Reliability and validity study of the Chinese version of the Cerebellar Cognitive Affective Syndrome Scale in patients with cerebellar injury

Reliability and validity study of the Chinese version of the Cerebellar Cognitive Affective Syndrome Scale in patients with cerebellar injury | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Reliability and validity study of the Chinese version of the Cerebellar Cognitive Affective Syndrome Scale in patients with cerebellar injury Jing Guo, Yi Zhang, Lu Chen, Chaolan Wang, Xiaofang Yuan, Fan Xie This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-2520761/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract To preliminarily investigate the reliability and validity of the Chinese version of the Cerebellar Cognitive Affective Syndrome Scale (CCAS scale) in the cerebellar injury population. In this study, 40 patients with cerebellar injury and 39 normal individuals hospitalized in a stroke center were assessed using the Chinese version of the CCAS scale A, MMSE, and PHQ2, and the results were analyzed using content validity, structural validity, internal consistency, inter-rater agreement, and retest reliability. RESULTS: The correlation coefficients of semantic fluency, phonemic fluency, category switching, digit span forward, digit span backward, cube, verbal recall, similarities and Go No-Go subscores in the Chinese version of the CCAS scale A were 0.586-0.831 (P≤0.05) with the total score, but there was no significant correlation between the affect and the total score (P=0.110). the total cognitive score of the Chinese version of the CCAS scale A was correlated with the(r=0.807, P≤0.01), and the total score of the Chinese version of the CCAS scale A affect was correlated with the total score of PHQ2 (r=0.884, P≤0.01). The 2 factors were extracted using principal component analysis, and the cumulative variance contribution rate was59.633%. The factor loadings of each of the corresponding factors were > 0.5, indicating good structural validity of the Chinese version of the CCAS scale A. Cronbach α=0.827 indicated good internal consistency, and inter-rater reliability (ICC>0.95) and retest reliability (ICC=0.717-0.895) indicated that the Chinese version of the CCAS scale A had good inter-rater reliability and retest reliability. Conclusion: The Chinese version of the CCAS scale A has good reliability and validity in the cerebellar injury population and is useful for screening cerebellar cognitive-emotional syndrome. cognition cerebellum scale reliability validity 1. Research Background Cerebellar Cognitive Affective Syndrome (CCAS) is a clinical syndrome proposed by Schmahmann and Sherman in 1998. is characterized by executive dysfunction, language dysfunction, spatial cognitive impairment, and affective impairment after cerebellar injury (Argyropoulos et al., 2019). The clinical symptoms are complex, with symptoms of cognitive impairment mixed with symptoms of emotional disorders, such as attention deficit, poor verbal fluency, grammatical errors, visuospatial confusion, depression, and behavioral abnormalities(Ahmadian et al., 2019; Braga-Neto et al., 2011; Schmahmann, 2004; Wolf et al., 2009).The symptoms of cognitive disorders are mixed with those of emotional disorders, such as attention disorders, poor verbal fluency, grammatical errors, visual-spatial disorders, depression, and behavioral abnormalities. In the past, MMSE and MoCA were commonly used clinically to diagnose cerebellar affective cognitive syndrome, but they are not considered suitable at present. In 2018, Schmahmann and Sherman developed and released the Cerebellar Cognitive Affective Syndrome Scale (CCAS scale) for assessing cerebellar cognitive affective syndrome, and foreign studies confirmed its high sensitivity and specificity. Since its release, the Cerebellar Cognitive Affective Since its publication, CCAS has been translated into different languages(Hoche, Guell, et al., 2018; Maeshima & Osawa, 2009; Thieme et al., 2020). It has been translated into different languages and applied to various cerebellar disorders(Hickey et al., 2018; Hoche, Daly, et al., 2018; Maas et al., 2021; Rodríguez-Labrada et al., 2021). However, no Chinese version of the scale has been published yet. Therefore, we assessed the Cerebellar Cognitive-Emotional Syndrome Scale in patients with cerebellar injury to determine whether it has good reliability and validity in the Chinese population and provide a theoretical basis for its subsequent use. 2. Methods Forty patients with cerebellar injuries admitted to the stroke center of Changzhou First People's Hospital from 2022.03 to 2022.11 were included in this study. Inclusion criteria: 1. history of new cerebellar injury; 2. diagnosis of cerebellar injury, including cerebral infarction and cerebral atrophy, by a professional neurologist based on CT and MRI ; 3. age > 18 years; 4. ability to cooperate in completing the full cognitive assessment; 5. patients who agreed to participate in this study. Exclusion criteria: 1. Patients who could not complete the full cognitive assessment due to visual or auditory impairment; 2. Patients who refused to participate in this study by themselves or their family members. There were 40 patients, 26 males, and 14 females. The average age was 64.88 ± 10.72 years. The mean years of education were 7.83 ± 3.84 years, of which 4 cases were illiterate, 14 cases had less than 9 years of education, and 22 cases had 9 years or more of education. 2.1 Assessment tools The Chinese version of the CCAS scale was completed jointly by the original author and Sun-Hee Nam and was divided into version A and version B. To verify the reliability of the retest, only version A was used in this study. in the verbal registration part of version A, there was the word Wang Jianguo, which was renamed after a male celebrity in mainland China, and to avoid influence, Wang Jianguo was amended to Zhang Jianguo after discussion with the original author and agreement. The Chinese version A of the CCAS has 10 items: semantic fluency, phonemic fluency, category switching, digit span forward, digit span backward, cube, verbal recall, similarities, Go No-Go, and affect. Among them, semantic fluency, phonemic fluency, category switching, digit span forward, digit span backward, cube, verbal recall, similarities and Go No-Go, were used to assess cognitive function, and affect was used to assess emotion. All items with raw scores less than or equal to the threshold were scored as a failure, with a standard score of 1 for failure and 0 for passing the standard score. 120 raw scores and 10 standard scores were given for the Chinese version of the CCAS scale. Total standard score = 1: CCAS may exist, total standard score = 2: CCAS is likely to exist, total standard score ≥ 3, CCAS exists. The Mini-mental State Examination (MMSE) is a scale developed by Folstein et al. in 1975 to assess cognitive functioning and is now widely used around the world(Tombaugh & McIntyre, 1992). The assessment includes orientation, attention, computation, and recall verbal ability. 30 points on the MMSE scale are considered cognitively impaired depending on the level of education, with scores of ≤ 19 for illiteracy, ≤ 22 for elementary school, and ≤ 26 for secondary school and above. It takes approximately 5–10 minutes to complete the assessment. The PHQ2 depression screening scale (two-item Patient Health Questionnaire, PHQ-2) is a widely used simple mood screening scale(Löwe et al., 2005; Manea et al., 2016). The PHQ2 has 2 items, each of which is rated 0–3, with a total score of 0–6. A total score of ≥ 3 is considered a mood disorder. 2.2 Process Three trained rehabilitation physicians performed cognitive assessments on the enrolled patients. The first assessment was conducted by the primary examiner who asked questions and the three assessors scored simultaneously and independently. A second assessment was conducted within 24–48 hours after the first assessment, and the second assessment was scored by the primary examiner alone. The first assessment included the Chinese version of the CCAS scale A, MMSE, and PHQ2, and the second assessment included only the Chinese version of the CCAS scale A. At the same time, the primary examiner performed cognitive assessments on 39 healthy adults, including the Chinese version of the CCAS scales A and MMSE. 2.3 Data Analysis SPSS 26.0 statistical software was used for data analysis. We performed an inter-rater reliability analysis for the data of the first assessment, and we performed a retest reliability analysis for the data of the second assessment. Data from the Chinese version A of the patient's CCAS scale was analyzed for validity with the MMSE and PHQ2. Internal consistency was expressed by Cronbach's alpha coefficient, and inter-rater reliability was expressed by the intra-group correlation coefficient (ICC). correlation between the Chinese version of the CCAS scale A and MMSE and PHQ2 scores was expressed by Spearman's correlation coefficient, and P < 0.05 was considered a statistically significant difference. 