What is the BIMS?
The Brief Interview for Mental Status (BIMS) is a performance-based cognitive screening tool developed by the Centers for Medicare & Medicaid Services (CMS) as part of the Minimum Data Set (MDS) 3.0. It was designed to replace staff-assessed cognitive items with a direct patient interview, improving accuracy and giving residents a voice in their own assessment.
The BIMS assesses two core cognitive domains: temporal orientation (awareness of the current year, month, and day) and short-term recall (ability to remember three words after a brief delay). It takes approximately 3–5 minutes to administer and requires no special equipment.
BIMS Components & Scoring
| Component | Question | Max Points | Scoring |
|---|---|---|---|
| Year | "What year is it?" | 3 | 3 = correct; 2 = off by 1 year; 1 = off by 2–5 years; 0 = off by >5 or no answer |
| Month | "What month is it?" | 2 | 2 = within 5 days; 1 = off by 6 days to 1 month; 0 = off by >1 month or no answer |
| Day of Week | "What day of the week is it?" | 1 | 1 = correct; 0 = incorrect or no answer |
| Recall: Sock | "What were those three words? (sock)" | 2 | 2 = no cue needed; 1 = recalled after cue; 0 = not recalled |
| Recall: Blue | "(blue)" | 2 | 2 = no cue needed; 1 = recalled after cue; 0 = not recalled |
| Recall: Bed | "(bed)" | 2 | 2 = no cue needed; 1 = recalled after cue; 0 = not recalled |
Interpretation
| Score | Category | Description |
|---|---|---|
| 13 – 15 | Cognitively Intact | No significant cognitive impairment detected |
| 8 – 12 | Moderately Impaired | Moderate cognitive impairment; further assessment recommended |
| 0 – 7 | Severely Impaired | Severe cognitive impairment; comprehensive evaluation needed |
Cognitive Status Classification
How to Administer the BIMS
- Introduce the task: "I am going to say three words for you to remember. Please repeat them after me."
- Say the words: "SOCK... BLUE... BED." Say each word clearly. If the patient cannot repeat all three, repeat the list (up to two additional times).
- Ask orientation questions: "What year is it right now?" "What month are we in?" "What day of the week is it?"
- Ask for recall: "Now, what were those three words I asked you to remember?" If the patient cannot recall a word, provide the category cue (e.g., "It was something to wear" for sock).
- Score each response according to the criteria above and sum the total.
BIMS and MDS 3.0
The BIMS is a required component of the MDS 3.0 assessment (Section C: Cognitive Patterns). It is used in:
- Skilled Nursing Facilities (SNFs) – for all residents at admission, quarterly, and annually
- Home Health – OASIS-E includes cognitive assessment items
- Inpatient Rehabilitation – IRF-PAI assessment
If a resident is unable to be interviewed (comatose, severe aphasia, or refusal), the staff assessment (CAM or CPS) should be used instead, and the BIMS is coded as "could not be completed."
BIMS vs. MMSE
| Feature | BIMS | MMSE |
|---|---|---|
| Time to administer | 3–5 minutes | 10–15 minutes |
| Max score | 15 | 30 |
| Domains assessed | Orientation, recall | Orientation, recall, attention, language, visuospatial |
| Cost | Free (public domain) | Copyrighted (requires license) |
| Training required | Minimal | Moderate |
| Correlation | BIMS correlates well with MMSE (r = 0.85–0.91) | |
Frequently Asked Questions
What if the patient can't be interviewed?
If the patient cannot participate due to coma, severe aphasia, hearing loss, or refusal, the BIMS cannot be completed. In MDS 3.0, use the Staff Assessment for Mental Status (items C0700–C0900) instead and code Section C0100 as "no" (interview not attempted or could not be completed).
How often should the BIMS be administered?
In nursing facilities, the BIMS is administered at admission, quarterly, annually, and with any significant change in status. It can also be administered more frequently if clinically indicated.
What is a "cue" in the recall section?
A cue is a category hint given if the patient cannot spontaneously recall a word. The standard cues are: "something to wear" (sock), "a color" (blue), "a piece of furniture" (bed). A cued response scores 1 point, while spontaneous recall scores 2 points.
Can the BIMS diagnose dementia?
No. The BIMS is a screening tool that identifies cognitive impairment but does not diagnose specific conditions like dementia, delirium, or depression. A low score should trigger referral for comprehensive neuropsychological evaluation.