BIMS Score Role in Identifying Dementia

The Brief Interview for Mental Status Test as Part of the MDS

Using the BIMS to Test for Dementia 150666792.jpg
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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. It is a required screening tool used in nursing homes 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.

 

What Does the BIMS Test Contain?

The first section of the BIMS tests the ability to repeat information through immediate recall and assesses attention. Three words are spoken to you, and you have to repeat them back to the test administrator. The words are sock, blue and bed.  After you repeat the words back to the test giver, the words are stated with cues: sock- something to wear, blue- a color and bed- a piece of furniture.

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

How Is the BIMS Scored?

Scoring is as follows:

Immediate Recall (Ability to Repeat) Section:

  • 1 point for each of the three words initially repeated correctly: Total of 3 possible points

Orientation Section:

Identification of Year-

  • No answer or incorrect by more than 5 years = 0 points
  • Missed correct answer by 2-5 years = 1 point
  • Missed correct answer by 1 year = 2 points
  • Correct answer = 3 points

Identification of Month-

  • Missed correct answer by more than one month = 0 points
  • Missed correct answer by 6 days to one month = 1 point
  • Correct answer within 5 days = 2 points

Identification of the day of the week-

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

The Orientation section has a total of 6 possible points.

Short-Term Memory Section:

For each of the three words, give 0 points if the word could not be recalled, 1 point for each word that was recalled with cues and 2 points for each word recalled correctly without cues.

The Short-Term Memory Section has a total of 6 possible points.

In order to score the test, add up the total points.

  • 13-15 points: the person is intact cognitively.
  • 8-12 points: the person is moderately impaired.
  • 0-7 points: the person is severely impaired.

How is the BIMS Used?

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. It is not used to diagnose dementia but it can help track and compare changes over time. Significant deficits in the BIMS may trigger other, more comprehensive, cognitive assessments to assess for dementia.

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. Or, if you're 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

How Accurate is the BIMS?

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 that he is because the BIMS does not assess other areas of cognition such as executive functioning. However, research on the BIMS does indicate that it is a more reliable way to screen for cognitive functioning than simple observation.

The goal of the BIMS is to provide a low-burden way (low in cost and time) to monitor for changes in cognition and based on clinical observation, it appears to be fairly effective in accomplishing this goal.

Why Does It Matter?

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 the social worker. You can ask facility staff how you scored on the BIMS. The BIMS is typically conducted on a quarterly basis but can be administered more frequently if significant changes are occurring in your condition.

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 a 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.

A Word from Verywell

While you might feel anxious about taking a cognitive screening test, it can be helpful to view the BIMS as a safeguard that helps monitor your cognitive abilities for any changes. If a decline does develop, early identification can help those around you evaluate what might be causing this change and how it might be treated and potentially reversed

Sources:

American Association of Post-Acute Care Nursing. CMS’s RAI Version 3.0 Manual . https://www.aanac.org/docs/mds-3.0-rai-users-manual/11118_mds_3-0_chapter_3_-_section_c_v1-12.pdf?sfvrsn=6​

The BCA: Home of the Brief Cognitive Assessment. Ask the BCAT Faculty: Accuracy Concerns with the BIMS Assessment Screen

Centers for Medicare and Medicaid Services. The MDS 3.0. January 2008. 

Maine Department of Human Services. Section C Cognitive Patterns (BIMS). August 2010. 

Maryland Medicaid Website.  Long Term Care Resources. Brief Interview for Mental Status (BIMS) - Form & Instructions.