Brief Cognitive Assessment Tool

The Brief Cognitive Assessment Tool (BCAT)
Cognitive screening tool
Industry Mental Health, Rehab Therapy, Primary Care, and Home Health Care
Founder Dr. William Mansbach
Headquarters Simpsonville, Maryland
Products The Brief Cognitive Assessment Tool (BCAT), The Brief Cognitive Assessment Tool Short Form (BCAT-SF), Kitchen Picture Test (KPT), Brief Cognitive Impairment Scale (BCIS)
Website www.thebcat.com

The Brief Cognitive Assessment Tool (BCAT) was designed and copywrited by Dr. William Mansbach to identify patients with and without dementia, and to be sensitive to different levels of cognitive impairment. The BCAT was designed as a multi-domain cognitive screening tool that assesses orientation, verbal recall, visual recognition, visual recall, attention, abstraction, language, executive functions, and visuo-spatial processing.[1][2][3] The BCAT, as well as the three cognitive BCAT "factors" (contextual memory, executive functions, and attention), have been shown to predict both cognitive diagnosis and functional status or Instrumental Activities of Daily Living (IADL).[4] The BCAT has been validated and published in the Journal of Clinical and Experimental Neuropsychology, 2012, Vol 34(2), 183-194. An abbreviated form of the Brief Cognitive Assessment Tool (BCAT-SF) has been published in the journal Aging and Mental Health, 2012, Vol 16(8), 1065-1071. The BCAT can be administered in 10–15 minutes.

Background

Over the past thirty years, cognitive functioning in older adults has become an important focus among clinicians and policy analysts. The increasing longevity of older adults, especially those in the "old-old" category, has been well documented. Epidemiological studies show that as people live longer, incidence and prevalence rates of dementia also increase. It is estimated that more than 5 million Americans over the age of 65 have Alzheimer's Disease (AD). This number is projected to exceed 13 million by 2050.[5]

While no clear preventive or curative interventions for Alzheimer’s disease are available, early detection may improve quality of life for patients and their families.[6][7] Furthermore, effective screening may aid in the development of intervention strategies that delay the insidiousness of the disease as well as nursing facility placement.[8] Early detection may enhance the efficacy of pharmacologic and non-pharmacologic treatments.[9]

A number of screening measures have been developed since the Mini-Mental State Examination (MMSE) was published in 1975.[10] Examples include the Short Test of Mental Status (STMS),[11] the Montreal Cognitive Assessment (MoCA),[12] and the St. Louis University Mental Status Examination (SLUMS).[13]

While each of these instruments identifies individuals with probable dementia, they lack specific integration of three critical neuro-cognitive clusters (contextual memory, executive functions, and attentional capacity) as predictors of cognitive functioning and performance of everyday activities of independent living.[14] The BCAT was designed to overcome this and other measurement issues.

Whereas the BCAT can be administered in a short period of time (10–15 minutes), a Short Version (BCAT-SF) has also been developed and normed. It can be administered in less than five minutes and is ideal for primary care settings and frontline providers who have little time to spend screening patients. The BCAT-SF can be also be administered, scored, and interpreted on-line in "real time" (as can the full BCAT). The psychometric properties of the BCAT-SF are robust.

The BCAT Validation Study

The first page of the BCAT cognitive screening tool, complete with an online scoring and interpretive program.

Introduction

Important characteristics of the BCAT are that it:

Methods

111 participants referred for neuropsychological evaluation were recruited from assisted-living facilities. Participants completed a clinical interview, informant interview, record review, and a comprehensive battery of neuropsychological tests including the new BCAT. The total possible BCAT score is 50 points.

