Table of ContentsView AllTable of ContentsWhat Is the ACLS?TasksScoringAllen’s Cognitive LevelsCompared to Other TestsUsesAccuracyPros and Cons
Table of ContentsView All
View All
Table of Contents
What Is the ACLS?
Tasks
Scoring
Allen’s Cognitive Levels
Compared to Other Tests
Uses
Accuracy
Pros and Cons
The Allen Cognitive Level Screen (ACLS), which requires a person to do a few short stitching tasks with a string and a needle, is used to screen for dementia.It involves following instructions, using fine motor skills, and learning.
In this article, you will learn about the ACLS, including why it is used, what the results can tell you, and how it’s different from other cognitive tests.
Steve Debenport / Getty Images
Tests that evaluate memory and reasoning are calledcognitive tests. Most of these tests ask questions that measure your thinking ability and skills (cognitive function).
The ACLS is different from other cognitive tests. Instead of answering questions, you will do some threading tasks using string, a needle, and a piece of leather with holes around the edges. One side of the string is light-colored and the other is dark-colored.
There are different versions of the test materials:
The ACLS is based on Allen’s Cognitive Levels. The levels are on a scale from 0 to 6. Each number is matched to a level of cognitive ability and function.
In general, the ACLS should not take longer than 20 minutes to complete. People with higher cognitive levels will likely finish sooner.
13 Diseases Linked to Dementia
Tasks In the ACLS
The ACLS uses sewing stitches to measure a person’s level of cognition. With each step, the tasks require more understanding to complete.
Here is what it’s like to do the ACLS test.
ACLS Scoring
Your score on the ACLS is based on the number of correct stitches and the difficulty of the stitch.You get more points for doing harder stitches and tasks correctly.
The final scores are turned into numbers that match a certain level. These levels often correspond to how much help a person probably needs to do tasks in their daily lives safely.
The Allen Cognitive Levels are based on a scale of 0 to 6, with 0 being comatose (i.e., unaware of the world around you) and 6 reflecting normal cognition. Scores of the ACLS range only from 3.0 to 5.8. If you’re at a cognitive level below 3, you would not be able to do the test.
The test scores stop at 5.8 instead of 6.0 on the higher end because the ACLS does not fully test your ability to plan for the future, which is part of a cognitive assessment.
Allen’s cognitive levels put a person’s functioning on a scale of 0 to 6.Each level also corresponds to how much help a person at that level might need to function as well as possible.
The ALCS cannot be used to determine levels below 3 or level 6.
Here are Allen’s cognitive levels and what being at each level means.
Level 0: Coma
A score of 0 means that a person is unaware of what’s going on around them. They can’t move or respond to their environment. This is described as beingcomatose.
Level 1: Awareness
This level means that cognition and awareness are very impaired. At this level, people will need total care, 24 hours a day.
This means that a person can move around a little on their own, but still needs 24-hour care.
They would need help with all activities of daily living, such as bathing, eating, andhygiene.
Level 3: Manual Actions
ALCS scores between 3.0 and 3.8 mean a person needs someone to look after them and help with daily activities.
They might need to be cued to do a task. For example, having someone hand them a toothbrush to make sure they brush their teeth.
Level 4: Familiar Activity
If the score is between a 4.0 and a 4.8, it’s recommended to have aroutine. Safety issues and problem-solving can be hard to manage.
With a score in the higher range of level 4, people might be able to live alone as long as they have a plan for what to do if they need help. For example, if something unexpected happens, they should know to call a loved one for support.
Level 5: Learning New Activity
A score between 5.0 and 5.8 means thatcognitive impairmentis mild. They can still function well on their own and learn new things.
At the lower range of this level, having weekly check-ins from a loved one or from other community support services can be useful.
A score in the upper range usually means that a person is likely to function well on their own and can do a job well.
Level 6: Planning New Activity
Level 6 is the highest level. This means that there is no apparent impairment of cognitive skills and the person is considered to be normally functioning.
At this level, a person is able to work out problems and make decisions using good judgment. This process is calledexecutive functioning. They also are likely to have complex thought processes that help make plans for the future.
