Popular Screens for Cognitive Impairment
Test Name
Brief Description
Validation
Scoring
Site
Comments
Allen Cognitive Level
Screen (ACLS)
*The ACL is an Occupational Therapy tool
developed by Claudia Allen in the 1970s for
individuals with mental health issues, but has been
used for dementia patients more recently.
*Individual completes a series of 3 leather lacing
stitches that are progressively difficult in nature.
While this is done, the therapist evaluates cognitive
scores and scores the individual within a scoring
system that has been aligned with the ACLs. At
the same time, the Cognitive Performance Test is
done, which focuses largely on IADL tasks. The 2
areas are combined for an ACL score.
* The evaluator observes how the patient interacts
with their environment
Unknown
Six Levels, ranging from:
Level 6 – Independent to
Level 1 – Totally Dependent
Severe Cognitive Impairment
www.allen-cognitivenetwork.org
*ADLs and IADLs are considered
* This is a test designed to assist with
recommendations to the caregiver for
development of a Plan of Care.
*This test is to be used to screen for various types
of dementia and other neurological disorders (in
conjunction with CT scan or MRI) .
* AQT tasks measure: processing speed, cognitive
shifts, working memory, parietal lobe dysfunction.
The test takes approximately 5 minutes to
administer.
* 11 part exam which takes 30 minutes to
administer
* Used as a primary outcome measuring tool in
many drug trials
*Considered to be a very good test of language and
memory skills
Se = 93.1%
Sp = 99.9%
*The clinical outcome
measure is the time in seconds
it takes to perform the test.
*Typical findings of a
cognitively impaired person
are 2+ SD from the norm.
Elisabeth H. Wiig,
2002
http://pearsonassess.co
m/haiweb/cultures/enus/productdetail.htm?p
id=015-8237-269
*This test is available for purchase
from Pearson Assessment. Scoring
results and other information are
available from that source.
Se = 89/19%
Sp = 88.53 %
ADAS-Cog best cut-off score
was 12. The score is adjusted
for age and formal education.
Test takes too much time to be
administered in the context of an
Assessment, however, the results may
be found in medical records when the
patient is taking part in a drug trial.
*The DRS was developed to identify cognitive
deficits in neurological disease and was originally
developed for research on cerebral blood flow in
dementia.
* The test covers attention, perseveration,
construction, conceptualization and memory.
* The test is administered by a clinician and is a 36
item test, presented in hierarchical order starting
with the most difficult.
Se= 95% at 123
Sp = 100
Scores range from 0 to 144.
Enhanced Mental
Skills Test (EMST)
The EMST is a test designed to detect cognitive
loss at the earliest stages before Dementia– Mild
Cognitive Impairment.
NA
NA
Rosen WG, Mohs RC,
Davis KL. A New
Rating Scale for
Alzheimer's Disease.
Am J Psychiatry. 1984
Nov 1;141(11):135664
Steven Mattis , 1973
Mental Status
Examination for
Organic Mental
Syndrome in the
Elderly Patient. In
Bellak, L and Karasau,
TB eds. Geriatric
Psychiatry. New York,
Grune and Stratton.
1976: 108-21.
NA
Functional Activities
Questionnaire (FAQ)
*The FAQ is not self-administered, but rather is
completed by someone who knows the patient,
such as the spouse, relative or close friend.
Various studies
have been done
finding ranges
Scores correlate with
Lawton’s IADL scale
A Quick Test of
Cognitive Speed
(AQT)
Alzheimer’s Disease
Assessment Scale –
Cognitive (ADAScog)
Dementia Rating
Scale (DRS)
Failure is considered to be in
Level 3 or 2.
Normal = 136 +
Mild AD = 103-130
Moderate AD 102 or below
*Age and education level
affect scoring
Pfeffer, R.T. Kurosaki,
C. Harrah, J. Chance,
and S. Filos. 1982.
*It was intended for use in severely
affected institutionalized patients who
could not complete more rigorous
neuropsych testing.
*The DRS is targeted to identify presenile and senile behaviors that
correspond to stages in pre-school age
development.
*This test should not be used at claim
time as it detects a VERY early stage
of cognitive loss incongruent with
LTCI Benefit Qualifiers.
*Results can be influenced by the
perception of the person completing
the FAQ
Test Name
Global Assessment of
Functioning (GAF)
mini-cog
Mini-Mental State
Exam (MMSE) aka
Folstein Test of
Mental Status
Brief Description
Validation
* It is a 10-item questionnaire based largely on
IADLs, social activities and current events
*In 1984, the test was expanded to include 4 ADL
questions and a question about initiative
as follows:
Sn = 85% to
94%
Sp = 81% to
84%
*Global Assessment of Functioning is for reporting
the clinician's judgment of the individual's overall
level of functioning and carrying out activities of
daily living. This information is useful in planning
treatment and measuring its impact, and in
predicting outcome.
