Brief Cognitive Status Exam (BCSE)

DESCRIPTION

The Brief Cognitive Status Exam (BCSE) is a screening measure of general cognitive functioning for individuals ages 16 through 90. The BCSE is intended to identify cognitive impairments and classify individuals by their level of cognitive function as average, low average, borderline, low, or very low. The BCSE is made up of 12 test items that assess seven cognitive domains: Orientation, Time Estimation, Mental Control, Clock Drawing, Incidental Recall, Inhibition, and Verbal Production. The assessment is designed to be administered individually. Administration takes approximately 10 minutes. The test can be administered by anyone trained to administer tests. However, only those with graduate or professional training should interpret the results. The test kit includes 25 record forms, a scoring template, and the test manual. The manual provides scoring instructions and examples for all tasks, including detailed scoring instructions for the Clock Drawing task.

DEVELOPMENT

The BCSE was initially developed as a brief screening measure for the Wechsler Memory Scale-Fourth Edition (WMS-IV) to detect significant cognitive deficits. The BCSE was designed to improve upon previous versions of the WMS by including measures of Clock Drawing, Incidental Recall, Inhibition, and Verbal Production in order to detect a wider range of cognitive impairments. Pilot testing of the BCSE was conducted with 136 individuals ages 16 through 87. Participants over the age of 45 also completed the Mini-Mental State Examination (MMSE) and the Neurobehavioral Functioning Inventory Patient Form (NFI) in order to determine if any participants had delirium or dementia. The pilot version of the BCSE included items from the Information and Orientation and Mental Control subtests of the WMS-III in order to determine which items had adequate clinical sensitivity to include in the final version. A tryout phase followed the pilot testing to determine factors like reliability, item bias, administration rules, and subtest administration time. Results from the tryout phase were compared to results from the MMSE and A Quick Test of Cognitive Speed (AQJ). According to the test manual, the BCSE demonstrated sensitivity to dementia that was equal to or higher than the MMSE or the AQJ.

TECHNICAL DETAILS

The normative sample for the BCSE consisted of 1,400 participants ages 16 through 90. The sample was representative of the 2005 Census in terms of age, sex, race/ethnicity, education level, and geographic region.

INTERNAL CONSISTENCY RELIABILITY

The BCSE has strong test-retest reliability and strong interscorer agreement.

VALIDITY

Content validity for the BCSE was determined through expert review, customer feedback, and review from an expert panel. Additional validity evidence was provided by analyzing response processes from test development. Concurrent validity was established by comparing BCSE scores with scores from assessments of activities of daily living: the Texas Functional Living Scale (TFLS) and the Independent Living Scales (ILS). 798 participants ages 16 through 90 completed the TFLS on the same day as the BCSE, and the resulting correlation was low (r = .21). 74 participants ages 65 through 89 completed the ILS and the BCSE within 0 to 164 days, and the correlation coefficients ranged from low to moderate (r = -.08 to r = .44). The test developers expected low correlations and noted that higher correlations might be found in clinical samples.

The BCSE scoring characteristics were also used to determine concurrent validity in special clinical groups. Researchers found that the lowest scores on the BCSE were associated with the most severe conditions, while scores were higher for less severe conditions. For example, 77.1% of participants with probable Alzheimer’s disease, 32.3% of participants with TBI, 26.0% of participants with mild cognitive impairment, 23.8% of participants with schizophrenia, and 7.7% of participants with major depression were classified as cognitively impaired by the BCSE. The BCSE had a sensitivity of .77 and a specificity of .98 when distinguishing individuals with Alzheimer’s disease from healthy individuals.

COMMENTARY

The BCSE is a well-designed screening tool for general cognitive functioning. The assessment is quick to administer, easy to score, and useful for clients who cannot tolerate long testing sessions. The BCSE does a good job of describing what constitutes average and low performance. Areas for further development include providing a more adequate explanation of the validity findings and detailing the research conducted during development of the measure. For example, the resources used to provide content validity evidence were not specified, and the developers did not identify how they demonstrated construct validity. Although the authors stated that the BCSE was based on WMS-III subtests and that the theoretical models were based on the WMS-III, they did not describe any other research from the development process.

SUMMARY

The BCSE is a measure of general cognitive functioning designed to be administered individually. It adequately measures the seven cognitive domains of Orientation, Time Estimation, Mental Control, Clock Drawing, Incidental Recall, Inhibition, and Verbal Production. The assessment is easy to administer and score and takes about 10 minutes to complete. Reliability has been adequately established, but more empirical evidence is needed to demonstrate the validity of the test scores. The BCSE is beneficial because it can quickly identify cognitive deficits, which can then be used to determine if further cognitive assessment is necessary.

REVIEWER’S REFERENCE

• Brinkman, J. J., & Varatharajah, B (2010). [Review of the Brief Cognitive Status Exam]. In R. A. Spies, & B. S. Plake (Eds.), The eighteenth mental measurements yearbook. http://marketplace.unl.edu/buros/
• Gass, C. (2010). [Review of the Brief Cognitive Status Exam]. In R. A. Spies, & B. S. Plake (Eds.), The eighteenth mental measurements yearbook. http://marketplace.unl.edu/buros/