Blessed Information-Memory-Concentration Test (BIMC)

Abstract

The Blessed Information-Memory-Concentration Test (BIMC), first published by Blessed, Tomlinson, and Roth in 1968, is a foundational brief screening instrument designed to quantitatively assess cognitive decline. It was originally developed to correlate clinical measures of dementia severity with post-mortem neuropathological findings in elderly patients. The test evaluates three primary cognitive domains—orientation (Information), immediate and remote recall (Memory), and mental manipulation (Concentration)—yielding a total score used to classify the degree of cognitive impairment, ranging from normal to severe.

A later, condensed version, often referred to as the Short Orientation-Memory-Concentration Test (SOMC) or the Modified Blessed Test, was validated by Katzman et al. in 1983. Both versions remain widely used in geriatric medicine and psychological research for rapid screening and longitudinal monitoring of cognitive status.

Keywords

Blessed Test, BIMC, cognitive impairment, dementia, geriatric assessment, memory screening, orientation, concentration, Blessed-Roth Dementia Scale, psychological scale.

Authors

G. Blessed, B.E. Tomlinson, M. Roth (1968); R. Katzman, T. Brown, P. Fuld, et al. (Modification, 1983).

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Purpose

The primary purpose of the BIMC is to provide a standardized, objective measure of mental status deterioration, specifically targeted at identifying and quantifying cognitive deficits associated with senile changes in the brain. The original work aimed to establish an association between behavioral measures of dementia and quantitative measures of cerebral grey matter pathology in elderly subjects.

In clinical practice, the BIMC and its shorter variants serve as efficient screening tools, allowing healthcare professionals to quickly assess a patient’s level of orientation, ability to recall information, and capacity for focused attention, thereby helping to distinguish between normal aging and pathological cognitive impairment.

Construct

The BIMC is structured around three core psychological constructs, each designed to tap into different aspects of global cognitive function that are typically compromised in neurodegenerative conditions:

• Information: Measures orientation in time and place, as well as general knowledge and recognition of common persons/roles. This reflects the subject’s awareness of their immediate environment and basic facts.
• Memory: Assesses both personal (autobiographical) and non-personal remote memory, alongside immediate and delayed verbal recall (e.g., the name and address phrase). This evaluates the integrity of both long-term and short-term memory systems.
• Concentration: Evaluates attention, sequencing, and working memory capacity through tasks requiring mental manipulation, such as counting backwards and reciting the months of the year in reverse order.

Validity

The BIMC demonstrates strong construct and criterion validity, particularly in its original context of correlating clinical scores with neuropathological findings. Blessed et al. (1968) established its foundational validity by linking higher scores (greater impairment) directly to greater senile changes in the cerebral grey matter.

Furthermore, the BIMC has shown high correlational validity when compared to other established cognitive screening tools. Studies, such as those by Thal et al. (1986) and Fillenbaum et al. (1987), demonstrated a significant correlation between the BIMC (and its modified version) and the widely used Mini-Mental State Examination (MMSE) in patients with Alzheimer’s disease, confirming its utility as an accurate measure of cognitive status.

Reliability

The BIMC is generally considered a highly reliable instrument for assessing cognitive status in older adults. Studies focusing on test-retest and inter-rater reliability have supported its consistent performance in diverse settings.

For instance, Lesher and Whelihan (1986) specifically investigated the reliability of mental status instruments, including the BIMC, when administered to nursing home residents. Their findings reinforced the BIMC’s status as a reliable measure, suggesting its scores are stable across different administrations and consistent across different assessors, making it suitable for routine clinical monitoring.

Factor Analysis

While the original 1968 paper focused on correlating the total score with anatomical pathology, the structure of the BIMC inherently suggests a multi-factor model comprising Information/Orientation, Memory, and Concentration. Subsequent clinical use and validation studies treat these three areas as distinct, yet correlated, cognitive factors that contribute cumulatively to the overall assessment of cognitive impairment. The distinct scoring for each section (e.g., 17 points for Information, 15 for Memory, 5 for Concentration in the full version) reflects the differential weighting of these factors in the overall assessment.

Instrument

Test Type: Performance-based screening test, clinical interview.

Format: Structured interview format, administered orally by a clinician or trained technician. The full version includes 26 items covering orientation, memory, and attention/concentration.

Language Available: Primarily English (UK and US versions exist with slight modifications, e.g., Monarch vs. President).

Population Group: Clinical populations being screened for dementia, particularly in hospital, nursing home, or research settings.

Age Group: Elderly subjects (typically 65 years and older).

Population Details: Originally validated on institutionalized elderly populations; later used extensively in community and clinical samples for diagnosing and tracking neurodegenerative disorders.

Test Methodology: Items are scored 0 (correct) or 1 (incorrect), except for the 5-minute recall item, which scores up to 5 points. The total score ranges from 0 (no impairment) to 37 (severe impairment). The score is a reverse score, meaning a higher numerical score indicates greater cognitive deficit.

Scoring Interpretation (Reverse Scoring):

• 0 to 8: Normality or minimal impairment.
• 9 to 19: Moderate impairment.
• 20 to 37: Severe impairment.

Keywords

Blessed Information-Memory-Concentration Test, SOMC, Alzheimer’s screening, geriatric psychiatry, cognitive assessment, mental status exam, neurocognitive disorder.

