CST

BSL Cognitive Screening Test

What is it?

The BSL CST is a screening tool for assessing cognition designed wholly in British Sign Language, to help detect dementia and acquired cognitive impairment in older deaf adults. It is designed to screen all areas of cognition, with items relating to memory, language, executive function, visuospatial ability, orientation and attention. It can be used detect neurodegeneration, or as a clinical baseline for future comparison.

What is involved?

This is a 30-45 minute test. It is designed to be administered by qualified clinical psychologists with a good level fluency in BSL because responses must be understood in BSL and recorded on a scoresheet. Clinicians may have to give additional test prompts in BSL. It is not validated for use via BSL interpreters.

The BSL Cognitive Screening Test is a wholly clinician-operated test, with standardised items and video instructions presented via video to the respondent in BSL. The clinician operates the test and enters response data. Once data is entered, a test report will be generated.

Who is it suitable for?

  • Older deaf adults aged 50-89 years where there is concern about a change in cognition. It may also be administered to younger deaf adults but there are no norms for younger age groups.
  • This test CANNOT be used for measuring cognition in deaf adults with developmental or learning disabilities. It is designed for assessing acquired cognitive problems only.

What normative data is available?

Older deaf adults aged 50 – 89 years for four age-bands: 50-59,60-69, 70-79, 80-89.

Who should use this test?

  • This test should only be used by qualified clinicians, who are fluent in BSL, with the supervision of a qualified clinical psychologist who is skilled in test interpretation.
  • Use of this test for diagnosis of dementia, neurodegenerative disorders, or acquired or developmental memory difficulties must be done in the context of full medical diagnostic workup, detailed clinical history, neuroimaging and medical tests. Other neuropsychological testing should also be used for diagnostic workup and differential diagnosis.

Test citation

Atkinson, J., Denmark, T., Marshall, J., Mummery, C., & Woll, B. (2015). Detecting Cognitive Impairment and Dementia in Deaf People: The British Sign Language Cognitive Screening Test. Archives of Clinical Neuropsychology.

Download Paper

Instructions

Respondents watch video instructions and questions in BSL on the screen. There are no English language requirements.

Please note that this test is not suitable for users of signed languages other than BSL.

Controlling the test

The test administrator should retain control of the computer at all times. Do not let the respondent operate the video control panel.

Download the scoresheet and response sheet

You will need to download and complete these for each test respondent.

Download the scoring guide

You will need to refer to this during scoring.

Equipment required

  • Pen
  • Table top
  • A drinking straw and a thin candle – such as a birthday candle. You will show these objects to the respondent during the Object Recognition task.
  • A stopwatch for recording quadrants in the Animal Fluency Tasks.

Recording the responses

The administrator must download the scoresheet and record responses using a pen. The scoresheet includes additional information relevant for clinical interpretation and should be completed carefully.

You may wish to video record the responses for the following items, so you can double-check your scoring afterwards:

  • BSL Production
  • BSL Sentence Repetition
  • Animal Fluency

The scoresheet provides reminders for when to turn your camera on. Videoing is recommended but may not be essential once you are very familiar with the test scoring.

Providing additional prompts

The test administrator may need to provide additional prompts in BSL. Please refer to the scoresheet for detailed directions.

Using the response sheets

The following items require the respondent to draw on the response sheets:

  • Copying Overlapping Pentagons
  • Copying Wire Cube
  • Alternating Trails

You will use the blank sheet of paper for:

  • Clock Drawing

You can also use the same sheet for folding during the:

  • Three-Stage Command Task

Be ready to hand over the appropriate response sheet at the right times during the assessment. The scoresheet and video provide visual reminders for these items.

Only allow the respondent to interact with one sheet at a time. Do not give them all pages in advance. Once completed, remove the response sheet and hide it from view to avoid distraction.

Entering scores

At the end of the session, scores should be entered by the administrator to generate the report, which includes the test score and age-related percentile.

Administering the test using a BSL–English interpreter

The test is normed only for administration by fluent BSL users, and the norms may not be valid when an interpreter translates BSL responses to English.

If an interpreter is used, include caveats in the clinical write-up. If you cannot sign fluently, refer the person for a specialist assessment conducted directly in BSL.

For more information, contact joanna.atkinson@ucl.ac.uk.

Ensuring you are qualified to administer

A clinical psychology qualification or supervision from a qualified clinical psychologist is essential.

Use additional tests in conjunction with the BSL CST

It is recommended to use the BSL Verbal Learning and Memory Test and the Modified Digit Span Tests with the BSL CST.

Downloads

Please download the following materials before administering the BSL Cognitive Screening Test (CST).


Format

Data is generated in CSV format for easy import into your preferred data management software

Task data

A separate CSV file is generated for each participant. Each contains the raw data including the order in which the items were presented and the score for each item.

Accuracy data

The overall maximum score for each trial is 12.



For questions related to this test, please contact the task owner, Jo Atkinson.