Design

Category Points Possible Description
Orientation 6 awareness of self, time, place, and situation
Immediate Verbal Recall 4 the ability to immediately recall a word list
Visual Recognition/Naming 3 the ability to accurate put names to objects
Attention 7 the ability to concentrate and focus
Abstraction 3 the ability to determine how objects are similar to one another
Language 3 the ability to understand and express speech
Executive 4 the "command and control" cognitive abilities
Visuo-spatial 4 the ability to understand visual processes and relationships
Delayed Verbal Recall 4 the ability to recall previously presented words after a time delay
Immediate Story Recall 2 the ability to immediately recall elements of a story
Delayed Visual Memory 3 the ability to recall previously presented pictures
Delayed Story Recall 2 the ability to recall elements of a previously presented story after a time delay
Story Recognition 5 the ability to recall previously presented story elements after cueing

Normative Values

BCAT Crosswalk and Cognitive Functional Status

Cognitive Range BCAT Range Cognitive & Functional Issues
Normal 44-50 No functional deficit; independent living; may be subjective memory complaints, but little to no objective evidence.
Mild Cognitive Impairment 34-43 Generally functionally normal, but early specific functional declines (IADL); subjective and objective memory deficits. Individuals at lower range more likely to have more significant cognitive deficits. Lower scores more suggestive of residential support needs. At the bottom range of MCI, consider medication management and consider support around community reintegration.
Mild Dementia 25-33 IADL deficits; typically requires residential support services; clear objective evidence of memory and other cognitive declines. Medication management and community reintegration support indicated for many people in this range.
Mild to Severe Dementia 0-24 Moderate (upper end of range) – Pervasive functional deficits (IADLs), but ADLs generally intact; marked deficits in memory and executive functions; behavioral and psychological symptoms are common; requires significant residential support.

Severe (lower end of range) – Needs assistance in ADLs/IADLs; pervasive cognitive deficits; requires complex care.

BCAT Crosswalk with MMSE & GDS

Cognitive Range BCAT Range MMSE GDS Cognitive & Functional Issues
Normal 44-50 26-30 1-2 No functional deficit; independent living; may be subjective memory complaints, but little to no objective evidence.
Mild Cognitive Impairment 34-43 24-27 3 Generally functionally normal, but early specific functional declines (IADL); subjective and objective memory deficits. Individuals at lower range more likely to have more significant cognitive deficits. Lower scores more suggestive of residential support needs. At the bottom range of MCI, consider medication management and consider support around community reintegration.
Mild Dementia 25-33 19-23 4 IADL deficits; typically requires residential support services; clear objective evidence of memory and other cognitive declines. Medication management and community reintegration support indicated for many people in this range.
Moderate to Severe Dementia 0-24 0-18 5-7 Moderate (upper end of range) – Pervasive functional deficits (IADLs), but ADLs generally intact; marked deficits in memory and executive functions; behavioral and psychological symptoms are common; requires significant residential support.

Severe (lower end of range) – Needs assistance in ADLs/IADLs; pervasive cognitive deficits; requires complex care.

Results

The psychometric quality of the BCAT was confirmed with strong evidence for reliability, construct validity, and predictive validity. The BCAT’s utility for detecting dementia was excellent, with a sensitivity of .99, a specificity of .79, and an area under the ROC curve of .95. Executive control items, contextual memory items, and attentional capacity items emerged as the best predictors of diagnostic category and of scores on a measure of IADLs.[16]

Analyses supported the psychometric properties of the BCAT. The BCAT also was effective in integrating contextual memory, executive functions, and attentional capacity components as a predictive tool for diagnostic status and functional capacity.

The BCAT Approach

The BCAT Approach is a unique applied concept for assessing and working with people who have memory and other cognitive impairments. The Approach integrates three distinct person-centered systems: the BCAT Test System, the BCAT Brain Rehabilitation Program, and the BCAT Recreation Program.

The BCAT Test System

Those who use the BCAT Approach as a screening and diagnostic tool, can log onto the website to utilize the scoring programs.

