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The Audio Recorded Cognitive Screen (ARCS): a flexible hybrid cognitive test instrument
  1. Peter W Schofield1,2,
  2. Stephen J Lee1,2,
  3. Terry J Lewin2,3,
  4. Grant Lyall1,2,
  5. Jonson Moyle1,2,
  6. John Attia4,5,
  7. Mark McEvoy5
  1. 1Neuropsychiatry Service, Hunter New England Mental Health, Newcastle, Australia
  2. 2Centre for Brain and Mental Health Research, Hunter New England Mental Health and the University of Newcastle, Australia
  3. 3Schizophrenia Research Institute, Sydney, Australia
  4. 4Department of Medicine, John Hunter Hospital, Hunter Medical Research Institute, Newcastle, Australia
  5. 5Centre for Clinical Epidemiology and Biostatistics, University of Newcastle, Newcastle, Australia
  1. Correspondence to Dr Peter W Schofield, Neuropsychiatry Service, Hunter New England Mental Health, PO Box 833, Newcastle, NSW 2300, Australia; peter.schofield{at}


Objective To describe and characterise the Audio Recorded Cognitive Screen (ARCS), a novel instrument that uses an audio device to administer selected neuropsychological tests to unsupervised individuals who write their responses in a special booklet for later scoring.

Methods The ARCS was administered to 733 individuals, comprising 550 from a normative community sample (mean age=59.14, range 18–84 years), 101 clinic patients and a separate validation sample of 82 community controls, who, together with the patients, underwent detailed neuropsychological assessments. These data were examined for the influence of demographic variables on ARCS performance, to establish normal performance and develop scoring routines, and to characterise the structure, reliability and validity of the instrument.

Results Age, gender and education influenced ARCS performance. ARCS tests were generally reliable and correlated well with corresponding conventional neuropsychological tests. Factor analyses indicated that the ARCS measures executive functioning/attention, memory, language, verbal fluency and visuospatial functioning. The ARCS discriminated well between normal (n=82), impaired (n=33) and demented (n=25) individuals, and significantly better than did the Mini Mental State Examination (MMSE), including on a single, demographically adjusted, global QuickARCS score obtainable in about 3 min of the clinician's time. Receiver Operating Characteristic analyses confirmed the superiority of the ARCS over MMSE as a screen for mild dementia (AUC 0.98, 99% CI 0.95 to 1.00) or cognitive impairment (AUC 0.90, 99% CI 0.83 to 0.97).

Conclusions The ARCS has good validity and reliability, has a sound normative base and measures functioning in multiple cognitive domains while imposing minimal time demands upon the clinician.

  • Cognitive screening test
  • audio administration
  • psychometric properties
  • community norms
  • dementia
  • cognition
  • dementia
  • memory

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  • Funding This work was made possible by a grant from the Centre for Mental Health that aided in the establishment of the Neuropsychiatry Service of Hunter New England Area Health. Grant support was also provided through the ‘Capacity Building in Research & Evaluation (‘CAPRE’) programme of the University of Newcastle. The University of Newcastle provides primary financial support for the Hunter Community Study’.

  • Competing interests None.

  • Patient consent Obtained.

  • Ethics approval Ethics approval was provided by the Hunter New England Research Ethics Committee Newcastle, Australia.

  • Provenance and peer review Not commissioned; externally peer reviewed.