Instrument Development

The Mini-Cog© was developed to help identify, in non-specialist settings, individuals likely to have clinically important cognitive impairment. The initial proof of concept came from a community study of older adults with no exposure to neurocognitive specialty providers, about half of whom were late-life immigrants of widely varying educational and ethnolinguistic backgrounds (many non-English speakers). Evidence of cognitive impairment was based on the Clinical Dementia Rating (CDR), a widely-used multi-domain assessment completed primarily as an interview with a knowledgeable partner (family or friend) and used to stage cognitive status from normal through advanced dementia.  The  Mini-Cog© was constructed from 3-word recall, a common element in many cognitive screening tests and the earliest to decline impairment in common dementias such as Alzheimer’s disease, and a clock drawing task included as an executive/cognitive composite.  The initial visual algorithm for scoring, validated by receiver operating characteristics, was later replaced with an equivalent numerical system and evaluated in two population studies.


Soo Borson, Developer of the Mini-Cog©


Soo Borson MD is a physician and researcher specializing in dementia. She formerly directed the Memory Disorders Clinic and Dementia Health Services Research Group at the University of Washington, where she was Professor in the School of Medicine and a member of the NIA-funded Alzheimer’s Disease Research Center. She created and, with her team at UW, systematically validated the Mini-Cog©, a simple tool to improve detection of cognitive impairment. The Mini-Cog© has been endorsed in a technology assessment by the National Institute on Aging and the Centers for Medicare and Medicaid Services, and is supported by a specific electronic medical record code to facilitate capture of data about cognitive status in administrative health data. This is a remarkable step toward developing a population-based approach to dementia care and realizing a fundamental aim of the US National Plan for Alzheimer’s Disease. The Mini-Cog© has been widely adopted as a preferred measure for detection of cognitive impairment in clinical practice, including in the Medicare Annual Wellness Visit. In addition to her research and scholarly work, Dr. Borson has long been committed to interprofessional mentoring, teaching, and service and to national and international efforts to improve dementia care quality.