3. Study Results 3.1 General Information Table 1 shows the basic situation of the Chinese version A scores of the CCAS scale, with semantic fluency mean score of 11.05 ± 4.862, phonemic fluency mean score of 3.30 ± 2.875, category switching mean score of2.58 ± 2.062, digit span forward mean score 5.83 ± 1.738, digit span backward mean score 2.78 ± 1.165, cube mean score 7.95 ± 4.039, and verbal recall mean score 6.98 ± 4.638, similarities mean score 3.85 ± 3.199, Go No-Go mean score 0.65 ± 0.893, affect 4.50 ± 1.617, and total score mean score 49.35 ± 19.57. Table 1. Basic A scores of the Chinese version of the CCAS scale Projects Score Highest score Semantic fluency 11.05±4.862 26 Phonemic fluency 3.30±2.875 19 Category switching 2.58±2.062 15 Digit span forward 5.83±1.738 8 Digit span backward 2.78±1.165 6 Cube 7.95±4.039 15 Verbal recall 6.98±4.638 15 Similarities 3.85±3.199 8 Go No-Go 0.65±0.893 2 Affect 4.50±1.617 6 Total Score 49.35±19.57 120 3.2 Reliability analysis 3.2.1 Internal Consistency Reliability The results showed that the Cronbach coefficient of the Chinese version of the CCAS scale was 0.827, which indicates that the scale has good internal consistency. 3.2.2 Inter-assessor consistency The results in Table 2 show that the ICC of the Chinese version of the CCAS scale A total score was 0.999 (95% CI 0.998,0.999), the ICC of semantic fluency was 0.997 (95% CI 0.995,0.998), phonemic fluency 0.997 (95% CI 0.995,0.998), category switching 0.998 (95% CI 0.997, 0.999), digit span forward 0.983 (95% CI 0.970,0.990), digit span backward0.992 (95% CI 0.986,0.995), cube 0.999 (95% CI 0.999,1.000), verbal recall 1.000 (95% CI 1.000,1.000), similarities 0.992 (95% CI 0.986,0.995), Go No-Go 0.996 (95% CI 0.994,0.998), and affect 0.992 (95% CI 0.986,0.995), which indicates good inter-rater agreement for this scale. Table 2. ICC analysis of the Chinese version of the CCAS scale between assessors for sub-scale A and total score Projects ICC 95% CI P Semantic fluency 0.997 (0.995,0.998) 0.000 Phonemic fluency 0.997 (0.995,0.998) 0.000 Category switching 0.998 (0.997,0.999) 0.000 Digit span forward 0.983 (0.970,0.990) 0.000 Digit span backward 0.992 (0.986,0.995) 0.000 Cube 0.999 (0.999,1.000) 0.000 Verbal recall 1.000 (1.000,1.000) 0.000 Similarities 0.992 (0.986,0.995) 0.000 Go No-Go 0.996 (0.994,0.998) 0.000 Affect 0.992 (0.986,0.995) 0.000 Total Score 0.999 (0.998,0.999) 0.000 3.2.3 Retest Reliability Table 3 shows that the retest ICC coefficient of the Chinese version of the CCAS scale A total score was 0.836, and the retest ICC coefficients of semantic fluency, phonemic fluency, category switching, digit span forward, digit span backward, cube, verbal recall, similarities, Go No-Go, and affect. were 0.717–0.895, which indicates that the scale has good retest reliability. Table 3. Retest reliability of the Chinese version of the CCAS scale for sub-item A and total score Projects ICC r P Semantic fluency 0.773 0.635 0.000 Phonemic fluency 0.895 0.823 0.000 Category switching 0.733 0.576 0.000 Digit span forward 0.778 0.640 0.000 Digit span backward 0.722 0.578 0.000 Cube 0.717 0.596 0.000 Verbal recall 0.803 0.690 0.000 Similarities 0.836 0.713 0.000 Go No-Go 0.744 0.587 0.000 Affect 0.846 0.730 0.000 Total Score 0.836 0.727 0.000 3.3. Validity 3.3.1 Content validity Table 5 shows the correlation between the sub-scores of the Chinese version of the CCAS scale A and the total score.semantic fluency, phonemic fluency,category switching,digit span forward, digit span backward, cube, verbal recall, similarities and Go No-Go showed a moderate positive correlation with the total score with correlation coefficients of 0.586–0.831. However, there was no significant correlation between the affect and the total score (p = 0.110). Table 5. Correlation between sub-scores and total scores of Chinese version A of the CCAS scale Projects r P Semantic fluency 0.727 0.000 Phonemic fluency 0.719 0.000 Category switching 0.615 0.000 Digit span forward 0.610 0.000 Digit span backward 0.586 0.000 Cube 0.784 0.000 Verbal recall 0.831 0.000 Similarities 0.684 0.000 Go No-Go 0.629 0.000 Affect 0.257 0.110 3.3.2 Principal component factor analysis Tables 6 and 7 show the principal component factor analysis performed on the sub-scales to clarify the structural validity of the scale. The Kaiser-Meyer-Olkim (KMO) test and Bartlett test were used to determine the feasibility of the factor analysis. the KMO value was 0.754 and the Bartlett sphericity test value was 163.343 with df = 45, p < 0.00, indicating that the factor analysis was appropriate. Using principal component analysis and orthogonal rotation methods, a total of two initial factors were obtained with a cumulative variance contribution of 59.633%. Table 6. common factor variance Projects Initial Extraction Semantic fluency 1.000 0.590 Phonemic fluency 1.000 1.000 0.471 0.792 Category switching 1.000 0.384 Digit span forward 1.000 0.549 Digit span backward 1.000 0.624 Cube 1.000 0.698 Verbal recall 1.000 1.000 0.631 0.517 Similarities 1.000 0.706 Table 7. variance and cumulative contribution margin Ingredients Initial Eigenvalue Extraction of the sum of squares of loads sum of rotation load squares Total Variance % Cumulative % Total Variance % Cumulative % Total Variance % Cumulative % 1 4.546 45.464 45.464 4.546 45.464 45.464 3.17 31.770 31.770 2 1.417 14.168 59.633 1.417 14.168 59.633 2.786 27.862 59.633 Table 8 shows that factor 1 was associated with semantic fluency, category switching, digit span backward, and verbal recall, and cue factor 1 was associated with language, attention, and memory. Factor 2 was associated with Phonemic fluency, cube, verbal recall, similarities, Go No-Go, and affect, and cue factor 2 was associated with language, visual space, executive function, memory, and emotion. Table 8. Rotated component matrix Factor 1 2 Semantic fluency 0.740 Phonemic fluency 0.584 Category switching 0.890 Digit span forward Digit span backward 0.674 Cube 0.647 Verbal recall 0.655 0.518 Similarities 0.688 Go No-Go 0.674 Affect 0.736 3.3.3 Validity of valid standards Table 9 shows that the MMSE with high reliability and validity was used as the validity standard for the cognitive total score (assessment items other than emotion) of the CCAS scale, and the results showed that the MMSE total score was 23.4 ± 5.063, and the Chinese version of the CCAS scale had a high positive correlation between the A cognitive total score and the MMSE total score (r = 0.818, p ≤ 0.01). Table 10 shows that PHQ2 was used as the total effective score validity scale in this study, and the results showed that the mean value of PHQ2: was 1.48 ± 1.894, the total affective score of 4.50 ± 1.617, and the total effective score showed a high positive correlation with PHQ2 (r = 0.891, P ≤ 0.01). Table 9. Correlation between a total cognitive score of CCAS Chinese version A and MMSE total score Mean r p MMSE 23.4±5.063 0.818 0.000 CCAS 44.85±18.712 Table 10. Correlation between the total score of emotion in the Chinese version of the CCAS scale A and the total score of MMSE Mean r p PHQ2 1.48±1.894 0.891 0.000 Affect 4.50±1.617 4. Discussion The impairments in executive function, speech function, spatial cognition, and emotions manifested by cerebellar cognitive-emotional syndrome severely affect the ability to perform daily activities and quality of life in patients with cerebellar injury. The cause of cognitive-emotional impairment in patients with cerebellar injury may be the disruption of cerebellar and limbic, prefrontal, and parietal cortical pathways(Argyropoulos et al., 2019; Schmahmann, 2019). Currently, for cognitive assessment of cerebellar injury patients, cognitive scales such as MMSE and MoCA and emotional scales such as PHQ2 and PHQ9 are commonly used clinically, but the existing cognitive scales do not reflect emotional disorders, and there are already emotional scales that do not reflect cognitive disorders, so the CCAS scale is a combination of cognitive and emotional assessment and is more suitable for clinical screening of cerebellar cognitive-emotional disorder syndrome. The Chinese version of CCAS Scale A has a total score of 120, which covers verbal function (37.5%), executive function (25.8%), visuospatial function(12.5%), memory function (12.5%), abstract reasoning (6.7%), and emotion (5%). Since the CCAS scale is a new scale, only the English and German versions have completed reliability studies, but all have shown good reliability(Hoche, Guell, et al., 2018; Thieme et al., 2020). In this study, only raw scores were used for analysis, and validity analysis showed that the correlation coefficient between the Chinese version of the CCAS scale A cognitive item score and the total score was between 0.586 and 0.831, which was moderate to highly significant, indicating that the scale had good content validity. Meanwhile, the total cognitive score of the Chinese version of the CCAS scale A was highly correlated with the total score of MMSE (r=0.818, p≤0.01), and the emotional item score of the Chinese version of CCAS scale A was highly correlated with the total score of PHQ2(r=0.891, p≤0.01) indicating that the Chinese version of CCAS scale A has good validity. In addition, factor analysis was used to examine the structural