Brief Cognitive Assessment Tool

The Brief Cognitive Assessment Tool (BCAT) was designed and copywrited by Dr. William Mansbach to identify patients with and without dementia, and to be sensitive to different levels of cognitive impairment. The BCAT was designed as a multi-domain cognitive screening tool that assesses*
 * Abstraction,
 * Attention,
 * Executive functions,
 * Language,
 * orientation,
 * verbal recall,
 * visual recognition,
 * visual recall,
 * visuo-spatial processing.

The BCAT, as well as the three cognitive BCAT "factors" (contextual memory, executive functions, and attention), have been shown to predict both cognitive diagnosis and functional status or Instrumental Activities of Daily Living (IADL). The BCAT has been validated and published in the Journal of Clinical and Experimental Neuropsychology, 2012, Vol 34(2), 183-194. An abbreviated form of the Brief Cognitive Assessment Tool (BCAT-SF) has been published in the journal Aging and Mental Health, 2012, Vol 16(8), 1065-1071. The BCAT can be administered in 10–15 minutes.

Background
Over the past thirty years, cognitive functioning in older adults has become an important focus among clinicians and policy analysts. The increasing longevity of older adults, especially those in the "old-old" category, has been well documented. Epidemiological studies show that as people live longer, incidence and prevalence rates of dementia also increase. It is estimated that more than 5 million Americans over the age of 65 have Alzheimer's Disease (AD). This number is projected to exceed 13 million by 2050.

While no clear preventive or curative interventions for Alzheimer’s disease are available, early detection may improve quality of life for patients and their families. Furthermore, effective screening may aid in the development of intervention strategies that delay the insidiousness of the disease as well as nursing facility placement. Early detection may enhance the efficacy of pharmacologic and non-pharmacologic treatments.

A number of screening measures have been developed since the Mini-Mental State Examination (MMSE) was published in 1975. Examples include the Short Test of Mental Status (STMS), the Montreal Cognitive Assessment (MoCA), and the St. Louis University Mental Status Examination (SLUMS).

While each of these instruments identifies individuals with probable dementia, they lack specific integration of three critical neuro-cognitive clusters (contextual memory, executive functions, and attentional capacity) as predictors of cognitive functioning and performance of everyday activities of independent living. The BCAT was designed to overcome this and other measurement issues.

Whereas the BCAT can be administered in a short period of time (10–15 minutes), a Short Version (BCAT-SF) has also been developed and normed. It can be administered in less than five minutes and is ideal for primary care settings and frontline providers who have little time to spend screening patients. The BCAT-SF can be also be administered, scored, and interpreted on-line in "real time" (as can the full BCAT). The psychometric properties of the BCAT-SF are robust.

Introduction
Important characteristics of the BCAT are that it:
 * can be administered by both paraprofessionals and clinicians.
 * can be completed in approximately 10–15 minutes.
 * can differentiate among MCI, mild dementia, and moderate dementia.
 * contains strong verbal recall components.
 * has a complex executive function component.
 * positively correlates with ADL and IADL performance.

Methods
111 participants referred for neuropsychological evaluation were recruited from assisted-living facilities. Participants completed a clinical interview, informant interview, record review, and a comprehensive battery of neuropsychological tests including the new BCAT. The total possible BCAT score is 50 points.

Results
The psychometric quality of the BCAT was confirmed with strong evidence for reliability, construct validity, and predictive validity. The BCAT’s utility for detecting dementia was excellent, with a sensitivity of .99, a specificity of .79, and an area under the ROC curve of .95. Executive control items, contextual memory items, and attentional capacity items emerged as the best predictors of diagnostic category and of scores on a measure of IADLs.

Analyses supported the psychometric properties of the BCAT. The BCAT also was effective in integrating contextual memory, executive functions, and attentional capacity components as a predictive tool for diagnostic status and functional capacity.

The BCAT Approach
The BCAT Approach is a unique applied concept for assessing and working with people who have memory and other cognitive impairments. The Approach integrates three distinct person-centered systems: the BCAT Test System, the BCAT Brain Rehabilitation Program, and the BCAT Recreation Program.

The BCAT Test System
Those who use the BCAT Approach as a screening and diagnostic tool, can log onto the website to utilize the scoring programs.

The comprehensive BCAT Test System consists of five cognitive tools that healthcare professionals can use to assess memory and cognitive functioning. The featured Brief Cognitive Assessment Tool (BCAT), is the primary test. The System also includes:
 * The Brief Cognitive Assessment Tool Short Form (BCAT-SF): The BCAT-SF was designed as a shorter version of the full BCAT. The short form can be administered in less than five minutes. While it is not as robust, or comprehensive, as the full BCAT, the Short Version has strong reliability, construct validity, and predictive validity. When time is particularly limited (e.g., primary care settings), the six-item, 21-point short form is a dependable cognitive screening tool. It can be downloaded or used as an online tool.
 * Kitchen Picture Test (KPT): The KPT was designed as a visually presented test of practical judgment. The KPT is a unique illustration of a kitchen scene in which three potentially dangerous situations are unfolding. Patients are asked to describe the scene as fully as they can, to identify the three problem situations, to rank the order of importance of each situation in terms of dangerousness, and to offer solutions that would resolve the three problems.
 * Brief Cognitive Impairment Scale (BCIS): The BCIS was designed to assess the cognitive functioning of patients with severe dementia. The BCIS is a 11-item, 14-point scale. It was developed to not only track cognitive changes in severely demented patients specifically, but to provide information to better manage those patients' behavior problems.
 * WIPE Depression Scale: The WIPE is a new depression scale based on four interview-style questions. It can be administered in 3 minutes or less and be used a "process" instrument over time. The WIPE has a "cut" score to differentiate those with and without depressive symptoms and has strong reliability, construct validity, and predictive ability.

The BCAT Brain Rehabilitation
Brain rehabilitation is a loss and restoration process, based on cognitive exercises that promote brain cells (neurons) to improve functioning. It is based on the principles of neuroplasticity and cognitive reserve. Brain rehabilitation exercises can improve cognition and, in some circumstances, protect against memory loss caused by brain diseases like Alzheimer’s disease.

The BCAT Brain Rehabilitation Program can be used as a cognitive rehabilitation program with the primary modules being online. They target attention, memory, and executive functions.

Additional non-interactive modules include Mazes, Word Searches, and Word Scrambles. Individuals who are cognitively normal, who have Mild Cognitive Impairment (MCI), and who have mild dementia show the most improvement. Brain Rehabilitation is not suggested for persons with moderate to severe dementia.

The BCAT Recreation Program


The BCAT Recreation Program is designed to assist staff in helping residents meet person-centered goals in a recreation context by integrating interests with actual capability to participate. The Brief Cognitive Assessment Tool measures attention, memory, and executive functions – three cognitive skills that can determine a resident’s ability to engage and complete an activity. Additionally, the BCAT The Recreation Interest Inventory consists of eight items that measure how interested or motivated the resident is in participating in activities. Once BCAT scores are entered and the Recreation Interest Inventory is completed, a person-centered recreation approach can be determined.