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Six-Item Cognitive Impairment Test (6CIT)

  • Tim M. Gale
  • Andrew J. Larner

Abstract

The Six-item Cognitive Impairment Test (6CIT) was designed to assess global cognitive status in dementia. Developed in the 1980s as an abbreviated version of the 26-item Blessed Information-Memory Concentration Scale, the 6CIT is an internationally used, and well-validated, screening tool. It was designed principally for use in primary care, but has also found application in secondary care settings. It has been compared favorably to the Mini-Mental State Examination (MMSE) due to its brevity and ease of use, and there are data to suggest that it is now used more frequently than the MMSE in primary care settings. Some evidence suggests that it outperforms the MMSE as a screening tool for dementia, especially in its mildest stage. The 6CIT has been translated into many different languages. It comprises six questions; one memory (remembering a 5-item name and address), two calculation (reciting numbers backwards from 20 to 1 and months of the year backwards) and three orientation (year, month, and time of day). The time taken to administer 6CIT is approximately 2 min, which compares favorably to other screening instruments. However this brevity has also been seen as disadvantageous, with the suggestion that more features of dementia can be detected using more comprehensive screening tools. Criticisms that the scoring system is too complex have been raised, but distribution of 6CIT with computer software may go some way to resolving this. In summary, the 6CIT is a brief, validated screening tool that may be preferable to the MMSE. Since a typical UK primary care consultation stands at only 7.5 min, the brevity and simplicity of the scale are its greatest advantages.

