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Six-Item Screener (SIS)
Administration: Tell the patient: "I am going to say three words. Please repeat them and try to remember them: Apple, Table, Penny." Once they repeat them, ask the 3 orientation questions, then ask them to recall the 3 words.
Identifying older adults who require a more comprehensive cognitive assessment.
Telephone-based cognitive screening.
The Pure Verbal Screen
Unlike the Mini-Cog which requires the patient to draw a clock, the SIS is entirely verbal, taking less than 1 minute to complete. This makes it ideal for the ED or for patients with severe arthritis or visual impairment.
Section 2
Formula & Logic
Scoring
3 questions assessing orientation (Year, Month, Day of week).
3 questions assessing short-term memory (Recall of 3 words: Apple, Table, Penny).
Total score: 0–6.
Score ≤ 3 indicates cognitive impairment.
Interpretation
Score 4 - 6
Normal. Low probability of significant cognitive impairment.
Score 0 - 3
Abnormal. High probability of cognitive impairment (delirium or dementia). Requires further workup.
Section 3
Pearls/Pitfalls
ED Triage Tool
The SIS is frequently embedded into acute triage protocols (like the TRST) because an abnormal score in the ED immediately flags the patient as high-risk for unsafe discharge, wandering, and inability to understand discharge instructions.
Section 4
Next Steps
Management
Section 5
Evidence Appraisal
Primary Reference
Six-item screener to identify cognitive impairment among potential subjects for clinical research.
Callahan CM et al. • Med Care.. 2002;40(9):771-81. Derived from the MMSE, demonstrating that these 6 items carry the vast majority of the statistical variance for detecting dementia.
Section 6
Origins
Derived from the MMSE
The SIS was derived directly from the MMSE database by identifying the 6 items with the highest diagnostic yield. It was created to provide a statistically rigorous but hyper-abbreviated tool for large epidemiological studies and busy emergency departments.