*The Global Assessment of Functioning (GAF) is a
numeric scale (0 through 100) used by mental
health clinicians and doctors to rate the social,
occupational and psychological functioning of
adults.
GAF levels are commonly used by the Veterans
Benefits Administration of the United States
Department of Veterans Affairs in determining the
appropriate level of disability compensation to be
paid to veterans who suffer from service connected
psychiatric disorders. The emphasis on using the
GAF score has, however, decreased in recent years.
*This instrument combines an uncued 3-item recall
test with a clock drawing test (CDT).
* The patient is given 3 words to recall. Then
asked to draw a clock with the hands at a specific
time. Instructions can be repeated, but no
additional instructions given. The CDT serves as
the recall distractor.
*The test was developed to give a global
impression of change in cognitive status in geriatric
inpatients.
*It covers the person’s orientation to time and
place, recall ability, short-term memory and
arithmetic ability.
It has been
found that the
FAQ is a
Sensitive as the
MMSE
unknown
unknown
*Sensitivity (at a
cut score of
23/24) is 93%,
*Specificity =
100% in the
highly educated;
specificity is
75% in the
lower educated
Scoring
Site
Comments
Measurement of
Functional
Activities of Older
Adults in the
Community. Journal
of Gerontology 37
(May): 323-9.
*The original scale is largely IADL
related. If this test is used, verify
which components were administered
– if ADLs were not included, thenthe
test is less useful for LTCI.
Scores 41 or below constitute
Serious symptoms OR any
serious impairment in social,
occupational, or school
functioning.
http://ptsdhelp2000.co
m/ptsd1.html
This test is used in mental health
functioning and therefore is not
specifically related to dementia; it can
include psychiatric diagnoses.
*Relatively uninfluenced by
age or education (according to
authors)
*Scoring:
0 = Positive Screen for
Dementia
1 or 2 with abnormal CDT =
Positive screen for dementia
1 or 2 with normal CDT =
Negative screen for dementia
3 = Negative screen for
dementia
*Maximum score is 30.
* Traditionally scores below
23 are considered to be
indicative of cognitive
impairment.
*Scoring is affected by age
and education.
Borson S, Scanlon J,
Brush M, Vitialiano P,
Dokmak A. The minicog: a cognitive “vital
signs” measure for
dementia screening in
multi-lingual elderly.
Int J Geriatr
Psychiatry. 2000
15(11):1021-1027.
* No validation score found.
* No specific instructions as to how
long the period between word
introduction and recall are provided.
Marshall Folstein,
1975
www.parinc.com
*The test is quick and easy to
administer.
*It may be used as a screening test for
cognitive loss.
*It should not be used to diagnose
dementia.
Test Name
Brief Description
Minnesota Cognitive
Acuity Screen
(MCAS)
The MCAS is a test designed to detect cognitive
loss at the earliest stages before Dementia– Mild
Cognitive Impairment.
Neuropsychiatric
Inventory
Questionnaire
(NPI-Q)
*The Neuropsychiatric Inventory Questionnaire
(NPI-Q) is a validated clinical instrument for
evaluating psychopathology in dementia.
* It is adapted from the NPI as a 2 page
questionnaire.
* 12 question survey of behaviors in dementia
*The authors developed a brief questionnaire form
of the NPI (NPI-Q), intended for use in routine
clinical practice, and cross-validated it with the NPI
in 60 Alzheimer’s patients.
* The SPMSQ is intended to offer rapid screen for
cognitive deficit in institutions and communitydwelling elderly persons.
* 10-item screen covering memory, orientation to
surroundings, knowledge of current events and
ability to perform math. To make the test more
challenging, an answer is scored correct if ALL
parts of the question are answered correctly.
The Short Portable
Mental Status
Questionnaire
(SPMSQ)
Validation
Scoring
Site
Comments
group
NA
NA
NA
*Test-retest
reliability was
acceptable.
*Each question is scored for
present or absent
*Present behaviors are scored
for severity and distress
A. Severity (1-Mild to 3Severe)
B. Distress (0-No distress to
5-Extremely Distressing)
Kaufer (2000) J
Neuropsychiatry Clin
Neurosci 12:233
*This test should not be used at claim
time as it detects a VERY early stage
of cognitive loss incongruent with
LTCI Benefit Qualifiers.
The NPI-Q is a self-administered tool
in the form of a questionnaire
Sensitivity =
88%
Specificity =
78%
*Scores are corrected for race
and education, but generally
are:
*Mild CI = 3-4 errors
Moderate CI = 5-7 errors
Severe CI = 8+ errors
Eric Pfeiffer, 1975
A Short Portable
Mental Status
Questionnaire for the
Assessment of
Organic Brain Deficit
in the Elderly. J AM
Geriatric Soc. 1975;
23-440.
* It detects organic intellectual
impairment and determines its degree.
* The test can be administered by a
clinician in under 5 minutes