The Galveston Orientation and Amnesia Test. A practical scale to assess cognition after head injury

The Galveston Orientation and Amnesia Test (GOAT) was developed to evaluate cognition serially during the subacute stage of recovery from closed head injury. This practical scale measures orientation to person, place, and time, and memory for events preceding and following the injury. The distribution of test scores in 50 patients who had recovered from a mild closed head injury was used to define the range of variation in performance and to analyze the effects of demographic factors. In a validity study of 52 closed head-injured patients, the duration of impaired GOAT scores was strongly related to the acute neurosurgical ratings of eye opening, motor responding, and verbal responding on the Glasgow Coma Scale. Duration of post-traumatic amnesia, as defined by the persistence of defective GOAT scores, was longer in patients with computed tomographic evidence of diffuse or bilateral brain injury as compared to cases with focal unilateral lesions. Serial GOAT scores were also predictive of long term level of recovery. Review of the brief cognitive test literature disclosed that several techniques have adequate validity data substantiating their use in the detection of dementia in geriatric, psychiatric, and medical populations. Recommendations for the clinical application of the various brief cognitive tests are discussed.