Journal of Aging Research in scores on orientation. Alternatively, the diﬀerences in orientation may be an artifact of the sample, since there is no evidence in the research literature to suggest that diﬀerences in orientation should exist between cognitive screens. Replications of this study using larger or more diverse samples may elucidate these ﬁndings. Unfortunately, neither measure has an alternate form available for use with those individuals with visual impair- ment or those with illiteracy. These same challenges exist for the majority of cognitive screens and many neuropsy- chological test instruments that are currently available (i.e., many rely heavily on visual and verbal abilities; e.g., Boston Naming Test) constituting a problem for the ﬁeld of neuropsychology as a whole. In a recent survey of neuropsychologists in the USA and Canada, Rabin and colleagues reported on the most common assessment used. Of the 20 neuropsychological assessment instruments used, 80% require adequate visual skills [30]. The authors are not aware of any published cognitive screening instruments that have been designed speciﬁcally for individuals with visual impairment or illiteracy. While this study is the ﬁrst large sample study to examine the CAM and the MMSE, the drawback to utilizing clinical data collected from an assessment center is that we cannot control for ethnic diversity and the clinicians may not have always been able to administer the assessments on the days planned. Patient cancellations and rescheduling of appoint- ments may have led to a longer delay in administration (e.g., one week in between administration of assessment measures rather than one day). Since participants with vision or reading disabilities were excluded from the study, results may only generalize to healthy and literate older adults. In addition, because the sample was predominantly European-American, we cannot assume generalization to more diverse samples. In addition, because these data are cross-sectional, we cannot assume that the relationship between the two measures will remain stable over time, particularly in the presence of cognitive impairment. Future research should include follow up data to assess whether the utility of these measures changes over time and with advanced impairment. In addition, in order to investigate the prognostic utility of the CAM, longitudinal studies are required to evaluate its ability to predict both mild cognitive impairment and dementia as compared to assessment by a trained neuropsychologist. 5. Conclusions This study ﬁnds the two measures to have good reliability and agreement in assessing cognitive impairment, but that each measure has a distinct advantage. The MMSE oﬀers a shorter administration time, which may be beneﬁcial in primary care settings where time constraints preclude a longer assessment for cognitive impairment but detailed function recommendations may not be needed. Whereas the direct clinical usefulness of some of the information from speciﬁc tasks of the CAM test (i.e., the problem solving task that involves completing multiple errands in a day—assesses executive functions that include planning, organization, and 5 sequencing ability) along with the opportunity to obtain a larger sample of behavior in all tasks assessed, are some of the strengths of the CAM. From an evidence-based perspective, the decision to select an assessment tool should be tied to the goal or purpose of the assessment [31]. If the purpose is only to obtain a quick simple screen (obtain a brief snapshot of the person’s cognition to evaluate for risk of cognitive impairment or to establish a baseline), then a clinician could choose to use the MMSE. If the purpose is to make clinically useful recommendations (e.g., focus on functional adaptive skill use), the longer assessment will be more helpful. The CAM is useful for geriatric teams where the goal is to obtain a more comprehensive measure of cognitive impairment. Given that the CAM allows for assessment of more practical aspects of cognitive impairment and oﬀers more extensive assessment information than the MMSE, including hierarchical grading of cognitive skills, the CAM may be more ideal for settings such as home health care or rehabilitation settings where the goal would be to have more information about practical skills and activities of daily living. However, the longer duration of testing may increase issues associated with fatigue during assessment. Thus, examiners would need to incorporate breaks as necessary or administer over sessions to minimize test fatigue. Therefore, our ﬁnding that the two measures are so closely related means that clinicians can adjust or tailor their screening based on the information they need (goal driven assessment). In addition, having strongly correlated measure means that those who work mainly with the MMSE can look at the CAM and have a good idea about the individual’s cog- nitive capacity and those who work with the CAM can look at the MMSE and have a good idea about the individual’s cognitive capacity (i.e., aids in communication within the scientiﬁc community). As Gerontology is an interdisciplinary ﬁeld, it is often useful to have tools that would aid in communication about a patient between disciplines. In sum, the CAM appears to be a promising measure for use with older adults with cognitive impairment and when examiners are interested in functional capacity recommenda- tions. More research is necessary exploring the psychometric properties of the CAM to explore its full utility with diverse populations. In addition, studies comparing the CAM to other measures of functional capacity may be warranted. Acknowledgments The authors would like to acknowledge the contribution of Anne Zemlick, RN, Patricia A. Arean, Ph.D., and Dan Segal, Ph.D. for their thoughts and comments regarding the paper. References [1] A. B. Bernstein and R. E. Remsburg, “Estimated prevalence of people with cognitive impairment: results from nationally representative community and institutional surveys,” Geron- tologist, vol. 47, no. 3, pp. 350–354, 2007. [2] R. A. Rustad et al., The Cognitive Assessment of Minnesota: Examiner’s Guide, The Psychological Corp., San Antonio, Tex, USA, 1993.