The comprehensive BCAT Test System consists of five cognitive tools that healthcare professionals can use to assess memory and cognitive functioning. The featured Brief Cognitive Assessment Tool (BCAT), is the primary test. The System also includes:

The BCAT Brain Rehabilitation

Brain rehabilitation is a loss and restoration process, based on cognitive exercises that promote brain cells (neurons) to improve functioning. It is based on the principles of neuroplasticity and cognitive reserve. Brain rehabilitation exercises can improve cognition and, in some circumstances, protect against memory loss caused by brain diseases like Alzheimer’s disease.

The BCAT Brain Rehabilitation Program can be used as a cognitive rehabilitation program with the primary modules being online. They target attention, memory, and executive functions.

Interactive Modules Cognitive Domain Description
Memory Match (Interactive) Attention and Memory This module focuses on attention and visual memory requiring the brain to focus and create unique visual memories.
Sort the Set (Interactive) Attention and Executive Functions This module focuses on set-shifting, a frontal lobe executive function, requiring the brain to juggle multiple tasks and keep things in order.
Color Illusion (Interactive) Attention and Executive Functions Inspired by the Stroop effect, this module focuses on "selective attention" which requires one to selectively pay attention to one task while not paying attention to a competing task. These exercises can increase cognitive control, strengthen one’s ability to attend and focus, and improve executive functions.

Additional non-interactive modules include Mazes, Word Searches, and Word Scrambles. Individuals who are cognitively normal, who have Mild Cognitive Impairment (MCI), and who have mild dementia show the most improvement. Brain Rehabilitation is not suggested for persons with moderate to severe dementia.

The BCAT Recreation Program

These nine cells describe nine recreation “types.” One of these nine cells will represent the most appropriate fit for the resident.

The BCAT Recreation Program is designed to assist staff in helping residents meet person-centered goals in a recreation context by integrating interests with actual capability to participate. The Brief Cognitive Assessment Tool measures attention, memory, and executive functions – three cognitive skills that can determine a resident’s ability to engage and complete an activity. Additionally, the BCAT The Recreation Interest Inventory consists of eight items that measure how interested or motivated the resident is in participating in activities. Once BCAT scores are entered and the Recreation Interest Inventory is completed, a person-centered recreation approach can be determined.

