The Six Item Cognitive Impairment Test (6CIT) was developed in 1983 by regression analysis of the Blessed Information Memory Concentration Scale (BIMC) by Katzman et al in the USA. Other groups have since confirmed validation on several occasions.
It consists of six questions that are simple, non-cultural, and don't require any complex interpretation. Unfortunately the original test had a complex inverse scoring system which we have sought to simplify.
We revalidated this test in the UK and altered the format (6CIT- Kingshill Version 2000©) so that it is now considerably more user friendly
Summary of validation work for the 6CIT
In a validation study (Brooke & Bullock, 1999) the 6CIT was administered to 287 participants. 70 participants had a mild dementia as defined by a Global Deterioration Score (GDS) of between 3-5 (Reisberg et al 1982), 82 had a more severe dementia GDS 6-7 and 135 participants had no dementia. Using a cutoff score of 8 or higher to indicate presence of dementia 90.1% of participants scoring 8 or higher were correctly identified as having dementia (90.1% sensitivity), whilst none scoring less than 8 had dementia (100% specificity).
Analysis of the mild dementia group (GDS 3-5) which is more representative of a screening population showed the 6CIT to have a sensitivity and specificity of 78.6% and 100% respectively at the 7/8 cutoff. This compares very favourably to the Mini Mental State Examination (MMSE) which had a sensitivity and specificity in the same study (at the 23/24 cutoff) of only 51.4% and 100% respectively. Thus when used for screening the MMSE can only be expected to detect 50% of people with dementia compared to just under 80% for the 6CIT.
287 subjects were tested: 135 controls, 70 GDS 3-5, 82 GDS 6-7. Analysis of size of effect: ETA2 = 0.867 giving a power > 90% Correlation of all groups produced a coefficient r2=-0.911 (p<0.01) Correlation of Group 2 only (mild dementia) gives a coefficient r2=-0.754 (p<0.01) 6CIT at a cutoff of 7/8 Sensitivity 78.57% Specificity 100% Positive Predictive Value 100% Negative Predictive Value 83.33%
MMSE at a cut off 23/24 Sensitivity 51.43% Specificity 100%
MMSE at a cut off 25/26 Sensitivity 64.29% Specificity 100%
- The 6CIT is a brief and simple test of cognition.
- The 6CIT correlates highly with the MMSE.
- The 6CIT is more sensitive than the MMSE at detecting mild dementia.
- The 6CIT is a useful tool for cognitive screening in primary care.
- The MMSE is lengthy and has poor sensitivity, rendering it unsuitable for primary care usage
How to perform and score the test
Try to perform the test in a quiet place with no obvious clock or calendar visible to the patient.
Ask The Patient:
- What year it is?
- What month is it?
- Tell the patient that you are going to tell them a fictional address that you would like them to try and memorise and then repeat back to you afterwards.
- Say: John / Brown / 42 / West Street / Bedford
- Make sure that the patient is able to repeat the address correctly before moving on and warn them to try and memorise it as you are going to ask them to repeat it again in a few minutes. No score is made at this stage.
- Ask the patient the time, (they only need to get within 60 minutes of the time to score correctly)
- Ask the patient to count backwards from 20 to 1.
- Ask the patient to say the months of the year backwards starting at December. I tend to give them plenty of time for this and it doesnâ€™t matter if they have to keep saying the months of the year forwards in order to get the answer. Inevitably they sometimes forget where they were, and I sometimes prompt them or offer encouragement that they're doing well.
- Finally ask them to repeat the address back to you. The address is broken into 5 segments and is scored for each error they make in remembering it.
The App will add up the score for you and interpret the result and guide you as to what to do next. You should have a score of between 0 & 28, which should be interpreted as follows:
- 0-7 Probably normal
- 8-28 Significant Cognitive impairment requiring more detailed assessment
Users should be aware that a small subgroup of people with dementia, (especially those with Fronto-Temporal disease) will perform normally on most short cognitive screening tests, therefore, if the tester believes there to be a significant clinical history of cognitive impairment the person should be referred even with a score in the normal range.
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