The Oxford COMPASS: A Brief Cognitive Screen to help guide Competency Assessments

Background:Inconsistent and poorly documented mental capacity assessments often lack detailed breakdowns of the four functional cognitive domains (understanding, retaining, weighing up, communicating), thereby failing legal standards. We developed the Oxford Competency Assessment Tool (COMPASS), a novel cognitive screening instrument aligned with the Mental Capacity Act (2005). COMPASS aims to identify potential cognitive difficulties and objectively document domain-specific strengths and weaknesses.Methods:We present the standardization and initial validation of COMPASS in 122 neurologically healthy controls (mean age 65.75 years, SD=12.04) and 136 neurological participants (mixed aetiology, mean age 73.59 years, SD=11.67). We assessed construct validity against matched neuropsychological assessments and MoCA, and re-test reliability. Normative data cut-offs were determined, and predictive validity was examined against a hypothetical financial capacity assessment.Results:COMPASS effectively identified cognitive impairments and differentiated between neurological and healthy participants (AUC > .80), demonstrated good internal consistency, test-retest consistency, and convergent/discriminant validity. When predicting outcomes of a hypothetical financial capacity interview, the four COMPASS subtask scores showed very high specificity (81-100%) with limited sensitivity (23-56%).Conclusion:COMPASS offers a valid and reliable performance-based cognitive screen measuring understanding, retaining, and executive functioning, closely aligning with neuropsychological assessments. It demonstrated high specificity for hypothetical mental capacity assessment outcomes.