Validation and normative data for the BAC app in Spanish-speaking individuals with psychosis and healthy controls

Abstract

Background: Cognitive impairment is central to psychosis and strongly linked to functional outcomes. The Brief Assessment of Cognition (BAC) app is a tablet-based, automated tool for assessing key cognitive domains but has not been validated in Spanish-speaking populations or across illness stages.

Methods: A total of 402 participants (117 with first-episode psychosis [FEP], 125 with schizophrenia, and 160 controls) completed the BAC app along with clinical and functional assessments. We evaluated internal consistency, group differences, convergent and discriminant validity, and the effects of sex, age, and education. Normative percentiles were derived from controls.

Results: The BAC app showed good internal consistency across groups (α = 0.76-0.87) and effectively differentiated individuals with psychosis from controls (area under the curve [AUC] = 0.862), with performance declining from controls to FEP to schizophrenia. Discrimination between FEP and schizophrenia was limited (AUC = 0.649). BAC App correlated positively with estimated intelligence quotient and functional capacity, and negatively with symptom severity, particularly in FEP. Performance varied by age, sex, and education, supporting the need for stratified normative data.

Conclusions: The BAC app showed strong reliability and validity for cognitive assessment in Spanish-speaking individuals with psychosis. Its brevity, automated scoring, and normative data support its clinical and research applications for cognitive screening, monitoring, and treatment evaluation.

Keywords: BAC app; cognitive assessment; first-episode psychosis; normative data; schizophrenia; validation study.

Figure 1.

Receiver operating characteristic (ROC) curves for Brief Assessment of Cognition (BAC) app subtests and composite score: clinical (first-episode psychosis [FEP] + schizophrenia) group versus controls. ROC curves comparing individuals with psychosis (FEP and schizophrenia combined) to healthy controls on BAC app subtest T-scores and the composite score. The composite score showed the highest discriminative validity (area under the curve [AUC] = 0.862), followed by symbol coding (AUC = 0.814), verbal fluency (AUC = 0.794), token motor (AUC = 0.785), verbal memory (AUC = 0.774), digit sequencing (AUC = 0.772), and tower of London (AUC = 0.741). The diagonal reference line (AUC = 0.50) represents chance-level performance.

Figure 2.

Receiver operating characteristic (ROC) curves for Brief Assessment of Cognition (BAC) app subtests and composite score: first-episode psychosis (FEP) versus schizophrenia. Note. ROC curves comparing individuals with FEP to those with schizophrenia on BAC app subtest T-scores and the composite score. The composite score showed poor discriminative validity (area under the curve [AUC] = 0.649), with the token motor subtest yielding the highest AUC (0.702) followed by verbal memory (AUC = 0.650), symbol coding (AUC = 0.632), tower of London (AUC = 0.580), verbal fluency (AUC = 0.553), and digit sequencing (AUC = 0.541). The diagonal reference line (AUC = 0.50) represents chance-level performance.