A Report on the Actuarial, Marketing, and Legal Analyses of the CLASS Program. B. Measuring “Substantial Cognitive Impairment”

10/14/2011

The CLASS Program benefit trigger requires that the individual must need substantial supervision to protect him or her from threats to health and safety due to substantial cognitive impairment. As noted earlier, this contractor recommends that “substantial cognitive impairment” be defined in the context of the CLASS Program benefit trigger specifically, as the level of cognitive impairment that results in threats to health and safety to which the individual is not able to respond effectively.

Many assessment instruments have been developed to measure cognitive impairment, and some of these instruments may be particularly useful for organizations and individuals that are implementing the CLASS Program benefit triggers. The lists of assessment instruments below include brief mental status tests, performance tests, and instruments for informant interviews.

Brief Mental Status Tests

  • Alzheimer’s Disease Assessment Scale: Cognitive Behavior (ADAS-Cog) (11 items) (Rosen et al., 1984)5
  • Blessed Information-Memory-Concentration Test (BIMC) (26 items) (Blessed et al., 1968)
  • Blessed Information-Memory-Concentration Test (BIMC) (26 items) (revised by Katzman et al., 1983).
  • Blessed Orientation-Memory-Concentration Test(BOMC) (Also called the Short Blessed Test (SBT) (6 items) (Katzman et al., 1983)
  • Clock Drawing Tests (many sources for scoring clock drawing tests
  • CLOX (an executive clock drawing test (Royall et al., 1998b)
  • Cognitive Abilities Screening Instrument (CASI) (25 items) (Teng et al., 1994)
  • Cognitive Abilities Screening Instrument-Short form (CASI-Short)(4 items) (Teng et al., 2001)
  • Community Screening Interview for Dementia (CSI ‘D’) (28 items for the person and other items for an informant (Hall et al., 1993)
  • EXIT (The Executive Interview) (Royall et al., 1992) This is a 25-item bedside measure
  • General Practitioner Assessment of Cognition (GPCOG) (6 items for the person and other items for an informant (Brodaty et al., 2002).
  • Isaacs Set Test (IST) (4 category verbal fluency test) (Isaacs et al., 1973)
  • Memory Impairment Screen (MIS) (4 items)(Buschkeet al., 1999)
  • Mental Status Questionnaire (MSQ) (10 items) (Kahn et al., 1960)
  • Mini-Cog (3 items) (Borson et al., 2000)
  • Mini-Mental State Examination (MMSE) (~12 items) (Folsteinet al., 1975)
  • Montreal Cognitive Assessment (MoCA) (30 points) (Nasreddine et al., 2005)
  • Modified Mini-Mental State Examination (3MS) (~ 16 items )(Tengand Chui 1987)
  • Ottawa 3D and Ottawa 3DY (3 items and 4 items, respectively) (Molnar et al. 2008)
  • Saint Louis University Mental Status Examination (SLUMS) (11 items) (Banks and Morley 2003)
  • Seven-Minute Screen (includes 4 tests: cued recall: naming animals for 1 minute; the Benton Temporal Orientation Test, and Clock Drawing) (Solomon and Pendlebury, 1998)
  • Short Portable Mental Status Questionnaire (SPMSQ) (10 items (Pfeiffer 1975)

Performance Tests

  • Drug Regimen Unassisted Grading Scale (DRUGS) (Edelberget al., 1999)
  • Everyday Problems Test for Cognitively Challenged Elderly (EPCCE) (Willis et al., 1996)
  • Face-Hand Test (FHT) (Fink et al., 1952)
  • The Home Visit (Kapust and Weintraub, 1988)
  • The Medication Management (MM) Test (Gurlandet al., 1994)
  • The Time and Change Test (Inouye et al., 1998)

Instruments for Informant Interviews

  • AD8(8 items) (Galvin et al., 2005)
  • Blessed Dementia Scale (22 items) (Blessed et al., 1968)
  • Dementia Severity Rating Scale (11 domains) (Clark and Ewbank 1996)
  • Everyday Cognition Scale (E-Cog) (39 items) (Fariaset al., 2008)
  • General Practitioner Assessment of Cognition (GPCOG) (6 items for the informant and other items for the person) (Brodaty et al., 2002).
  • Informant Questionnaire on Cognitive Decline in the Elderly (IQCODE) (26 items) (Jorm and Jacomb1989)
  • The Community Screening Interview for Dementia (CSI’D’) (3o items for the informant and other items for the person) (Hall et al., 1993)

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