validity of the scale. A total of 2 common factors were extracted, the cumulative variance contribution rate was 59.633%, and the factor loadings of each item were > 0.50, indicating that the Chinese version of CCAS Scale A has good structural validity. The above findings indicate that the Chinese version A of the CCAS scale has high validity when applied to the Chinese population. From the reliability analysis, this study used the most commonly used reliability coefficient, Cronbach's alpha coefficient, which was 0.827, greater than 0.7, indicating that the Chinese version of the CCAS scale A has good internal consistency. The inter-rater agreement reliability was high, with the ICC of the item scores and the total score ranging from 0.982 to 1.000, indicating a high inter-operator agreement. the retest reliability of the total score of the Chinese version of the CCAS scale A was 0.836, and the retest reliability of the item scores also ranged from 0.717 to 0.895, indicating that the Chinese version of the CCAS scale A has good inter-temporal stability. These indicate that the Chinese version of the CCAS scale A has good reliability in assessing cerebellar cognitive-emotional syndrome. Overall, the Chinese version of the CCAS scale A has good reliability and validity in the Chinese cerebellar injury population and can be promoted for clinical use in the future to provide targeted cognitive training to further improve the cognitive function and activities of daily living of patients(Maeshima & Osawa, 2009; Ruffieux et al., 2016). The limitations of this study are the older age of the subjects and the lower years of education, the difficulty of the Chinese version of the CCAS scale A is difficult for the subjects, and the original authors also suggest that the CCAS scale is recommended for patients under 50 years of age with a higher level of education(Schmahmann et al., 2021; Thieme et al., 2021). The original authors also suggested that the Chinese version of the CCAS scale is recommended for patients under 50 years of age with a high level of education, and further research on the Chinese version of the CCAS scale can be conducted for age and education. The present study only analyzed the raw scores, and further analysis of the Chinese version of the CCAS scale can be conducted to determine the appropriate sub-scale boundaries for the Chinese version. Declarations Ethical Approval This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of the First People's Hospital of Changzhou, Jiangsu Province, China.Ethics number is (2020)科第146号, Competing interests The authors have no relevant financial or non-financial interests to disclose. Authors' contributions All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Jing Guo，Chaolan Wang，Xiaofang Yuan，Fan Xie and Lu Chen. The first draft of the manuscript was written by Jing Guo and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript. Funding No funding was received to assist with the preparation of this manuscript. Data availability statement The authors confirm that the data supporting the findings of this study are available within the article and its supplementary materials. References Ahmadian, N., van Baarsen, K., van Zandvoort, M., & Robe, P. A. (2019). 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Reference values for the Cerebellar Cognitive Affective Syndrome Scale: age and education matter. Brain , 144 (2), e20–e20. https://doi.org/10.1093/BRAIN/AWAA417 Tombaugh, T. N., & McIntyre, N. J. (1992). The Mini-Mental State Examination: A Comprehensive Review. Journal of the American Geriatrics Society , 40 (9), 922–935. https://doi.org/10.1111/J.1532-5415.1992.TB01992.X Wolf, U., Rapoport, M. J., & Schweizer, T. A. (2009). Evaluating the affective component of the cerebellar cognitive affective syndrome. Journal of Neuropsychiatry and Clinical Neurosciences , 21 (3), 245–253. https://doi.org/10.1176/JNP.2009.21.3.245/ASSET/IMAGES/LARGE/AO03090074WF1.JPEG Additional Declarations No competing interests reported. Supplementary Files CCASVersion1A.pdf CCAS.xlsx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-2520761","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":172062242,"identity":"33375f28-f435-4f70-a16e-130f763650fb","order_by":0,"name":"Jing Guo","email":"","orcid":"","institution":"Changzhou First People's Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Jing","middleName":"","lastName":"Guo","suffix":""},{"id":172062243,"identity":"46871cca-18c4-40a1-9cfa-e2fa400cc5cf","order_by":1,"name":"Yi Zhang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABBklEQVRIie3QsUoDMRzH8YRAuuS49R+q9BX+Uui1ULxXuSLY5ebSSXIGMvkAJ/ocxTGHYJejrgcd5Cg49walQwWtuDg07SiY7xAI/D5DQojP9xeDnxMJzVYf26EIQ3U0YRoDdXkic3sUIV+kZSBQj0NUiVt07vRr/Wb6cdTKDMiHZ4HE0nWT7if0/inqnhpgg5tC98/KpYiYYvJ2tp8wSHptaYBjNcqqhC/FQFnOAgfhMH7fEYEvtQLLFwJt4iYC0p5sDABW9Fpmxh4mAOmkTRaAWI50l5QXQuaFdr6lk49ncjO5inE+r1dkeh6HoS7WjYN8f0HAf92pcu93k8324Mbn8/n+c5/Gp1Br9a7NSQAAAABJRU5ErkJggg==","orcid":"","institution":"Changzhou First People's Hospital","correspondingAuthor":true,"submittingAuthor":false,"prefix":"","firstName":"Yi","middleName":"","lastName":"Zhang","suffix":""},{"id":172062244,"identity":"ae5c8063-3235-4d60-af47-0972900b1cba","order_by":2,"name":"Lu Chen","email":"","orcid":"","institution":"Changzhou First People's Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Lu","middleName":"","lastName":"Chen","suffix":""},{"id":172062245,"identity":"91c4909c-522c-4b65-ab71-5ad7079a0cef","order_by":3,"name":"Chaolan Wang","email":"","orcid":"","institution":"Changzhou First People's Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Chaolan","middleName":"","lastName":"Wang","suffix":""},{"id":172062247,"identity":"797b870c-ba99-49df-84d1-5910d1b52052","order_by":4,"name":"Xiaofang Yuan","email":"","orcid":"","institution":"Changzhou First People's Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Xiaofang","middleName":"","lastName":"Yuan","suffix":""},{"id":172062248,"identity":"3852c83c-3b5c-492a-ad1b-c52cbddfeb59","order_by":5,"name":"Fan Xie","email":"","orcid":"","institution":"Changzhou First People's Hospital","correspondingAuthor":false,"submittingAuthor":false,"prefix":"","firstName":"Fan","middleName":"","lastName":"Xie","suffix":""}],"badges":[],"createdAt":"2023-01-27 14:29:19","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-2520761/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-2520761/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":33009663,"identity":"ee9e258c-2807-43b2-9eb5-3b4364aede98","added_by":"auto","created_at":"2023-02-16 03:44:37","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":201249,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-2520761/v1/4851e3ca-4ab7-48a0-9dfa-9917e1b0c723.pdf"},{"id":32345619,"identity":"627fa3bc-90c3-4859-88df-8312af5cdd4b","added_by":"auto","created_at":"2023-02-01 18:56:28","extension":"pdf","order_by":2,"title":"","display":"","copyAsset":false,"role":"supplement","size":300481,"visible":true,"origin":"","legend":"","description":"","filename":"CCASVersion1A.pdf","url":"https://assets-eu.researchsquare.com/files/rs-2520761/v1/99c328d0fd85c84814f34534.pdf"},{"id":32345543,"identity":"6188a74b-de64-4faf-85b2-c6aa76dc2f43","added_by":"auto","created_at":"2023-02-01 18:48:28","extension":"xlsx","order_by":3,"title":"","display":"","copyAsset":false,"role":"supplement","size":20513,"visible":true,"origin":"","legend":"","description":"","filename":"CCAS.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-2520761/v1/adf051edda7ccde5670de7e2.xlsx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Reliability and validity study of the Chinese version of the Cerebellar Cognitive Affective Syndrome Scale in patients with cerebellar injury","fulltext":[{"header":"1. Research Background","content":"\u003cp\u003eCerebellar Cognitive Affective Syndrome (CCAS) is a clinical syndrome proposed by Schmahmann and Sherman in 1998. is characterized by executive dysfunction, language dysfunction, spatial cognitive impairment, and affective impairment after cerebellar injury (Argyropoulos et al., 2019). The clinical symptoms are complex, with symptoms of cognitive impairment mixed with symptoms of emotional disorders, such as attention deficit, poor verbal fluency, grammatical errors, visuospatial confusion, depression, and behavioral abnormalities(Ahmadian et al., 2019; Braga-Neto et al., 2011; Schmahmann, 2004; Wolf et al., 2009).The symptoms of cognitive disorders are mixed with those of emotional disorders, such as attention disorders, poor verbal fluency, grammatical errors, visual-spatial disorders, depression, and behavioral abnormalities. In the past, MMSE and MoCA were commonly used clinically to diagnose cerebellar affective cognitive syndrome, but they are not considered suitable at present. In 2018, Schmahmann and Sherman developed and released the Cerebellar Cognitive Affective Syndrome Scale (CCAS scale) for assessing cerebellar cognitive affective syndrome, and foreign studies confirmed its high sensitivity and specificity. Since its release, the Cerebellar Cognitive Affective Since its publication, CCAS has been translated into different languages(Hoche, Guell, et al., 2018; Maeshima \u0026amp; Osawa, 2009; Thieme et al., 2020). It has been translated into different languages and applied to various cerebellar disorders(Hickey et al., 2018; Hoche, Daly, et al., 2018; Maas et al., 2021; Rodr\u0026iacute;guez-Labrada et al., 2021). However, no Chinese version of the scale has been published yet. Therefore, we assessed the Cerebellar Cognitive-Emotional Syndrome Scale in patients with cerebellar injury to determine whether it has good reliability and validity in the Chinese population and provide a theoretical basis for its subsequent use.