BIMS Score Role in Identifying Dementia

9 Questions Used to Monitor Cognitive Decline

BIMS stands for Brief Interview for Mental Status. The BIMS test is used to get a quick snapshot of how well you are functioning cognitively at the moment. It is a required screening tool used in nursing homes to assess cognition. Because the BIMS is given every quarter, the scores can help measure if you're improving, remaining the same, or declining in cognitive ability. 

Components of the Test

The first section of the BIMS tests the ability to repeat information through immediate recall and assesses attention. Three words are spoken to you, and you have to repeat them back to the test administrator. The words are sock, blue and bed. After you repeat the words back to the test giver, the words are stated with cues: sock- something to wear, blue- a color and bed- a piece of furniture.

The second section of the BIMS assesses orientation. You will be asked to identify what month we are in currently, which year it is and what day of the week it is.

The third section of the BIMS tests short-term memory after the distracting task of orientation questions. It asks you to recall the three words you had to repeat earlier. If you can't recall the words, you will be given the cue to help trigger the memory, such as "something to wear" to determine if that helps you be able to recall and say the word "sock."

Scoring the Immediate Recall Test

For the immediate recall test, 1 point is assigned for each of the three words repeated correctly for a maximum of 3 points.

Scoring the Orientation Test

For the orientation test, between 1 and 3 points are assigned for each of the three sections for a maximum of 6 points.

Identification of the year

  • No answer or incorrect by more than 5 years = 0 points
  • Missed correct answer by 2-5 years = 1 point
  • Missed correct answer by 1 year = 2 points
  • Correct answer = 3 points

Identification of the month

  • Missed correct answer by more than one month = 0 points
  • Missed correct answer by 6 days to one month = 1 point
  • Correct answer within 5 days = 2 points

Identification of the Day of the week

  • Incorrect answer = 0 points
  • Correct answer = 1 point

Scoring the Short-Term Memory Test

For the short-term memory test, between 0 and 1 points are assigned for each of three words based on whether you:

  • Are unable to recall the word = 0 points
  • Can recall the word with cues = 1 point
  • Can recall the word without clue = 2 points

The short-term memory test offers a maximum of 6 points.

Interpreting the Result

To reach a final tally, add up the total points from all three tests. The numeric value can be interpreted as follows:

  • 13 to 15 points: intact cognition
  • 8 to 12 points: moderately impaired cognition
  • 0-7 points: severely impaired cogniition

The BIMS is most often used as part of an assessment tool called the Minimum Data Set (MDS) in nursing homes. The BIMS is conducted periodically to assess cognition over time.

While the BIMS is not used to diagnose dementia, it can help identify changes in cognition over time. Significant deterioration of a BIMS score may trigger other, more comprehensive evaluations for dementia.

The BIMS score can also help identify some basic needs of the person. For example, if you are unable to repeat the three words in the first section of the test, perhaps you have a hearing impairment or you are unable to communicate verbally.

Alternately, if you are only able to remember the three words at the end of the test when the cues are provided, this can be a reminder to staff members that offering verbal or visual cues may be helpful in your activities of daily living

Accuracy the BIMS Testing

The BIMS assesses limited areas in cognition and thus it does not give a fully accurate picture of cognition. A person may appear to be higher functioning because the BIMS does not assess other areas of cognition such as executive functioning. However, research does indicate that it is a more reliable way to screen for cognitive functioning than simple observation.

Value of BIMS Testing

If you are in a nursing home—either for long-term care or for rehabilitation on a short-term basis—the BIMS will be administered, typically by a social worker. It typically conducted on a quarterly basis but can be administered more frequently if significant changes are occurring in your condition.

The value of the BIMS testing is that it can monitor for changes in cognition in way that is fast and replicable. Because the responses are less open to interpretation, the results tend to more consistent even if conducted by different testers.

Moreover, it allows caregivers to know when it is time for more active intervention. A decline in score, for example, a 13 to a 9, demonstrates a notable change in mental abilities. A sudden decline in the BIMS score could help point out a condition such as a delirium.

Delirium sometimes develops from infections, including urinary tract infections and pneumonia. Prompt identification and treatment can often partially or fully restore cognitive functioning to its level prior to the delirium.

A Word from Verywell

While you might feel anxious about taking a cognitive screening test, it can be helpful to view the BIMS as a safeguard that helps monitor your cognitive abilities for any changes. If a decline does develop, early identification can help those around you evaluate what might be causing this change and how it might be treated and potentially reversed. 

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