Usefulness in rehabilitation of the paper Multiple Errands Test to assess executive functions in patients with schizophrenia, bipolar or autism disorders. Results from the REHABase cohort study.

Abstract

Objective: Neuropsychological tests measuring executive functions are useful for identifying specific cognitive disorders, but they have limits for characterizing executive dysfunction in everyday activities. This study aims to investigate the socio-demographic, clinical, and psychosocial features associated with executive functions in patients with schizophrenia, bipolar, and autism spectrum disorders using a Paper Multiple Errands Test.

Patients or materials and methods: A total of 1071 adults with schizophrenia spectrum disorder, 329 with bipolar spectrum disorder, and 254 with autism spectrum disorder were recruited from the French National Centers of Reference for Psychiatric Rehabilitation (REHABase) cohort between January 2016 and October 2022. Executive function severity was assessed by the multiple errands test. Socio-demographic and clinical data were extracted as well as results from standardized scales for self-stigma, quality of life, well-being, and self-esteem. Data were analyzed using bivariate and Quasi-Poisson regression model.

Results: The mean number of errors measured by the paper multiple errands test was 3.1±1.9 in patients with schizophrenia spectrum disorder (n=1071), 2.4±1.8 in bipolar disorder (n=329), and 2.6±1.9 in autism disorder (n=254). Factors significantly associated with the number of errors were (1) age, illness duration, number of hospitalizations, education level, working memory, and insight in patients with schizophrenia; (2) age, illness duration, number of hospitalizations, education level, and working memory in patients with bipolar disorder; and (3) education level and working memory in patients with autism disorder. The number of errors was associated with lower quality of life, well-being and self-esteem, but not self-stigma, in all three disorders.

Conclusion: The predictors of executive dysfunction observed with the paper multiple errands test were similar to those found with other tests of executive function. The paper multiple errands test is associated with essential psychosocial determinants in rehabilitation, particularly quality of life and well-being, and provides a wide range of information about functioning in community living.