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Version: 1.0.0
Last Updated: 2026-04-04
Status: ✅ Active

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Overview

CL-02-EN-59 adds MoCA, SLUMS, and MMSE cognitive screening instruments to the CL-02 assessment library. This is a CL-internal enhancement — no new tables, no new cross-core dependencies.

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Components

ComponentPathPurpose
Scoring utilitiessrc/cores/cl/utils/cognitiveScoring.ts6 pure functions: compute + threshold for MoCA, SLUMS, MMSE
Instrument constantssrc/cores/cl/constants/cognitive-instruments.tsCOGNITIVE_INSTRUMENT_CODES, isCognitiveInstrument()
Assessment formsrc/cores/cl/components/CognitiveAssessmentForm.tsxDialog with item-level inputs, consent gating, event publishing
Result alertsrc/cores/cl/components/CognitiveResultAlert.tsxInline banner for threshold warnings
Typessrc/cores/cl/types/assessment.tsCognitiveScoringRules, CognitiveThresholdResult, MocaThresholds, etc.

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Instrument Seed Data

Instruments are seeded into cl_assessment_instruments via migration with ON CONFLICT (organization_id, instrument_code) DO NOTHING. Each instrument’s scoring_rules JSONB contains population-specific thresholds:
  • MoCA: default: 26, geriatric: 23, sud: 24, geriatric_tbi: 22; education adjustment +1 when ≤12 years
  • SLUMS: Education-stratified: high-ed normal ≥27, low-ed normal ≥25; mild NCD ranges
  • MMSE: Education-stratified cutoffs: illiterate 17, primary 20, secondary+ 24

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Event Contract

Event: cl_assessment_completed
Channel: cl_events
Payload: See EVENT_CONTRACTS.md § cl_assessment_completed (CL-02-EN-59) Key field: instrument_code (one of moca, slums, mmse) enables subscribers to differentiate cognitive assessments.
For SUD-flagged clients, the form calls cl_has_sud_consent(chart_id) before displaying or saving. If consent is absent, the form is blocked with a user-readable message.

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MMSE Licensing

MMSE is copyrighted by PAR Inc. The implementation does not embed copyrighted item content. Items are labeled generically (e.g., “see licensed administration materials”). Only responses and scores are stored.

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Deferred

  • Phase 2: PF-70 terminology migration (LOINC panel codes for MoCA/SLUMS/MMSE)
  • Eligibility/appropriateness UI (CL-08 CDS integration)