Interview For Mental Status Research Articles

IDENTIFYING COGNITIVE IMPAIRMENT WITH PRIMARY CARE IMPLEMENTATION OF THE BRIEF INTERVIEW FOR MENTAL STATUS

Overview: An estimated 5.7 million Americans are affected by Alzheimer’s disease (AD; 2018 Alzheimer’s disease facts and figures, 2018, p. 367). Cognitive impairment fails to be identified in the primary care setting as often as 76% of the time (Moyer, 2014, p. 793). Screening can identify patients with emerging impairment who might otherwise appear cognitively intact Grober, Wakefield, Ehrlich, Mabie & Lipton, 2017, p.191). Early identification of cognitive impairment promotes evaluation of treatable causes (Possin et al., 2018, p. 150), and access to early treatment for irreversible disease, facilitating future planning (Swallow, 2017, pp. 57, 63). Methods: This quantitative study’s aim was to identify patients with occult cognitive impairment. After training staff in a Palm Beach County Florida primary care practice, the Brief Interview of Mental Status (BIMS) was administered to patients aged 45 years and older. Results: Seven of 120 screened patients, with no known AD diagnosis, scored as moderately impaired. One of these patients was 64 years of age, the remaining six ranged from age 71 to 93. Fourteen patients scored at the lowest range of “cognitively intact,” eight were under age 65. Conclusion: Cognitive screening of primary care patients with no known diagnosis of AD identified approximately 7% scoring as moderately impaired; an additional 12% scored at the lowest range of “cognitively intact,” suggesting a potentially emerging cognitive impairment warranting follow up evaluation for treatable causes, developing AD, or a related neurocognitive disorder.

CAN THE BRIEF INTERVIEW OF MENTAL STATUS (BIMS) IDENTIFY RISK FOR IMPAIRED IADLS DUE TO FUNCTIONAL COGNITIVE DEFICITS

The Brief Interview of Mental Status (BIMS) was introduced to the Minimum Data Set (MDS) 3.0 as a cognitive screening tool. It includes temporal orientation and word recall (Saliba et al., 2012). This study examined the ability of the BIMS to identify impairment on performance-based functional cognitive screening tests that assess instrumental activities of daily living (IADLs). We recruited a cross-sectional sample of 200 participants who met the following inclusion criteria: age 55 and older, living independently in the community, and able to read and communicate in English.. Participants ranged in age from 55 to 92 years (Mean 70.96:SD = 8.56),were predominantly White (68%) and female (65%). Participants were administered the BIMS and a battery of performance-based tests of functional cognition -the Performance Assessment of Self Care Skills and the Weekly Calendar Planning Activity (WCPA). There was a mismatch in screening results: Among Individuals identified as cognitively intact on the BIMS 22-45% were found to be impaired on the PASS and/or the WCPA. Sensitivity of the BIMS to identify impaired IADL function did not exceed .06, although specificities were high (< .95). These findings suggest that individuals categorized as cognitively normal by the BIMS may be impaired on more complex IADL tasks. Individuals classified as unimpaired on the BIMS, may benefit from more complex functional cognitive screening to further assess IADLs function to better estimate ability to live independently in the community. Performance based assessments can improve discharge planning by identifying elders at risk after hospitalization.

Is the Brief Interview of Mental Status (BIMS) Adequate to Predict Posthospital Cognitive and Instrumental Activities of Daily Living (IADL) Risk?

Abstract Date Presented 04/05/19 This study was conducted to compare the BIMS to alternate screening measures in the identification of individuals with functional cognition and IADL impairment that may compromise community independence post-hospital-discharge. Findings demonstrate that the BIMS, along with a brief performance-based screening measure and self-report, could better identify individuals who are at risk for poor outcomes in acute or postacute settings. Primary Author and Speaker: Timothy Marks Additional Authors and Speakers: Brittany Nguyen, Courtney Smith, Erika Hoffman, Hayley Engel, Muhammad Al-Heizan, Gordon Giles, Dorothy Farrar Edwards

Cognitive and Functional Status of Persons Newly Enrolled at Dementia-Specific Adult Day Centers and Burden of Their Caregivers.

