From the Guidelines
The Mini-Cog is a brief cognitive screening tool that consists of two components: a 3-item recall test and the Clock Drawing Test 1.
Key Components
- The 3-item recall test assesses memory by asking the patient to recall three unrelated words, such as "apple", "table", and "penny" 1.
- The Clock Drawing Test evaluates executive function and visuospatial skills by asking the patient to draw a clock face with numbers and hands set to a specific time, typically 11:10 1.
Administration and Scoring
To administer the Mini-Cog, first ask the patient to repeat and try to retain the three words, which can be repeated up to three times if needed 1. Then, provide a preprinted large circle and instruct the patient to fill in the numbers of a clock face and set the hands to the specified time. Finally, ask the patient to recall the three words. The patient receives 1 point for each word recalled correctly and a dichotomous score (0 or 2) for the clock draw 1.
Interpretation
A score of less than 3 is concerning for possible dementia 1. If concerns about cognitive impairment arise, further evaluation with a comprehensive diagnostic assessment is recommended 1. The Mini-Cog is a useful tool for rapid cognitive screening, but it should be used in conjunction with other assessments and evaluations to determine the likelihood of clinically significant impairment 1.
From the Research
Definition and Components of the Mini-Cog
- The Mini-Cog is a rapid, valid, and reliable screening tool for cognitive impairment, consisting of a 3-word recall and an executive clock drawing test (CDT) 2.
- It combines a brief memory test and a simply scored clock-drawing test, allowing for rapid screening of short-term memory defects, learning, and different cognitive abilities that are impaired in dementia patients 3.
Administration and Scoring
- The Mini-Cog can be administered in as little as 3 minutes and can be easily administered by personnel unfamiliar with cognitive testing 3.
- The test consists of a clock-drawing task and a 3-item recall, with a total score of 0-2 considered positive for dementia 3.
- The clock-drawing test is scored as abnormal (0 points) or normal (1 point), and 1 point is given for each recalled word in the memory test 3.
Modifications and Alternatives
- A modification of the Mini-Cog (MMC) has been developed for use with nonliterate and literate individuals, replacing the CDT with two tasks of everyday life: a serial subtraction task or a multistep performance task 2.
- The Mini-Cog has been compared to other screening tests, such as the Codex (cognitive disorders examination), and has been found to have high sensitivity for dementia diagnosis, but lower specificity compared to the Codex 4.
Clinical Utility and Applications
- The Mini-Cog has been found to be an effective screening tool for dementia and mild cognitive impairment (MCI) in various studies 3, 4, 5.
- It has been recommended as a useful tool for healthcare providers to uncover cognitive impairment in its earliest stages, particularly in older adults 6.
- The Mini-Cog can be used in outpatient services, by general practitioners, and in the planning and management of healthcare services 3.