Mini-Cog: Mini-Cog Cognitive Assessment

Overview: The Mini-Cog is a brief cognitive screening instrument that combines a three-item recall test with a clock drawing test. Developed in 2000, it takes approximately 3 minutes to administer and has become one of the most widely used dementia screening tools in primary care and clinical settings.

Clinical Background: The Mini-Cog was designed to detect cognitive impairment in older adults and is particularly useful for identifying dementia. Unlike longer assessments, the Mini-Cog can be administered quickly while maintaining good diagnostic accuracy.

Evidence & Validation: Meta-analyses have demonstrated the Mini-Cog's reliability for detecting both dementia (76% sensitivity, 83% specificity) and mild cognitive impairment (84% sensitivity, 79% specificity). In primary care settings, it showed 73% sensitivity and 84% specificity, making it comparable to or better than lengthier screening tools.

Components:

1. Three-Word Recall: Tests short-term memory by asking patients to remember and later recall three unrelated words
2. Clock Drawing Test: Assesses visuospatial abilities, executive function, and semantic memory by having patients draw a clock face showing a specific time

Why Use the Mini-Cog?

• Faster than MMSE (3 minutes vs. 8-10 minutes)
• Less influenced by education level or language
• No copyright restrictions (unlike MMSE)
• Validated across diverse populations
• Easy to administer and score
• Can be used for screening and progress monitoring

Appropriate Use Cases:

• Primary care cognitive screening
• Annual wellness visits for older adults
• Monitoring progression in known cognitive impairment
• Pre-surgical cognitive baseline
• Emergency department cognitive assessment

Important Limitations:

• This is a screening tool, NOT a diagnostic test
• Positive screens require comprehensive neuropsychological evaluation
• Cannot distinguish between types of dementia
• May miss subtle or domain-specific impairments
• Should not be used alone for clinical decision-making

Crisis Resources: If you or someone you know is experiencing severe confusion, sudden cognitive changes, or other concerning symptoms, seek immediate medical attention by calling 911 or going to the nearest emergency room.

The Mini-Cog has 3 steps and takes approximately 3 minutes:

Step 1: Word Registration (Not Scored)

• The clinician reads 3 words aloud: BANANA, SUNRISE, CHAIR
• The patient repeats them back to confirm they heard correctly
• This step ensures the words were registered but is not scored yet

Step 2: Clock Drawing Test (0 or 2 points)

• The patient is asked to "Draw a clock showing 10 past 11" (11:10)
• While the patient draws, the delay allows the 3 words to be "forgotten"
• Normal clock (2 points): All numbers 1-12 in correct positions, hands showing 11:10
• Abnormal clock (0 points): Any errors in numbers, sequence, or hand placement

Step 3: Delayed Recall (0-3 points)

• The clinician asks: "What were the 3 words I asked you to remember?"
• 1 point awarded for each word recalled without cues
• Only free recall counts (no hints or multiple choice)

Total Score: Clock score (0 or 2) + Recall score (0-3) = 0-5 points

After Completion: Instant results show:

• Clock drawing score
• Delayed recall score (number of words remembered)
• Total Mini-Cog score
• Interpretation (positive or negative screen)
• Clinical recommendations
• Professional PDF for medical records