Background and ObjectivesRecognizing the important role that dementia-specific adult day centers have in maintaining persons with a neurocognitive disorder in their home, this article examines three critical indicators at the time when people first enroll in such a center: cognitive and functional impairment of the enrollee, and burden reported by their family caregivers. We also considered variations in these 3 indicators by race/ethnicity and by the relationship of caregiver to the new enrollee.Research Design and MethodsWe conducted a secondary analysis of data collected by a nonprofit organization operating 11 dementia-specific adult day centers located on the east coast of Florida. Nursing staff conducted intake interviews with enrollees and their caregivers, and assessed functional status within one month of admission. Instruments included the Zarit Burden Scale and components of the Minimum Data Set: the Brief Interview for Mental Status (BIMS) and 4 measures of functional status.ResultsOn average the cognitive scores of newly enrollees were well-within the range indicated for severe impairment, and these levels did not differ by race/ethnicity. Burden reported by caregivers however differed significantly, with Latinx caregivers reporting the greatest burden and African American/Black caregivers reporting the least. Further, while daughters generally reported higher levels of burden than other family caregivers, Black daughters reported the least.Discussion and ImplicationsResults suggest a need for greater dissemination efforts about adult day programs to the Latinx community, as well as attention to the disparate burden placed upon differing family relationships of caregivers to enrollees.

Reliability and Validity of a Functional Cognition Screening Tool to Identify the Need for Occupational Therapy.

The Centers for Medicare & Medicaid Services (CMS) has identified the need to assess functional cognition as part of the postacute care planning process. We examined the reliability, validity, and clinical utility of the Menu Task (MT) as a screening measure of functional cognition to assess the need for occupational therapy services. Cross-sectional study testing a convenience sample of community-dwelling older adults (n = 130) and adults hospitalized for elective orthopedic surgery (n = 60). The MT and four neuropsychological screening tests-the Brief Interview of Mental Status, the Montreal Cognitive Assessment, Trail Making Tests A and B, and an instrumental activities of daily living (IADL) scale-were administered. Community-dwelling participants were tested at the University of Wisconsin occupational therapy program and in community settings. Hospitalized participants were tested at the University of Missouri Orthopedic Institute. We recruited healthy community-dwelling adults in Madison, WI (community sample; n = 130) and patients hospitalized for elective orthopedic surgery in Columbia, MO (hospital sample; n = 60). Inclusion criteria were age 55 yr or older, living in the community, and willingness to be tested in English; for the hospital sample, participants had to be referred for elective orthopedic surgery requiring a hospital stay and be independent in activities of daily living before being admitted for surgery. We found significant differences between groups classified as impaired or not impaired on the basis of MT scores. Participants classified as impaired on the MT performed significantly less well than those classified as not impaired on the neurocognitive and IADL measures. The reliability and validity of the MT were supported. The American Occupational Therapy Association and the occupational therapy experts advising CMS have stressed the importance of a brief performance-based screening tool to identify people who need more comprehensive occupational therapy evaluation. The implementation of a functional cognition screening tool as part of the required CMS assessment protocol should greatly increase the number of patients referred for occupational therapy evaluation and treatment. The MT has the capacity to address the gap in the proposed CMS assessment of Medicare recipients across postacute care settings.

Item-Level Psychometric Properties of the Brief Interview for Mental Status for Patients Discharged to Skilled Nursing Facilities

Abstract Date Presented 4/22/2018 This study examined the item-level psychometric properties of the Brief Interview for Mental Status (BIMS) for patients discharged to a skilled nursing facility. We suggest that rehabilitation practitioners, including occupational therapists, interpret BIMS assessment results cautiously. Primary Author and Speaker: Chih-Ying (Cynthia) Li Additional Authors and Speakers: Brian Downer, Amol Karmarkar, Kenneth Ottenbacher

The construct validity of a new screening measure of functional cognitive ability: The menu task

ABSTRACTThis study evaluated the construct validity of the Menu Task (MT): a new performance-based screening measure of functional cognition. We enrolled 114 community dwelling adults (55 years or older) in the study: all participants completed the MT and four other neuropsychological screening measures. Construct validity was evaluated using a three-step hierarchical regression model with the MT as the dependent variable. Demographic control variables were entered at step 1, followed by the Brief Interview of Mental Status (BIMS), and the Trail Making Test A (TMT A) at step 2, and finally TMT B and the Montreal Cognitive Assessment (MoCA) at step 3. It was hypothesised that measures sensitive to executive functioning (TMT B and MoCA) would significantly explain MT performance after controlling for demographic variables and adding measures of cognitive function to the model, providing additional evidence for construct validity of the MT. All three steps of the model were statistically significant (p < 0.01). Inclusion of measures sensitive to executive function in step 3 explained 30% of variability in MT score (adjusted R2 = 0.30). Our findings provide further empirical support for the construct validity of the MT, and offer implications for the use of the MT in acute and post-acute care settings.

