Rancho Los Amigos Levels of Cognitive Functioning Scale

Question 1

Rancho Los Amigos Cognitive Scale - Level I

Answer 1

No Response - Patient appears to be in a deep sleep and is completely unresponsive to any stimuli

Question 2

Rancho Los Amigos Cognitive Scale - Level II

Answer 2

Generalized response - pt reacts inconsistently and non-purposeful to stimuli in a nonspecific manner. Responses are limited and often the same regardless of stimulus presented.

Question 3

Rancho Los Amigos Cognitive Scale - Level III

Answer 3

Localized Response - pt reacts specifically, but inconsistently to stimuli.

• Responses are directly related to the type of stimulus presented
• May follow specific commands such as closing the eyes or squeezing the hand.

Question 4

Rancho Los Amigos Cognitive Scale - Level IV

Answer 4

Confused-Agitated - pt is in a heightened state of activity. Behavior is bizarre and non-purposeful relative to the immediate environment.

• Does no discriminate among persons or objects
• Unable to cooperate directly with treatment efforts.
• Verbalizations are incoherent and inappropriate to the environment
• Confabulation may be present.
• Pt lacks short and long term recall

Question 5

Rancho Los Amigos Cognitive Scale - Level V

Answer 5

Confused-Inappropriate - able to respond to simple commands fairly consistently but not complex.

• Gross attention to environment, but highly distractible and unable to focus attention on a specific task.
• Verbalization is often inappropriate and confabulatory
• Memory severely impaired
• Able to perform previously learned tasks automatically but cannot learn new information

Question 6

Rancho Los Amigos Cognitive Scale - Level VI

Answer 6

Confused-Appropriate - shows goal-directed behavior, but is dependent on external input or direction.

• Follows simple directions consistently and shows carryover for relearned tasks such as self-care
• responses may be incorrect due to memory problems, but are appropriate to the situation

Question 7

Rancho Los Amigos Cognitive Scale - Level VII

Answer 7

Automatic-Appropriate - appears appropriate and oriented within the hospital and home setting. Goes through daily routine automatically.

• minimal to no confusion
• shows carryover for new learning, but at a decreased rate
• Impaired judgement

Question 8

Rancho Los Amigos Cognitive Scale - Level VIII

Answer 8

Purposeful-Appropriate - Patient is able to recall and integrate past and recent events and is aware of and responsive to environment.

• shows carryover for new learning and needs no supervision once activities are learned
• may continue to show decreased ability relative to premorbid abilities, abstract reasoning, tolerance to stress, and judgement in unusual circumstances.

Question 9

Rancho Los Amigos Cognitive Scale - Level IX

Answer 9

Purposeful-Appropriate - Stand-by Assistance on request

Question 10

Rancho Los Amigos Cognitive Scale - Level X

Answer 10

Purposeful-Appropriate - Modified Independent