Minnesota Cognitive Acuity Screen

Last Updated

September 02, 2024

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Purpose

The Minnesota Cognitive Acuity Screen is a cognitive screening tool used to screen patients over the phone. It has nine tests designed to assess cognitive impairment. These tests were created to facilitate reliable administration over the phone but can be done in person as well.

Acronym MCAS

Area of Assessment

Cognition
Executive Functioning
Mental Functions

Assessment Type

Performance Measure

Administration Mode

Paper & Pencil

Cost

Free

CDE Status

Not a CDE--last searched 9/2/2024

Mixed Conditions

Neurologic Conditions

The MCAS consists of nine tests (Orientation, Attention, Delayed Word Recall, Comprehension, Repetition, Naming, Computation, Judgment, and Verbal Fluency) which are used to assess cognitive impairment.
Higher scores indicate better cognitive function, while lower scores suggest cognitive impairment.
The exact cut-off for ‘impaired’ is determined based on the population that is being tested.
MCAS is designed to be administered over the phone but can be done in person.

Number of Items

The MCAS consists of nine tests: Orientation, Attention, Delayed Word Recall, Comprehension, Repetition, Naming, Computation, Judgement, and Verbal Fluency

Printed form of MCAS
Pencil
Scissors (required for the cards for the Delayed Word Recall section if not completed during early administration)

Average of 15 minutes

Required Training

No Training

Adult

18 - 64

years

Elderly Adult

65 +

years

Instrument Reviewers

Initially reviewed in 9/2024 by Sara Gonzales, OTS; Natalia Syutyk, OTS; Nancy Cuellar-Sanchez, OTS; & Kiara Rana, OTS, under the direction of Sabrin Rizk, PhD, OTR/L, Department of Occupational Therapy, University of Illinois Chicago.

ICF Domain

Body Function

Measurement Domain

Cognition

Professional Association Recommendation

None found--last searched 9/2/2024

Considerations

The MCAS questions are to be completed in the order they appear.
During the phone call, the administrator's voice is evenly modulated and speaks slowly.
The administrator must not deviate from the script to maintain standardized administration.
If the applicant does not understand the instructions administrator must slowly repeat the same set of instructions.
The MCAS cannot be administered to patients with auditory impairments.
MCAS only available in English
A modified version of the MCAS—the MCAS-m—added learning and recognition memory components to the original to distinguish amnestic mild cognitive impairment (aMCI) from healthy controls, resulting in a 10% increase in specificity (Pillemer et al., 2018).

Cut-Off Scores

Mixed Conditions: (Tremont et al., 2011; n = 200 (50 Healthy controls (HC), mean age = 70.28 (7.88), female = 72%; 100 w/Mild Cognitive Impairment (MCI), mean age = 72.92 (6.70), female = 57%; 50 w/Alzheimer’s Disease (AD), mean age = 74.08, female = 58%; testing w/MCAS an average of 18.91 (15.20) days following their office visit)

Youden index approach estimated optimal pairs cutoff scores for the 3-class classification problem:
- MCI region boundaries (42.5, 52.5)
- Scores < 42.5 classified as AD (sensitivity 86%; specificity 77%)
- Scores > 52.5 classified as HC (sensitivity 86%; specificity 78%)

Normative Data

Mixed Conditions: (Knopman et al., 2000, n = 228 (99 mild to moderately demented nursing home residents w/diagnosis of dementia, female = 70%, mean age = 82.4 (9.4) years and 129 community-dwelling senior citizens, female = 71%, mean age = 73.8 (6.4) years)

Means and Std. Deviations (SD) of Minnesota Cognitive Acuity Screen by Subtest*

Subtest	Impaired Group Mean (SD)	Non-Impaired Group Mean (SD)
Orientation	5.73 (1.84)	8.98 (0.15)
Attention	3.90 (1.55)	5.05 (1.12)
Delayed word recall	0.93 (1.47)	5.53 (2.31)
Comprehension	1.88 (1.10)	2.86 (0.39)
Repetition	3.28 (0.98)	3.88 (0.40)
Naming	3.23 (1.08)	3.90 (0.35)
Computation	4.06 (2.50)	7.40 (0.94)
Judgment	4.28 (1.49)	6.27 (0.78)
Verbal fluency	7.26 (3.24)	14.67 (3.44)

*Uncorrected for age and education; all group differences significant at p < 0.01

Mixed Conditions: (Tremont et al., 2011)

Mean Minnesota Cognitive Acuity Screen Scores by Group^a

Domain	Controls M (SD)	MCI M (SD)	AD M (SD)
Orientation	7.98^b (0.14)	7.39^c (0.83)	6.88^d (1.10)
Digit Span	5.16^b (1.00)	4.93^b,c (1.20)	4.54^c (1.42)
Comprehension	2.72^b (0.54)	2.46^c (0.61)	1.74^d (0.97)
Repetition	3.78^b (0.51)	3.48^c (0.79)	3.24^c (1.14)
Naming	3.92^b (0.27)	3.85^b (0.41)	3.80^b (0.40)
Computation	7.40^b (0.99)	6.36^c (1.54)	4.42^d (2.00)
Judgment	6.12^b (1.27)	5.51^c (1.32)	4.82^d (1.35)
Verbal fluency	14.64^b (4.68)	9.93^c (3.20)	6.68^d (2.69)
Delayed word recall	5.64^b (2.04)	2.19^c (2.25)	0.94^d (1.53)
MCAS sum	57.36^b (6.30)	46.10^c (6.10)	37.06^d (5.66)

MCI = mild cognitive impairment, AD = Alzheimer’s disease, SD = standard deviation

^aMeans sharing the same subscript are not significantly different from each other (Fisher’s least significant difference, p < 0.05), except digit span (MCI = Controls) and naming (no differences between the groups).

