TICS Form

TICS Form and Dictionary

TICS Form

Download Dictionary:
TICS Form
Variable / Field Name Field Label Choices, Calculations, OR Slider Labels
tics_adcid Site: 39 ADCID
tics_ptid Subject ID: PTID
tics_testdate Form Date: (Y-M-D)
tics_visitnum Visit number: 1 (Initial visit), 2 and up (Follow up visit) VISITNUM
tics_examiner Examiner's initials: INITIALS
tics_text_01 TICS Administration Instructions Prior to the TICS administration, examiners should ensure that they have obtained all of the necessary information (e. g. examinee's full name, complete address, etc.) Instructions to Proctor In a couple of minutes, I am going to be asking [examinee's name] a number of different questions to test [his/her] thinking and memory. Before we start, I need to ask you whether the address I have for your current location is correct. Please don't repeat it out loud if [examinee's name] is in the room with you, since I will be asking [his/her] the same question in a few minutes. Is your current address [examinee's address]? If the answer is "no", please ask the proctor either to step into another room before giving you the correct address or to have the examinee leave the room briefly before giving the address. Then go on say, Please be sure that all papers, pencils, books, calendars, newspapers, and everything else that might provide distraction or visual cues are removed from [examinee's name] sight. Also, please be sure that room is quiet; there should be no television, radio, or music playing. Some of the questions may be difficult for [examinee's name] to answer. [He/She] may ask you for help. If [he/she] does, just encourage [him/her] to do as well as [he/she] can. [He/She] should guess if necessary. Please do not give [him/her] any answers or hints. O.K.? If you and [examinee's name] are ready, please put [him/her] on the phone. Instructions to Examinee I am going to ask you some questions to test your memory. Some of these are likely to be easy for you, but some may be difficult. Please bear with me and try to answer all the questions as best you can. If you can't answer a question, don't worry. Just try your best. Are you ready? These instructions may be repeated verbatimor paraphrased, if necessary. For each of actual TICS items, except Item 5 and Item 8, single repetitions are permitted.
tics_item1a 1a. First Name
tics_item1b 1b. Last Name
tics_item1_score 1. Total Score 1 point for correct first name (or nickname) and 1 point for correct last name Max Score= 2 2, 2 | 1, 1 | 0, 0
tics_item2a 2a. Month
tics_item2a_score 2a. Score 1 point for correct month 1, 1 | 0, 0
tics_item2b 2b. Date
tics_item2b_score 2b. Score 1 point for correct date 1, 1 | 0, 0
tics_item2c 2c. Year
tics_item2c_score 2c. Score 1 point for correct year 1, 1 | 0, 0
tics_item2d 2d. Day of the Week
tics_item2d_score 2d. Score 1 point for correct day of the week 1, 1 | 0, 0
tics_item2e 2e. Season
tics_item2e_score 2e. Score 1 point for correct season 1, 1 | 0, 0
tics_item2_score 2. Total Score 1 point each for precisely correct month, date, year, day of the week, and season (e.g. a hot day in early June is not summer) Max Score= 5 [tics_item2a_score]+[tics_item2b_score]+[tics_item2c_score]+[tics_item2d_score]+[tics_item2e_score]
tics_item3a 3a. House Number
tics_item3a_score 3a. Score 1 point for correct house number 1, 1 | 0, 0
tics_item3b 3b. Street
tics_item3b_score 3b. Score 1 point for correct street 1, 1 | 0, 0
tics_item3c 3c. City
tics_item3c_score 3c. Score 1 point for correct city 1, 1 | 0, 0
tics_item3d 3d. State
tics_item3d_score 3d. Score 1 point for correct state 1, 1 | 0, 0
tics_item3e 3e. Zip Code
tics_item3e_score 3e. Score 1 point for correct zip code 1, 1 | 0, 0
tics_item3_score 3. Total Score 1 point each for correct house number, street, city, state, and zip code (5-digit zip code is sufficient). If examinee is in a facility with no house number (e.g. hospital, nursing home), the name of facility may be substituted for the house number Max Score= 5 [tics_item3a_score]+[tics_item3b_score]+[tics_item3c_score]+[tics_item3d_score]+[tics_item3e_score]
