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Rehab Measures: Cognistat Cognitive Assessment (AKA: Neurobehavioral Cognitive Status Examination)

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Link to Instrument 

Title of Assessment

Cognistat Cognitive Assessment (AKA: Neurobehavioral Cognitive Status Examination) 


Cognistat / NCSE

Instrument Reviewer(s)

Initial review complete by: Timothy Shea, Psy.D.; Chelsea M. Kane, Psy.D.; Melody Mickens, Ph.D., LCP

Summary Date



The Cognistat instrument is an assessment of neurocognitive functioning in three general domains: 1) consciousness, 2) orientation, and 3) simple attention; and five major domains 1) language, 2) constructional ability, 3) memory, 4) calculation skills, and 5) executive skills (Macaulay et al., 2003).


  • 62 Items 
  • Min Score = 0; Max Score = 12)
  • Sum scores for each domain; use test booklet table to determine presence and severity of deficiencies using the domain raw score.
  • “Screen and metric” approach utilized for several domains:
    • If participant fails “normal” difficulty item, an easier task is attempted to establish a performance floor.
    • Task is discontinued after two consecutive failures ((Kiernan, Meuller, and Langston, 1988).
  • Administration of all metric items reduces false negatives and provides a better estimate of a patient’s cognitive functioning post-CVA (Drane et al., 2003; Oehlert et al., 1997)

  • Administration of the screening and metric items for the construction subtest should be considered; each set of items assess different cognitive functions (Fouty and Brzezinski, 2009).

Area of Assessment

Apraxia; Attention and Working Memory; Cognition; Executive Function; Language 

Body Part

Not Applicable 

ICF Domain

Body Structure; Body Function; Activity; Participation 



Assessment Type

Performance Measure 

Length of Test

06 to 30 Minutes 

Time to Administer

Approximately 15-20 Min (Intact); 20-30 Min (Impaired) (Cognistat and Cognistat Five, 2016)

Number of Items

62 Items 

Equipment Required

  • Test booklet
  • Writing utensil
  • Stimuli (stimulus booklet, piece of paper or index card, pen, keys, coin, and at least three other small objects, eight tokens).
  • Computer administration requires laptop, desktop computer, or tablet.

Training Required

Yes; participation in a training course is required.

Type of training required

Training Course 


Not Free 

Actual Cost

Additional pricing information can be located at the following URL:

Age Range

Adolescent: 13-17 years; Adult: 18-64 years; Elderly adult: 65+ 

Administration Mode




Populations Tested

Physical Medicine & Rehabilitation
Traumatic Brain Injury 
Substance Abuse 
Nursing Assessments 
Parkinson's Disease 
Coronary Artery Bypass Surgery

Standard Error of Measurement (SEM)

Not Established

Minimal Detectable Change (MDC)

Not Established

Minimally Clinically Important Difference (MCID)

Not Established: Mild Cognitive Impairment Index (MCI) scores, which range from 0 (i.e., absence of impairment) to 6 (strongly suggestive of dementia) allows clinicians to gauge qualitative and clinical levels of improvement (Novatek Medical Data Systems, 2016).

Cut-Off Scores

Cut-score ranges for older adult and neurologic patient population may differ; consult Cognistat manual for standardization and normative data.

Normative Data

  • The Cognistat has been normed for use with adolescents (12-19), adults (20-59) and seniors in 3 age groups: (60–64, 65–74 and 75–84).
  • For CVA, normative sample included 30 patients with documented brain lesion (i.e. stroke, brain tumor) after neurosurgical intervention. Mean scores were significantly lower than all standardization groups for all subtests (Kiernan, Meuller, and Langston, 1995).
  • When interpreting test performance, reference group-specific norms for neurosurgical standardization sample.

Test-retest Reliability

  • Reliability in populations with neuropathology and unstable clinical presentation difficult to assess (Kiernan, Meuller, and Langston, 1988).
  • Re-administration possible; duration between and frequency of re-administrations not specified (Kiernan, Meuller, and Langston, 1995). Two additional 4-word lists are provided for the Memory subtest.

Interrater/Intrarater Reliability

Not Established

Internal Consistency

Not Established

Criterion Validity (Predictive/Concurrent)


  • Cognistat demonstrates greater sensitivity to cognitive impairment than other commonly used assessments (Allen, 2011; Drane et al., 2003; Mysiw, Beegan, and Gatens, 1989; Schwamm et al., 1987)
  • Cognistat is sensitive to cognitive impairment in inpatient stroke patients with sensitivity for language (Naming Subtest: 0.80, 95% CI: 44-98) and memory (0.69: 95% CI: 52-87). Composite scores are sensitive at 0.82 (95% CI: 71-94) for detecting deficits in any domain following stroke (Nøkleby et al., 2008).
  • Limited research on use of Cognistat for assessing cognitive differences between types of CVA. No differences between right unilateral and left unilateral stroke on subscales of the Cognistat has been reported (Osmon et al., 1992). Construction, similarities, and judgement subtest score differ for patients with subcortical lesions, compared to patients with frontal lesions or parietal lesions post-CVA (Chan et al., 2015).

Construct Validity (Convergent/Discriminant)

Adequate: Correlations between Cognistat subtests and other similar neuropsychological measures suggest satisfactory construct validity (Allen, 2011; Nabors, Millis, and Rosenthal, 1997).

Content Validity

Not Statistically Assessed

Face Validity

Not Statistically Assessed

Floor/Ceiling Effects

  • Not sensitive to above average performances.
  • Healthy patients expected to perform almost perfectly.
  • Impaired performances likely indicate cognitive alteration or impairment.
  • Not sensitive to subtle or mild impairment; may yield false negative results in these cases.


