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Dr. William Mansbach October 25, 2011

The New Brief Cognitive Assessment Tool (BCAT): The Role of Cognitive Assessment in Improving Health Outcomes. Dr. William Mansbach October 25, 2011. Aging Population Driving Demand for LTC. Over 65 population projected to double from 36 million in 2003 to 72 million

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Dr. William Mansbach October 25, 2011

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  1. The New Brief Cognitive Assessment Tool (BCAT):The Role of Cognitive Assessment in Improving Health Outcomes Dr. William Mansbach October 25, 2011

  2. Aging Population Driving Demand for LTC Over 65 population projected to double from 36 million in 2003 to 72 million in 2030, and will increase from 12% to 20% of the total population Over 85 population also projected to double from 4.7 million in 2003 to 9.6 million in 2030 Alzheimer’s disease (AD) affects over 5 million Americans, with people 85 and older at the highest risk It is estimated that by 2050, 13 million Americans will have AD Current prevalence rates of dementia in SNF and ALF is at or above 50% Estimated cumulative costs associated with AD alone will exceed $20 trillion between 2010 and 2050

  3. The Cognitive Continuum What are normal cognitive changes? What is MCI? How do you recognize dementia? Common causes of dementia Differentiating dementia or MCI form Delirium

  4. Utility & Value of Cognitive Screening Measures:Some Important Questions What is a cognitive screening tool? Who should be screened? Who should do the screening? What is “early detection”

  5. Utility & Value of Cognitive Screening Measures:Some Specifics Manage expectations: patient, family, caregiver, professional Expand treatment options: medications, non-pharmacological, residential Limit “crisis to crisis” pattern Slow down LTC placement Possibly save money: short-term versus long-term Many patients won’t agree to formal or comprehensive testing

  6. “Always better to manage from a plan rather than from a crisis”

  7. Why a New Cognitive Screening Tool? Mini-Mental State Examination (MMSE) Short Test of Mental Status (STMS) Montreal Cognitive Assessment (MoCA) St. Louis University Mental Status Examination (SLUMS) Brief Interview for Mental Status (BIMS)

  8. The Brief Cognitive Assessment Tool (BCAT) Key Characteristics Can be administered by professionals and paraprofessionals 21 items, 50-point scale Can be administered in 10-15 minutes Has a “cut” score separating dementia from Mild Cognitive Impairment (MCI) Has scores ranges for MCI, mild dementia, & moderate dementia Contains a multi-level verbal memory component Contains a broadly complex executive functions component Predicts Instrumental Activities of Daily Living (IADL) The BCAT website has an automated scoring program

  9. BCAT: The 3 Clusters1. Contextual Memory • Immediate Story Recall • Delayed Story Recall • Story Recognition • Orientation “Carol borrowed $10 from her brother Jack last week. She couldn’t pay him back because she bought a delicious ice cream cone atthe circus.” example

  10. BCAT: The 3 Clusters2. Executive Functions • Verbal Trails (OTMT) • Mental Control (days of the week, backward) • Judgment • Arithmetic Reasoning • Digits Backward “Suppose you have a 1 PM appointment with your doctor. It takes45 minutes to get there. What time is the latest you can leave toget there at 1 PM?” example

  11. BCAT: The 3 Clusters2. Executive Functions • Verbal Trails (OTMT) • Mental Control (days of the week, backward) • Judgment • Arithmetic Reasoning • Digits Backward “You have $25 to spend at the grocery store. You buy milk for $3.You buy 2 apples for a $1. How much money do you have left?” example

  12. BCAT: The 3 Clusters3. AttentionalCapacity • Immediate Word List • Naming • Letter List Banana… Justice… Sara… Bridge… example

  13. Introducing the BCAT Website – www.thebcat.com

  14. BCAT Impact of “Skilled” / Rehab Residents Relationship between cognitive functioning and IADLs The “Cognitive Task Manager” Assist in discharge planning: Can the resident go home? Provide information to enhance outcomes for rehab therapies Educate and counsel families & caregivers Track change in mental status from baseline (Delirium)

  15. Interpreting BCAT Scores “Cut” score separating dementia from Mild Cognitive Impairment is 37/38 How to interpret the Contextual Memory Cluster How to interpret the Executive Functions Cluster How to interpret the Attentional Capacity Cluster

  16. Published BCAT Research 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. Journal of Clinical and Experimental Neuropsychology, 34(2), 183-194.

  17. William E. Mansbach, Ph.D. Founder and CEO, Mansbach Health Tools, LLC Chief Operating Officer, MedOptions wmansbach @ thebcat.com (443) 824-4208

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