CAPE (Clifton Assessment Procedures for the Elderly) test and scoring system
CAPE assesses the severity of impairment in mental and behavioural functioning. It was originally devised for use in elderly, long-term psychiatric patients. The CAPE consists of two components, the Cognitive Assessment Scale (CAS) and the Behaviour Rating Scale (BRS).
The CAPE is generally administered by nurses treating a patient and includes a 12-item information and orientation subtest (taking the form of questions such as “what is your date of birth?”), a brief mental abilities test (e.g. “Will you count up from 1 to 20 for me – as quickly as you can?”) and a psychomotor performance test that involves tracing a line through a maze. The time taken for the psychomotor maze test and the number of errors on the other tests are converted into a CAS score out of 12. A cut-off point of 8 is recommended with scores of 7 or less generally indicating dementia or acute organic brain syndrome.
The BRS contains 18 items and is completed by relatives or staff familiar with the patient’s behaviour. It covers physical disability including performance of activities of daily living (ADL s), apathy, communication difficulties and social disturbance. BRS scores range from 0 to 36 with higher scores within this range indicating greater disability.
Scores on the two components are transferred onto a report form that summarises ‘raw’ scores in a five-category grading of the patient’s level of dependency and hence, the support the patient is likely to require.
| CAPE grade | CAPE grading description |
|---|---|
| Grade A | No mental impairment and no significant behavioural disability. |
| Grade B | Mild impairment in both areas requiring some support for people living in the community. |
| Grade C | Medium levels of impairment requiring considerable support for community living. |
| Grade D | Marked impairment and dependency. People in this category are usually institutionalised. |
| Grade E | Maximal impairment typical of psycho-geriatric patients requiring a great deal of nursing attention and care. |
The CAPE has been tested in several studies using large samples of patients. The results show good reliability and high sensitivity and specificity when used with psychiatric inpatients. It has been mainly tested on hospital populations but its performance on ‘community’ samples remains unknown.
The issue has been raised of how to score the CAPE when a patient cannot complete the maze test as a result of blindness or impairment of the hands e.g. by arthritis. The original approach of awarding ‘zero’ may lead to falsely classifying physical difficulties as a cognitive problem; pro-rating the score based on scores in other parts of the CAPE does not work well.
Overall, the CAPE provides reliable estimates of cognitive and behavioural impairment for the institutionalised elderly population. As a screening test for ‘community’ use, the CAPE is considered probably to be less adequate than other available instruments such as the Mini Mental State Examination (MMSE).
