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
• Free for clinical and educational use (Mini-Cog© is still copyrighted)
• Validated across diverse populations
• Easy to administer and score
• Can be used for screening and progress monitoring

Copyright: Mini-Cog© is copyrighted by Soo Borson, MD. It is made available free of charge for clinical and educational use so the test is given and scored as written. This page is a clinician scoring aid, not a substitute for the official instrument at mini-cog.com. It is not a self-test.

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. Do not show this screen to the person being screened.

Step 1: Word Registration (Not Scored)

• Read three words aloud from an official Mini-Cog© word list
• The person repeats them back to confirm they heard correctly
• Do not leave the word list visible. This step is not scored yet

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

• Ask the person to draw a clock showing 10 past 11 (11:10)
• The drawing creates the delay before recall
• Normal clock (2 points): Numbers 1–12 once, clockwise, roughly correct positions; one hand to the 11 and one hand to the 2
• Abnormal clock (0 points): Any other clock, or refusal
• Hand length is not scored

Step 3: Delayed Recall (0-3 points)

• Ask: "What were the 3 words I asked you to remember?"
• 1 point per word recalled without cues
• Only free recall counts (no hints, category cues, 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

The Mini-Cog uses a simple binary classification based on total score:

Total Score: 0-2 points → POSITIVE SCREEN

• Interpretation: Positive screen for cognitive impairment. The score pattern suggests higher likelihood of clinically significant cognitive impairment.
• Clinical Action: Comprehensive cognitive evaluation recommended. Consider referral to neurology, neuropsychology, or geriatrics for further assessment.
• Follow-up: Rule out reversible causes (medication effects, delirium, depression, vitamin deficiencies, thyroid dysfunction).

Total Score: 3-5 points → NEGATIVE SCREEN

• Interpretation: Negative screen. Score suggests lower likelihood of dementia.
• Clinical Action: Routine monitoring as appropriate for age and risk factors.
• Important Note: A negative screen does NOT rule out all cognitive impairment. Some individuals with mild cognitive impairment or early dementia may still score in this range.

Score Component Breakdown:

Clock Drawing (0 or 2 points):

• 2 points (Normal): Intact visuospatial abilities, executive function, and ability to follow commands
• 0 points (Abnormal): Suggests deficits in visuospatial processing, executive function, or semantic memory

Delayed Recall (0-3 points):

• Official Mini-Cog© scoring awards 1 point per word freely recalled. It does not publish separate “mild / significant memory impairment” labels for the recall item alone.
• Use the total 0–2 vs 3–5 cut, not an unofficial recall-only severity band.

Clinical notes (not official Mini-Cog© scoring):

• Isolated clock-drawing errors can raise a question about visuospatial or executive demand
• Isolated recall errors can raise a question about memory
• Combined deficits increase concern for a dementia syndrome
• Depression, delirium, hearing, language, and test-taking factors can all affect performance

Next Steps After Positive Screen:

• Complete medical history and physical exam
• Laboratory workup (B12, thyroid, metabolic panel)
• Medication review
• Depression screening
• Comprehensive neuropsychological testing
• Brain imaging if indicated (MRI or CT)