Mini-Cog
The Mini-Cog is the recommended quick mental status assessment tool, taking only 2-4 minutes to administer with 76% sensitivity and 89% specificity for detecting cognitive impairment. 1, 2
Why the Mini-Cog is the Best Choice
The Alzheimer's Association specifically endorses the Mini-Cog for use in primary care settings during Medicare annual wellness visits, making it the gold standard for rapid cognitive screening. 1, 2
The Mini-Cog can be administered by any trained healthcare team member, not just physicians, which makes it highly practical for busy clinical settings. 1, 2
It is validated in heterogeneous populations and available in multiple languages, enhancing accessibility across diverse patient groups. 1, 2
The test requires no special equipment, no reading or writing ability, and no user fees (unlike the MMSE which is copyrighted). 1
How to Administer the Mini-Cog
The Mini-Cog consists of three simple steps that take less than 5 minutes total: 1
Registration: Present 3 unrelated words and ask the patient to repeat them (can repeat up to 3 times for encoding). 1
Clock Draw: Provide a preprinted large circle and instruct the patient to fill in the numbers of a clock face and set the hands to "10 past 11." 1
Recall: Ask the patient to recall the 3 words from step 1. 1
Scoring
- 1 point for each word recalled correctly (0-3 points). 1
- Dichotomous score for clock draw (0 or 2 points). 1
- A total score of less than 3 is concerning for possible dementia and warrants further evaluation. 1
Clinical Context
Routine use of brief cognitive assessment tools like the Mini-Cog increases detection of cognitive impairment by two- to threefold compared to unaided clinical judgment. 1, 3
A positive screen (score <3) should trigger comprehensive evaluation including functional status assessment, neuropsychiatric evaluation, medical history, physical examination, and laboratory testing to rule out reversible causes. 2
The Mini-Cog score alone cannot establish a diagnosis—it must be interpreted within the full clinical context including patient education level, language, and age. 1
Alternative Tools for Specific Situations
For patients with motor disabilities who cannot perform clock drawing, use the Memory Impairment Screen (MIS), which is verbally administered. 1, 3
For detecting delirium specifically (not general cognitive impairment), use the Confusion Assessment Method (CAM), which takes less than 5 minutes and has 94-100% sensitivity. 1, 4