Brief Alzheimer Screen (BAS)

       DATE           TIME (24hr) 

I would like to ask you some questions to check your memory.

I am going to say three words. After I have said them, I want you to
repeat them. Remember what they are because I am going to ask you to name
them again in a few minutes.

They are: "PEN", "TABLE", "ORANGE".

Could you please repeat these for me?
The items should be read at a rate of 1 per second, speaking clearly and audibly.
You are allowed to read the words only once before scoring.
Score on first trial
right / wrong
   1. "PEN"
   2. "TABLE"
   3. "ORANGE"
                            IMMEDIATE RECALL 
Repeat the words until: 1) the subject correctly repeats all three or
2) 3 total trials have been presented (including initial presentation).
After the subject has said them once correctly, ask:
    "Please repeat them once more so you will remember them."
   4. Repeats correctly on second request

   5. What is the date today? (score for day of the month, +/-2 days is acceptable)
                            DATE 

NAMING:

6.  In 30 seconds, name as many animals as you can, GO: (stop after 30 seconds)

Ready, GO: (click to start ->) (0) []

You may click the numbers or use the right arrow to advance the count or the left arrow to reduce it.
  0 []
  1 []        2 []       3 []       4 []       5 []
  6 []        7 []       8 []       9 []     10 []
11 []     12 []     13 []     14 []     15 []
16 []     17 []     18 []     19 []     20+ []

                            CATEGORY FLUENCY 

SPELLING / REVERSE SPELLING:
Now, I am going to give you a word and ask you to spell it forwards and then
backwards. The word is "WORLD." Spell "WORLD" forwards.
If the subject is unable to spell the word, spell it outloud, and ask the subject to repeat the
spelling. Continue until it has been spelled successfully or until you have spelled it to the
subject three times.

right / wrong
   7. Spells World forwards  (score right only if correct on first trial)

Now spell the word "WORLD" backwards:
right / wrong
   8.   D
   9.   L
   10. R
   11. O
   12. W              "DLROW" TOTAL 
Score 5 points for a correct sequence. Count 1 error for each omission, letter transposition (switching
adjacent letters), insertion (inserting a new letter), or misplacemeent (moving W,O,R,L,D by more than one
space).

RECALL:
Now, what were the three words I asked you to remember?
(This should administered as soon as the naming item is completed.
Cueing is allowed if the subject is not able to recall words,
but credit is not given for any word recalled after a cue.)
right / wrong
   13. "PEN"
   14. "TABLE"
   15. "ORANGE"
                            DELAYED VERBAL RECALL 

TEXT FOR YOUR RECORDS:
- To copy text, highlight all text (hit "Ctrl-A") or text to be copied, then hit "Ctrl-C".
- To paste into your patient's record, position the cursor then hit "Ctrl-V"

BAS = 3 x R + 2/3 x A + 4.75 x D + 2 x S
(Brief Alzheimer Screen, maximum score = 37)

27 - 37   normal, depending on age, education, complaints
23 - 26   possible impairment
0 - 22   probable impairment

Start TIME (24hr):      End TIME (24hr):      Total Time (seconds): 

BAS - developed by Marta Mendiondo, Ph.D., Wes Ashford, M.D., Ph.D., Richard Kryscio, Ph.D., Frederick A. Schmitt, Ph.D.
Designing a Brief Alzheimer Screen (BAS). J Alzheimers Dis. 2003 Dec 5:391-398.
ABSTRACT
PDF

See this link for powerpoint slides of Dementia and Alzheimer Screening, with BAS data.
See this link for earlier neuropsychiatric examination elements,
See this link for journal article addressing need for dementia screening.
See this link for ACNP poster on cost-worthiness calculations

Electronic form developed by Medafile.com
There is no individual or agency that takes responsibility for the results obtained
with this test or this form.