Cognitive Capacity Screening Exam (CCSE)

Name: Cognitive Capacity Screening Exam (CCSE)
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mohammad looti

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 ______

This instrument can be found at: www.a4ebm.org/sites/default/files/Measuring%20Health.pdf

Jacobs‚ J.W.‚ Bernhard‚ M.R.‚ Delgado‚ A.‚ Strain‚ J.J. (1977). Screening for organic mental syndromes in the medically ill. Ann Intern Med‚ 86: 40–46.

Kaufman‚ D.M.‚ Weinberger‚ M.‚ Strain‚ J.J.‚ et al. (1979). Detection of cognitive deficits by a brief mental status examination: the Cognitive Capacity Screening Examination‚ a reappraisal and a review. Gen Hosp Psychiatry‚ 1:247–255.

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

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mohammad looti (2026). Cognitive Capacity Screening Exam (CCSE). PSYCHOLOGICAL SCALES. Retrieved from https://scales.arabpsychology.com/s/cognitive-capacity-screening-exam-ccse/

mohammad looti. "Cognitive Capacity Screening Exam (CCSE)." PSYCHOLOGICAL SCALES, 25 Apr. 2026, https://scales.arabpsychology.com/s/cognitive-capacity-screening-exam-ccse/.

mohammad looti. "Cognitive Capacity Screening Exam (CCSE)." PSYCHOLOGICAL SCALES, 2026. https://scales.arabpsychology.com/s/cognitive-capacity-screening-exam-ccse/.

mohammad looti (2026) 'Cognitive Capacity Screening Exam (CCSE)', PSYCHOLOGICAL SCALES. Available at: https://scales.arabpsychology.com/s/cognitive-capacity-screening-exam-ccse/.

[1] mohammad looti, "Cognitive Capacity Screening Exam (CCSE)," PSYCHOLOGICAL SCALES, vol. X, no. Y, ص Z-Z, April, 2026.

mohammad looti. Cognitive Capacity Screening Exam (CCSE). PSYCHOLOGICAL SCALES. 2026;vol(issue):pages.

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