Making Sense of Dementia Screening

Making Sense of Dementia Screening

Cognitive Impairment and Pain Among Nursing Home Residents With Cancer

ContextThe prevalence of pain and its management has been shown to be inversely associated with greater levels of cognitive impairment. ObjectivesTo evaluate whether the documentation and management of pain varies by level of cognitive impairment among nursing home residents with cancer. MethodsUsing a cross-sectional study, we identified all newly admitted U.S. nursing home residents with a cancer diagnosis in 2011–2012 (n = 367,462). Minimum Data Set 3.0 admission assessment was used to evaluate pain/pain management in the past five days and cognitive impairment (assessed via the Brief Interview for Mental Status or the Cognitive Performance Scale for 91.6% and 8.4%, respectively). Adjusted prevalence ratios with 95% CI were estimated from robust Poisson regression models. ResultsFor those with staff-assessed pain, pain prevalence was 55.5% with no/mild cognitive impairment and 50.5% in those severely impaired. Pain was common in those able to self-report (67.9% no/mild, 55.9% moderate, and 41.8% severe cognitive impairment). Greater cognitive impairment was associated with reduced prevalence of any pain (adjusted prevalence ratio severe vs. no/mild cognitive impairment; self-assessed pain 0.77; 95% CI 0.76–0.78; staff-assessed pain 0.96; 95% CI 0.93–0.99). Pharmacologic pain management was less prevalent in those with severe cognitive impairment (59.4% vs. 74.9% in those with no/mild cognitive impairment). ConclusionIn nursing home residents with cancer, pain was less frequently documented in those with severe cognitive impairment, which may lead to less frequent use of treatments for pain. Techniques to improve documentation and treatment of pain in nursing home residents with cognitive impairment are needed.

The Minimum Data Set 3.0 Cognitive Function Scale.

The Minimum Data Set (MDS) 3.0 introduced the Brief Interview for Mental Status (BIMS), a short performance-based cognitive screener for nursing home (NH) residents. Not all residents are able to complete the BIMS and are consequently assessed by staff. We designed a Cognitive Function Scale (CFS) integrating self-report and staff-report data and present evidence of the scale's construct validity. A retrospective cohort study. The subjects consisted of 3 cohorts: (1) long-stay NH residents (N=941,077) and (2) new admissions (N=2,066,580) during 2011-2012, and (3) residents with the older MDS 2.0 assessment in 2010 and the newer MDS 3.0 assessment (n=688,511). MDS 3.0 items were used to create a single, integrated 4-category hierarchical CFS that was compared with residents' prior MDS 2.0 Cognitive Performance Scale scores and other concurrent MDS 3.0 measures of construct validity. The new CFS suggests that 28% of the long-stay cohort in 2011-2012 were cognitively intact, 22% were mildly impaired, 33% were moderately impaired, and 17% were severely impaired. For the admission cohort, the CFS noted 56% as cognitively intact, 23% as mildly impaired, 17% as moderately impaired, and 4% as severely impaired. The CFS corresponded closely with residents' prior MDS 2.0 Cognitive Performance Scale scores and with performance of Activities of Daily Living, and nurses' judgments of function and behavior in both the admission and long-stay cohorts. The new CFS is valuable to researchers as it provides a single, integrated measure of NH residents' cognitive function, regardless of the mode of assessment.

