Q: Is it OK to change a few things in the KSCAr?
No. The “S” in the KSCAr stands for “Standardized”. This means that everyone must get the same test in order for the norms to apply. The norms are what are used to get the percentiles and any meaningful interpretation of a given individual’s performance. Therefore, in order to be able to interpret a given performance on this test, it must be given exactly “as is”, or in the way it is written.
Q: The people I test need more explanations than the written instructions allow. Can I give them better explanations for the tasks, or say more than what is written down for me?
No. The “S” in the KSCAr stands for “Standardized”. This means that everyone must get the same test in order for the norms to apply. The norms are what are used to get the percentiles and any meaningful interpretation of a given individual’s performance. Therefore, in order to be able to interpret a given performance on this test, it must be given exactly “as is”, or in the way it is written. However, instructions can be repeated.
Q: I’ve found some patients get irritated when I spring the word list memory task on them. Is it OK to warn them about the recall aspects of this task before I show them the words?
The word list recall task is a hard one. It is designed to be that way. People will often complain that they weren’t adequately warned that they would have to remember the words they just read, or some such claim that the test isn’t fair. To begin with, this claim isn’t necessarily true; people tend to perform as well, or as poorly regardless of how much warning they’ve been given.
Secondly, The task is designed to assess recall for a list of words encoded at a similar level of processing as a person would of typical everyday information (we do not get warnings about what is and what is not going to be important to remember later in everyday life). Often providing this explanation to the patient dispels the complaint.
Q: Can I administer parts of the KSCAr, if I don’t have time to give the whole thing?
No. The “S” in the KSCAr stands for “Standardized”. This means that everyone must get the same test in order for the norms to apply. The norms are what are used to get the percentiles and any meaningful interpretation of a given individual’s performance. Therefore, in order to be able to interpret a given performance on this test, it must be given exactly “as is”, or in the way it is written. Giving parts of the test means you can’t use the norms or percentiles. If you really don’t have the time to give the full KSCAr, consider using the BriefKSCA.
Q: Should the KSCA-r be used for diagnosis?
The KSCAr is designed to quickly assess elderly individuals suspected of having a progressive dementia. While it is not diagnostic, the KSCAr alerts the user to the possibility of an existing organic disease process, and raises the question of whether further evaluation is needed. It should never be used alone for the purposes of diagnosis. It is an useful component of a larger diagnostic process, including clinical history, interviews, medical examinations, and other cognitive assessment instruments.
Q: Is it OK to give the KSCAr to a patient who is delirious?
The KSCAr can be given to a patient who is delirious, but the reasons for doing so will be different, and the results more fleeting. Assessing the cognitive status of a delirious patient will provide insights into the impact of delirium on their current cognitive status (i.e., during the period when they are experiencing the symptoms of delirium), but this should not be interpreted as being the level of cognitive functioning overall. Patients should be re-tested after symptoms of delirium have abated.
Q: How much prompting and cuing is acceptable when a patient says they don’t know or that they can’t recall an item?
People often tend to give up more easily than they should, when responding to test items. Prompting once during free recall of word lists is recommended; more than that is not. For example, if a patient says they can’t recall any more words after giving three or four, say, “Take a moment and see if any more words come to mind,” or “What else do you remember from that list?” Pause for a few seconds to see if they can come up with another word or two. Most other subtests should be administered as described.
The hand movements for the Perseveration subtest, part a) also often require more time for patients to observe and attempt before they can do it along with the examiner. Some prompting and cuing is acceptable here, as well. If they stop the movements shortly after the examiner stops (i.e., before they reach the criterion number of 5 repetitions), they should be encouraged to keep going until you tell them to stop.
Q: I’ve found that some people appear to be living alone in the community and doing fine, but their scores on the KSCAr suggest they’re in the severely impaired range. Isn’t the KSCAr a little too sensitive, or ‘drastic’ in its clinical range designations?
The KSCAr is designed as a cognitive screening tool for organic brain damage, not as a scale to assess activities of daily living or independent functioning. Cognitive problems of the sort detectable by the KSCAr are often seen before they translate into functional impairments. Indeed it is highly desirable to detect cognitive problems early, before an individual runs into serious problems with independent functioning. In some cases, a patient may score in the severe range of impairment on the KSCAr, but appear to be functioning much better than that.
The test scores from the KSCAr must always be interpreted in the context of other available clinical information, and not in isolation. It may be that there were aspects of the testing itself that may have yielded an underestimate of the individual’s abilities. Individuals, even at their cognitive best, have a wide range of strengths and weaknesses that the KSCAr can capture.
It may be that the individual was always functioning at a lower level of cognitive abilities, and thus may have established routines and strategies for living with cognitive impairment. It may be that the problems picked up by the KSCAr, indicating the possibilities of organic cognitive impairment are indeed there, but have not affected an individual’s abilities to exist on their own.
One must also examine more closely just how well the individual is actually getting on in the community with a severe cognitive impairment. It may be the impression that they are ‘doing fine’ on their own is where the error is. There is a wide gap between merely surviving, and functioning well within the community.