ACLS vs. Other Cognitive Tests
Many assessments and screenings can be used to measure a person’s cognitive abilities.Other cognitive tests look at a person’sshort- and long-term memory. For example, theMini-Mental Status Exam (MMSE)scores a person’s cognitive abilities.
The tests can check for signs of mild cognitive impairment and signs of diseases that causedementia, likeAlzheimer’s disease, vascular disease,Lewy body dementia,frontotemporal degeneration, residual impairments after moderate or severe traumatic brain injury, andchronic traumatic encephalopathy.
The ACLS is not meant to be a diagnostic test, but it can help providers spot cognitive conditions like dementia. It can be used with other screenings and medical tests in the process of diagnosing these conditions.
Sometimes, a person’s score on one cognitive test doesn’t match their ability to function in their daily living. This is because a person’s cognitive skills are not always used the same way in the practical areas of their life. The ACLS tries to bridge that gap.
Occupational Therapy in a Skilled Nursing Facility
How Is This Test Used?
The ACLS is used to help figure out if a person has the thinking and physical abilities to safely do the tasks they need to do every day. This is called functional cognition.
People in different situations can benefit from being tested with the ACLS.
For example:
How Accurate Is the ACLS?
The results of the ACLS test can often detect potential problems with independence.
How Is Dementia Diagnosed?
Pros and Cons of the ACLS
An advantage of the ACLS is that it tests integrated skills, rather than memory or verbal answers to questions.
On the other hand, people with physical limitations may not be able to do the ACLS test. For example, a person needs to be able to use both hands. They also need to have good vision and hearing. In some cases, modified versions of the ACLS (like one with a bigger needle and string that’s easier to see) might be available.
What Is the Clock Drawing Test Used For?
Summary
The Allen Cognitive Level Screen (ACLS) is one of the tools that’s used to help figure out if it’s safe for a person to live on their own.
The ACLS is different from other cognitive tests. Instead of asking questions, it has people complete a task with strings. A person’s score on the test is related to how well they are able to learn different stitches and do them correctly.
A person’s score on the ACLS is more than just a number. Their level also determines how much help they need. Some people may only need a little bit of help from family and friends, while others need someone to care for them all the time.
Can Your Job Protect You From Dementia?
5 SourcesVerywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Rojo-mota G, Pedrero-pérez EJ, Huertas-hoyas E, Merritt B, Mackenzie D.Allen Cognitive Level Screen for the classification of subjects treated for addiction.Scand J Occup Ther. 2017;24(4):290-298.Kwon JS, Oh DW.The use of task-based cognitive tests for defining vocational aptness of individuals with disabilities.Osong Public Health Res Perspect. 2015;6(3):164-9. doi:10.1016/j.phrp.2015.05.002Wesson J, Clemson L, Brodaty H, et al.A feasibility study and pilot randomised trial of a tailored prevention program to reduce falls in older people with mild dementia.BMC Geriatr. 2013;13:89. doi:10.1186/1471-2318-13-89American Academy of Family Physicians.Cognitive evaluation.Brown T, Joliffe L, Fielding L.Is the Mini Mental Status Examination (MMSE) associated with inpatients’ functional performance?.Physical & Occupational Therapy In Geriatrics.2014;32(3):228-240.Additional ReadingAllen CK.Cognitive disability and reimbursement for rehabilitation and psychiatry.Journal of Insurance Medicine. 1991;23 (4).Earhart C.A brief history of the cognitive disabilities model and assessments.The Allen Cognitive Group.The Allen Cognitive Group.ACLS-5 and LACLS-5 Test: Psychometric properties and use of scores for evidence-based practice. 2016.The American Occupational Therapy Foundation.Research priority: Functional cognition.
