Brief Short-Term Memory Assessment
For rapid office-based assessment of short-term memory and working memory, use the Mini-Cog (2-3 minutes) which tests three-word recall after a brief delay, or ask the patient to learn a street address (e.g., "John Brown, 42 Market Street, Chicago") and recall it after a few minutes of distraction. 1, 2, 3
Validated Rapid Screening Options
The most recent 2025 Alzheimer's Association guidelines prioritize these ultra-brief tools for primary care settings 2:
Mini-Cog (2-3 minutes)
- Three-word registration and recall after clock drawing task
- Assesses immediate storage and retention over brief delay
- Sensitivity 76-81%, specificity 89% for cognitive impairment
- Score <3/5 indicates concern for dementia
- Key advantage: Demonstrates attention on immediate recall, then uses this as baseline to assess retention 2, 3
Informal Bedside Techniques
When formal testing isn't feasible, the 2011 NIA-Alzheimer's Association guidelines explicitly recommend 1:
Three-object placement test:
- Name three objects (pen, paper clip, dollar bill)
- Place them in different locations around the room
- Ask patient to recall names AND locations after brief delay
Street address recall:
- "John Brown, 42 Market Street, Chicago"
- Recall after few minutes of distraction (counting backwards, conversation)
Important Caveats
These informal tests have significant limitations 1:
- Insensitive to subtle cognitive dysfunction in early MCI
- Often yield normal performance in mild impairment
- Typically assess only memory domain, not executive function or other domains
When More Comprehensive Testing Is Needed
If screening suggests impairment or you suspect MCI in high-functioning individuals, escalate to 4:
Montreal Cognitive Assessment (MoCA) (10-15 minutes):
- More sensitive than MMSE for detecting MCI (sensitivity 80-85%)
- Assesses multiple domains including working memory
- Provides Memory Index Score for specific memory performance
- Preferred when initial screening is "normal" but clinical suspicion remains 4
Formal Neuropsychological Tests for Working Memory
For specialty settings or when detailed assessment is required 1:
Word-list learning tests with multiple trials:
- Rey Auditory Verbal Learning Test
- California Verbal Learning Test
- Free and Cued Selective Reminding Test
These reveal:
- Rate of learning over time
- Maximum acquisition across trials
- Both immediate AND delayed recall to determine retention over delay
- Attention to task on immediate recall (baseline for delayed performance)
Paragraph recall:
- Logical Memory I and II (Wechsler Memory Scale)
- Immediate and delayed recall components
Attention/working memory specific:
- Digit span forward (simple attention)
- More complex span tasks for working memory capacity
Clinical Decision Algorithm
Start with Mini-Cog or three-word recall in all patients with cognitive concerns (2-3 minutes)
If abnormal or high clinical suspicion despite normal score: Proceed to MoCA (10-15 minutes) 4
If MoCA suggests impairment: Refer for formal neuropsychological testing with multi-trial word-list learning tests 1
Critical point: Scores 1-1.5 standard deviations below age/education-matched norms indicate MCI-level impairment (these are guidelines, not rigid cutoffs) 1
Practical Considerations
The 2020 Canadian Consensus strongly recommends combining cognitive testing with functional assessment and informant reports for optimal detection 4. A patient may perform adequately on brief memory tests but show functional decline in real-world memory tasks (missed appointments, medication errors, difficulty following instructions).
For patients unable to perform written tasks (motor disabilities), use the Memory Impairment Screen or Picture-Based Memory Impairment Screen as verbal alternatives 3.