The Mini-Cog™ is a 3-minute instrument that can increase detection of cognitive impairment in older adults. It can be used effectively after brief training in both healthcare and community settings. It consists of two components, a 3-item recall test for memory and a simply scored clock drawing test. As a screening test, however, it does not substitute for a complete diagnostic workup.
Cognitive impairment is an important determinant of clinical outcomes, but is often unrecognized until a crisis develops. Proactive management, aimed at crisis prevention, depends on timely detection of cognitive impairment and care planning. Cognitive assessment is a first step to better management.
Cognitive impairment and dementia reflect impaired brain function. The brain is the only vital organ that is not routinely assessed in clinical practice, yet good brain function is essential for clinician-patient partnership. The causes of cognitive impairment and dementia can be primary brain diseases (most commonly Alzheimer’s disease, ischemic vascular disease, and conditions related to Parkinson’s disease) or secondary effects of systemic diseases, medications, and other conditions. Many chronic medical disorders, including diabetes, kidney disease, chronic obstructive pulmonary disease, and heart disease are associated with significant cognitive deficits that affect outcomes of treatment. People with cognitive impairment or dementia are often unaware of the extent or impact of their cognitive deficits and can look and act healthy in routine clinical encounters.
The Mini-Cog™ can be used to screen for cognitive impairment quickly during both routine visits and other clinical settings. It serves to identify patients who need more thorough evaluation.
The goal of screening for cognitive impairment in primary care is to find patients whose cognitive deficits have gone unnoticed or unrecorded in routine clinical encounters, but may be severe enough to interfere with the patient’s self-care or to affect medical management.
Primary care patients can be routinely screened for cognitive impairment as part of the Medicare Annual Wellness Visit (AWV). This test may also be used to rapidly establish a baseline to compare with future assessments. Medicare (CMS) requires detection of any cognitive impairment as part of the AWV. The Alzheimer’s Association, the Gerontological Society of America, and the National Institute on Aging all support the use of the Mini-Cog™ as a valid and reliable tool that can improve detection of cognitive impairment in primary care and prompt decision making regarding the need for more detailed evaluation and follow up.
More examples of how the Mini-Cog™ has been used in primary care can be found on the references page of this website.
The Mini-Cog™ has been used in various community settings. The test has minimal language content, which reduces cultural and educational bias. It has been translated into several languages and non-English language versions have been created:
More examples of how the Mini-Cog™ has been used in the community can be found on the references page of this website.
Other Clinical Settings
The Mini-Cog™ has been used in other clinical settings, including in studies related to heart failure, surgery, health literacy, and pharmacy.
More examples of how the Mini-Cog™ has been used in other clinical settings can be found on the references page of this website.