What is the procedure for administering the mini cog test?

Mini-Cog Test Administration Procedure

The Mini-Cog test is administered in three simple steps: three-word recall, clock drawing test, and delayed recall of the three words, taking approximately 2-4 minutes to complete. 1

Step-by-Step Administration Protocol

Step 1: Three-Word Registration

1. Present 3 unrelated words from a word bank to the patient
2. Ask the patient to repeat the words to ensure initial registration
3. Instruct the patient to remember these words for later recall
4. You may repeat the 3 words up to 3 times if needed for initial learning 1

Step 2: Clock Drawing Test

1. Provide the patient with a preprinted large circle on a piece of paper
2. Instruct the patient to fill in the numbers of a clock face
3. Ask the patient to set the hands of the clock to "10 past 11"
4. Repeat directions if needed
5. Score the clock drawing as follows:
   • Normal clock (all numbers in correct sequence and position, hands pointing to 11 and 2) = 2 points
   • Abnormal clock = 0 points 1, 2

Step 3: Three-Word Recall

1. Ask the patient to recall the 3 words presented earlier
2. Score 1 point for each word correctly recalled (0-3 points) 1

Scoring and Interpretation

• Total score ranges from 0-5 points:

  • 0-2 points: Positive screen for cognitive impairment (concerning for possible dementia)
  • 3-5 points: Negative screen for cognitive impairment 1, 2

• Scoring breakdown:

  • Three-word recall: 0-3 points (1 point per word correctly recalled)
  • Clock drawing test: 0 or 2 points (normal=2, abnormal=0) 1

Clinical Considerations

Advantages of the Mini-Cog

• Brief administration time (2-4 minutes) 3, 4
• Minimal training required for administration 4
• Validated in primary care settings with heterogeneous populations 1
• Available in multiple languages 1
• Less influenced by education or language than other cognitive screening tools 3
• Endorsed by the Alzheimer's Association for use in primary care during Medicare annual wellness visits 1
• High sensitivity (76%) and specificity (89%) for identifying possible dementia 1

Limitations and Caveats

• Less sensitive for detecting mild cognitive impairment compared to more comprehensive tests like MoCA 2
• A positive screen requires follow-up with more comprehensive evaluation 2
• Clock drawing may be difficult for patients with motor disabilities 1
• Consider using alternative tests like the Memory Impairment Screen for patients unable to perform the clock drawing test 1

Follow-Up for Positive Screens

• An abnormal Mini-Cog score (less than 3) must be discussed with the patient 1
• Further evaluation should include:
  • Neurologic examination
  • More comprehensive cognitive assessment (e.g., MoCA, MMSE)
  • Appropriate laboratory studies
  • Brain imaging studies 1
• Consider screening for depression and delirium, which can mimic dementia symptoms 1

Alternative Cognitive Screening Tools

• Montreal Cognitive Assessment (MoCA): More comprehensive, takes 10-15 minutes, better for detecting mild cognitive impairment 2
• Memory Impairment Screen: Verbal-only alternative for patients with motor disabilities 1
• AD8 (Eight-Item Informant Interview): Informant-based questionnaire for patients unwilling to participate in direct testing 1

The Mini-Cog provides a rapid cognitive "vital signs" assessment that can be easily incorporated into clinical practice, though positive results should always prompt more comprehensive evaluation.