Cambridge Cognition Examination (CAMCOG)

Purpose of the measure

The Cambridge Cognition Examination (CAMCOG) is the cognitive and self-contained part of the Cambridge Examination for Mental Disorders of the Elderly (CAMDEX). The CAMCOG is a standardized instrument used to measure the extent of dementia, and to assess the level of cognitive impairment. The measure assesses orientation, language, memory, praxis, attention, abstract thinking, perception and calculation (Roth, Tym, Mountjoy, Huppert, Hendrie, Verma, et al., 1986).

Available versions

The CAMCOG was developed in 1986 by Roth, Tym, Mountjov, Huppert, Hendrie, Verma and Godddard. In 1999, Roth, Huppert, Mountjoy and Tym reviewed it and then published the CAMCOG-R. In 2000, de Koning, Dippel, van Kooten and Koudstall shortened the 67 items of the CAMCOG to 25 items, known as the Rotterdam CAMCOG (R-CAMCOG).

Features of the measure

Items:
The CAMCOG consists of 67 items, including the 19 items from the Mini Mental State Examination (MMSE) (Folstein, Folstein, & McHugh, 1975). It is divided into 8 subscales: orientation, language (comprehension and expression), memory (remote, recent and learning), attention, praxis, calculation, abstraction and perception (de Koning, van Kooten, Dippel, van Harskramp, Grobbee, Kluft, et al. 1998).

The orientation subscale is comprised of 10 items taken from the MMSE. In the language subscale, comprehension is assessed through nonverbal and verbal responses to spoken and written questions, and expression is assessed through tests of naming, repetition, fluency and definitions. The memory subscale assesses remote memory (famous events and people), recent memory (news items, prime minister, etc.), and learning (the recall and recognition of non-verbal and pictorial information learned incidentally as well as intentionally). Attention is assessed by serial sevens and counting backwards from 20. Praxis is assessed by copying, drawing, and writing as well as carrying out instructions. In the calculation subscale, the client is asked to perform an addition and a subtraction question involving money. For the abstraction subscale, the client is asked about similarities between an apple and a banana, a shirt and a dress, a chair and a table, and a plant and an animal. In the perception subscale, the client is asked to identify photographs of famous people and familiar objects from unusual angles, in addition to the tactile recognition of coins (Huppert, Jorm, Brayne, Girling, Barkley, Bearsdall et al., 1996).

The number of scored items for each subscale is as follows (de Koning et al., 1998; Huppert et al., 1996).

CAMCOG subscales Number of scored items
Orientation 10
Language
Comprehension
Expression
9
8
Memory
Learning
Recent
Remote
3
4
6
Concentration 2
Praxis 8
Calculation 2
Perception 3
Abstraction 4
Number of scored items 59

Items related to aphasia or upper extremity paresis may not be tested in all clients and depend on stroke severity.

Detailed administration guidelines are in the CAMCOG manual that can be obtained from the Cambridge University Department of Psychiatry.

Scoring:
The CAMCOG total score ranges from 0 to 107. Scores lower than 80 are considered indicative of dementia (de Koning et al., 1998; Roth et al., 1986). Among the 67 CAMCOG items, 39 are scored as ‘right’ or ‘wrong’; 11 are scored on a 3-point scale with ‘wrong’, ‘right to a certain degree’ or ‘completely right’ as response options; 9 items encompass questions or commands, and the score for each item is the sum of the correct answers; and finally 8 items are not scored. Five of the non-scored items are from the MMSE and they are not included in the total score because they are assessed in more detail by other CAMCOG items. The remaining 3 items are optional during the examination (de Koning, Dippel, van Kooten, & Koudstall, 2000; Huppert et al.,1996).

The maximum score per subscale is as follows (Huppert et al., 1996):

CAMCOG subscales Number of scored items
Orientation 10
Language
Comprehension
Expression
9
21
Memory
Learning
Recent
Remote
17
4
6
Concentration 4
Praxis 12
Calculation 5
Perception 11
Abstraction 8
Maximum Total Score 107

Time:
The CAMCOG takes 20 to 30 to administer and the R-CAMCOG takes 10 to 15 minutes to administer (de Koning et al, 1998; de Koning et al., 2000; Huppert et al., 1996).

Subscales:
The CAMCOG is comprised of 8 subscales:

  • Orientation
  • Language: subdivided into comprehensive and expressive language
  • Memory: subdivided into remote, recent and learning memory
  • Attention
  • Praxis
  • Calculation
  • Abstraction
  • Perception

Equipment:
The CAMCOG requires no specialized equipment. Only the test and a pencil are needed to complete the assessment.

The CAMCOG requires specialized equipment that are enclosed within its manual. The manual can be purchased from the Cambridge University Department of Psychiatry.

Alternative forms of the CAMCOG
  • Revised CAMCOG (CAMCOG-R):
    Published in 1999 by Roth, Huppert, Mountjoy and Tym, the CAMCOG-R improved the ability of the measure to detect certain types of dementia and to make clinical diagnoses based on the ICD-10 and DSM-IV. This version includes updated items from the remote memory subscale and the addition of items to assess executive function (Leeds, Meara, Woods & Hobson, 2001; Roth, Huppert, Mountjoy & Tym, 1999).
  • Rotterdam CAMCOG (R-CAMCOG):
    Published in 2000, the R-CAMCOG is a shortened version of the CAMCOG with 25 items. It takes 10 to 15 minutes to administer and is as accurate as the CAMCOG in screening for post-stroke dementia (de Koning et al., 2000).
  • General Practitioner Assessment of Cognition (GPCOG):
    Published in 2002 to be used in primary care settings, the GPCOG contains 9 cognitive and 6 informant items that were derived from the Cambridge Cognitive Examination, the Psychogeriatric Assessment Scale (Jorm, Mackinnon, Henderson, Scott, Christensen, Korten et al. 1995) and the instrumental Activities of Daily Living Scale (Lawton & Brody, 1969). The GPCOG takes 4 to 5 minutes to administer and appears to have a diagnostic accuracy similar to the Mini-Mental State Examination (Folstein, Folstein, & McHugh, 1975) in detecting dementia (Brodaty, Pond, Kemp, Luscombe, Harding, Berman et al., 2002).
Client suitability

Can be used with:

  • Clients with stroke
  • Clients with different types of dementia

Should not be used with:

  • The CAMCOG should not be used with clients with severe cognitive impairment.
  • Items related to aphasia and upper extremity paresis might not be tested on all clients and appropriate use depends on stroke severity.
In what languages is the measure available?

English and Dutch (de Koning et al., 2000).