Brief Interview for Mental Status (BIMS): A Cognitive Assessment Tool
The Brief Interview for Mental Status (BIMS) is a validated cognitive screening tool primarily used in nursing homes and post-acute care settings that takes 2-3 minutes to administer, consisting of temporal orientation questions and a three-word recall task, with scores ranging from 0-15 (higher scores indicating better cognitive function). 1
Structure and Administration of BIMS
The BIMS consists of two main components:
- Temporal orientation questions - Assessing awareness of current time and place
- Three-word recall task - Testing short-term memory
The assessment takes approximately 2-3 minutes to complete and is scored on a scale of 0-15 points, with the following interpretation:
- 13-15: Cognitively intact
- 8-12: Moderate cognitive impairment
- 0-7: Severe cognitive impairment 1
Clinical Applications
Primary Settings for Use
- Required in skilled nursing facilities as part of the Minimum Data Set (MDS) 3.0 assessment mandated by the Centers for Medicare and Medicaid Services (CMS) 2, 1
- Post-acute care settings for baseline cognitive assessment
- Long-term care facilities for monitoring cognitive status
Purpose and Utility
- Screening for cognitive impairment in older adults
- Monitoring cognitive changes over time
- Care planning based on cognitive status
- Identifying patients who need additional support or more comprehensive cognitive evaluation 1
Strengths and Limitations
Strengths
- Brief administration time (2-3 minutes) making it practical for routine use
- Standardized scoring for consistent interpretation
- Minimal training required for administration
- Required component of MDS 3.0 assessment in nursing facilities 1
Limitations
- Limited sensitivity for detecting mild cognitive impairment, with research showing low sensitivity (0.257) for mild and moderate (0.384) cognitive impairment 3
- Ceiling effect with more than 40% of patients achieving maximum scores in some studies 4
- Narrow cognitive domain assessment focusing primarily on orientation and memory, without evaluation of executive function, visuospatial abilities, or language skills 1
- Limited ability to distinguish individuals into more than two cognitive levels 4
Comparison to Other Cognitive Assessment Tools
The BIMS is one of several brief cognitive assessment tools available:
- MMSE (Mini-Mental State Examination): More comprehensive but requires copyright permissions; takes 7-10 minutes 2
- MoCA (Montreal Cognitive Assessment): More sensitive for mild cognitive impairment; takes 10-15 minutes 2, 3
- Mini-Cog: Very brief (2-3 minutes) with good sensitivity for dementia 2
- SLUMS (St. Louis University Mental Status): More sensitive than MMSE for detecting MCI; takes 7-10 minutes 2
Research has shown that compared to the MoCA, the BIMS is less effective at predicting rehabilitation outcomes and has lower sensitivity for detecting cognitive impairments 3.
Best Practices for Use
- Use BIMS as an initial screening tool in appropriate settings, particularly nursing homes and post-acute care
- Document baseline performance for future comparison, as serial assessments are more meaningful than single evaluations 1
- Consider more comprehensive testing if there are clinical concerns despite normal BIMS scores
- Interpret with caution in patients with suspected mild cognitive impairment due to limited sensitivity 4
- Evaluate functional status through assessment of ADLs and IADLs alongside cognitive testing 1
- Monitor for changes in cognition at regular intervals (typically every 6-12 months) using the same assessment tool for consistency 1
When Further Evaluation is Needed
Consider more comprehensive cognitive assessment when:
- There are informant reports of cognitive or functional decline
- The patient has risk factors for cognitive impairment
- Behavioral or personality changes are observed
- The patient reports subjective cognitive complaints
- BIMS scores are inconsistent with clinical observations 1
The BIMS serves as a useful initial screening tool in specific settings but should be supplemented with more comprehensive testing when clinically indicated.