Validation of the Arabic Version of Cognitive Complaints in Bipolar Disorder Rating Assessment (COBRA)

Abstract

INTRODUCTION: Cognitive disorders can be early and persistent symptoms of bipolar disorder, even in the euthymic phase. These impairments significantly affect patients' quality of life. Early detection and regular follow-up are therefore crucial to effective, comprehensive management. To achieve this, it is essential to have validated tools adapted to the patient's language, guaranteeing accurate and reliable assessment. To facilitate this task, we chose to translate and validate the Arabic version of the COBRA scale. AIM: The main objective of this study was to translate and validate the Arabic version of the Cognitive Complaints in Bipolar Disorder Rating Assessment (COBRA) scale. Specifically, we aimed to evaluate the psychometric properties, including reliability, validity, and feasibility of the Arabic version of the COBRA in a sample of Arabic-speaking individuals with bipolar disorder and healthy controls. METHODS: This is a psychometric validation study of the Arabic version of the COBRA, obtained by a back-translation method of the original version, conducted on a sample of 161 participants, including 71 patients diagnosed with bipolar disorder and followed at Razi Hospital and 90 subjects with no personal or family psychiatric history, as assessed by the MINI International Neuropsychiatric Interview. The validity study was based on face and content validity, reliability, discriminative validity, construct validity and feasibility. RESULTS: The Arabic version of the COBRA demonstrated satisfying psychometric properties with excellent internal consistency (Cronbach's alpha=0.86) and all inter-item correlations significantly positive (p < 0.05). Bipolar patients showed significantly greater cognitive complaints than healthy controls, with a mean total score of 17.53 ± 5.21 versus 7.12 ± 1.7 respectively, suggesting high discriminative validity of the instrument. Convergent validity was confirmed by significant correlations (p<0.001) with cognitive tests. Factor analysis revealed a four-factor structure explaining 57.48% of the variance, with a dominant factor. The analysis yielded a cutoff score of 10.5 for identifying cognitive impairments with a sensitivity of 90% and a specificity of 97%. Furthermore, COBRA scores were significantly associated with age (r = 0.242, p = 0.002), duration of illness (r = 0.420, p < 0.05), and annual hospitalizations (r = 0.215, p = 0.042).The scale also demonstrated high feasibility. CONCLUSION: The Arabic version of the COBRA has very satisfactory psychometric properties and can be used to screen for cognitive complaints in patients with bipolar disorder.