> ## Documentation Index
> Fetch the complete documentation index at: https://docs.encoreos.io/llms.txt
> Use this file to discover all available pages before exploring further.

# Cognitive Screening Instruments — Integration Document

> 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 n…

**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

| Component            | Path                                                  | Purpose                                                                     |
| -------------------- | ----------------------------------------------------- | --------------------------------------------------------------------------- |
| Scoring utilities    | `src/cores/cl/utils/cognitiveScoring.ts`              | 6 pure functions: compute + threshold for MoCA, SLUMS, MMSE                 |
| Instrument constants | `src/cores/cl/constants/cognitive-instruments.ts`     | `COGNITIVE_INSTRUMENT_CODES`, `isCognitiveInstrument()`                     |
| Assessment form      | `src/cores/cl/components/CognitiveAssessmentForm.tsx` | Dialog with item-level inputs, consent gating, event publishing             |
| Result alert         | `src/cores/cl/components/CognitiveResultAlert.tsx`    | Inline banner for threshold warnings                                        |
| Types                | `src/cores/cl/types/assessment.ts`                    | `CognitiveScoringRules`, `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.

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## Consent Gating (42 CFR Part 2)

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)