6CIT Calculator (Six Item Cognitive Impairment Test)

6CIT explained

The 6CIT is a brief dementia screening tool commonly used in primary care. The Kingshill Research Centre, Swindon, UK owns the copyright to The Kingshill Version 2000 of the 6CIT but allows free usage to healthcare professionals.

The test takes about 5-10 minutes to administer and consists of:

• Three orientation items (current year, month and time);
• Counting backwards from 20;
• Stating the months of the year in reverse;
• Reproducing a learned address.

The 6CIT is a relatively newer test compared to the Abbreviated Mental Test (AMT). While it shows promise for cultural and linguistic adaptability with favorable probability statistics, its more complex scoring system presents a limitation. Additionally, further large-scale population studies would be beneficial to validate its use.

Scoring the 6CIT

This dementia screening instrument uses an inverse score and the questions are weighted so to produce a total score ranging between 0 and 28. Scores of 0-7 are considered normal and 8 or more significant.

The test has demonstrated high sensitivity, without compromising specificity, even in mild dementia, at the 7/8 cut-off:

• Overall figures - sensitivity = 90%, specificity = 100%;
• in mild dementia - sensitivity = 78%, specificity = 100%.

For diagnosis purposes other instruments should be employed and not relied upon entirely on the 6CIT for diagnosis. Also, when cognitive impairment is present, consider alternative diagnoses, including treatable causes.

About the original study and validations

The 6CIT was developed in 1983 by regression analysis of the Blessed Information Memory Concentration Scale (BIMC).

The short administration time of the 6CIT, suggests it may be useful when assessing or monitoring cognitive impairment in busy memory clinics, though larger samples are required to evaluate.

There was a positive correlation between scores on the 6-item test and plaque counts obtained from the cerebral cortex of 38 subjects at autopsy. This test, which is easily administered by a nonphysician, has been shown to discriminate among mild, moderate, and severe cognitive deficits.

The 6CIT has been further validated in secondary care settings for the diagnosis of dementia and mild cognitive impairment (MCI) and has been compared to the simultaneously administered Mini-Mental State Examination.

In a study by Abdel-Aziz K and Larner AJ, 6CIT had good sensitivity (0.88) and specificity (0.78) for dementia diagnosis; it was more sensitive than MMSE (0.59) but less specific (0.85). For MCI diagnosis, 6CIT was again more sensitive (0.66) than MMSE (0.51) but less specific (0.70 vs. 0.75).

In another validation study by O’Sullivan et al. it was shown that 6-CIT and 4AT accurately exclude delirium and dementia in older ED attendees. 6-CIT does not require collateral history but has lower PPV for delirium.

References

Original reference

Katzman R, Brown T, Fuld P, Peck A, Schechter R, Schimmel H. Validation of a short Orientation-Memory-Concentration Test of cognitive impairment. Am J Psychiatry. 1983; 140(6):734-9.

Validation

Brooke P, Bullock R; Validation of a 6 item cognitive impairment test with a view to primary care usage. Int J Geriatr Psychiatry. 1999; 14(11):936-40.

O'Sullivan D, O'Regan NA, Timmons S. Validity and Reliability of the 6-Item Cognitive Impairment Test for Screening Cognitive Impairment: A Review. Dement Geriatr Cogn Disord. 2016; 42(1-2):42-9.