Cognitive Capacity Screening Exam (CCSE)

Cognitive Capacity Screening Exam (CCSE)
Jacobs‚ 1977
 
Introduction to patient: “I would like to ask you a few questions. Some you will find very easy and others may be very hard. Just do your best.”
1.    What day of the week is this? ______
2.    What month? ______
3.    What day of month? ______
4.    What year? ______
5.    What place is this? ______
6.    Repeat the numbers 8 7 2. ______
7.    Say them backwards. ______
8.    Repeat these numbers 6 3 7 1. ______
9.    Listen to these numbers 6 9 4. Count 1 through 10 out loud‚ then repeat 6 9 4. (Help if needed. Then use numbers 5 7 3.) ______
10.Listen to these numbers: 8 1 4 3. Count l through 10 out loud‚ then repeat 8 1 4 3. ______
11.Beginning with Sunday‚ say the days of the week backwards. ______
12.9 + 3 is ______
13.Add 6 (to the previous answer or “to 12”). ______
14.Take away 5 (“from 18”). Repeat these words after me and remember them. I will ask for them later: HAT‚ CAR‚ TREE‚ TWENTY-SIX. ______
15.The opposite of fast is slow. The opposite of up is ______
16.The opposite of large is ______
17.The opposite of hard is ______
18.An orange and a banana are both fruits. Red and blue are both ______
19.A penny and a dime are both ______
20.What were those words I asked you to remember? (HAT) ______
21.(CAR) ______
22.(TREE) ______
23.(TWENTY-SIX) ______
24.Take away 7 from 100‚ then take away 7 from what is left and keep going: 100 – 7 is ______
25.Minus 7 ______
26.Minus 7 (write down answers; check correct subtraction of 7) ______
27.Minus 7 ______
28.Minus 7 ______
29.Minus 7 ______
30.Minus 7 ______ 
 

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Beresford ‚T.P.‚ Holt‚ R.E.‚ Hall‚ R.C.W‚ et al. (1985)‚ Cognitive screening at the bedside: usefulness of a structured examination. Psychosomatics‚ 26:319–324.

Foreman‚ M.D. (1987). Reliability and validity of mental status questionnaires in elderly hospitalized patients. Nurs Res‚ 36:216–220.

Schwamm‚ L.H.‚ Van Dyke‚ C.‚ Kiernan‚ R.J.‚ Merrin‚ E.L.‚ Mueller‚ J. (1987). The Neurobehavioral Cognitive Status Examination: comparison with the Cognitive Capacity Screening Examination and the Mini-Mental State Examination in a neurosurgical population. Ann Intern Med‚ 107‚ 486–491.

Hershey‚ L.A.‚ Jaffe‚ D.F.‚ Greenough‚ P.G‚ et al. (1987). Validation of cognitive and functional assessment instruments in vascular dementia. Int J Psychiatry Med‚ 17:183–192.

McDowell‚ Ian. (2006). Measuring Health: A Guide to Rating Scales and Questionnaires‚ Third Edition. OXFORD UNIVERSITY PRESS