Keywords

Dementia Alzheimer’s Disease Cognitive Impairment Test Screening 

References

  1. 1.
    Katzman R, Brown T, Fuld P, Peck A, Schechter R, Schimmel H. Validation of a short orientation memory concentration test of cognitive impairment. Am J Psychiatry. 1983;40:734–9.Google Scholar
  2. 2.
    Blessed G, Tomlinson BE, Roth M. The association between quantitative measures of dementia and of senile change in the cerebral grey matter of elderly subjects. Br J Psychiatry. 1968;114:797–811.CrossRefPubMedGoogle Scholar
  3. 3.
    Brooke P, Bullock R. Validation of a 6 item cognitive impairment test with a view to primary care usage. Int J Geriatr Psychiatry. 1999;14:936–40.CrossRefPubMedGoogle Scholar
  4. 4.
    Morris JC, Heyman A, Mohs RC, Hughes JP, Van Belle G, Fillenbaum G, Mellits ED, Clark C. The Consortium to Establish a Registry for Alzheimer’s Disease (CERAD). Part 1. Clinical and neuropsychological assessment of Alzheimer’s disease. Neurology. 1989;39:1159–65.CrossRefPubMedGoogle Scholar
  5. 5.
    Folstein MF, Folstein SE, McHugh PR. “Mini-Mental State”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatric Res. 1975;12:189–98.CrossRefGoogle Scholar
  6. 6.
    Larner AJ. Six-Item Cognitive Impairment Test: suitable for the visually impaired? Prog Neurol Psychiatry. 2015;19(6):20–2.CrossRefGoogle Scholar
  7. 7.
    Lee DY, Yoon JC, Lee KU, Jhoo JH, Kim KW, Lee JH, Woo JI. Reliability and validity of Korean version of Short Blessed Test (SBT-K) as a dementia screening instrument. J Korean Neuropsychiatr Assoc. 1998;38:1365–75.Google Scholar
  8. 8.
    Nasreddine Z. Short clinical assessments applicable to busy practices. CNS Spectr. 2008;13(10 Suppl 16):6–9.CrossRefPubMedGoogle Scholar
  9. 9.
    Petersen RC, Smith GE, Waring SC, Ivnik RJ, Tangalos EG, Kokmen E. Mild cognitive impairment: clinical characterization and outcome. Arch Neurol. 1999;56:303–8.CrossRefPubMedGoogle Scholar
  10. 10.
    Wind AW, Schellevis FG, Van Staveren G, Scholten RP, Jonker C, Van Eijk JT. Limitations of the Mini-Mental State Examination in diagnosing dementia in general practice. Int J Geriatr Psychiatry. 1997;12:101–8.CrossRefPubMedGoogle Scholar
  11. 11.
    Godbolt AK, Cipolotti L, Watt H, Fox NC, Janssen JC, Rossor MN. The natural history of Alzheimer disease: a longitudinal presymptomatic and symptomatic study of a familial cohort. Arch Neurol. 2004;61:1743–8.CrossRefPubMedGoogle Scholar
  12. 12.
    White N, Scott A, Woods RT, Wenger GC, Keady JD, Devakumar M. The limited utility of the Mini-Mental State Examination in screening people over the age of 75 years for dementia in primary care. Br J Gen Pract. 2002;52:1002–3.PubMedPubMedCentralGoogle Scholar
  13. 13.
    Copeland JR, Dewey ME, Griffiths-Jones HM. A computerized psychiatric diagnostic system and case nomenclature for elderly subjects: GMS and AGECAT. Psychol Med. 1986;16:89–99.CrossRefPubMedGoogle Scholar
  14. 14.
    Ismail Z, Rajji TK, Shulman KI. Brief cognitive screening instruments: an update. Int J Geriatr Psychiatry. 2010;25:111–20.CrossRefPubMedGoogle Scholar
  15. 15.
    Milne A, Culverwell A, Guss R, Tuppen J, Whelton R. Screening for dementia in primary care: a review of the use, efficacy and quality of measures. Int Psychogeriatr. 2008;20:911–26.CrossRefPubMedGoogle Scholar
  16. 16.
    Fisher CAH, Larner AJ. Frequency and diagnostic utility of cognitive test instrument use by GPs prior to memory clinic referral. Fam Pract. 2007;24:495–7.CrossRefPubMedGoogle Scholar
  17. 17.
    Menon R, Larner AJ. Use of cognitive screening instruments in primary care: the impact of national dementia directives (NICE/SCIE, National Dementia Strategy). Fam Pract. 2011;28:272–6.CrossRefPubMedGoogle Scholar
  18. 18.
    Cagliarini AM, Price HL, Livemore ST, Larner AJ. Will use of the Six-Item Cognitive Impairment Test help to close the dementia diagnosis gap? Aging Health. 2013;9:563–6.CrossRefGoogle Scholar
  19. 19.
    Wojtowicz A, Larner AJ. General Practitioner Assessment of Cognition: use in primary care prior to memory clinic referral. Neurodegener Dis Manag. 2015;5:505–10.CrossRefPubMedGoogle Scholar
  20. 20.
    Ismail Z, Mulsant BH, Herrmann N, Rapoport M, Nilsson M, Shulman K. Canadian Academy of Geriatric Psychiatry survey of brief cognitive screening instruments. Can Geriatr J. 2013;16:54–60.CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Barua A, Kar N. Screening for depression in elderly Indian population. Indian J Psychiatry. 2010;52:150–3.CrossRefPubMedPubMedCentralGoogle Scholar
  22. 22.
    Broderick K. Correlation between scores on two screening tools for dementia in Xhosa women. S Afr J Occup Ther. 2002;32:8–13.Google Scholar
