validate the latter in a cerebellar infarction cohort to investigate the applicability of the Chinese CCAS-s in Chinese populations and the relationship between its scores and the ataxia severity of the patients.Methods: The English CCAS-s was translated into a preliminary Chinese CCAS-s using a standard scale translation procedure,with the permission from its original authors.The Chinese CCAS-s was pretested among 5 patients with cerebellar infarction and 5 health controls.We discussed with the original authors about the test results and made modifications repeatedly to ensure that the final version was easy to understand.Any information was neither lost nor added during the translation.Twenty-seven(27)patients with cerebellar infarction and 25 health controls with matched sex,age and education were selected for assessment of internal consistency reliability,discriminant validity and convergent validity for the Chinese CCAS-s.The 27 patients with cerebellar infarction also received the tests of Montreal cognitive assessment(Mo CA)and scale for the assessment and rating of ataxia(SARA)at the same time.Results:The Chinese CCAS-s had acceptable internal consistency(Cronbach’s alpha = 0.7435).Based on the cutoff values of the English counterpart,the sensitivity and specificity were calculated for each entry of the Chinese CCAS-s,and the best cutoff values of the Chinese CCAS-s were adjusted,yielding good discriminability.In the cerebellar infarction patient cohort,the scores of the Chinese CCAS-s were associated with the Mo CA scores,and meanwhile,the Chinese CCAS-s showed higher sensitivity than Mo CA.However,due to the influence of the cultural difference,age and education,the Chinese CCAS-s needs further improvement.In addition,the results of the Chinese CCAS-s for the patients with cerebellar infarction were associated with the results of SARA test to some extent.Conclusion: Chinese CCAS-s is applicable to Chinese populations,and can be used to evaluate the cognitive impairments of the patients with cerebellar injuries under the circumstances of taking the cultural difference,age and education into account.Chinese CCAS-s can screen out the cognitive disorders among the patients with cerebellar lesions earlier than the Mo CA scale.The results of the Chinese CCAS-s for the patients with cerebellar infarction are associated with the results of the SARA test,and the positions of cerebellar injuries should be taken into account when interpreting the results.