Brief Interview For Mental Status (BIMS)

BIMS explained

The Brief Interview for Mental Status (BIMS) is a structured evaluation aimed at evaluating aspects of cognition in elderly patients. The three parts of the assessment look at:

■ Patient attention;

■ Level of orientation;

■ Ability to recall information.

The use of BIMS has contributed to a decrease in incorrect diagnosis of cognitive impairment and a more specific detection of dementia and delirium.

The method is now performed on a quarterly basis in nursing homes all over the world.

There are three assessment stages in the BIMS assessment:

■ During part I, the patient is asked to repeat three words that are to be given by the assessor. The accuracy of the word reproduction is assessed. Also, the patient is informed that they will need to remember the words at a later moment during the evaluation.

■ During part II, temporal orientation is evaluated by asking the patient to recall temporary coordinates (current year, month and day of the week). These are to be asked in separate questions and about 30 seconds are to be given for response.

■ During part III the patient is asked to recall the three words given in part I. If needed, cues may be given after waiting for 5 seconds for spontaneous recall.

The main criticism of the method refers to the fact that it doesn’t assess cognition as a whole and cannot evaluate executive functions.

Result interpretation

Each of the seven items that BIMS consists of, is awarded a number of points ranging from 0 to 3. The higher the score, the lower the impairment to the cognitive response. Scores closer to 0 indicate severe cognitive impact whilst scores closer to 15 indicate an intact cognitive response:

In some cases, due to extreme frailty, hearing impairment or lack of interaction during the assessment, the result may not accurately reflect the cognitive status of the patient.

Between subsequent evaluations, a decline in score of even 1 to 2 points shows a notable mental status change.

This type of evaluation is an initial one and should be followed by more specialized investigations, especially for dementia diagnosis.

The BIMS is correlated with results from other scales such as the MMSE (Mini-Mental State Exam). If the elderly patient also displays behavioural symptoms linked to depression, they may be referred to take the Geriatric Depression Scale (GDS).

Very serious and time abrupt changes in behaviour and mental status (e.g. delirium) may indicate an underlying condition.

References

1. Saliba D, Buchanan J, Edelen MO, Streim J, Ouslander J, Berlowitz D, Chodosh J. MDS 3.0: brief interview for mental status. J Am Med Dir Assoc. 2012; 13(7):611-7.

2. Mansbach WE, Mace RA, Clark KM. 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. Aging Ment Health. 2014; 18(7):921-8.