Preliminary validation of the Bulgarian SCCAN: initial reliability, validity, and screening accuracy across neurological populations

Abstract

Purpose Bulgaria currently lacks standardized instruments for assessing cognitive-communicative abilities in adults with neurological disorders. This study reports preliminary validation evidence for the Bulgarian version of the Scales of Cognitive and Communicative Ability for Neurorehabilitation (SCCAN-B). Methods Eighty-nine Bulgarian-speaking adults were assessed at a tertiary university hospital in Plovdiv, Bulgaria. The main analytic sample included four separate groups: neurotypical controls, individuals with mild cognitive impairment (MCI), Alzheimer’s disease (AD) dementia, and ischemic stroke. All participants had previously received a formal diagnosis prior to being classified within one of these four groups. After informed consent was obtained, participants completed the SCCAN-B and the validated Bulgarian version of the Mini-Mental State Examination (MMSE-B). Analyses examined internal consistency, convergent validity with MMSE-B, known-groups differences, and preliminary screening classification using receiver operating characteristic analysis. Results The SCCAN-B showed high internal consistency across the eight performance scales, α = 0.931. The SCCAN-B total score correlated strongly with MMSE-B scores, ρ = 0.84, p < 0.001. Significant group differences were observed for the SCCAN-B total score and all performance scales, with the largest impairments in the Alzheimer’s disease group. ROC analysis distinguishing controls from the main clinical groups yielded an AUC of 0.850. A preliminary SCCAN-B total cut-off of 80 showed 70.7% sensitivity and 87.1% specificity. Conclusion Findings provide preliminary evidence that the SCCAN-B is a clinically promising screening instrument for identifying cognitive-communicative difficulties in Bulgarian-speaking neurological populations. However, the results should be interpreted cautiously because of the modest sample size, clinical heterogeneity, limited control of confounding variables, and the need for further normative and cross-cultural validation work.