COWAT Questions

In the administration of the COWAT, numbers are not mentioned in the directions as being incorrect, but they are scored as incorrect.  Does this apply to only consecutive numbers (e.g., forty five, forty six, forty seven, etc.) or are any numbers mentioned marked as incorrect?  Should we include this in the directions?

The responses to the numbers should be scored as you would score words. So fifty-one, fifty-two, fifty-three… would be considered the same word with a different ending. Participants would then only be given credit for fifty-one. If they said forty and fifty, they would be given credit for both.


The patient said “sat” and immediately after said “sit.” Should I consider “sit” as an intrusion since it is the present tense of “sat”? How should we classify something like this?

The general rule is that words that are basically the same but that have different endings (e.g., for tenses) are NOT allowed.  So, in your example, “said” would not count. With verbs, you care about tense, while we are more permissive for nouns, for example, access and accessory would both get credit.


I tested a patient today who gave me the following answers (in order): Someday (adverb), Someone (pronoun), Somehow (adverb). Would “someone” and “somehow” be perseverations?

No, they are different words and are more likely a search strategy. Give credit for all three.


If someone says eat and then eating would we categorize eating as a perseveration or an intrusion?

It should be an intrusion since perseverations are strictly words that were repeated exactly. I understand we could be referring to the root word as being repeated, but an intrusion is a better categorization of the error.


How should we query homonyms? Should we assume that they meant the same word as prior? ( e.g., see and sea)

Some judgement is required. If the words appear one right after the other (“see, the other sea”) or appear in a set (for example, sea, shore, smell, see), you can use context to give credit for different words. If they appear randomly (beginning and end of the list without context), it is hard to know if they meant two different words or are repeating. To query them wouldn’t necessarily get you the right answer if they weren’t aware they said it twice. So, in summary, unless it is intuitive or they volunteer that it is two different words, consider it a perseveration.


If a patient says “a” and then “an,” is “an” considered a perseveration?

An intrusion because it is the same word with a different ending.


A participant said “fallopian tube” and I wasn’t sure how to count it. She didn’t have any other intrusions. 

Yes, this would get credit. Consider that the first word is correct and not the violation of the rules. The second part of the response just went with the first.


Would the following receive credit if given by the same participant? Or would they be errors?  Taking/took, succeed/success, act/action, art/artist

Stick to the rule that we give credit for everything except for the same word with a different ending. So in these examples, acts and artists would not get credit, but the above examples do.

September 12, 2015
Primary teaching affiliate
of BU School of Medicine