5 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.Rojo-mota G, Pedrero-pérez EJ, Huertas-hoyas E, Merritt B, Mackenzie D.Allen Cognitive Level Screen for the classification of subjects treated for addiction.Scand J Occup Ther. 2017;24(4):290-298.Kwon JS, Oh DW.The use of task-based cognitive tests for defining vocational aptness of individuals with disabilities.Osong Public Health Res Perspect. 2015;6(3):164-9. doi:10.1016/j.phrp.2015.05.002Wesson J, Clemson L, Brodaty H, et al.A feasibility study and pilot randomised trial of a tailored prevention program to reduce falls in older people with mild dementia.BMC Geriatr. 2013;13:89. doi:10.1186/1471-2318-13-89American Academy of Family Physicians.Cognitive evaluation.Brown T, Joliffe L, Fielding L.Is the Mini Mental Status Examination (MMSE) associated with inpatients’ functional performance?.Physical & Occupational Therapy In Geriatrics.2014;32(3):228-240.Additional ReadingAllen CK.Cognitive disability and reimbursement for rehabilitation and psychiatry.Journal of Insurance Medicine. 1991;23 (4).Earhart C.A brief history of the cognitive disabilities model and assessments.The Allen Cognitive Group.The Allen Cognitive Group.ACLS-5 and LACLS-5 Test: Psychometric properties and use of scores for evidence-based practice. 2016.The American Occupational Therapy Foundation.Research priority: Functional cognition.
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Rojo-mota G, Pedrero-pérez EJ, Huertas-hoyas E, Merritt B, Mackenzie D.Allen Cognitive Level Screen for the classification of subjects treated for addiction.Scand J Occup Ther. 2017;24(4):290-298.Kwon JS, Oh DW.The use of task-based cognitive tests for defining vocational aptness of individuals with disabilities.Osong Public Health Res Perspect. 2015;6(3):164-9. doi:10.1016/j.phrp.2015.05.002Wesson J, Clemson L, Brodaty H, et al.A feasibility study and pilot randomised trial of a tailored prevention program to reduce falls in older people with mild dementia.BMC Geriatr. 2013;13:89. doi:10.1186/1471-2318-13-89American Academy of Family Physicians.Cognitive evaluation.Brown T, Joliffe L, Fielding L.Is the Mini Mental Status Examination (MMSE) associated with inpatients’ functional performance?.Physical & Occupational Therapy In Geriatrics.2014;32(3):228-240.
Rojo-mota G, Pedrero-pérez EJ, Huertas-hoyas E, Merritt B, Mackenzie D.Allen Cognitive Level Screen for the classification of subjects treated for addiction.Scand J Occup Ther. 2017;24(4):290-298.
Kwon JS, Oh DW.The use of task-based cognitive tests for defining vocational aptness of individuals with disabilities.Osong Public Health Res Perspect. 2015;6(3):164-9. doi:10.1016/j.phrp.2015.05.002
Wesson J, Clemson L, Brodaty H, et al.A feasibility study and pilot randomised trial of a tailored prevention program to reduce falls in older people with mild dementia.BMC Geriatr. 2013;13:89. doi:10.1186/1471-2318-13-89
American Academy of Family Physicians.Cognitive evaluation.
Brown T, Joliffe L, Fielding L.Is the Mini Mental Status Examination (MMSE) associated with inpatients’ functional performance?.Physical & Occupational Therapy In Geriatrics.2014;32(3):228-240.
Allen CK.Cognitive disability and reimbursement for rehabilitation and psychiatry.Journal of Insurance Medicine. 1991;23 (4).Earhart C.A brief history of the cognitive disabilities model and assessments.The Allen Cognitive Group.The Allen Cognitive Group.ACLS-5 and LACLS-5 Test: Psychometric properties and use of scores for evidence-based practice. 2016.The American Occupational Therapy Foundation.Research priority: Functional cognition.
Allen CK.Cognitive disability and reimbursement for rehabilitation and psychiatry.Journal of Insurance Medicine. 1991;23 (4).
Earhart C.A brief history of the cognitive disabilities model and assessments.The Allen Cognitive Group.
The Allen Cognitive Group.ACLS-5 and LACLS-5 Test: Psychometric properties and use of scores for evidence-based practice. 2016.
The American Occupational Therapy Foundation.Research priority: Functional cognition.
Meet Our Medical Expert Board
Share Feedback
Was this page helpful?Thanks for your feedback!What is your feedback?OtherHelpfulReport an ErrorSubmit
Was this page helpful?
Thanks for your feedback!
What is your feedback?OtherHelpfulReport an ErrorSubmit
What is your feedback?
