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Rehab Measures: Brief Cognitive Assessment Tool

Link to instrument

https://www.thebcat.com/bcat-test-system 

Title of Assessment

Brief Cognitive Assessment Tool  

Acronym

BCAT

Instrument Reviewer(s)

Initially reviewed by William Mansbach, PhD, Ryan A. Mace, and Kristen M. Clark in 8/2014

Summary Date

12/1/2014 

Purpose

A multi-domain cognitive instrument that assesses orientation, verbal recall, visual recognition, visual recall, attention, abstraction, language, executive functions, and visuo-spatial processing in adult and older adult populations

Description

  • 21 items
  • Scores range from 0 to 50
  • Item-level scores are determined by correct responses
  • Produces a total score to assess global cognitive functioning and a Contextual Memory Factor (CMF) and Executive Control Functions Factor (ECFF)
  • Can be downloaded and used as a paper-and-pencil instrument, but it should be scored online through the BCAT website (above). This is how to get BCAT factor scores, clinical considerations, and a test report.

Area of Assessment

 

Body Part

 

ICF Domain

Body Function 

Domain

Cognition 

Assessment Type

 

Length of Test

06 to 30 Minutes 

Time to Administer

15-20 minutes

Number of Items

21 items 

Equipment Required

The BCAT test (paper and pencil or online), enlarged BCAT stimulus images (if needed), electronic device with internet access for scoring and report writing

Training Required

Licensing inclusive of a training course: “Cognition as the Sixth “Vital Sign”: New Approaches to Assessment and Treatment. Training is available through a guided online course or a downloadable PowerPoint presentation.

Type of training required

Training Course 

Cost

Not Free 

Actual Cost

$195 annual licensing fee includes training and unlimited access to the BCAT Test System and BCAT Brain Rehabilitation Modules

Age Range

 

Administration Mode

 

Diagnosis

Geriatrics 

Populations Tested

  • Assisted living facility
  • Skilled nursing facility
  • Community-dwelling older adults
  • Hospitals
  • Adult daycare
  • Dementia (mild, moderate, & severe)
  • Mild cognitive impairment (MCI)
  • Normal cognition
  • Older adults with mood disorders

Standard Error of Measurement (SEM)

Not Established

Minimal Detectable Change (MDC)

Not Established

Minimally Clinically Important Difference (MCID)

Not Established

Cut-Off Scores

Older adults (aged 60+): (Mansbach, MacDougall, & Rosenzweig, 2012)

  • 44-50 normal cognitive functioning: independent living
  • 34-43 MCI: functional decline in instrumental activities of daily living (IADL)
  • 25-33 mild dementia: IADL deficits, memory and cognitive decline
  • 0-24 moderate to severe dementia: functional deficits, marked decline in memory and executive functions, behavioral and psychological symptoms common (upper end of range); requires complex care, pervasive cognitive deficits (lower end of range)

Normative Data

Community-dwelling: (Mansbach, MacDougall, Clark, & Mace, in press; n = 49; mean age = 69.33 ± 9.27)

  • In cognitively normal older adults:
    • Mean (SD) BCAT score = 46.65 (2.35), range = 40-50, median = 47
    • Mean (SD) CMF score = 14.69 (.68), range = 13-15, median = 15
    • Mean (SD) ECFF score = 6.33 (.99), range = 3-7, median = 7

Test-retest Reliability

Assisted living facilities: (Mansbach et al., 2012)

  • Excellent test-retest reliability (ICC = .99) (average interval = 11.5 days)

Interrater/Intrarater Reliability

Not Established

Internal Consistency

Assisted living facilities: (Mansbach et al., 2012)

  • Excellent internal consistency (Chronbach’s alpha = .92)

Skilled nursing facilities: (Mansbach, Mace, & Clark, 2014)

  • Excellent internal consistency (Chronbach’s alpha = .94)

Community-dwelling adults: (Mansbach et al., in press)

  • Adequate internal consistency (Chronbach’s alpha = .76)

Criterion Validity (Predictive/Concurrent)

Assisted living facilities: (Mansbach et al., 2012)

  • Excellent predictive validity of basic and instrumental ADLs, as measured by the PSMS (ß = −.41, p < .001) and the Lawton IADL scale (ß = .63, p < .001).
  • Excellent predictive validity of BCAT ECFF (B = −1.92, p < .001), Attentional Capacity (B = −1.64, p < .01), and the CMF(B = –1.67, p < .01) as predictors of diagnostic category (MCI vs dementia).
  • Excellent predictive validity for identifying dementia (versus MCI): Area under the Curve = .96; Sensitivity = .99, Specificity = .77 (Positive predictive validity = .91, Negative predictive validity = .69)

Skilled nursing facilities: (Mansbach, Mace, & Clark, 2014)

