Mini-Cog Test for Dementia and Alzheimer’s: Accuracy, Administration & Scoring

What is the Mini-Cog Test?

The Mini-Cog is a quick and easy screening test that can recognize Alzheimer’s disease and other dementias in their early stages. The Mini-Cog can’t diagnose dementia on its own, but its results can help determine if a more thorough assessment by medical professionals is necessary.

Completing the Mini-Cog test takes about 3 minutes. Learning how to give the test takes less than 10 minutes, and no special medical knowledge is needed.

You or your loved one should consider taking the Mini-Cog, or a similar at-home test, if you’re experiencing any of the following symptoms:

• Difficulty planning or solving problems
• Difficulty with familiar tasks
• Losing track of time
• Getting lost
• Misplacing commonly used items
• Problems speaking or writing
• Mood swings
• Social withdrawal

Detecting dementia in its early stages, which is the primary use for the Mini-Cog, can be crucial. There is no cure for Alzheimer’s or other dementias, but there are pharmaceutical, therapeutic and alternative treatments that can manage symptoms and improve the quality of life for dementia patients and their families. The earlier the disease is identified, the more effective these treatments will be.

The following is everything you need to know about the Mini-Cog, including where to get it, how it works and how to administer the test to a loved one.

How Does it Work?

The Mini-Cog tests several aspects of brain function with just two simple tasks that make up the entirety of the test – three-word recall and the Clock-Drawing Test.

1. Three-word recall

The test begins with the administrator reading three unrelated words aloud and in a strong voice to ensure they’re clearly heard. Examples would be “banana, sunrise, chair,” or “daughter, heaven, mountain.” Then the test-taker is asked to draw a clock (see below). After completing the drawing, the test-taker is asked to repeat the three words that were spoken at the beginning of the test.

The three-word recall is a means of testing short-term memory. One of the first signs of dementia, including Alzheimer’s disease, is difficulty with short-term memory. Asking for these words to be repeated after the distraction of drawing the clock challenges memory. It will often be too difficult for someone in the earliest stages of dementia.

2. Clock-Drawing Test (CDT)

The second part of the Mini-Cog is exactly what it sounds like. The subject is asked to draw an analog clock (with minute and hour hands) showing a specific time, usually “10 past 11.” You can give the person the circle or not. This seems like a basic task, but several types of thinking are tested:

Verbal understanding: Turning words (“Draw a clock”) into actions.

Visual memory: Remembering what a clock even looks like. People with dementia often struggle with this.

Planning and understanding: It takes multiple steps to draw a clock. The circle comes first, then the numbers are written in the correct places, followed by the hands.

Abstract thinking: The “10 past 11” part requires the brain to do some work. The test-taker has to think about those numbers and know that “10” means the minute hand is pointed toward the 2, and not the 10.

Learn more about the CDT by clicking here.

Mini-Cog Pros and Cons

Pros:

• Easy to use. All you need is the test instructions, two writing instruments and two pieces of paper.
• Quick to administer. The Mini-Cog takes about three minutes.
• Basic. Other tests, like the Mini-Mental State Exam, have been found to require a certain level of education, while the Mini-Cog can be taken by anyone.
• Identifies early signs. The early stages of dementia are the hardest to recognize, but the Mini-Cog has been shown to identify them. The MMSE often misses early warning signs.

Cons:

• Not always accurate. Studies show the Mini-Cog can be wrong about 25% of the time when it comes to correctly identifying dementia.
• The Mini-Cog does not identify the stage or extent of a person’s dementia.
• People with vision issues may have difficulty with the clock drawing.

Accuracy

According to this study published in 2018 and conducted by multiple research teams, the Mini-Cog has a sensitivity of 76%, which means it correctly identifies people who have dementia 76% of the time, and it has a specificity of 73%, which means it correctly identifies people who don’t have dementia 73% of the time. This means the test has not been proven effective enough to be used in clinical or doctor’s-office settings as a screening test for dementia, like the Mini-Mental State Exam. However, the Mini-Cog is still considered effective for its stated purpose, which is identifying people who should seek further advice from experts.

How to Administer

Step 1 – Download and print the test. You will need a clock or some other timing device, two writing instruments and two pieces of paper.

Step 2 – Take the person being tested to a comfortable room without distractions. Have them sit at a table and provide them with a pencil with an eraser and a piece of paper for drawing the clock.

Step 3 – Look at the person being tested and say “I’m going to say three words. I want you to repeat them back to me, and you will need to remember them again at the end of the test.” Then clearly speak three unrelated words, which are provided by the test. An example is “river, nation, finger.”

Step 4 – Have the words spoken back by the test-taker as soon as you’ve said all three.

Step 5 – Have the test-taker draw a clock with the time “10 past 11.” You can provide the circle, or outline of the clock. Allow three minutes to complete this task. Do not help, but be friendly and encouraging.

Step 6 – Ask the person “What were the three words I spoke at the beginning of the test?” Write down the answers.

Step 7 – Compile the score (see below).

Interpreting the Results

There are five total points a person can score on the Mini-Cog:

• Give one point for each word that was correctly remembered. (0-3 points)
• Give two points for a correctly drawn clock, meaning the numbers are in roughly the correct locations and two hands are pointed to the 11 and the 2. The length of the hands does not matter. (0 or 2 points)

If the test-taker scored less than three points, an appointment should be scheduled with their primary care doctor for follow-up testing. Take the results of the Mini-Cog test, including the clock they drew, to this appointment. The primary care doctor will be able to decide what steps to take next, including a possible referral to a neurologist who specializes in brain function and impairment.

Alternatives and Comparisons

Compared to the Self-Administered Gerocognitive Exam

The Self-Administered Gerocognitive Exam (SAGE) is similar to the Mini-Cog in that both include the Clock Drawing Test. The SAGE can be taken alone, however: All a person needs is the printed-out test and a pencil. There is no active administrator role like there is with the Mini-Cog, where words need to be spoken aloud. The SAGE takes slightly longer, about 10 minutes, because there are more questions. This makes it more challenging than the Mini-Cog, and studies have shown it is a more accurate predictor of dementia. Both tests are useful tools, however, and the Mini-Cog is easier and takes less time. The SAGE, like the Mini-Cog, is meant to tell someone if further evaluation is needed and should not be used to make an actual diagnosis.

Compared to the Mini-Mental State Exam

The Mini-Mental State Exam (MMSE) is a 30-question test that measures cognitive ability and impairment. The MMSE was designed to be administered by a healthcare professional in a clinical setting, but a version of the test can be found online and taken at home. Scoring the test is straightforward and can also be done at home, but the results should not be considered a diagnosis of dementia. They should only be used as an indication if further testing is needed, same as the Mini-Cog. The MMSE is most effective at differentiating between the stages of dementia, and it is not as effective at detecting early stage dementia as the SAGE described above.

Compared to the Montreal Cognitive Assessment

The Montreal Cognitive Assessment (MoCA) is a 30-question test that screens adults for early signs of dementia and mild cognitive impairment. The MoCA is meant to be administered and graded by a healthcare professional, who will then decide if further evaluation is necessary. The MoCA can accurately detect early signs of dementia about 90% of the time, which makes it more accurate than the Mini-Cog in that regard, but the Mini-Cog is a much simpler test and easier first step to take for most people.