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Name: ______________________________________________________
DOB: _________________________________________________________
Gender: Female / Male
Education: ______________________________________________
Examiner: ______________________________________________
ORIENTATION
Year Month Day/Week State City Situation
Today’s Date: _____________________________________________
Total Score: _______________________________________
Cut Score: 37/38 (dementia < 37; non-dementia > 38)
IMMEDIATE VERBAL RECALL
BANANA JUSTICE SARA BRIDGE(Instructions: Score Only 1st Trial) 1st Trial
2nd Trial
VISUAL RECOGNITION/NAMING
ATTENTION
Letter List: (Instructions: Read Letters, Instructing Patient to Tap with Hand at Each Letter C; No Errors=1 Point, Error=0 Points) C F B T O L C C Q A Z C B R B Q W D C S B L R B C B Z X C B
Mental Control: (Instructions: Count Backward from 20-1) (Instructions: Recite Days of the Week Backward from Sunday)
Digits: FORWARD 2 5 9 7 4 5 1 7 8 9 6
BACKWARD 6 2 7 4 1 8 9
LANGUAGE
Repeat: (Instructions: No Errors=1 Point, Error=0 Points) “Michael married Marie’s mother.”
Fluency: (Instructions: Girl Names/60 Seconds; X > 15 = 2 points, X = 8-14 = 1 point, X < 7 = 0 points)
ABSTRACTION
(Instructions: Find the Similarities) Apple - Orange Train - Boat Book - Newspaper
POINTS
_______ / 6
_______ / 4
_______ / 3
_______ / 1
_______ / 1_______ / 1
_______ / 2
_______ / 2
_______ / 3
_______ / 1
_______ / 2
BCAT® Test Enlarged Images
BCAT® All Rights Reserved. | William Mansbach, Ph.D.
7067 Columbia Gateway DriveSuite 180Columbia, MD 21046
e: info@thebcat.come-fax: 855.850.8661w: thebcat.com
Name: ______________________________________________________
DOB: _________________________________________________________
Gender: Female / Male
Education: ______________________________________________
Examiner: ______________________________________________
ORIENTATION
Year Month Day/Week State City Situation
Today’s Date: _____________________________________________
Total Score: _______________________________________
Cut Score: 37/38 (dementia < 37; non-dementia > 38)
IMMEDIATE VERBAL RECALL
BANANA JUSTICE SARA BRIDGE(Instructions: Score Only 1st Trial) 1st Trial
2nd Trial
VISUAL RECOGNITION/NAMING
ATTENTION
Letter List: (Instructions: Read Letters, Instructing Patient to Tap with Hand at Each Letter C; No Errors=1 Point, Error=0 Points) C F B T O L C C Q A Z C B R B Q W D C S B L R B C B Z X C B
Mental Control: (Instructions: Count Backward from 20-1) (Instructions: Recite Days of the Week Backward from Sunday)
Digits: FORWARD 2 5 9 7 4 5 1 7 8 9 6
BACKWARD 6 2 7 4 1 8 9
ABSTRACTION
(Instructions: Find the Similarities) Apple - Orange Train - Boat Book - Newspaper
POINTS
_______ / 6
_______ / 4
_______ / 3
_______ / 1
_______ / 1_______ / 1
_______ / 2
_______ / 2
_______ / 3
® All Rights Reserved | William Mansbach, Ph.D. | www.thebcat.com
BCAT® Test Enlarged Images
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