Important Care and Activity Preferences in a Nationally Representative Sample of Nursing Home Residents

ObjectivesPerson-centered care (PCC), which considers nursing home resident preferences in care delivery, has been linked to important outcomes such as improved quality of life, resident satisfaction with care, and mood and reduced behavioral symptoms for residents with dementia. Delivery of PCC fundamentally relies on knowledge of resident preferences. The Minimum Data Set (MDS) 3.0 Preference Assessment Tool (PAT) is a standardized, abbreviated assessment that facilitates systematic examination of preferences from a population of nursing home residents. However, it is unknown how well the PAT discriminates preferences across residents or items. The purpose of this study was to use MDS 3.0 PAT data to describe (1) overall resident preferences, (2) variation in preferences across items, and (3) variation in preferences across residents. DataData from admission MDS assessments between October 1, 2011 and December 31, 2011 were used for this study. SampleA nationally representative sample of 244,718 residents over the age of 65 years who were able to complete the resident interview version of preference, cognition, and depression assessments were included. MeasurementsImportance ratings of 16 daily care and activity preferences were the primary outcome measures. Resident factors including function (MDS Activities of Daily Living-Long Form), depression (Patient Health Questionnaire-9), cognitive impairment (Brief Interview for Mental Status), and sociodemographics (age, race, sex, and marital status) were used as predictors of important preferences. AnalysisOverall preferences were examined using descriptive statistics. Proportional differences tests were used to describe variation across items. Logistic regression was used to describe variation in preferences across residents. ResultsThe majority of residents rated all 16 preferences important. However, there was variation across items and residents. Involvement of family in care and individualizing daily care and activities were rated important by the largest proportion of residents. Several resident factors including cognitive impairment, depression, sex, and race were significant predictors of preferences. ConclusionsFindings demonstrate the PAT captures variation in preferences across items and residents. Residents with possible depression and cognitive impairment were less likely to rate preferences important than residents without those conditions. Non-Caucasian and male residents reported some preferences differently than Caucasian and female residents. Additional assessment and care planning may be important for these residents. More research is needed to determine the factors that influence preferences and the ways to incorporate them into care.

Health literacy, cognition, and urinary incontinence among geriatric inpatients discharged to skilled nursing facilities.

To investigate the association between health literacy and cognition and nursing and patient-reported incontinence in a geriatric inpatient population transitioning to skilled nursing facilities (SNF). Health literacy, depression, and cognition were assessed via the Brief Health Literacy Screen (BHLS), Geriatric Depression Scale 5-item (GDS) and Brief Interview for Mental Status (BIMS), respectively. Multivariable logistic regression assessed the association between BHLS score and incontinence by: (1) nursing-reported urinary incontinence during hospitalization; and (2) patient self-reported "bladder accidents" in the post-enrollment study interview. A total of 1556 hospitalized patients aged 65 and older met inclusion criteria, of whom 922 (59.3%) were women and 1480 had available BHLS scores. A total of 464 (29.8%) and 515 (33.1%) patients had nursing-reported and self-reported urinary incontinence, respectively. Nursing-reported incontinence was significantly associated with lower BHLS (ie, poorer health literacy) (aOR 0.93, 95%CI 0.89-0.99) and BIMS (ie, poorer cognition) (aOR 0.90, 95%CI 0.83-0.97) scores and need for assistance with toileting (aOR 7.08, 95%CI 2.16-23.21). Patient-reported incontinence was significantly associated with female sex (aOR 1.62, 95%CI 1.19-2.21), increased GDS score (ie, greater likelihood of depression) (aOR 1.22, 95%CI 1.10-1.36) and need for assistance with toileting (aOR 2.46, 95%CI 1.26-4.79). Poorer health literacy and cognition are independently associated with an increased likelihood of nursing-reported urinary incontinence among geriatric inpatients transitioning to SNF. Practitioners should consider assessment of health literacy and cognition in frail patients at risk for urinary incontinence and that patient and nursing assessment may be required to capture the diagnosis.

Personas mayores con demencia institucionalizadas: efectos de la musicoterapia versus los talleres de reminiscencia-recreación

