The ARCS: A One Minute 47 Second Cognitive Screen
Objective
To describe a novel cognitive screening instrument, the Audio Recorded Cognitive Screen (ARCS), and report on its performance in a mixed clinical sample.
Method
Previously, we demonstrated that cognitive tests could be administered by a tape recorder to unsupervised subjects who write their responses in a booklet for later scoring (Schofield et al. JAGS 2003;3:415). The ARCS represents an extensive revision of the earlier instrument and is administered using a portable CD player. Testing lasts 34 minutes but the time-cost to the clinician is about 2 minutes (for scoring). Diagnoses (normal, mild cognitive impairment (MCI), demented) based on detailed neuropsychological and clinical evaluations were made on 92 outpatients, independent of ARCS and Mini Mental State Examination (MMSE) scores. Here, we compare discriminant validity of the ARCS with the MMSE in this clinical sample.
Results
All 92 patients had been referred to the Neuropsychiatry Service for assessment. Thirty-five were judged to have no cognitive impairment, 34 MCI, and 23 dementia. In Analyses of Variance with bonferroni correction (F 2,89=38.9, p<.001), mean global score derived from the ARCS was significantly different for each of the 3 diagnostic groups. By contrast, group mean MMSE score (F 2,89=13.9, p<.001) differed between dementia and both normal and MCI groups, but not between normal and MCI groups. Mean scoring time for 10 randomly selected ARCS response booklets was 1 minute 47 seconds.
Conclusion
The ARCS is highly efficient for the clinician and appears to have considerably better psychometric properties than the MMSE.