\u003c/p\u003e"},{"header":"2. Methods","content":"\u003cp\u003eForty patients with cerebellar injuries admitted to the stroke center of Changzhou First People's Hospital from 2022.03 to 2022.11 were included in this study. Inclusion criteria: 1. history of new cerebellar injury; 2. diagnosis of cerebellar injury, including cerebral infarction and cerebral atrophy, by a professional neurologist based on CT and MRI ; 3. age\u0026thinsp;\u0026gt;\u0026thinsp;18 years; 4. ability to cooperate in completing the full cognitive assessment; 5. patients who agreed to participate in this study. Exclusion criteria: 1. Patients who could not complete the full cognitive assessment due to visual or auditory impairment; 2. Patients who refused to participate in this study by themselves or their family members. There were 40 patients, 26 males, and 14 females. The average age was 64.88\u0026thinsp;\u0026plusmn;\u0026thinsp;10.72 years. The mean years of education were 7.83\u0026thinsp;\u0026plusmn;\u0026thinsp;3.84 years, of which 4 cases were illiterate, 14 cases had less than 9 years of education, and 22 cases had 9 years or more of education.\u003c/p\u003e\n\u003cp\u003e2.1 Assessment tools\u003c/p\u003e\n\u003cp\u003eThe Chinese version of the CCAS scale was completed jointly by the original author and Sun-Hee Nam and was divided into version A and version B. To verify the reliability of the retest, only version A was used in this study. in the verbal registration part of version A, there was the word Wang Jianguo, which was renamed after a male celebrity in mainland China, and to avoid influence, Wang Jianguo was amended to Zhang Jianguo after discussion with the original author and agreement.\u003c/p\u003e\n\u003cp\u003eThe Chinese version A of the CCAS has 10 items: semantic fluency, phonemic fluency, category switching, digit span forward, digit span backward, cube, verbal recall, similarities, Go No-Go, and affect. Among them, semantic fluency, phonemic fluency, category switching, digit span forward, digit span backward, cube, verbal recall, similarities and Go No-Go, were used to assess cognitive function, and affect was used to assess emotion. All items with raw scores less than or equal to the threshold were scored as a failure, with a standard score of 1 for failure and 0 for passing the standard score. 120 raw scores and 10 standard scores were given for the Chinese version of the CCAS scale. Total standard score\u0026thinsp;=\u0026thinsp;1: CCAS may exist, total standard score\u0026thinsp;=\u0026thinsp;2: CCAS is likely to exist, total standard score\u0026thinsp;\u0026ge;\u0026thinsp;3, CCAS exists.\u003c/p\u003e\n\u003cp\u003eThe Mini-mental State Examination (MMSE) is a scale developed by Folstein et al. in 1975 to assess cognitive functioning and is now widely used around the world(Tombaugh \u0026amp; McIntyre, 1992). The assessment includes orientation, attention, computation, and recall verbal ability. 30 points on the MMSE scale are considered cognitively impaired depending on the level of education, with scores of \u0026le;\u0026thinsp;19 for illiteracy, \u0026le;\u0026thinsp;22 for elementary school, and \u0026le;\u0026thinsp;26 for secondary school and above. It takes approximately 5\u0026ndash;10 minutes to complete the assessment. The PHQ2 depression screening scale (two-item Patient Health Questionnaire, PHQ-2) is a widely used simple mood screening scale(L\u0026ouml;we et al., 2005; Manea et al., 2016). The PHQ2 has 2 items, each of which is rated 0\u0026ndash;3, with a total score of 0\u0026ndash;6. A total score of \u0026ge;\u0026thinsp;3 is considered a mood disorder.\u003c/p\u003e\n\u003cp\u003e2.2 Process\u003c/p\u003e\n\u003cp\u003eThree trained rehabilitation physicians performed cognitive assessments on the enrolled patients. The first assessment was conducted by the primary examiner who asked questions and the three assessors scored simultaneously and independently. A second assessment was conducted within 24\u0026ndash;48 hours after the first assessment, and the second assessment was scored by the primary examiner alone. The first assessment included the Chinese version of the CCAS scale A, MMSE, and PHQ2, and the second assessment included only the Chinese version of the CCAS scale A. At the same time, the primary examiner performed cognitive assessments on 39 healthy adults, including the Chinese version of the CCAS scales A and MMSE.\u003c/p\u003e\n\u003cp\u003e2.3 Data Analysis\u003c/p\u003e\n\u003cp\u003eSPSS 26.0 statistical software was used for data analysis. We performed an inter-rater reliability analysis for the data of the first assessment, and we performed a retest reliability analysis for the data of the second assessment. Data from the Chinese version A of the patient's CCAS scale was analyzed for validity with the MMSE and PHQ2. Internal consistency was expressed by Cronbach's alpha coefficient, and inter-rater reliability was expressed by the intra-group correlation coefficient (ICC). correlation between the Chinese version of the CCAS scale A and MMSE and PHQ2 scores was expressed by Spearman's correlation coefficient, and P\u0026thinsp;\u0026lt;\u0026thinsp;0.05 was considered a statistically significant difference.\u003c/p\u003e"},{"header":"3. Study Results","content":"\u003cp\u003e3.1 General Information\u003c/p\u003e\n\u003cp\u003eTable\u0026nbsp;1 shows the basic situation of the Chinese version A scores of the CCAS scale, with semantic fluency mean score of 11.05\u0026thinsp;\u0026plusmn;\u0026thinsp;4.862, phonemic fluency mean score of 3.30\u0026thinsp;\u0026plusmn;\u0026thinsp;2.875, category switching mean score of2.58\u0026thinsp;\u0026plusmn;\u0026thinsp;2.062, digit span forward mean score 5.83\u0026thinsp;\u0026plusmn;\u0026thinsp;1.738, digit span backward mean score 2.78\u0026thinsp;\u0026plusmn;\u0026thinsp;1.165, cube mean score 7.95\u0026thinsp;\u0026plusmn;\u0026thinsp;4.039, and verbal recall mean score 6.98\u0026thinsp;\u0026plusmn;\u0026thinsp;4.638, similarities mean score 3.85\u0026thinsp;\u0026plusmn;\u0026thinsp;3.199, Go No-Go mean score 0.65\u0026thinsp;\u0026plusmn;\u0026thinsp;0.893, affect 4.50\u0026thinsp;\u0026plusmn;\u0026thinsp;1.617, and total score mean score 49.35\u0026thinsp;\u0026plusmn;\u0026thinsp;19.57.\u003c/p\u003e\n\u003cp\u003eTable 1. Basic A scores of the Chinese version of the CCAS scale\u003c/p\u003e\n\u003ctable border=\"1\" cellpadding=\"0\" cellspacing=\"0\" width=\"543\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"34.9264705882353%\"\u003e\n \u003cp\u003eProjects\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"31.801470588235293%\"\u003e\n \u003cp\u003eScore\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"33.27205882352941%\"\u003e\n \u003cp\u003eHighest\u0026nbsp;score\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"34.9264705882353%\"\u003e\n \u003cp\u003eSemantic\u0026nbsp;fluency\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"31.801470588235293%\"\u003e\n \u003cp\u003e11.05\u0026plusmn;4.862\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"33.27205882352941%\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"34.9264705882353%\"\u003e\n \u003cp\u003ePhonemic fluency\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"31.801470588235293%\"\u003e\n \u003cp\u003e3.30\u0026plusmn;2.875\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"33.27205882352941%\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"34.9264705882353%\"\u003e\n \u003cp\u003eCategory switching\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"31.801470588235293%\"\u003e\n \u003cp\u003e2.58\u0026plusmn;2.062\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"33.27205882352941%\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"34.9264705882353%\"\u003e\n \u003cp\u003eDigit span forward\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"31.801470588235293%\"\u003e\n \u003cp\u003e5.83\u0026plusmn;1.738\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"33.27205882352941%\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"34.9264705882353%\"\u003e\n \u003cp\u003eDigit span backward\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"31.801470588235293%\"\u003e\n \u003cp\u003e2.78\u0026plusmn;1.165\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"33.27205882352941%\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"34.9264705882353%\"\u003e\n \u003cp\u003eCube\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"31.801470588235293%\"\u003e\n \u003cp\u003e7.95\u0026plusmn;4.039\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"33.27205882352941%\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"34.9264705882353%\"\u003e\n \u003cp\u003eVerbal recall\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"31.801470588235293%\"\u003e\n \u003cp\u003e6.98\u0026plusmn;4.638\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"33.27205882352941%\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"34.9264705882353%\"\u003e\n \u003cp\u003eSimilarities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"31.801470588235293%\"\u003e\n \u003cp\u003e3.85\u0026plusmn;3.199\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"33.27205882352941%\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"34.9264705882353%\"\u003e\n \u003cp\u003eGo No-Go\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"31.801470588235293%\"\u003e\n \u003cp\u003e0.65\u0026plusmn;0.893\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"33.27205882352941%\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"34.9264705882353%\"\u003e\n \u003cp\u003eAffect\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"31.801470588235293%\"\u003e\n \u003cp\u003e4.50\u0026plusmn;1.617\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"33.27205882352941%\"\u003e\n \u003cp\u003e6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"34.9264705882353%\"\u003e\n \u003cp\u003eTotal\u0026nbsp;Score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"31.801470588235293%\"\u003e\n \u003cp\u003e49.35\u0026plusmn;19.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"33.27205882352941%\"\u003e\n \u003cp\u003e120\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e3.2 Reliability analysis\u003c/p\u003e\n\u003cp\u003e3.2.1 Internal Consistency Reliability\u003c/p\u003e\n\u003cp\u003eThe results showed that the Cronbach coefficient of the Chinese version of the CCAS scale was 0.827, which indicates that the scale has good internal consistency. 3.2.2 Inter-assessor consistency\u003c/p\u003e\n\u003cp\u003eThe results in Table\u0026nbsp;2 show that the ICC of the Chinese version of the CCAS scale A total score was 0.999 (95% CI 0.998,0.999), the ICC of semantic fluency was 0.997 (95% CI 0.995,0.998), phonemic fluency 0.997 (95% CI 0.995,0.998), category switching 0.998 (95% CI 0.997, 0.999), digit span forward 0.983 (95% CI 0.970,0.990), digit span backward0.992 (95% CI 0.986,0.995), cube 0.999 (95% CI 0.999,1.000), verbal recall 1.000 (95% CI 1.000,1.000), similarities 0.992 (95% CI 0.986,0.995), Go No-Go 0.996 (95% CI 0.994,0.998), and affect 0.992 (95% CI 0.986,0.995), which indicates good inter-rater agreement for this scale.\u003c/p\u003e\n\u003cp\u003eTable 2. ICC analysis of the Chinese version of the CCAS scale between assessors for sub-scale A and total score\u003c/p\u003e\n\u003ctable border=\"1\" width=\"569\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"143\"\u003e\n \u003cp\u003eProjects\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"45\"\u003e\n \u003cp\u003eICC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"223\"\u003e\n \u003cp\u003e95% CI\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"158\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"143\"\u003e\n \u003cp\u003eSemantic fluency\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"45\"\u003e\n \u003cp\u003e0.997\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"223\"\u003e\n \u003cp\u003e(0.995,0.998)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"158\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"143\"\u003e\n \u003cp\u003ePhonemic fluency\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"45\"\u003e\n \u003cp\u003e0.997\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"223\"\u003e\n \u003cp\u003e(0.995,0.998)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"158\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"143\"\u003e\n \u003cp\u003eCategory switching\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"45\"\u003e\n \u003cp\u003e0.998\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"223\"\u003e\n \u003cp\u003e(0.997,0.999)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"158\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"143\"\u003e\n \u003cp\u003eDigit span forward\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"45\"\u003e\n \u003cp\u003e0.983\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"223\"\u003e\n \u003cp\u003e(0.970,0.990)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"158\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"143\"\u003e\n \u003cp\u003eDigit span backward\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"45\"\u003e\n \u003cp\u003e0.992\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"223\"\u003e\n \u003cp\u003e(0.986,0.995)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"158\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"143\"\u003e\n \u003cp\u003eCube\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"45\"\u003e\n \u003cp\u003e0.999\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"223\"\u003e\n \u003cp\u003e(0.999,1.000)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"158\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"143\"\u003e\n \u003cp\u003eVerbal recall\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"45\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"223\"\u003e\n \u003cp\u003e(1.000,1.000)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"158\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"143\"\u003e\n \u003cp\u003eSimilarities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"45\"\u003e\n \u003cp\u003e0.992\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"223\"\u003e\n \u003cp\u003e(0.986,0.995)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"158\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"143\"\u003e\n \u003cp\u003eGo No-Go\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"45\"\u003e\n \u003cp\u003e0.996\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"223\"\u003e\n \u003cp\u003e(0.994,0.998)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"158\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"143\"\u003e\n \u003cp\u003eAffect\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"45\"\u003e\n \u003cp\u003e0.992\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"223\"\u003e\n \u003cp\u003e(0.986,0.995)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"158\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"143\"\u003e\n \u003cp\u003eTotal Score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"45\"\u003e\n \u003cp\u003e0.999\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"223\"\u003e\n \u003cp\u003e(0.998,0.999)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"158\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e3.2.3 Retest Reliability\u003c/p\u003e\n\u003cp\u003eTable\u0026nbsp;3 shows that the retest ICC coefficient of the Chinese version of the CCAS scale\u003c/p\u003e\n\u003cp\u003eA total score was 0.836, and the retest ICC coefficients of semantic fluency, phonemic fluency, category switching, digit span forward, digit span backward, cube, verbal recall, similarities, Go No-Go, and affect. were 0.717\u0026ndash;0.895, which indicates that the scale has good retest reliability.\u003c/p\u003e\n\u003cp\u003eTable 3. Retest reliability of the Chinese version of the CCAS scale for sub-item A and total score\u003c/p\u003e\n\u003ctable border=\"1\" width=\"577\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"166\"\u003e\n \u003cp\u003eProjects\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"121\"\u003e\n \u003cp\u003eICC\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"144\"\u003e\n \u003cp\u003er\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"146\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"166\"\u003e\n \u003cp\u003eSemantic fluency\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"121\"\u003e\n \u003cp\u003e0.773\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"144\"\u003e\n \u003cp\u003e0.635\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"146\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"166\"\u003e\n \u003cp\u003ePhonemic fluency\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"121\"\u003e\n \u003cp\u003e0.895\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"144\"\u003e\n \u003cp\u003e0.823\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"146\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"166\"\u003e\n \u003cp\u003eCategory switching\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"121\"\u003e\n \u003cp\u003e0.733\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"144\"\u003e\n \u003cp\u003e0.576\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"146\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"166\"\u003e\n \u003cp\u003eDigit span forward\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"121\"\u003e\n \u003cp\u003e0.778\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"144\"\u003e\n \u003cp\u003e0.640\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"146\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"166\"\u003e\n \u003cp\u003eDigit span backward\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"121\"\u003e\n \u003cp\u003e0.722\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"144\"\u003e\n \u003cp\u003e0.578\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"146\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"166\"\u003e\n \u003cp\u003eCube\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"121\"\u003e\n \u003cp\u003e0.717\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"144\"\u003e\n \u003cp\u003e0.596\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"146\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"166\"\u003e\n \u003cp\u003eVerbal recall\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"121\"\u003e\n \u003cp\u003e0.803\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"144\"\u003e\n \u003cp\u003e0.690\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"146\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"166\"\u003e\n \u003cp\u003eSimilarities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"121\"\u003e\n \u003cp\u003e0.836\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"144\"\u003e\n \u003cp\u003e0.713\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"146\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"166\"\u003e\n \u003cp\u003eGo No-Go\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"121\"\u003e\n \u003cp\u003e0.744\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"144\"\u003e\n \u003cp\u003e0.587\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"146\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"166\"\u003e\n \u003cp\u003eAffect\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"121\"\u003e\n \u003cp\u003e0.846\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"144\"\u003e\n \u003cp\u003e0.730\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"146\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"166\"\u003e\n \u003cp\u003eTotal Score\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"121\"\u003e\n \u003cp\u003e0.836\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"144\"\u003e\n \u003cp\u003e0.727\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"146\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e3.3. Validity\u003c/p\u003e\n\u003cp\u003e3.3.1 Content validity\u003c/p\u003e\n\u003cp\u003eTable\u0026nbsp;5 shows the correlation between the sub-scores of the Chinese version of the CCAS scale A and the total score.semantic fluency, phonemic fluency,category switching,digit span forward, digit span backward, cube, verbal recall, similarities and Go No-Go showed a moderate positive correlation with the total score with correlation coefficients of 0.586\u0026ndash;0.831. However, there was no significant correlation between the affect and the total score (p\u0026thinsp;=\u0026thinsp;0.110).\u003c/p\u003e\n\u003cp\u003eTable 5. Correlation between sub-scores and total scores of Chinese version A of the CCAS scale\u003c/p\u003e\n\u003ctable border=\"1\" width=\"573\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"238\"\u003e\n \u003cp\u003eProjects\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"174\"\u003e\n \u003cp\u003er\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"161\"\u003e\n \u003cp\u003eP\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"238\"\u003e\n \u003cp\u003eSemantic fluency\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"174\"\u003e\n \u003cp\u003e0.727\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"161\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"238\"\u003e\n \u003cp\u003ePhonemic fluency\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"174\"\u003e\n \u003cp\u003e0.719\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"161\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"238\"\u003e\n \u003cp\u003eCategory switching\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"174\"\u003e\n \u003cp\u003e0.615\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"161\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"238\"\u003e\n \u003cp\u003eDigit span forward\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"174\"\u003e\n \u003cp\u003e0.610\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"161\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"238\"\u003e\n \u003cp\u003eDigit span backward\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"174\"\u003e\n \u003cp\u003e0.586\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"161\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"238\"\u003e\n \u003cp\u003eCube\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"174\"\u003e\n \u003cp\u003e0.784\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"161\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"238\"\u003e\n \u003cp\u003eVerbal recall\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"174\"\u003e\n \u003cp\u003e0.831\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"161\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"238\"\u003e\n \u003cp\u003eSimilarities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"174\"\u003e\n \u003cp\u003e0.684\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"161\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"238\"\u003e\n \u003cp\u003eGo No-Go\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"174\"\u003e\n \u003cp\u003e0.629\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"161\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"238\"\u003e\n \u003cp\u003eAffect\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"174\"\u003e\n \u003cp\u003e0.257\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"161\"\u003e\n \u003cp\u003e0.110\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e3.3.2 Principal component factor analysis\u003c/p\u003e\n\u003cp\u003eTables\u0026nbsp;6 and 7 show the principal component factor analysis performed on the sub-scales to clarify the structural validity of the scale. The Kaiser-Meyer-Olkim (KMO) test and Bartlett test were used to determine the feasibility of the factor analysis. the KMO value was 0.754 and the Bartlett sphericity test value was 163.343 with df\u0026thinsp;=\u0026thinsp;45, p\u0026thinsp;\u0026lt;\u0026thinsp;0.00, indicating that the factor analysis was appropriate. Using principal component analysis and orthogonal rotation methods, a total of two initial factors were obtained with a cumulative variance contribution of 59.633%.\u003c/p\u003e\n\u003cp\u003eTable 6. common factor variance\u003c/p\u003e\n\u003ctable border=\"1\" width=\"569\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"173\"\u003e\n \u003cp\u003eProjects\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"143\"\u003e\n \u003cp\u003eInitial\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"253\"\u003e\n \u003cp\u003eExtraction\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"173\"\u003e\n \u003cp\u003eSemantic fluency\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"143\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"253\"\u003e\n \u003cp\u003e0.590\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"173\"\u003e\n \u003cp\u003ePhonemic fluency\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"143\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"253\"\u003e\n \u003cp\u003e0.471\u003c/p\u003e\n \u003cp\u003e0.792\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"173\"\u003e\n \u003cp\u003eCategory switching\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"143\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"253\"\u003e\n \u003cp\u003e0.384\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"173\"\u003e\n \u003cp\u003eDigit span forward\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"143\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"253\"\u003e\n \u003cp\u003e0.549\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"173\"\u003e\n \u003cp\u003eDigit span backward\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"143\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"253\"\u003e\n \u003cp\u003e0.624\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"173\"\u003e\n \u003cp\u003eCube\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"143\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"253\"\u003e\n \u003cp\u003e0.698\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"173\"\u003e\n \u003cp\u003eVerbal recall\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"143\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"253\"\u003e\n \u003cp\u003e0.631\u003c/p\u003e\n \u003cp\u003e0.517\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"173\"\u003e\n \u003cp\u003eSimilarities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"143\"\u003e\n \u003cp\u003e1.000\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"253\"\u003e\n \u003cp\u003e0.706\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 7. variance and cumulative contribution margin\u003c/p\u003e\n\u003ctable border=\"1\" width=\"642\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd rowspan=\"2\" width=\"58\"\u003e\n \u003cp\u003eIngredients\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" width=\"237\"\u003e\n \u003cp\u003eInitial Eigenvalue\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" width=\"186\"\u003e\n \u003cp\u003eExtraction of the sum of squares of loads\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd colspan=\"3\" width=\"162\"\u003e\n \u003cp\u003esum of rotation load squares\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"60\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"84\"\u003e\n \u003cp\u003eVariance %\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"92\"\u003e\n \u003cp\u003eCumulative %\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"62\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"62\"\u003e\n \u003cp\u003eVariance %\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"62\"\u003e\n \u003cp\u003eCumulative %\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"51\"\u003e\n \u003cp\u003eTotal\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"51\"\u003e\n \u003cp\u003eVariance %\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"60\"\u003e\n \u003cp\u003eCumulative %\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"58\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"60\"\u003e\n \u003cp\u003e4.546\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"84\"\u003e\n \u003cp\u003e45.464\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"92\"\u003e\n \u003cp\u003e45.464\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"62\"\u003e\n \u003cp\u003e4.546\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"62\"\u003e\n \u003cp\u003e45.464\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"62\"\u003e\n \u003cp\u003e45.464\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"51\"\u003e\n \u003cp\u003e3.17\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"51\"\u003e\n \u003cp\u003e31.770\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"60\"\u003e\n \u003cp\u003e31.770\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"58\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"60\"\u003e\n \u003cp\u003e1.417\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"84\"\u003e\n \u003cp\u003e14.168\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"92\"\u003e\n \u003cp\u003e59.633\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"62\"\u003e\n \u003cp\u003e1.417\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"62\"\u003e\n \u003cp\u003e14.168\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"62\"\u003e\n \u003cp\u003e59.633\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"51\"\u003e\n \u003cp\u003e2.786\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"51\"\u003e\n \u003cp\u003e27.862\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"60\"\u003e\n \u003cp\u003e59.633\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable\u0026nbsp;8 shows that factor 1 was associated with semantic fluency, category switching, digit span backward, and verbal recall, and cue factor 1 was associated with language, attention, and memory. Factor 2 was associated with Phonemic fluency, cube, verbal recall, similarities, Go No-Go, and affect, and cue factor 2 was associated with language, visual space, executive function, memory, and emotion.\u003c/p\u003e\n\u003cp\u003eTable 8. Rotated component matrix\u003c/p\u003e\n\u003ctable border=\"1\" width=\"625\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"208\"\u003e\n \u003cp\u003e\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp;\u0026nbsp; Factor\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"208\"\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"208\"\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"208\"\u003e\n \u003cp\u003eSemantic fluency\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"208\"\u003e\n \u003cp\u003e0.740\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"208\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"208\"\u003e\n \u003cp\u003ePhonemic fluency\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"208\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"208\"\u003e\n \u003cp\u003e0.584\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"208\"\u003e\n \u003cp\u003eCategory switching\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"208\"\u003e\n \u003cp\u003e0.890\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"208\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"208\"\u003e\n \u003cp\u003eDigit span forward\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"208\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"208\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"208\"\u003e\n \u003cp\u003eDigit span backward\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"208\"\u003e\n \u003cp\u003e0.674\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"208\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"208\"\u003e\n \u003cp\u003eCube\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"208\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"208\"\u003e\n \u003cp\u003e0.647\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"208\"\u003e\n \u003cp\u003eVerbal recall\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"208\"\u003e\n \u003cp\u003e0.655\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"208\"\u003e\n \u003cp\u003e0.518\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"208\"\u003e\n \u003cp\u003eSimilarities\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"208\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"208\"\u003e\n \u003cp\u003e0.688\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"208\"\u003e\n \u003cp\u003eGo No-Go\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"208\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"208\"\u003e\n \u003cp\u003e0.674\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"208\"\u003e\n \u003cp\u003eAffect\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.736\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e3.3.3 Validity of valid standards\u003c/p\u003e\n\u003cp\u003eTable\u0026nbsp;9 shows that the MMSE with high reliability and validity was used as the validity standard for the cognitive total score (assessment items other than emotion) of the CCAS scale, and the results showed that the MMSE total score was 23.4\u0026thinsp;\u0026plusmn;\u0026thinsp;5.063, and the Chinese version of the CCAS scale had a high positive correlation between the A cognitive total score and the MMSE total score (r\u0026thinsp;=\u0026thinsp;0.818, p\u0026thinsp;\u0026le;\u0026thinsp;0.01). Table\u0026nbsp;10 shows that PHQ2 was used as the total effective score validity scale in this study, and the results showed that the mean value of PHQ2: was 1.48\u0026thinsp;\u0026plusmn;\u0026thinsp;1.894, the total affective score of 4.50\u0026thinsp;\u0026plusmn;\u0026thinsp;1.617, and the total effective score showed a high positive correlation with PHQ2 (r\u0026thinsp;=\u0026thinsp;0.891, P\u0026thinsp;\u0026le;\u0026thinsp;0.01).\u003c/p\u003e\n\u003cp\u003eTable 9. Correlation between a total cognitive score of CCAS Chinese version A and MMSE total score\u003c/p\u003e\n\u003ctable border=\"1\" width=\"587\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"147\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"147\"\u003e\n \u003cp\u003eMean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"147\"\u003e\n \u003cp\u003er\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"147\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"147\"\u003e\n \u003cp\u003eMMSE\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"147\"\u003e\n \u003cp\u003e23.4\u0026plusmn;5.063\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" width=\"147\"\u003e\n \u003cp\u003e0.818\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" width=\"147\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"147\"\u003e\n \u003cp\u003eCCAS\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"147\"\u003e\n \u003cp\u003e44.85\u0026plusmn;18.712\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 10. Correlation between the total score of emotion in the Chinese version of the CCAS scale A and the total score of MMSE\u003c/p\u003e\n\u003ctable border=\"1\" cellpadding=\"0\" cellspacing=\"0\" width=\"587\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"25%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"25%\"\u003e\n \u003cp\u003eMean\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"25%\"\u003e\n \u003cp\u003er\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"25%\"\u003e\n \u003cp\u003ep\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"25%\"\u003e\n \u003cp\u003ePHQ2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"25%\"\u003e\n \u003cp\u003e1.48\u0026plusmn;1.894\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" width=\"25%\"\u003e\n \u003cp\u003e0.891\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd rowspan=\"2\" valign=\"top\" width=\"25%\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd valign=\"top\" width=\"50%\"\u003e\n \u003cp\u003eAffect\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd valign=\"top\" width=\"50%\"\u003e\n \u003cp\u003e4.50\u0026plusmn;1.617\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eThe impairments in executive function, speech function, spatial cognition, and emotions manifested by cerebellar cognitive-emotional syndrome severely affect the ability to perform daily activities and quality of life in patients with cerebellar injury. The cause of cognitive-emotional impairment in patients with cerebellar injury may be the disruption of cerebellar and limbic, prefrontal, and parietal cortical pathways(Argyropoulos et al., 2019; Schmahmann, 2019).