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Purpose
The Brief Cognitive Rating Scale (BCRS) is an objective measure which determines stage of cognitive decline on the Global Deterioration Scale (GDS) using five axes.
Link to Instrument
Acronym
BCRS
Primary Image
Brief Cognitive Rating Scale
Expertise, Instruction and Mentorship
Center for Smart Use of Technologies to Assess Real World Outcomes (C-STAR)
Upcoming Stroke Course
May 9–10
Live and Online
Offered by Academy, Shirley Ryan AbilityLab
Populations
Number of Items
Consists of five axes (concentration; recent memory; past memory; orientation; and functioning and self care)
Equipment Required
- A copy of the test, scoring guidelines, and a writing utensil to score the test.
Time to Administer
15-30 minutes
Required Training
No TrainingInstrument Reviewers
Initially reviewed by Tricia Holmes, OTR and Anne Reynolds, MPH in 2018.
ICF Domain
Body FunctionActivity
Participation
Measurement Domain
Participation & ActivitiesCognition
Activities of Daily Living
Considerations
- Although this test has been used for many years it has not been further analyzed in recent years, and would benefit from more recent analysis.
- This test would benefit from further testing to configure the MDC, SEM, and MDIC.
- This test appears to be most responsive with people who have significant signs and symptoms of dementia which would suggest this is the most appropriate population for this test.
- Axes I through IV can be administered multiple times in the same day for continuous measurement. Axis V requires a resting interval of several days between administration for appropriate scoring (Reisberg & Ferris, 1988).
- Axis V showed differing inter-rater reliability when administered by physicians compared to non-physicians in a long term care facility. Due to the influence of psychiatric and physical illness on this axis, physicians are likely more able to appropriately assess this axis (Foster et al., 1988).
Older Adults and Geriatric Care
back to PopulationsNormative Data
Community dwelling older adults with dementia and nursing home dwelling older adults with dementia: (Cohen-Mansfield & Taylor, 1998; senior daycare center participants, n = 195, mean age = 80; nursing home dwelling participants, n = 408, mean age = 85)
- BCRS score for senior daycare centers participants = 4.4 (range 1-7)
- BCRS score for nursing home dwelling participants = 4.0 (range 1-7)
Adults aged ≥ 40 years with and without subjective cognitive impairment: (Reisberg, Shulman, Torossian, Leng, & Zhu, 2010; n = 213, mean age = 66.8 ± 9.0 years; During a mean period of 6.8 ± 3.4 years)
- BCRS total score for participants with no cognitive impairment (NCI, n = 47) = 5.74 ± 0.9 (p < .001)
- Axis I: Concentration, mean = 1.28 ± 0.6
- Axis II: Recent Memory, mean = 1.23 ± 0.4
- Axis III: Past Memory, mean = 1.13 ± 0.3
- Axis IV: Orientation, mean = 1.00 ± 0.0
- Axis V: Functioning and Self-Care, mean = 1.11 ± 0.3
- BCRS total score for participants with subjective cognitive impairment (SCI, n = 164*) = 8.97 ± 1.6 (p < .001) [*2 SCI subjects were not scored on the BCRS]
- Axis I: Concentration, mean = 2.23 ± 0.8
- Axis II: Recent Memory, mean = 2.09 ± 0.4
- Axis III: Past Memory, mean = 1.65 ± 0.7
- Axis IV: Orientation, mean = 1.23 ± 0.4
- Axis V: Functioning and Self-Care, mean = 1.77 ± 0.5
Interrater/Intrarater Reliability
Geriatric patients with mild to severe symptoms of age-associated cognitive decline in subjects institutionalized: (Reisberg et al., 1989; 38 patients in dementia research program; normal aged (n=2), normal aging and evidence of cerebrovascular disease (n=2), individuals with dementia without evidence of cerebrovascular disease (n=27), and individuals with dementia and evidence of notable cerebrovascular disease (n=6). Mean age = 69.3 ± 7.9 years.)
- Excellent inter-rater reliability 0.82 to 0.86
- Axis I: Concentration, r= 0.82
- Axis II: Recent Memory, r= 0.85
- Axis III: Past Memory, r= 0.83
- Axis IV: Orientation, r= 0.86
- Axis V: Functioning, r= 0.83
- Axis I-V: Total Score, r= 0.96
Internal Consistency
Geriatric patients with mild to severe symptoms of age-associated cognitive decline in subjects institutionalized: (Reisberg et al., 1989)
- Excellent internal consistency
- Axis I: Concentration, r = 0.82
- Axis II: Recent Memory, r = 0.85
- Axis III: Past Memory, r = 0.83
- Axis IV: Orientation, r = 0.86
- Axis V: Functioning and Self-Care, r = 0.83
- BCRS total scores: r = 0.96
Criterion Validity (Predictive/Concurrent)
Normal aging and Alzheimer’s Disease: (Reisberg et al., 1985)
- Excellent concurrent validity with total Guild Test Battery for combined memory test scores (r = 0.74, p ≤ .001)
- Excellent concurrent validity with total Digit Span for combined memory test scores (r = 0.79, p ≤ .001)
- Excellent concurrent validity with WAIS Vocabulary subscale for general language ability (r = 0.76, p ≤ .001)
- Excellent concurrent validity with Digit Symbol substitution test for psychomotor functioning (r = 0.78, p ≤ .001)
- Excellent concurrent validity with Mental Status Questionnaire for global mental status (r = 0.77, p ≤ .001)
Construct Validity
Normal aging and Alzheimer's Disease: (Reisberg et al., 1988)
- Excellent convergent validity on all axes compared to the Global Deterioration Scale (GDS).