Resumen Las personas afectadas de demencia continúan creciendo cada año.. Dentro del marco de la Psicología Positiva, vamos a estudiar los efectos positivos de la musicoterapia en la calidad de vida de las personas con demencia. El Objetivo principal es analizar y comparar los efectos de un programa de musicoterapia (grupo experimental), y un programa de reminiscencia/recreación (grupo control) en personas mayores institucionalizadas. Se analiza el impacto: cognitivo, estado anímico y participación-interacción de individuos en fases moderadas a avanzadas de la demencias. Método: Estudio: Cuasi- experimental. Pre y post test con grupo control. Los Participantes son 24 personas con demencia en fases 5 y 6. Aleatoriamente fueron asignados a un grupo de musicoterapia o de reminiscencia/recreación. Ambos grupos recibieron un total de 12 sesiones, 2 sesiones semanales. Los Instrumentos de medición son: Funcionamiento cognitivo: BIMS (Brief Interview for Mental Status); Escala de autopercepción del estado de ánimo OERS (Observed Emotion Rating Scale); Observaciones de las musicoterapeutas i análisis de videos (sesiones 1, 6, y 12). Los Resultados, se presentaran para cada grupo de estudio así como la comparativa entre grupos. Cabe resaltar que los individuos que participaban en el grupo de musicoterapia tuvieron un gradual aumento en las puntuaciones cognitivas (atención, memoria, orientación temporal) en toda la duración del estudio, mientras que los del grupo de reminiscencias / recreación disminuyó. Las puntuaciones medias de los participantes de ambos grupos indican incrementos positivos del estado de ánimo antes y después de la sesión y un aumento significativo de la interacción entre los participantes. Cabe destacar que disminuyen notablemente las conductas de agitación y apatía en el grupo de demencia avanzada de musicoterapia. Conclusiones: La musicoterapia contribuye a mantener y mejorar aspectos cognitivos, conductuales y socio-emocionales en personas mayores con demencia en fases moderada a avanzada a un nivel superior a la reminiscencia-recreación.Este proyecto ha sido financiado por la FPCEE Blanquerna (URL) y en colaboración con Sanitas Residencial S.L.

Geriatric Syndromes in Hospitalized Older Adults Discharged to Skilled Nursing Facilities.

To determine the prevalence, recognition, co-occurrence, and recent onset of geriatric syndromes in individuals transferred from the hospital to a skilled nursing facility (SNF). Quality improvement project. Acute care academic medical center and 23 regional partner SNFs. Medicare beneficiaries hospitalized between January 2013 and April 2014 and referred to SNFs (N = 686). Project staff measured nine geriatric syndromes: weight loss, lack of appetite, incontinence, and pain (standardized interview); depression (Geriatric Depression Scale); delirium (Brief Confusion Assessment Method); cognitive impairment (Brief Interview for Mental Status); and falls and pressure ulcers (hospital medical record using hospital-implemented screening tools). Estimated prevalence, new-onset prevalence, and common coexisting clusters were determined. The extent to which treating physicians commonly recognized syndromes and communicated them to SNFs in hospital discharge documentation was evaluated. Geriatric syndromes were prevalent in more than 90% of hospitalized adults referred to SNFs; 55% met criteria for three or more coexisting syndromes. The most-prevalent syndromes were falls (39%), incontinence (39%), loss of appetite (37%), and weight loss (33%). In individuals who met criteria for three or more syndromes, the most common triad clusters were nutritional syndromes (weight loss, loss of appetite), incontinence, and depression. Treating hospital physicians commonly did not recognize and document geriatric syndromes in discharge summaries, missing 33% to 95% of syndromes present according to research personnel. Geriatric syndromes in hospitalized older adults transferred to SNFs are prevalent and commonly coexist, with the most frequent clusters including nutritional syndromes, depression, and incontinence. Despite the high prevalence, this clinical information is rarely communicated to SNFs on discharge.

Rapid Cognitive Assessment of Nursing Home Residents: A Comparison of the Brief Interview for Mental Status (BIMS) and Brief Cognitive Assessment Tool-Short Form (BCAT-SF).

In nursing homes, the ability to identify residents with cognitive impairment is critical; however, many providers fail to address symptoms of dementia due to insufficient time to assess cognition. In the current study, the authors compared two rapidly administered instruments, the Brief Interview for Mental Status (BIMS) and Brief Cognitive Assessment Tool-Short Form (BCAT-SF), in predicting specific cognitive stages. Two hundred twenty-five nursing home residents who were referred for neurocognitive evaluation and met inclusion criteria participated in the study. Both cognitive instruments were found to predict cognitive diagnoses generally, but only the BCAT-SF demonstrated sensitivity in differentiating among all cognitive levels. Receiver operating characteristic analyses did not confirm cutoff scores reported in the original BIMS study. However, sensitivity (0.91) and specificity (0.96) values for the BCAT-SF were robust for differentiating between dementia and non-dementia. The BCAT-SF appears to be a more sensitive instrument for predicting cognitive stages than the BIMS for nursing home residents.

