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  2. Cognistat Cognitive Assessment/ Neurobehavioral Cognitive Status Examination

Cognistat Cognitive Assessment/ Neurobehavioral Cognitive Status Examination

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Purpose

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).

Link to Instrument

Instrument Details

Acronym Cognistat or NCSE

Area of Assessment

Cognition

Cost

Not Free

Actual Cost

$475.00

Diagnosis/Conditions

  • Brain Injury Recovery
  • Parkinson's Disease & Neurologic Rehabilitation
  • Stroke Recovery

Populations

Stroke
Older Adults and Geriatric Care
Non-Specific Patient Population
Alzheimer's Disease and Progressive Dementia
Brain Injury

Key Descriptions

  • 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)

Number of Items

62

Equipment Required

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

Time to Administer

15-20 minutes

Up to 30 minutes if impaired

Required Training

Training Course

Instrument Reviewers

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

ICF Domain

Body Structure
Body Function
Activity
Participation

Considerations

  • Not sensitive to above average performances (Nokleby et al. 2008; Macaulay et al., 2003).

  • Healthy patients expected to perform almost perfectly.

  • Impaired performances likely indicate cognitive alteration or impairment.

  • “Screen and Metric approach” may not be sensitive to subtle or mild impairment; may yield false negative results in these cases (Nokleby et al. 2008; Oehlert et al. 1997).

  • 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).

Stroke

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Criterion Validity (Predictive/Concurrent)

Stroke: (Mysiw, Beegan, and Gatens, 1989; Schwamm et al., 1987)

Cognistat demonstrates greater sensitivity to cognitive impairment than other commonly used assessments, such as the Mini Mental State Exam (MMSE), Albert’s Test, and the Cognitive Capacity Screening Exam (CCSE).

Nokleby et al.; 2008

 

 

 

Domain

Subtest

Sensitivity (95% CI)

Specificity

Language

Similarities

60 (26-88)

82 (70-94)
 

Comprehension

60 (26-88)

77 (64-90)
 

Naming

80 (44-98)

77 (64-90)
 

Repitition

60 (26-88)

82 (70-94)

Memory

Memory

69 (52-87)

52 (32-73)
 

Attention

54 (35-73)

73 (56-92)

Visuospacial

Visuoconstruction

64 (44-84)

67 (49-84)

Attention and Neglect

Visuoconstruction

64 (31-89)

58 (41-74)

Speed

Visuoconstruction

61 (41-81)

68 (49-88)
 

Naming

61 (41-81)

71 (52-91)

Praxis

Attention

80 (28-100)

65 (50-80)
       
 

Total

81 (68-93)

67 (22-96)
 

Composite

82 (71-94)

50 (12-88)

Construct Validity

Discriminant Validity

Stroke: (Osmon et al. 1992; n=36 (n=12 left unilateral stroke, n=12 right unilateral stroke, n=12 orthopedic control))

No differences between right unilateral and left unilateral stroke on subscales of the Cognistat has been reported. However, significant differences were found between the control group and both stroke groups. The left group differed from the orthopedic control group in similarities, memory, naming, and comprehension scales. The right group differed from the orthopedic control group in constructions and naming scales.

The lack of difference between the two stroke groups demonstrates that the test is not differentially sensitive to the side of stroke.

Non-Specific Patient Population

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Floor/Ceiling Effects

  • Healthy patients expected to perform almost perfectly.
  • Not sensitive to above average performances (Nokleby et al. 2008; Macaulay et al., 2003).

Brain Injury

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Criterion Validity (Predictive/Concurrent)

TBI: (Doninger et al., 2006; n=416 with TBI)

 

The Cognistat/NCSE was unable to detect specific cognitive impairments that occur among persons with TBI across a range of severity and settings.

Construct Validity

Convergent Validity

Traumatic Brain Injury Patients (Nabors et al., 1997; n=45 TBI patients, average age = 39.5 (SD=15.7))

  • Correlation with the Trails Making Test for Trails A (Adequate, r = -.33)
  • Correlation with the Token Test (Poor, r = .30)
  • Correlation with the California Verbal Learning Test (Excellent, r = .68)
  • Correlation with the Wechsler Memory Sclae-- Revised (WMS-R) Logical Memory II (Adequate, r = .43)
  • Correlation with the Wechsler Adult Intelligence Scale-- Revised (WAIS-R) Block Design (Adequate, r = .54)

Alzheimer's Disease and Progressive Dementia

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Construct Validity

Discriminant Validity

 

Aging/Dementia: (Drane & Osato, 1997; n=41 (n=21 diagnosed with dementia, average age =76.9; n=20 healthy controls, average age =79.3))

NCSE correctly identified impairment in 100% of the dementia group, but falsely identified impairment in 70% of the healthy controls, indicating poor discriminant validity.

Older Adults and Geriatric Care

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Normative Data

Healthy Older Adults: (Drane et al., 2003)

Table 3; Drane et al. 2003

      
 

Group 1: 60-69 (n=33)

Group 2: 70-79 (n=44)

Group 3: > 80 (n=31)
       

Composite Score

75.15

73.55

70.97

9th Percentile

69

67

63
       

Orientation

11.85

11.68

11.65

9th Percentile

11

11

11
       

Attention

7.21

7.27

6.87

9th Percentile

6

6

5
       

Comprehension

5.58

5.68

5.74

9th Percentile

5

5

5
       

Repetition

11.82

11.57

11.55

9th Percentile

11

10

10
       

Naming

7.76

7.68

7.42

9th Percentile

6

6

6
       

Construction

5.09

4.59

4.29

9th Percentile

2

2

2
       

Verbal memory

10.42

9.68

8.65

9th Percentile

7

6

6
       

Free Recall

8.91

7.36

4.55

9th Percentile

3

0

0
       

Semantic and Cueing Score

10.06

9.11

7.9

9th Percentile

7

4

4
       

Recognition Recall Score

10.42

9.68

8.65

9th Percentile

6

6

7
       

Calculations

3.61

3.73

3.48

9th Percentile

3

3

3
       

Similarities

6.36

6.34

6.52

9th Percentile

4

4

5
       

Judgement

5.06

5.11

4.9

9th Percentile

3

4

4

Bibliography

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

Cognistat and Cognistat Five. (2016). Retrieved May 25, 2016 from http://www.cognistat.com

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.25.1.133.13628

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

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

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