Development and administration of the flexible adapted cognitive test battery for schizophrenia (FACTS)

Background

Age and educational eligibility criteria for administration of the most widely used cognitive battery for schizophrenia typically exclude 20 % of individuals with schizophrenia in high-income countries and 25–50 % in middle- and low-income countries.

Methods

We developed the Flexible Adapted Cognitive Test battery for Schizophrenia (FACTS) that can be administered to all individuals with schizophrenia, regardless of age or education. To evaluate the utility and validity of the nine tests in the FACTS, two process measures are assessed during the administration of each test: ‘test comprehension’ and ‘test completion’ (successful or unsuccessful). The FACTS was administered to 495 community-dwelling individuals with schizophrenia and 308 healthy controls, including 473 (58.9 %) older or undereducated individuals typically excluded from studies of cognition in schizophrenia. Inter-rater reliability of the test comprehension and completion measures was assessed.

Findings

Older, undereducated participants successfully completed 82 % (3499/4257) of the administered tests. The mean weighted Kappa value for the nine test comprehension measures was 0.90 (range: 0.82–0.96), and the mean unweighted Kappa for the 20 test and subtest completion measures was 0.94 (range: 0.85–1.00).

Interpretation

Cognitive functioning is a core symptom cluster of schizophrenia, so the comprehensive assessment of cognitive functioning must become a standard part of the assessment of all individuals with schizophrenia, regardless of age or education. The development of the FACTS, which can be successfully administered to most older, undereducated individuals with schizophrenia, provides a model for doing this.

Funding

This study was supported by National Institute of Mental Health grants MH108385-R01 and MH127631-R01.