Clinical Effectiveness of Assessments of Cognitive Ability for Severely Demented Patients

The Mini Mental State Examination (MMSE) is the most commonly used cognitive assessment in clinical practice. However, in severely demented patients, the MMSE has noted floor effects. The gold standard of cognitive assessment of severely demented patients is the Severe Impairment Battery (SIB) but it takes 20 minutes to administer. The objective of this study is to examine 5 different cognitive assessments, SIB, Severe Impairment Battery-8 (SIB-8), Brief Interview of Mental Status (BIMS), MMSE, and Severe Mini Mental State Examination (sMMSE) to determine the validity and utility of shorter scales for clinical practice based upon scores, time of administration, and the administrator's impression of the patient frustration, comprehension, fatigue, and ability to attend to task.

Story recall and word lists: Differential and combined utilities in predicting cognitive diagnosis

Objectives: Verbal memory assessment metrics are an essential component of cognitive screening tools. We compared the relative utilities of word list and story recall metrics in predicting cognitive functioning in nondemented and demented nursing home patients. We selected memory metrics from the Brief Cognitive Assessment Tool (BCAT) and the Brief Interview for Mental Status (BIMS). The BCAT incorporates both word lists and story recall metrics, while the BIMS only has a word list feature. Method: Two hundred and thirty-nine individuals residing in a Maryland skilled nursing facility were referred for neurocognitive evaluation over a one-year period. These residents met inclusion criteria for retrospective data analysis by completing the BCAT and BIMS and were aged 60 or older. Results: For the entire sample and for demented individuals, all four verbal memory metrics significantly predicted cognitive diagnosis. For nondemented individuals, only the BCAT delayed word list significantly predicted cognitive diagnosis. There appears to be enhanced utility in using both verbal memory metric types, as the inclusion of word list and story recall was a stronger predictor of cognitive diagnosis than any individual verbal memory metric. Conclusion: This study highlights the importance of using cognitive screening tools that contain both story recall and word list metrics. This is particularly true in long-term care settings where the base rate of cognitive impairment is high.

Art and Music Programs Prove Their Worth

Art and Music Programs Prove Their Worth

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

Objectives: In US nursing homes, cognitive assessment has been an essential component of the federally mandated Minimum Data Set assessment system, inclusive of the Brief Interview for Mental Status (BIMS) for identifying possible cognitive impairment. We compare it with the Brief Cognitive Assessment Tool (BCAT) to determine which instrument is more sensitive in differentiating degrees of cognitive functioning in nursing home residents. We attempt to cross-validate the psychometric properties of both measures.Method: Two hundred twenty-nine individuals residing in a Maryland skilled nursing facility were referred for neurocognitive evaluation over a 10-month period. One hundred eighty-nine of these residents met inclusion criteria by completing the BCAT and BIMS, and were aged 60 or older.Results: The BIMS and the BCAT were confirmed to have strong internal consistency reliability and construct validity. Both cognitive tools were found to predict cognitive diagnoses generally, but only the BCAT was able to identify residents at all specific cognitive levels. The BIMS did not differentiate between residents with normal cognition and those with mild cognitive impairment, or between mild and moderate dementia. Both measures demonstrated high specificity and positive predictive values for identifying severe cognitive impairment or probable dementia. The BIMS had lower sensitivity and negative predictive values for identifying dementia compared to the BCAT. The BCAT accounted for an additional 47% of the variance in dementia diagnoses over and above BIMS scores.Conclusion: Based on these findings, the BCAT appears to be more sensitive than the BIMS in predicting cognitive level for nursing home residents.

Effectiveness of the Brief Interview for Mental Status (BIMS) as a Screening Tool for Cognitive Impairment in the Geriatric Heart Failure Population

Cognitive impairment in patients with heart failure is highly prevalent and often under-recognized. As a result of impaired cognition, these patients, who are followed throughout the care continuum, often have difficulty complying with fluid and salt restrictions, medication regimens, and appointments. Noncompliance due to cognitive impairment may reduce patient quality of life and may increase the risk of hospital admissions and readmissions and the risk of mortality due to heart failure. The Brief Interview for Mental Status (BIMS) is used in skilled and long term care facilities to screen for cognitive impairment. There is no accepted brief screening tool for cognitive impairment in heart failure.