British Sign Language Cognitive Screening Test

Original Editor - Momina Khalid

Top Contributors - Momina Khalid, Kirenga Bamurange Liliane and Kim Jackson

Introduction[edit | edit source]

The British Sign Language Cognitive Screening Test (BSL-CST) is a screening tool for cognition assessment written in British Sign Language that is used to identify dementia and acquired cognitive impairment in elderly deaf individuals. It can be used to detect neurodegeneration or as a clinical baseline for future comparison. [1]

This test is used to assess acquired cognitive problems only. It is designed to screen all areas of cognition, with items relating to:

  • Memory,
  • Language,
  • Executive function,
  • Visuospatial ability,
  • Orientation, and
  • Attention.

Administration[edit | edit source]

This test takes up to 30 to 45 minutes. The BSL-CST is a clinician operated test with standardised items and video instructions presented through video to the respondent in sign language.

Population[edit | edit source]

  • Older deaf adults aged between 50-89 years are concerned about changes in cognition.
  • Younger deaf adults. [1]

Not Applicable[edit | edit source]

This test cannot be used to measure cognition in deaf adults with developmental and learning disabilities. [1]

Test Procedure[edit | edit source]

It is designed for administration in clinical and community settings, with questions and instructions presented in BSL video format on a laptop and taking 30 to 45 minutes to complete. The respondent views the video and signs his/her response to each test item. The investigator is present during testing and records responses on the score sheet. Clarification is provided where instructions are not understood, and video clips may be repeated. Test sessions are video recorded to enable scoring to be double checked.

Evidence[edit | edit source]

Previous studies have shown that utilising an interpreter for cognitive evaluation is unreliable because hearing oral speakers and deaf signers have different languages and cultures, (Hill-Briggs et al., 2007; Dean et al., 2009).[2]

Atkinson et al. (2015) state that sign language should be used in the development of assessments that are used to determine the cognitive impairments of older adult deaf participants.[3]

Verbal language ability and verbal memory are measured on these tests, and the results are compared to norms from the general population. Since both domains are known to be poor in prelingually deaf people's cognitive profiles, they will necessarily be invalid for deaf individuals. (see Baker & Baker, 2011). [4]

The Mini Mental State Examination (MMSE), the Addenbrookes Cognitive Examination Revised (ACE-R) and Montreal Cognitive Assessment (MoCA) do not translate well to sign language. [3]

Written instructions are not used with Deaf individuals due to their low literacy rates.[5]

BSL video instructions ensured standardized administration, which is impossible to achieve using paper-based tests as BSL has no written form. [5]

Scoring[edit | edit source]

The maximum BSL-CST score of 110 points is composed of seven component scores:

  • Orientation (9 points),
  • Attention (11),
  • Memory (27),
  • Fluency (7),
  • Language (39)
  • Visuospatial/perceptual (11), and
  • Executive function (6). [6]

British Sign Language: Cognitive Screening Test[edit | edit source]


References[edit | edit source]

  1. 1.0 1.1 1.2 DCAL [Internet]. 2015 [cited 2024 Feb 21]. Available from:,impairment%20in%20older%20deaf%20adults. ‌
  2. Hill-Briggs F, Dial JG, Morere DA, Joyce A. Neuropsychological assessment of persons with physical disability, visual impairment or blindness, and hearing impairment or deafness. Archives of clinical neuropsychology. 2007 Mar 1;22(3):389-404.
  3. 3.0 3.1 Atkinson J, Denmark T, Marshall J, Mummery C, Woll B. Detecting cognitive impairment and dementia in deaf people: the British Sign Language cognitive screening test. Archives of Clinical Neuropsychology. 2015 Nov 1;30(7):694-711.
  4. Baker K, Baker F. The Barberry, Vincent Drive, Birmingham. 2. Community Assessment and Treatment Team. International Journal on Mental Health and Deafness [Internet]. 2011 [cited 2024 Feb 22];1. Available from: ‌
  5. 5.0 5.1 Luna S, Joubert S, Gagné J. ADAPTATION OF THE BRITISH SIGN LANGUAGE COGNITIVE SCREENING TEST IN QUéBEC SIGN LANGUAGE. Innovation in Aging. 2017 Jul;1(suppl_1):775-.
  6. Atkinson J, Denmark T, Marshall J, Woll B. Detecting Cognitive Impairment and Dementia in Deaf People: The British Sign Language Cognitive Screening Test [Internet]. ResearchGate. Oxford University Press; 2015 [cited 2024 Feb 21]. Available from: ‌