See also

References

  1. ↑ Mansbach, W. E.; MacDougall, E.E.; Rosenzweig, A.S. (2012). "The Brief Cognitive Assessment Tool (BCAT): a new test emphasizing contextual memory, executive functions, attentional capacity, and the prediction of instrumental activities of daily living". Journal of Clinical and Experimental Neuropsychology 34 (2): 183–194. doi:10.1080/13803395.2011.630649. PMID 22149477.
  2. ↑ Mansbach, W.E.; MacDougall, E. E; Rosenzweig, A.S. (November 2011). "The BCAT : A New Cognitive Test Emphasizing Contextual Memory and Executive Functions" (PDF). Presented at the Gerontological Society of America annual meeting.
  3. ↑ Powell, S.; MacDougall, E.E.; Mansbach, W.E.; Clark, K. (March 2013). "Psychometric analyses of short forms of cognitive screening measures". Southeastern Psychological Association’s Annual Meeting, Atlanta, GA.
  4. ↑ Mansbach, W.E.; MacDougall, E. E (November 2011). "The Oral Trail Making Test as a Predictor of Dementia & IADLs" (PDF). presented at the Gerontological Society of America annual meeting.
  5. ↑ "2012 Alzheimer's Disease Facts and Figures" (PDF). Alzheimer’s & Dementia. Alzheimer's Association. Retrieved 25 July 2012.
  6. ↑ Watson, Lea C.; Lewis, Carmen L.; Moore, Charity G.; Jeste, Dilip V. (1 April 2011). "Perceptions of depression among dementia caregivers: findings from the CATIE-AD trial". International Journal of Geriatric Psychiatry 26 (4): 397–402. doi:10.1002/gps.2539. Check date values in: |year= / |date= mismatch (help)
  7. ↑ Vitaliano, Peter P.; Zhang, Jianping; Scanlan, James M. (1 January 2003). "Is Caregiving Hazardous to One's Physical Health? A Meta-Analysis". Psychological Bulletin 129 (6): 946–972. doi:10.1037/0033-2909.129.6.946.
  8. ↑ Burdick, D. J.; Rosenblatt, A.; Samus, Q. M.; Steele, C.; Baker, A.; Harper, M.; Mayer, L.; Brandt, J.; Rabins, P.; Lyketsos, C. G. (1 February 2005). "Predictors of Functional Impairment in Residents of Assisted-Living Facilities: The Maryland Assisted Living Study". The Journals of Gerontology Series A: Biological Sciences and Medical Sciences 60 (2): 258–264. doi:10.1093/gerona/60.2.258.
  9. ↑ Mansbach, W.E. (October 2011). "The New Brief Cognitive Assessment Tool (BCAT): The Role of Cognitive Assessment in Improving Health Outcomes." (PDF). Paper presented at the October meeting of the Health Facilities Association of Maryland.
  10. ↑ Folstein, Marshal F.; Folstein, Susan E.; McHugh, Paul R. (1 November 1975). "Mini-mental state". Journal of Psychiatric Research 12 (3): 189–198. doi:10.1016/0022-3956(75)90026-6. PMID 1202204.
  11. ↑ Kokmen, E.; Smith, G. E.; Petersen, R. C.; Tangalos, E.; Ivnik, R. J. (1991). "The Short Test of Mental Status: Correlations with standardized psychometric testing". Archives of Neurology 48 (7): 725–728. doi:10.1001/archneur.1991.00530190071018.
  12. ↑ Nasreddine, Z. S.; Phillips, N. A.; Bedirian, V.; Charbonneau, S.; Whitehead, V.; Collin, I. (2005). "The Montreal Cognitive Assessment, MoCA: A brief screening tool for mild cognitive impairment". Journal of the American Geriatrics Society 53 (4): 695–699. doi:10.1111/j.1532-5415.2005.53221.x. PMID 15817019.
  13. ↑ Tang-Wai, D. F.; Knopman, D. S.; Geda, Y. E.; Edland, S. D.; Smith, G. E.; Invik, R. J. (2003). "Comparison of the Short Test of Mental Status and the Mini-Mental State Examination in mild cognitive impairment". Archives of Neurology 60 (12): 1777–1781. doi:10.1001/archneur.60.12.1777.
  14. ↑ Naugle, R. I.; Kawczak, K. (1989). "Limitations of the Mini-Mental State Examination". Cleveland Clinic Journal of Medicine 56 (3): 277–281. doi:10.3949/ccjm.56.3.277.
  15. ↑ Morris, J. C.; Storandt, M.; Miller, J. P.; McKeel, D. W.; Price, J. L.; Rubin, E. H. (2001). "Mild cognitive impairment represents early-stage Alzheimer's Disease". Archives of Neurology 58 (3): 397–405. doi:10.1001/archneur.58.3.397.
  16. ↑ Mansbach, W.E.; MacDougall, E.E.; Rosenzweig, A.S. (2012). "The Brief Cognitive Assessment Tool (BCAT): A new test emphasizing contextual memory, executive functions, attentional capacity, and the prediction of instrumental activities of daily living". Journal of Clinical and Experimental Neuropsychology 34 (2): 183–194. doi:10.1080/13803395.2011.630649. PMID 22149477.
  17. ↑ Mansbach, W.E.; MacDougall, E.E. (2012). "Development and validation of the short form of the Brief Cognitive Assessment Tool (BCAT-SF)". Aging & Mental Health 16 (8): 1065–1071. doi:10.1080/13607863.2012.702729.
  18. ↑ Mansbach, W. E.; MacDougall, E. E.; Clark, K. M; Mace, R. A. (in press). "Preliminary Investigation of the Kitchen Picture Test (KPT): A New Screening Test of Practical Judgment for Older Adults.". Aging, Neuropsychology, and Cognition. Check date values in: |date= (help)
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