- Axis I: r = 0.90 (p ≤ .001)
- Axis II: r = 0.94 (p ≤ .001)
- Axis III: r = 0.87 (p ≤ .001)
- Axis IV: r = 0.94 (p ≤ .001)
Axis V: r = 0.91 (p ≤ .001)
Alzheimer's Disease and Progressive Dementia
back to PopulationsInterrater/Intrarater Reliability
Long Term Care Facility patients with dementia diagnosis: (Foster et al., 1988; study 1: n=20, mean age = 63.0 ± 13.7 years; study 2: n=20, mean age = 52.6 ± 18.4 years.)
- Excellent inter-rater reliability 0.76 to 0.97
- Axis I: Concentration, 0.85
- Axis II: Recent Memory, 0.82
- Axis III: Past Memory, 0.90
- Axis IV: Orientation, 0.93
- Axis V: Functioning and Self-Care, 0.76
Criterion Validity (Predictive/Concurrent)
Normal aging and Alzheimer’s Disease: (Reisberg et al., 1985)
- Excellent concurrent validity with total Guild Test Battery for combined memory test scores (r = 0.74, p ≤ .001)
- Excellent concurrent validity with total Digit Span for combined memory test scores (r = 0.79, p ≤ .001)
- Excellent concurrent validity with WAIS Vocabulary subscale for general language ability (r = 0.76, p ≤ .001)
- Excellent concurrent validity with Digit Symbol substitution test for psychomotor functioning (r = 0.78, p ≤ .001)
- Excellent concurrent validity with Mental Status Questionnaire for global mental status (r = 0.77, p ≤ .001)
Construct Validity
Normal aging and Alzheimer's Disease: (Reisberg et al., 1988)
- Excellent convergent validity on all axes compared to the Global Deterioration Scale (GDS).
- Axis I: r = 0.90 (p ≤ .001)
- Axis II: r = 0.94 (p ≤ .001)
- Axis III: r = 0.87 (p ≤ .001)
- Axis IV: r = 0.94 (p ≤ .001)
Axis V: r = 0.91 (p ≤ .001)
Mixed Populations
back to PopulationsNormative Data
Postpartum Women: (Meena, Soni, Jain, Jilowa & Omprakash, 2016; n = 300, mean age = 21, study conducted in North India).
- BCRS score for cases (n=200) = 1.50 ± 0.44
- BCRS score for controls (n=100) = 1.08 ± 0.18
Adults aged ≥ 40 years with and without subjective cognitive impairment: (Reisberg, Shulman, Torossian, Leng, & Zhu, 2010; n = 213, mean age = 66.8 ± 9.0 years; During a mean period of 6.8 ± 3.4 years)
- BCRS total score for participants with no cognitive impairment (NCI, n = 47) = 5.74 ± 0.9 (p < .001)
- Axis I: Concentration, mean = 1.28 ± 0.6
- Axis II: Recent Memory, mean = 1.23 ± 0.4
- Axis III: Past Memory, mean = 1.13 ± 0.3
- Axis IV: Orientation, mean = 1.00 ± 0.0
- Axis V: Functioning and Self-Care, mean = 1.11 ± 0.3
- BCRS total score for participants with subjective cognitive impairment (SCI, n = 164*) = 8.97 ± 1.6 (p < .001) [*2 SCI subjects were not scored on the BCRS]
- Axis I: Concentration, mean = 2.23 ± 0.8
- Axis II: Recent Memory, mean = 2.09 ± 0.4
- Axis III: Past Memory, mean = 1.65 ± 0.7
- Axis IV: Orientation, mean = 1.23 ± 0.4
- Axis V: Functioning and Self-Care, mean = 1.77 ± 0.5
Bibliography
Cohen-Mansfield, J., & Taylor, L. (1998). The relationship between depressed affect, pain and cognitive function: A cross-sectional analysis of two elderly populations. Aging & Mental Health, 2(4), 313-318. Find it on PubMed.
Foster, J. R., Sclan, S., Welkowitz, J., Boksay, I., & Seeland, I. (1988). Psychiatric assessment in medical long-term care facilities: Reliability of commonly used rating scales. International Journal of Geriatric Psychiatry, 3, 229-233. Find it on PubMed.
Meena, P. S., Soni, R., Jain, M., Jilowa, C. S., & Omprakash. (2016). Cognitive dysfunction and associated behaviour problems in postpartum women: A study from north India. East Asian Archives of Psychiatry, 26(3), 104-108. Find it on PubMed.
Reisberg, B., Ferris, S. H., Anand, R., de Leon, M. J., Schneck, M. K., & Crook, T. (1985). Clinical assessment of cognitive decline in normal aging and primary degenerative dementia: Concordant ordinal measures. In P. Pinchot, P. Berner, R. Wolf, & K. Thau (Eds.), Psychiatry (pp. 333-338). New York, NY: Plenum Press.
Reisberg, B., & Ferris, S. H. (1988). Brief Cognitive Rating Scale (BCRS). Psychopharmacology Bulletin, 24(4), 629-636. Find it on PubMed.
Reisberg, B., Ferris, S. H., Steinberg, G., Shulman, E., de Leon, M. J., & Sinaiko, E. (1989). Longitudinal study of dementia patients and aged controls. In M. P. Lawton, & A. R. Herzog (Eds.), Special Research Methods for Gerontology (pp. 195-231). Amityville, NY: Baywood. Find it on PubMed.
Reisberg, B., Shulman, M. B., Torossian, C., Leng, L., & Zhu, W. (2010). Outcome over seven years of healthy adults with and without subjective cognitive impairment. Alzheimer’s & Dementia, 6(1). doi: 10.1016/j.jalz.2009.10.002. Find it on PubMed.