The BCIS: A New Test for Assessing Severe Cognitive Deficits

Abstract

Geriatric healthcare professionals generally agree that there are numerous challenges in providing care to patients with severe dementia. Unfortunately, a majority of cognitive the screening tools currently available are not particularly helpful to providers who are tasked with managing severe cognitive and behavioral issues commonly found among those with severe dementia. These instruments have “floor” effects that make accurate tracking of cognitive declines over time questionable. Furthermore, cognitive instruments are generally not designed to provide information that can be directly transferable to behavioral management plans. We contend that the ideal cognitive screening tool for severe dementia: (1) can be rapidly administered (five minutes or less), (2) can be used by a broad spectrum of providers, particularly aides; (3) can accurately track severe impairment over time; (4) have strong psychometrics with the ability to accurately identify patients with severe dementia; and (5) can provide direct information in formulating behavior management plans. The Brief Cognitive Impairment Scale (BCIS) is such an instrument. 90 subjects from long-term care settings were recruited for this validation study. The psychometric quality of the BCIS was confirmed by strong evidence of reliability, construct validity, and predictive validity. A cut-score was established to maximize sensitivity (.91) and corresponding specificity (.74). The accuracy of the BCIS, as measured by the area under the ROC curve (AUC = .89), was strong. The strengths and weaknesses of the BCIS in comparison with comparable instruments are discussed. So too are ways to use the BCIS in managing difficult behaviors.

Full text

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