BIMS Score Role in Identifying Dementia

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. A BIMS score can range from 0 to 15, with lower scores indicating a decline in cognitive performance.

It is a required screening tool used in nursing homes and other long-term care facilities 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.

This article explains how the BIMS test works. It covers how test results are scored and interpreted, along with how healthcare providers can use the results to tailor your care.

Components of the BIMS Test

There are three sections in the BIMS assessment.

The first section of the BIMS assesses immediate recall. The test administrator will speak three words, like "sock," "blue," and "bed," which you will then repeat back.

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 assesses short-term memory. After the distracting task of orientation questions, you will be asked to recall the three words you had to repeat earlier. If you can't recall the words, you will be given a cue to help trigger the memory, such as "something to wear" to determine if that helps you to recall and say the word "sock."

What BIMS Scores Mean

The BIMS assessment uses a points system that ranges from 0 to 15 points:

• 0 to 7 points suggests severe cognitive impairment.
• 8 to 12 points suggests moderate cognitive impairment.
• 13 to 15 points suggests that cognition is intact.

Test takers begin with zero points and are awarded 1 point for each correct response they give.

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.

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 five years = 0 points
• Missed correct answer by two to five years = 1 point
• Missed correct answer by one 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 six days to one month = 1 point
• Correct answer within five days = 2 points

Identification of the Day of the Week

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

Short-Term Memory Test

The short-term memory test offers a maximum of 6 points. For this section, 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

Interpreting the BIMS Score

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.

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 of the BIMS Score

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. Other methods for predicting cognitive stages are also available.

How BIMS Scores Are Used

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 is typically conducted on a quarterly basis but can be administered more frequently if significant changes are occurring in your condition.

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 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.

Summary

The Brief Interview for Mental Status (BIMS) is an assessment used in nursing homes and other long-term care facilities to monitor cognition. The assessment involves three sections with the ultimate purpose of testing short-term word recall and orientation in time. Test scores range from 0, suggesting severe cognitive impairment, to 15, suggesting intact cognition. The BIMS tests some areas of cognition, but not all. Nonetheless, it is a valuable tool for healthcare providers to identify and treat changes in mental abilities.