  • Excellent ability to differentiate among five categories of cognitive functioning (normal, MCI, mild dementia, moderate dementia, and severe dementia) (F (4, 186) = 381.0, p = .00)
  • Excellent ability to predict cognitive diagnosis accounting for 47% of the variance in Clinical Dementia Rating scores over and above the Brief Interview for Mental Status
  • Excellent predictive validity for identifying dementia (versus MCI): Area under the Curve = .99; Sensitivity = .99, Specificity = .81(Positive predictive validity = .89, Negative predictive validity = .98)

Community-dwelling adults: (Mansbach et al., in press)

  • Excellent predictive validity to differentiate participants who exhibited cognitive impairment on the Montreal Cognitive Assessment (t(31.11) = 6.10, p < .001, Cohen’s d = 1.62) from participants who were cognitively intact on the Montreal Cognitive Assessment.
  • Excellent predictive validity for identifying cognitive impairment (versus no cognitive impairment): Area under the Curve = .90; Sensitivity = .81, Specificity = .80 (Positive predictive validity = .68, Negative predictive validity = .89)

Construct Validity (Convergent/Discriminant)

Assisted living facilities: (Mansbach et al., 2012)

  • Excellent correlation with Mini-Mental Status Examination (r = 0.88, p < .001)
  • Excellent correlation with Short Test of Mental Status (r = 0.80, p < .001)
  • Adequate to excellent correlation with Lawton IADL scale (r = 0.66, p < .001)
  • Adequate correlation with Lawton IADL scale (r = -.040, p < .001)

Skilled nursing facilities: (Mansbach, Mace, & Clark, 2014)

  • Adequate to excellent correlation with Kitchen Picture Test (r = 0.63, p < .001)
  • Adequate to excellent correlation with Brief Interview for Mental Status (r = 0.68, p < .001)

Community-dwelling adults: (Mansbach et al., in press)

  • Adequate to excellent correlation with Montreal Cognitive Assessment (r = 0.68, p < .001)
  • Adequate to excellent correlation with Neuropsychological Assessment Battery – Judgment Subtest (r = 0.55, p < .001)

Content Validity

The tool was developed over an 18-month period. Initially, there were 30 items and nine items were deleted based on feedback from two psychologists trained in neurocognitive assessment. Several of the items were revised to improve their clarity.

Face Validity

  • Not statistically assessed, however, each item was screened for face validity by two psychologists trained in neurocognitive assessment. The 21 items were pilot tested in various clinical situations.

Floor/Ceiling Effects

  • Not statistically assessed, however, the BCAT may be less sensitive in differentiating between moderate and severe impairment (BCAT < 25)
  • We recommend using the BCIS when severe cognitive impairment has already been established, or when the patient scores under 25 on the BCAT.

Responsiveness

Not Established

Professional Association Recommendations

Endorsed by the National Association of Professional Geriatric Care Managers

Considerations

When time is especially limited, the therapist might choose to administer the short form of the BCAT (BCAT-SF). If the therapist is particularly concerned about IADL skills, he/she may want to administer the Kitchen Picture Test (of practical judgment). Information about both tools, and other information, is available at https://www.thebcat.com/bcat-test-system

Bibliography

MacDougall, E. E., & Mansbach, W. E. (2013). The Judgment Test of the Neuropsychological Assessment Battery (NAB): psychometric considerations in an assisted-living sample. Clin Neuropsychol, 27(5), 827-839.

MacDougall, E. E., Mansbach, W. E., Clark, K., & Mace, R. A. (2014). The brief cognitive assessment tool (BCAT): cross-validation in a community dwelling older adult sample. Int Psychogeriatr, 1-8.

Mansbach, W. E., MacDougall, E. E., Clark, K. M., & Mace, R. A. (2014). Preliminary investigation of the Kitchen Picture Test (KPT): a new screening test of practical judgment for older adults. Neuropsychol Dev Cogn B Aging Neuropsychol Cogn, 21(6), 674-692.

Mansbach, W. E., MacDougall, E. E., & Rosenzweig, A. S. (2012). The Brief Cognitive Assessment Tool (BCAT): a new test emphasizing contextual memory, executive functions, attentional capacity, and the prediction of instrumental activities of daily living. J Clin Exp Neuropsychol, 34(2), 183-194.

Mansbach, W. E., Mace, R. A., & Clark, K. M. (2014a). Differentiating levels of cognitive functioning: a comparison of the Brief Interview for Mental Status (BIMS) and the Brief Cognitive Assessment Tool (BCAT) in a nursing home sample. Aging Ment Health, 18(7), 921-928.

Mansbach, W. E., Mace, R. A., & Clark, K. M. (2014b). Story recall and word lists: differential and combined utilities in predicting cognitive diagnosis. J Clin Exp Neuropsychol, 36(6), 569-576.

Year published

 

Instrument in PDF Format

Yes 
Approval Status Approved 
 
Attachments
Created at 12/19/2014 8:08 AM  by Jason Raad 
Last modified at 12/19/2014 8:22 AM  by Jason Raad