tics_item4 4. Please count backward from 20 to 1. If examinee makes an error, ask him or her to try again. 2 points if completely correct on the first trial. 1 point if completely correct on the second trial. Max Score= 2 2, 2 | 1, 1 | 0, 0
tics_item5_words_recalled 5. Words Recalled 1, Cabin | 2, Pipe | 3, Elephant | 4, Chest | 5, Silk | 6, Theater | 7, Watch | 8, Whip | 9, Pillow | 10, Giant
tics_item5_score 5. Total Score 1 point for each correctly recalled word 0 points for incorrect responses, repetitions, or intrusions Max Score= 10 10, 10 | 9, 9 | 8, 8 | 7, 7 | 6, 6 | 5, 5 | 4, 4 | 3, 3 | 2, 2 | 1, 1 | 0, 0
tics_item6 6. I would like you to take the number 100 and subtract 7. (Pause for a response.) Now keep subtracting 7 from the answer until I tell you to stop. No further prompts or instructions are given, except to "keep going." Stop the examinee after five serial subtractions.
tics_item6_score 6. Total Score 1 point for each correct subtraction Do not inform examinee of incorrect responses, but allow subtractions to be made from the last response. For example, "93, 85, 78, 71, 65" would be awarded 3 points Max Score= 5 5, 5 | 4, 4 | 3, 3 | 2, 2 | 1, 1 | 0, 0
tics_item7_1 7a. What do people usually use to cut paper? Pause for a response. 1, 1 Scissors or Shears | 0, 0 Other
tics_item7_1_other 7a. If Other
tics_item7_2 7b. How many things are in a dozen? Pause for a response. 1, 1 12 | 0, 0 Other
tics_item7_2_other 7b. If Other
tics_item7_3 7c. What do you call the prickly green plant that lives in the desert? Pause for a response. 1, 1 Cactus | 0, 0 Other
tics_item7_3_other 7c. If Other
tics_item7_4 7d. What animal does wool come from? 1, 1 Sheep or Lamb | 0, 0 Other
tics_item7_4_other 7d. If Other
tics_item7_score 7. Total Score Max Score= 4 [tics_item7_1]+[tics_item7_2]+[tics_item7_3]+[tics_item7_4]
tics_item8_1 8a. Please repeat this after me. "No ifs, ands or buts." No repetitions of the phrase is permitted. 1, No | 2, ifs | 3, ands | 4, or | 5, buts
tics_item8_1_score 8a. Score 1 point for correct repetition. 1, 1 | 0, 0
tics_item8_2 8b. Please repeat this after me. "Methodist Episcopal." No repetitions of the phrase is permitted. 1, Methodist | 2, Episcopal
tics_item8_2_score 8b. Score 1 point for correct repetition. 1, 1 | 0, 0
tics_item8_score 8. Total Score Max Score= 2 [tics_item8_1_score]+[tics_item8_2_score]
tics_item9a 9a. President First Name
tics_item9b 9b. President Last Name
tics_item9ab_score 9ab. Score 1 point for correct first and last name. 1, 1 | 0, 0
tics_item9c 9c. Vice President First Name
tics_item9d 9d. Vice President Last Name
tics_item9cd_score 9cd. Score 1 point for correct first and last name. 1, 1 | 0, 0
tics_item9_score 9. Total Score Max Score= 2 [tics_item9ab_score]+[tics_item9cd_score]
tics_item10 10. With your finger, tap five times on the part of the phone you speak into. 2 points if five taps are clearly heard. 1 point if either more than or fewer than 5 taps are heard. 0 point if no taps are heard. Max Score= 2 If the TICS is being administered in person, the examinee should be asked to tap on the table rather than on a telephone receiver. 2, 2 | 1, 1 | 0, 0
tics_item11_1 11a. What is the opposite of "west"? 1, 1 East | 0, 0 Other
tics_item11_1_other 11a. If Other
tics_item11_2 11b. What is the opposite of "generous"? 1, 1 Cheap, Stingy, Tight, Selfish, Greedy, Mean, Meager, or other correct antonym | 0, 0 Other
tics_item11_2_other 11b. If Other
tics_item11_score 11. Total Score Max Score= 2 [tics_item11_1]+[tics_item11_2]
tics_total_score TICS Total score Total Possible Points=41 [tics_item1_score]+[tics_item2_score]+[tics_item3_score]+[tics_item4]+[tics_item5_score]+[tics_item6_score]+[tics_item7_score]+[tics_item8_score]+[tics_item9_score]+[tics_item10]+[tics_item11_score]
tics_score Suggested Qualitative Interpretive Ranges for TICS Total Score Range 0, 33-41; Nonimpaired | 1, 26-32; Ambiguous | 2, 21-25; Mildly Impaired | 3, less or equal than 20; Moderately to Severely Impaired