What are the components of the Mini-Cog (cognitive impairment screening) test?

Components of the Mini-Cog Cognitive Screening Test

The Mini-Cog test consists of a 3-item word recall and a clock drawing test, taking approximately 2-3 minutes to administer and providing a rapid, validated screening tool for cognitive impairment. 1

Test Administration Process

Word Recall Component

1. Three-word registration: The test administrator presents 3 unrelated words from a word bank and asks the patient to repeat and try to remember these words
2. The clinician may repeat the 3 words up to 3 times to ensure initial registration
3. Delayed recall: After the clock drawing task, the patient is asked to recall the 3 words
4. Scoring: 1 point is awarded for each correctly recalled word (0-3 points possible)

Clock Drawing Test (CDT)

1. The administrator provides a preprinted large circle
2. The patient is instructed to:
   • Fill in the numbers of a clock face
   • Set the hands to show "10 past 11"
3. Scoring: The clock drawing is scored as either normal (2 points) or abnormal (0 points)

Total Scoring

• Total possible score: 0-5 points
• Interpretation: A score of less than 3 points is concerning for possible dementia 1

Clinical Utility

The Mini-Cog has demonstrated strong diagnostic performance with:

• Sensitivity of 76% for identifying possible dementia
• Specificity of 89% for identifying possible dementia 1
• Administration time of only 2-3 minutes, significantly shorter than other cognitive screening tools 1, 2

Advantages of the Mini-Cog

• Efficiency: Can be administered in as little as 3 minutes 3
• Accessibility: Available in multiple languages and can be administered by any trained healthcare team member 1
• Validation: Endorsed by the Alzheimer's Association for use in primary care settings during Medicare annual wellness visits 1
• Versatility: Validated in heterogeneous populations with diverse educational and cultural backgrounds 1, 2

Limitations and Considerations

• The Mini-Cog is a screening tool, not a diagnostic test 1
• May have lower sensitivity for detecting mild cognitive impairment (MCI) in individuals with higher intellectual capability 1
• Patient characteristics such as native language, education level, and age can affect test performance 1
• The clock drawing component requires basic literacy and familiarity with analog clocks, which may limit use in some populations 4

Alternative Approaches

For patients with motor disabilities that prevent clock drawing:

• The Memory Impairment Screen is a verbally administered alternative 1
• Modified versions of the Mini-Cog have been developed for nonliterate individuals, replacing the clock drawing with everyday tasks like serial subtraction or multistep performance tasks 4

Follow-up After Screening

An abnormal Mini-Cog score (<3) should prompt:

1. Discussion with the patient
2. Further evaluation including:
   • Neurological examination
   • Multidomain mental status testing
   • Appropriate laboratory studies
   • Imaging studies when indicated 1

The Mini-Cog serves as an important first-line screening tool that can help identify patients who need more comprehensive cognitive assessment, potentially leading to earlier diagnosis and intervention for conditions affecting cognition and quality of life.