  23. 23.
    Upadhyaya AK, Rajagopal M, Gale TM. 6 Item Cognitive Impairment Test (6-CIT) as a screening test for dementia: comparison with Mini-Mental State Examination (MMSE). Curr Aging Sci. 2010;3:138–42.CrossRefPubMedGoogle Scholar
  24. 24.
    Larner AJ. Implications of changing the Six-item Cognitive Impairment Test cutoff. Int J Geriatr Psychiatry. 2015;30:778–9.CrossRefPubMedGoogle Scholar
  25. 25.
    Tuijl JP, Scholte EM, de Craen AJM, van der Mast RC. Screening for cognitive impairment in older general hospital patients: comparison of the Six-Item Cognitive Impairment Test with the Mini-Mental State Examination. Int J Geriatr Psychiatry. 2012;27:755–62.CrossRefPubMedGoogle Scholar
  26. 26.
    Hessler J, Bronner M, Etgen T, Ander KH, Forstl H, Poppert H, Sander D, Bickel H. Suitability of the 6CIT as a screening test for dementia in primary care patients. Aging Ment Health. 2014;18:515–20.CrossRefPubMedGoogle Scholar
  27. 27.
    Abdel-Aziz K, Larner AJ. Six-item Cognitive Impairment Test (6CIT): pragmatic diagnostic accuracy study for dementia and MCI. Int Psychogeriatr. 2015;27:991–7.CrossRefPubMedGoogle Scholar
  28. 28.
    Larner AJ. Effect size (Cohen’s d) of cognitive screening instruments examined in pragmatic diagnostic accuracy studies. Dement Geriatr Cogn Dis Extra. 2014;4:236–41.CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Larner AJ. Short performance-based cognitive screening instruments for the diagnosis of mild cognitive impairment. Prog Neurol Psychiatry. 2016;20(2):21–6.Google Scholar
  30. 30.
    Brodaty H, Low LF, Gibson L, Burns K. What is the best dementia screening instrument for general practitioners to use? Am J Geriatr Psychiatry. 2006;14:391–400.CrossRefPubMedGoogle Scholar
  31. 31.
    Larner AJ. Speed versus accuracy in cognitive assessment when using CSIs. Prog Neurol Psychiatry. 2015;19(1):21–4.CrossRefGoogle Scholar
  32. 32.
    Larner AJ. Performance-based cognitive screening instruments: an extended analysis of the time versus accuracy trade-off. Diagnostics (Basel). 2015;5:504–12.Google Scholar
  33. 33.
    Cannon P, Larner AJ. Errors in the scoring and reporting of cognitive screening instruments administered in primary care. Neurodegener Dis Manag. 2016;6:271–6.Google Scholar
  34. 34.
    Mitchell AJ, Malladi S. Screening and case-finding tools for the detection of dementia. Part I: evidence-based meta-analysis of multidomain tests. Am J Geriatr Psychiatry. 2010;18:759–82.CrossRefPubMedGoogle Scholar
  35. 35.
    Randall A, Larner AJ. Late-onset cerebellar ataxia: don’t forget SCA17. Eur J Neurol. 2016;23(Suppl1):696 (abstract P31191).Google Scholar
  36. 36.
    Yaffe K, Weston AL, Blackwell T, Krueger KA. The metabolic syndrome and development of cognitive impairment among older women. Arch Neurol. 2009;66:324–8.CrossRefPubMedPubMedCentralGoogle Scholar
  37. 37.
    Sander K, Bickel H, Förstl H, Etgen T, Briesenick C, Poppert H, Sander D. Carotid-intima media thickness is independently associated with cognitive decline: the INVADE study. Int J Geriatr Psychiatry. 2010;25:389–94.CrossRefPubMedGoogle Scholar
  38. 38.
    Etgen T, Sander D, Huntgeburth U, Poppert H, Förstl H, Bickel H. Physical activity and incident cognitive impairment in elderly persons: the INVADE Study. Arch Intern Med. 2010;170:186–93.CrossRefPubMedGoogle Scholar
  39. 39.
    Carpenter CR, Bassett ER, Fischer GM, Shirshekan J, Galvin JE, Morris JC. Four sensitive screening tools to detect cognitive dysfunction in geriatric emergency department patients: brief Alzheimer’s Screen, Short Blessed Test, Ottawa 3DY, and the caregiver-completed AD8. Acad Emerg Med. 2011;18:374–84.CrossRefPubMedPubMedCentralGoogle Scholar
  40. 40.
    O’Caoimh R, Molloy W. Brief dementia screens in clinic: comparison of the Quick mild cognitive impairment (Qmci) screen and Six item Cognitive Impairment Test (6CIT). Ir J Med Sci. 2014;183(Suppl7):379.Google Scholar
  41. 41.
    Larner AJ. Population-based screening for dementia: a role for 6CIT? Prog Neurol Psychiatry. 2016;20(2):35.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2017

Authors and Affiliations

  1. 1.Research & Development DepartmentHertfordshire Partnership NHS Foundation TrustAbbots LangleyUK
  2. 2.School of Life and Medical Sciences, University of HertfordshireHatfieldUK
  3. 3.Research & Development DepartmentHPFT Learning & Development CentreHatfield, HertsUK
  4. 4.Cognitive Function Clinic, Walton Centre for Neurology and NeurosurgeryLiverpoolUK

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