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

Last Updated: May 28, 2020

 

What is the Mini-Cog Test?

The Mini-Cog is a tool for seeing whether someone shows signs of dementia. It tests cognition, or thinking ability, in a way that has been scientifically demonstrated to help determine if someone might be in the early stages of Alzheimer’s disease or a related dementia. The test is incredibly brief, only taking about three minutes, and easy to administer at home.

Importantly, the Mini-Cog does not replace a doctor’s diagnosis. Instead, it should be considered as a nudge toward speaking with healthcare professionals about whether an actual, in-depth diagnosis should be sought by someone having issues with memory and/or concentration. The Mini-Cog is a simple way to decide whether you need to bring these issues up with a doctor.

  Looking to administer the Mini-Cog Test? Download it here

The Mini-Cog includes two elements: three-word recall test and the Clock Drawing Test.

1. Three-Word Recall
The test begins with the administrator reading three unrelated words aloud, 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 most kinds 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. The Clock Drawing Test (CDT)
The second part of the Mini-Cog is exactly what it sounds like. The subject is asked to draw a clock 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.

Further information on the CDT is available here.

 

Compared to the SAGE

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 read 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. Also, the SAGE is meant to tell someone if further evaluation is needed, like the Mini-Cog, and not make an actual diagnosis.

 

Compared to the MMSE

The Mini-Mental State Exam (MMSE) is a 30-point test meant to be administered by a doctor or other healthcare professional, though like the Mini-Cog it does not stand alone as a means to diagnose dementia. The MMSE is often used by researchers and clinicians who study Alzheimer’s, to know the stage of dementia for people participating in studies. The MMSE has several questions that test different aspects of memory and thinking ability, and the scoring is complicated and meant to be done in a professional setting. The MMSE has been shown to be less reliable in predicting dementia than the SAGE, and about as reliable as the Mini-Cog.

 

Compared to the MoCA

The Montreal Cognitive Assessment is a 30-point test like the MMSE that must be administered and scored by a healthcare professional. It cannot be taken at home like the Mini-Cog, and takes longer (about 10 to 15 minutes) to complete. Studies have shown the MoCA is more accurate than the MMSE, and better at identifying early-stage dementia, but people who want an at-home assessment before making a doctor’s appointment should not consider the MoCA a good option like the Mini-Cog.

 

How Accurate is the Mini-Cog?

Studies have shown that the Mini-Cog correctly identifies dementia in about three-quarters of the people who are tested. Researchers say that it is not 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 (see above). However, this does not mean that it is ineffective for its stated purpose of identifying people who should seek further advice from experts because their memory loss may indicate dementia. As a means of deciding whether you or your loved one should seek further advice from a doctor, the Mini-Cog is useful.

  Did You Know? These are the earliest signs of dementia. Someone experiencing these symptoms should consider taking the Mini-Cog, or a similar at-home test, to see if further evaluation should be sought:
– 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

 

How to Administer the Mini-Cog

Step 1 – Download and print the test. You’ll need a pencil or pen to keep score. You will also need a stopwatch or timer.

Step 2 – Take the person being tested to a comfortable room that does not have distractions. Have them sit at a table and provide a pencil with an eraser. They also need a piece of paper for drawing the clock, and you can decide whether the paper is blank or if you’re providing the circle. (The link in Step 1 above provides the circle.)

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. 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.

 

How to Score the Mini-Cog

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, this is considered evidence enough that an appointment should be scheduled with your primary care doctor. Take the results of the test 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 treating illnesses in the brain.

 

Pros & Cons of the Mini-Cog

Pros:
1. Easy to use. The only thing you need is the test and a couple writing instruments.
2. Quick to administer. The Mini-Cog should not take more than three to five minutes.
3. Basic. Other tests, like the MMSE, have been found to require a certain level of education, while the Mini-Cog can be taken by anyone.
4. Useful in identifying mild cognitive impairment (MCI). People in the earliest stages of dementia are harder to find, but the Mini-Cog has been shown to identify them. (The MMSE often misses people with MCI.)

Cons:
1. Not always accurate. The Mini-Cog has been shown in studies to correctly identify dementia about three-quarters of the time.
2. The Mini-Cog does not identify the stage or extent of a person’s dementia.
3. People with sight issues have difficulty with the clock drawing.