\u003c/p\u003e\n\u003cp\u003eCurrently, for cognitive assessment of cerebellar injury patients, cognitive scales such as MMSE and MoCA and emotional scales such as PHQ2 and PHQ9 are commonly used clinically, but the existing cognitive scales do not reflect emotional disorders, and there are already emotional scales that do not reflect cognitive disorders, so the CCAS scale is a combination of cognitive and emotional assessment and is more suitable for clinical screening of cerebellar cognitive-emotional disorder syndrome. The Chinese version of CCAS Scale A has a total score of 120, which covers verbal function (37.5%), executive function (25.8%), visuospatial function(12.5%), memory function (12.5%), abstract reasoning (6.7%), and emotion (5%). Since the CCAS scale is a new scale, only the English and German versions have completed reliability studies, but all have shown good reliability(Hoche, Guell, et al., 2018; Thieme et al., 2020).\u003c/p\u003e\n\u003cp\u003eIn this study, only raw scores were used for analysis, and validity analysis showed that the correlation coefficient between the Chinese version of the CCAS scale A cognitive item score and the total score was between 0.586 and 0.831, which was moderate to highly significant, indicating that the scale had good content validity. Meanwhile, the total cognitive score of the Chinese version of the CCAS scale A was highly correlated with the total score of MMSE (r=0.818, p\u0026le;0.01), and the emotional item score of the Chinese version of CCAS scale A was highly correlated with the total score of PHQ2(r=0.891, p\u0026le;0.01) indicating that the Chinese version of CCAS scale A has good validity. In addition, factor analysis was used to examine the structural validity of the scale. A total of 2 common factors were extracted, the cumulative variance contribution rate was 59.633%, and the factor loadings of each item were \u0026gt; 0.50, indicating that the Chinese version of CCAS Scale A has good structural validity. The above findings indicate that the Chinese version A of the CCAS scale has high validity when applied to the Chinese population.\u003c/p\u003e\n\u003cp\u003eFrom the reliability analysis, this study used the most commonly used reliability coefficient, Cronbach\u0026apos;s alpha coefficient, which was 0.827, greater than 0.7, indicating that the Chinese version of the CCAS scale A has good internal consistency. The inter-rater agreement reliability was high, with the ICC of the item scores and the total score ranging from 0.982 to 1.000, indicating a high inter-operator agreement. the retest reliability of the total score of the Chinese version of the CCAS scale A was 0.836, and the retest reliability of the item scores also ranged from 0.717 to 0.895, indicating that the Chinese version of the CCAS scale A has good inter-temporal stability. These indicate that the Chinese version of the CCAS scale A has good reliability in assessing cerebellar cognitive-emotional syndrome.\u003c/p\u003e\n\u003cp\u003eOverall, the Chinese version of the CCAS scale A has good reliability and validity in the Chinese cerebellar injury population and can be promoted for clinical use in the future to provide targeted cognitive training to further improve the cognitive function and activities of daily living of patients(Maeshima \u0026amp; Osawa, 2009; Ruffieux et al., 2016).\u003c/p\u003e\n\u003cp\u003eThe limitations of this study are the older age of the subjects and the lower years of education, the difficulty of the Chinese version of the CCAS scale A is difficult for the subjects, and the original authors also suggest that the CCAS scale is recommended for patients under 50 years of age with a higher level of education(Schmahmann et al., 2021; Thieme et al., 2021). The original authors also suggested that the Chinese version of the CCAS scale is recommended for patients under 50 years of age with a high level of education, and further research on the Chinese version of the CCAS scale can be conducted for age and education. The present study only analyzed the raw scores, and further analysis of the Chinese version of the CCAS scale can be conducted to determine the appropriate sub-scale boundaries for the Chinese version.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthical Approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee\u0026nbsp;of the First People\u0026apos;s Hospital of Changzhou, Jiangsu Province, China.Ethics number is (2020)科第146号,\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors have no relevant financial or non-financial interests to disclose.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Jing Guo，Chaolan Wang，Xiaofang Yuan，Fan Xie and Lu Chen. The first draft of the manuscript was written by Jing Guo and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNo funding was received to assist with the preparation of this manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors confirm that the data supporting the findings of this study are available within the article and its supplementary materials.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eAhmadian, N., van Baarsen, K., van Zandvoort, M., \u0026amp; Robe, P. A. (2019). The Cerebellar Cognitive Affective Syndrome\u0026mdash;a Meta-analysis. \u003cem\u003eCerebellum\u003c/em\u003e, \u003cem\u003e18\u003c/em\u003e(5), 941\u0026ndash;950. https://doi.org/10.1007/S12311-019-01060-2/FIGURES/3\u003c/li\u003e\n\u003cli\u003eArgyropoulos, G. P. 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Evaluating the affective component of the cerebellar cognitive affective syndrome. \u003cem\u003eJournal of Neuropsychiatry and Clinical Neurosciences\u003c/em\u003e, \u003cem\u003e21\u003c/em\u003e(3), 245\u0026ndash;253. https://doi.org/10.1176/JNP.2009.21.3.245/ASSET/IMAGES/LARGE/AO03090074WF1.JPEG\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"cognition, cerebellum, scale, reliability, validity","lastPublishedDoi":"10.21203/rs.3.rs-2520761/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-2520761/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003eTo preliminarily investigate the reliability and validity of the Chinese version of the Cerebellar Cognitive Affective Syndrome Scale (CCAS scale) in the cerebellar injury population. In this study, 40 patients with cerebellar injury and 39 normal individuals hospitalized in a stroke center were assessed using the Chinese version of the CCAS scale A, MMSE, and PHQ2, and the results were analyzed using content validity, structural validity, internal consistency, inter-rater agreement, and retest reliability.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eRESULTS: The correlation coefficients of semantic fluency, phonemic fluency, category switching, digit span forward, digit span backward, cube, verbal recall, similarities and Go No-Go subscores in the Chinese version of the CCAS scale A were 0.586-0.831 (P≤0.05) with the total score, but there was no significant correlation between the affect and the total score (P=0.110). the total cognitive score of the Chinese version of the CCAS scale A was correlated with the(r=0.807, P≤0.01), and the total score of the Chinese version of the CCAS scale A affect was correlated with the total score of PHQ2 (r=0.884, P≤0.01). The 2 factors were extracted using principal component analysis, and the cumulative variance contribution rate was59.633%. The factor loadings of each of the corresponding factors were \u0026gt; 0.5, indicating good structural validity of the Chinese version of the CCAS scale A. Cronbach α=0.827 indicated good internal consistency, and inter-rater reliability (ICC\u0026gt;0.95) and retest reliability (ICC=0.717-0.895) indicated that the Chinese version of the CCAS scale A had good inter-rater reliability and retest reliability.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eConclusion: The Chinese version of the CCAS scale A has good reliability and validity in the cerebellar injury population and is useful for screening cerebellar cognitive-emotional syndrome.\u003c/p\u003e","manuscriptTitle":"Reliability and validity study of the Chinese version of the Cerebellar Cognitive Affective Syndrome Scale in patients with cerebellar injury","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2023-02-01 18:48:24","doi":"10.21203/rs.3.rs-2520761/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"4f4c8d02-3d42-410b-b853-086490e7c3d7","owner":[],"postedDate":"February 1st, 2023","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2023-02-16T03:44:25+00:00","versionOfRecord":[],"versionCreatedAt":"2023-02-01 18:48:24","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-2520761","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-2520761","identity":"rs-2520761","version":["v1"]},"buildId":"rHA-KDH7Qsr4HCuvH75dn","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}