Not Established

Professional Association Recommendations



  • Advanced age is associated with diminished performance on construction, memory, similarities, attention, and calculation domains.
  • Construction and memory most impacted by age (Drane and Osato, 1997); test makers specify broader score ranges for “average” performance among elderly participants (Kiernan, Mueller, and Langson, 1988, 1997).
  • Lower education is associated with diminished performance (Macaulay et al., 2003); it is recommended that interpretation of performance in older adults and those with limited education be tentative (Allen, 2011; Drane and Osato, 1997).


Allen, D. (2011). Cognistat. In Caplan, B. (Ed.), Encyclopedia of Clinical Neuropsychology. New York, NY: Springer.

Chan, S.C., Chan, C., Wu, Y., Liu, K., & Xu, Y-w. (2015). Differentiating cognitive functions of poststroke patients with specific brain lesions: A preliminary study on the clinical utility of the Cognistat-P. Applied Neuropsychology: Adult, 1-10. doi: 10.1080/23279095.2015.1055565

Cognistat and Cognistat Five. (2016). Retrieved May 25, 2016 from

Drane, D.L. & Osato, S.S. (1997). Using the neurobehavioral cognitive status examination as a screening measure for older adults. Archive of Clinical Neuropsychology, 12, 139–143. doi: 10.1016/S0887-6177(96)00057-1

Drane, D.L., Yuspeh, R.L., Huthwaite, J.S., Klingler, L.K., Foster, L.M., Mrazik, M., & Axelrod, B. N. (2003). Healthy older adult performance on modified version of the Cognistat (NCSE): Demographic issues and preliminary normative data. Journal of Clinical and Experimental Neuropsychology, 25, 133–144. doi: 10.1076/jcen.

Fouty, H.E. & Brzezinski, S.B. (2009). Rectifying the inconsistent administration procedures of the Cognistat constructional ability subtest. Applied Neuropsychology, 16, 169-170. doi: 10.1080/09084280903098539

Kiernan, R.J., Mueller, J. & Langston, J.W. (1988). Cognistat: The Neurobehavioral Cognitive Status Examination. The Northern California Neurobehavioral Group, Inc.

Kiernan, R.J., Mueller, J., & Langston, J.W. (1995). Cognistat (Neurobehavioral Cognitive Status Examination). Lutz, FL: Psychological Assessment Resources.

Kiernan, R.J., Mueller J., Langston J.W., & Van Dyke, C. (1987). The Neurobehavioral Cognitive Status Examination, A Brief but Differentiated Approach to Cognitive Assessment. Annals of Internal Medicine, 107, 481–485. doi:10.7326/0003-4819-107-4-481 

Macaulay, C., Battista, M., Lebby, P., & Mueller, J. (2003). Geriatric performance on the Neurobehavioral Cognitive Status Examination (Cognistat). What is normal? Archives of Clinical Neuropsychology, 18, 463-71. doi:10.1016/S0887-6177(02)00141-5

Mysiw, W.J., Beegan, J.G., & Gatens, P.F. (1989). Prospective cognitive assessment of stroke patients before inpatient rehabilitation: The relationship of the Neurobehavioral Cognitive Status Examination to functional improvement. American Journal of Physical Medicine and Rehabilitation, 68, 168-171.

Nabors, N. A., Millis, S. R., & Rosenthal, M. (1997). Use of the Neurobehavioral Cognitive Status Examination (Cognistat) in traumatic brain injury. Journal of Head Trauma Rehabilitation, 12(3), 79–84.

Nøkleby, K., Boland, E., Bergersen, H., Schanke, A.K., Farner, L., Wagle, J., & Wyller, T.B. (2008). Screening for cognitive deficits after stroke: a comparison of three screening tools. Clinical Rehabilitation, 22, 1095–1104. doi: 10.1177/0269215508094711

Novatek Medical Data Systems (2016). About the Exam (FAQ). Retrieved April 22, 2016, from

Oehlert, M.E., Hass, S.D., Freeman, M.R., Williams, M.D., Ryan, J.J., & Sumerall, S.W. (1997). The Neurobehavioral cognitive status examination: Accuracy of the ‘screen-metric’ approach in a clinical sample. Journal of Clinical Psychology, 53, 733-737. doi: 10.1002/(SICI)1097-4679(199711)53:7<733::AID-JCLP11>3.0.CO;2-M

Osmon, D.C., Smet, L.C., Winegarden, B., & Gandhawadi, B. (1992). Neurobehavioral Cognitive Status Examination: Its use with unilateral stroke patients in a rehabilitation setting. Archives of Physical Medicine and Rehabilitation, 73, 414-418.

Schwamm L.H., Van Dyke C., Kiernan R.J., Merrin E., & Mueller J. (1987). The Neurobehavioral Cognitive Status Examination, Comparison of the NCSE and MMSE in a Neurosurgical Population. Annals of Internal Medicine, 107, 486-491. doi:10.7326/0003-4819-107-4-486 

Stolwyk, R., O’Neill, M.H., McKay, A.J., & Wong, D. (2014). Are Cognitive Screening Tools Sensitive and Specific Enough for Use After Stroke?: A Systematic Literature Review. Stroke 45, 3129-3134. doi:10.1161/STROKEAHA.114.004232

Year published


Instrument in PDF Format

Approval Status Approved 
Created at 11/17/2016 11:02 AM  by Jason Raad 
Last modified at 12/12/2016 12:08 PM  by Jason Raad