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Authors

Author ORCID Identifier: N/A (Information not available in source material).

Affiliation Email addresses: N/A (Information not available in source material).

Correspondence Address: N/A (Information not available in source material).

Permissions & Fee and Test Year

The original test was published in 1968 (Blessed et al.) and the widely used modification by Katzman et al. was published in 1983. As a foundational academic instrument published decades ago, the BIMC is frequently used in clinical and academic settings without specific fees, though its use should always be cited appropriately.

The instrument documentation can be found online, including the following links cited in the source material. The original PDF describing the context of use is available here: www.a4ebm.org/sites/default/files/Measuring Health.pdf. Additional documentation is available here: http://web.stanford.edu/~ashford/MMSgenealogy/Several tests.doc.

Reference’s

• Blessed. G.‚ Tomlinson‚ B.E.‚ Roth‚ M. (1968). The association between quantitative measures of dementia and of senile change in the cerebral grey matter of elderly subjects. Br J Psychiatry‚ 114:797–811.
• Katzman‚ R.‚ Brown‚ T.‚ Fuld‚ P.‚ et al. (1983). Validation of a Short Orientation-Memory-Concentration Test of cognitive impairment. Am J Psychiatry‚ 140:734–739.
• Lesher‚ E.L.‚ Whelihan‚ W.M. (1986).Reliability of mental status instruments administered to nursing home residents. J Consult Clin Psychol‚ 54:726–727.
• Thal‚ L.J.‚ Grundman‚ M.‚ Golden‚ R. (1986). Alzheimer’s disease: a correlational analysis of the Blessed Information-Memory-Concentration Test and the Mini-Mental State Exam. Neurology‚ 36:262–264.
• Fillenbaum‚ G.G.‚ Heyman‚ A.‚ Wilkinson‚ W.E‚ et al. (1987). Comparison of two screening tests in Alzheimer’s disease: the correlation and reliability of the Mini-Mental State Examination and the modified Blessed Test. Arch Neurol‚ 44:924–927.
• Blessed. G.‚ Tomlinson‚ B.E.‚ Roth‚ M.(1988). Blessed-Roth Dementia Scale (DS). Psychopharmacol Bull‚ 24:705–708.
• McDowell‚ Ian. (2006). Measuring Health: A Guide to Rating Scales and Questionnaires‚ Third Edition. OXFORD UNIVERSITY PRESS.

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Items of the Blessed Information-Memory- Concentration Test (BIMC)

Blessed Information-Memory- Concentration Test (BIMC)

Blessed‚ 1968

Information Test

• Name (1)
• Age (1)
• Time (hour) (1)
• Time of day (1)
• Day of week (1)
• Date (1)
• Month (1)
• Season (1)
• Year (1)
• Place—Name (1)
• Place—Street (1)
• Place—Town (1)
• Type of place (e.g.‚ home‚ hospital‚ etc.) (1)
• Recognition of persons (cleaner‚ doctor‚ nurse‚ patient‚ relative; any two available) (2)

Memory Test

1. Personal

• Date of birth (1)
• Place of birth (1)
• School attended (1)
• Occupation (1)
• Name of sibs or Name of wife (1)
• Name of any town where patient had worked (1)
• Name of employers (1)

2. Non-personal

• Date of World War I (1) *
• Date of World War II (1) *
• Monarch (1) **
• Prime Minister (1) ***

3. Name and address (5-minute recall) (5)

Concentration Test

• Months of year backwards (2 1 0)
• Counting 1–20(2 1 0)
• Counting 20–1 (2 1 0)

1. Name

2. Age

3. When born

4. Where born

5. Name of this place

6. What street is it on

7. How long have you been here (How long today)

8. Name of this city

9. Today’s date

10. Month

11. Year

12. Day of week

13. Part of day

14. Time (Best guess)__________ (Actual time:_______)

15. Season

Repeat this phrase after me: John Brown‚ 42 Market Street‚ Chicago.

16. Mother’s first name

17. Name of one school you attended

18. What kind of work have you done

19. Who is the president now

20. Who was the last president

21. Date of World War I

22. Date of World War II

23. Months of the year backwards. (Start with December) D N O S A Jl Jn M Ap M F Ja

24. Count from 1 to 20

25. Count backwards 20 to 1: 20 19 18 17 16 15 14 13 12 11 10 9 8 7 6 5 4 3 2 1

26. Recall name and address: John Brown‚ 42 Market St.‚ Chicago (Cue with “John Brown” only. Score up to 5 errors)

Score each item “1” for incorrect response‚ “0” for correct response (except Item 26)

Katzman et al‚ 1983 (Short Orientation-Memory-Concentration Test)

1. What year is it now?
2. What month is it now?

Repeat this phrase after me: John Brown‚ 42 Market Street‚ Chicago

3. About what time is it? (within 1 hour)
4. Count backwards 20 to 1
5. Say the months in reverse order (start with December)
6. Repeat the memory phrase

Scores for correct responses shown; incorrect responses score 0.

* 1/2 point for approximation within 3 years

** President in U.S. version

*** Vice President in U.S. version

Reverse scores range from 0 (no impairment) to 37 (severe impairment) where a positive score is given to each correct answer. Score from 0 to 8 indicate normality/ minimal impairment; 9 to 19 indicate moderate impairment; 20 to 37 indicate severe impairment.