Brief Interview for Mental Status (BIMS) Calculator

This Brief Interview for Mental Status (BIMS) calculator checks the resident cognitive impairment and whether further intervention is required for dementia diagnosis. Below the form you can find instructions on how to perform the test and how to interpret the results.


Part I – Repetition of three words

Inform the resident that you are going to say three words and that he or she needs to remember the words and to repeat them. Say the three words: sock, blue and bed. Ask the resident to reproduce the three words and note the number after the first attempt:

Part II – Temporal orientation

A. Ask the resident what year is it right now and report their answer:
B. Ask the resident what month we are in at the moment and report their answer:
C. Ask the resident what day of the week is today and report their answer:

Part III – Recall

Tell the resident that you are going back to the earlier question and ask them to say the words that they were asked to repeat. If they are unable to remember a word, provide cues such as “something to wear”,” a color”, “a piece of furniture”.
A. Able to recall “sock”
B. Able to recall “blue”
C. Able to recall “bed”

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How does this Brief Interview for Mental Status (BIMS) Calculator work?

This is a health tool that aims to determine the subject’s attention, level of orientation and ability to recall information and helps clinicians and medical professional diagnose and plan decisions.

Being a structured evaluation, this Brief Interview for Mental Status (BIMS) calculator gives the assessor the opportunity to observe the overall condition of the subject and look for any signs and symptoms of mental decay.

This form is a required screening tool used in nursing homes all over the world to assess cognition and is performed on a quarterly basis usually but more frequently if particular cases demand it.

There are studies that have shown that BIMS has highly contributed to a decrease in incorrect diagnosis of cognitive impairment and a more specific detection of delirium.

The BIMS is more reliable than simple observation but one of the major criticisms received by it concerns the fact that it doesn’t assess cognition on a whole and it doesn’t evaluate in any way executive functions.

In a particular case, a decline in score of even 1 to 2 points is indicative of a notable change in mental status. Sudden declines of significant points may indicate that delirium is being installed.

The assessment consists of three stages:

■ Part I – Repetition of three words (one item) by informing the resident that you are going to say three words and that he or she needs to remember the words and to repeat them. After saying the words, the resident needs to reproduce them and is assessed based on accuracy.

■ Part II – Temporal orientation (three items). The resident is asked to recall temporary coordinates in terms of year, month and current day of the week. After each question, the resident is given 30 seconds and then expected the answer. The assessor then evaluates how accurate the answers were and notes the right amount of points.

■ Part III – Recall (three items). The assessor notes whether the resident was able to recall any or all the words from part I, with or without cues and awards a specific number of points to each of the three situations. The assessor is advised to wait for 5 seconds for the spontaneous recall and then use the cue.

BIMS score interpretation

Each of the items discussed above is awarded a number of points, ranging from 0 to 3, depending on the answer choice. Unlike most questionnaires where the higher the score, the more severe the situation, BIMS items are scored 0 for cognitive impairment situations and 3 for intact cognitive response.

Therefore when summing the items for the result, scores between 0 and 7 indicate severe cognitive impact, scores between 8 and 12, moderate impairment while scores above 13 show little to no impairment.

The evaluation is used to detect cognitive impairment at a preliminary stage and should be followed by other investigations and a dementia diagnosis should only be put after an elaborate assessment of the patient’s cognitive performance.

Often the score is correlated to others scales such as the MMSE (Mini-Mental State Exam) or residents might be referred to the Geriatric Depression Scale (GDS) in case certain aspects of their behaviour surface.

It is important to emphasize situations when the result of the assessment might be incorrect due to the extreme frailty, hearing impairment or lack of interaction from otherwise cognitively intact subjects.

At the same time abrupt changes in behaviour and mental status, such as delirium might indicate an underlying condition and the care plan should be personalized.

References

1) Mansbach WE, Mace RA, Clark KM. (2014) Differentiating levels of cognitive functioning: a comparison of the Brief Interview for Mental Status (BIMS) and the Brief Cognitive Assessment Tool (BCAT) in a nursing home sample. Aging Ment Health; 18(7):921-8.

2) Saliba D, Buchanan J, Edelen MO, Streim J, Ouslander J, Berlowitz D, Chodosh J. (2012) MDS 3.0: brief interview for mental status. J Am Med Dir Assoc; 13(7):611-7.

20 Nov, 2015