Mixed Conditions: (Margolis et al., 2018; n = 146 (HC = 37, MCI = 70, AD = 39), age range = 56-86, initial baseline MCAS testing with follow-up over eight years for establishing dates of starting homecare, institutionalization, and death)

Mean MCAS total score = 47.03 (9.08)
Median MCAS score = 47.5

Criterion Validity (Predictive/Concurrent)

Predictive validity:

Mild Cognitive Impairment: (Tremont et al., 2016; n = 61, mean age = 73.3 (6.0), age range = 60-84, established diagnosis of amnestic MCI)

Cognitive Decline

The MCAS total score at baseline was not predictive of the rate of cognitive decline in participants with MCI after controlling for time since study entry (p = 0.21, see Table below)
The computation subscale was the only nominally significant predictor of cognitive decline (p = 0.01, see Table below), with DRS-2 total score at follow-up decreasing by 1.56 points per 1-point decrease in baseline computation score

Effects of Baseline Minnesota Cognitive Acuity Screen and its Subscales on Annual Dementia Rating Scale-2 Change in Individuals with Mild Cognitive Impairment*

Subtest	Beta (Std. Error)	Z-Score	P-Value
Orientation	1.27 (1.40)	0.91	0.37
Digit span	0.97 (0.73)	1.34	0.18
Comprehension	0.67 (1.45)	0.46	0.64
Repetition	-2.48 (1.45)	-1.71	0.09
Naming	-0.38 (2.15)	-0.18	0.86
Computation	1.56 (0.60)	2.60	0.01
Judgment	-1.09 (0.65)	-1.70	0.09
Verbal fluency	0.21 (0.29)	0.73	0.47
Delayed word recall	0.35 (0.40)	0.89	0.38
MCAS total score	0.19 (0.16)	1.25	0.21

*All regression coefficients were adjusted for time since study entry, modeled in the logarithmic scale

Functional Decline

The MCAS total score at baseline was significantly associated with slower functional decline in participants with MCI after controlling for time since study entry (p = 0.02, see Table below). Increases in baseline MCAS total scores from 43 to 50 points were associated with 0.59-point decreases in Clinical Dementia Rating Scale-Sum of Box (CDR-SOB) scores at follow-up.
The delayed word recall (DWR) subtest was a very significant (p = 0.001, see Table below) predictor of functional decline of the individual MCAS subtests, with each 1-point increase in baseline DWR score associated with 0.22-point decreases in CDR-SOB scores at follow-up.
The computation subscale was only nominally associated with functional decline (p = 0.01, see Table below), with 1-point increases in baseline computation scores associated with 0.28-point decreases in CDR-SOB scores at follow-up.

Effects of Baseline Minnesota Cognitive Acuity Screen and its Subscales on Annual Clinical Dementia Rating Scale—Sum of Box Score Change in Individuals with Mild Cognitive Impairment*

Subtest	Beta (Std. Error)	Z-Score	P-Value
Orientation	-0.17 (0.25)	-0.69	0.49
Digit span	-0.22 (0.13)	-1.69	0.09
Comprehension	-0.06 (0.26)	-0.24	0.81
Repetition	0.19 (0.31)	0.59	0.56
Naming	-0.36 (0.36)	-1.00	0.32
Computation	-0.28 (0.11)	-2.56	0.01
Judgment	-0.04 (0.13)	-0.31	0.76
Verbal fluency	-0.05 (0.05)	-0.85	0.40
Delayed word recall	-0.22 (0.06)	-3.50	<0.001
MCAS total score	-0.08 (0.03)	-3.22	0.002

*All regression coefficients were adjusted for time since study entry, modeled in the logarithmic scale

Participants with MCI had a 46% lower risk of dementia at any given follow-up time if their MCAS total score was in the third rather than the first sample quartile (hazard ratio = 0.54)

Bibliography

Knopman, D. S., Knudson, D., Yoes, M. E., & Weiss, D. J. (2000). Development and standardization of a new telephonic cognitive screening test: the Minnesota Cognitive Acuity Screen (MCAS). Neuropsychiatry, Neuropsychology, and Behavioral Neurology, 13(4), 286–296.

Margolis, S. A., Papandonatos, G. D., Tremont, G., & Ott, B. R. (2018). Telephone-based Minnesota Cognitive Acuity Screen predicts time to institutionalization and homecare. International Psychogeriatrics, 30(3), 365-373. https://doi.org/10.1017/S1041610217001739

Pillemer, S., Papandonatos, G. D., Crook, C., Ott, B. R., & Tremont, G. (2018). The modified telephone-administered Minnesota Cognitive Acuity Screen for mild cognitive impairment. Journal of Geriatric Psychiatry and Neurology, 31(3), 123–128. https://doi.org/10.1177/0891988718776131

Tremont, G., Papandonatos, G. D., Springate, B., Huminski, B., McQuiggan, M. D., Grace, J., Frakey, L., & Ott, B. R. (2011). Use of the telephone-administered Minnesota Cognitive Acuity Screen to detect mild cognitive impairment. American Journal of Alzheimer's Disease and Other Dementias, 26(7), 555–562. https://doi.org/10.1177/1533317511428151

Tremont, G., Papandonatos, G. D., Kelley, P., Bryant, K., Galioto, R., & Ott, B. R. (2016). Prediction of cognitive and functional decline using the telephone-administered Minnesota Cognitive Acuity Screen. Journal of the American Geriatrics Society, 64(3), 608–613. https://doi.org/10.1111/jgs.13940