Mini-Cog Instrument Administration and Scoring Guide

Mini-Cog Instrument Administration and Scoring Guide

The Mini-Cog Instrument is a widely used tool for screening cognitive impairment in older adults. It consists of a three-word recall task and a clock-drawing exercise, designed to assess memory and executive function. This guide provides detailed instructions for administering the Mini-Cog, including scoring criteria and interpretations of results. Healthcare professionals can utilize this instrument to identify individuals who may require further cognitive evaluation. The Mini-Cog is essential for geriatric assessments and can aid in early detection of dementia and other cognitive disorders.

Key Points

  • Includes step-by-step instructions for administering the Mini-Cog assessment.
  • Describes scoring methods for the three-word recall and clock-drawing tasks.
  • Provides insights into interpreting Mini-Cog scores for cognitive impairment screening.
  • Highlights the importance of the Mini-Cog in geriatric healthcare settings.
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Mini-Cog™
Instructions for Administration & Scoring
Step 1: Three Word Registration
Step 2: Clock Drawing
Step 3: Three Word Recall
Scoring
Look directly at person and say, “Please listen carefully. I am going to say three words that I want you to repeat back
to me now and try to remember. The words are [select a list of words from the versions below]. Please say them for
me now.” If the person is unable to repeat the words after three attempts, move on to Step 2 (clock drawing).
The following and other word lists have been used in one or more clinical studies.
1-3
For repeated administrations,
use of an alternative word list is recommended.
Say: “Next, I want you to draw a clock for me. First, put in all of the numbers where they go.” When that is completed,
say: “Now, set the hands to 10 past 11.”
Use preprinted circle (see next page) for this exercise. Repeat instructions as needed as this is not a memory test.
Move to Step 3 if the clock is not complete within three minutes.
Ask the person to recall the three words you stated in Step 1. Say: “What were the three words I asked you to
remember?” Record the word list version number and the person’s answers below.
Word List Version: _____ Person’s Answers: ___________________ ___________________ ___________________
Version 1
Banana
Sunrise
Chair
Version 4
River
Nation
Finger
Version 2
Leader
Season
Table
Version 5
Captain
Garden
Picture
Version 3
Village
Kitchen
Baby
Version 6
Daughter
Heaven
Mountain
Word Recall: ______ (0-3 points) 1 point for each word spontaneously recalled without cueing.
Clock Draw: ______ (0 or 2 points)
Normal clock = 2 points. A normal clock has all numbers placed in the correct
sequence and approximately correct position (e.g., 12, 3, 6 and 9 are in anchor
positions) with no missing or duplicate numbers. Hands are pointing to the 11
and 2 (11:10). Hand length is not scored.
Inability or refusal to draw a clock (abnormal) = 0 points.
Total Score: ______ (0-5 points)
Total score = Word Recall score + Clock Draw score.
A cut point of <3 on the Mini-Cog™ has been validated for dementia screening,
but many individuals with clinically meaningful cognitive impairment will score
higher. When greater sensitivity is desired, a cut point of <4 is recommended as
it may indicate a need for further evaluation of cognitive status.
Mini-Cog™ © S. Borson. All rights reserved. Reprinted with permission of the author solely for clinical and educational purposes.
May not be modified or used for commercial, marketing, or research purposes without permission of the author (soob@uw.edu).
v. 01.19.16
ID: ______________ Date: ________________________
1. Borson S, Scanlan JM, Chen PJ et al. The Mini-Cog as a screen for dementia: Validation in a population-based
sample. J Am Geriatr Soc 2003;51:1451–1454.
2. Borson S, Scanlan JM, Watanabe J et al. Improving identification of cognitive impairment in primary care. Int J
Geriatr Psychiatry 2006;21: 349–355.
3. Lessig M, Scanlan J et al. Time that tells: Critical clock-drawing errors for dementia screening. Int
Psychogeriatr. 2008 June; 20(3): 459–470.
4. Tsoi K, Chan J et al. Cognitive tests to detect dementia: A systematic review and meta-analysis. JAMA Intern
Med. 2015; E1-E9.
5. McCarten J, Anderson P et al. Screening for cognitive impairment in an elderly veteran population:
Acceptability and results using different versions of the Mini-Cog. J Am Geriatr Soc 2011; 59: 309-213.
6. McCarten J, Anderson P et al. Finding dementia in primary care: The results of a clinical demonstration
project. J Am Geriatr Soc 2012; 60: 210-217.
7. Scanlan J & Borson S. The Mini-Cog: Receiver operating characteristics with the expert and naive raters. Int J
Geriatr Psychiatry 2001; 16: 216-222.
References
Clock Drawing
ID: ______________ Date: ________________________
Mini-Cog™ © S. Borson. All rights reserved. Reprinted with permission of the author solely for clinical and educational purposes.
May not be modified or used for commercial, marketing, or research purposes without permission of the author (soob@uw.edu).
v. 01.19.16
8/24/2017 Administering the Mini-Cog™ – Mini-Cog™
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Mini-Cog™ (http://mini-cog.com/)
Screening for Cognitive Impairment in Older Adults
Administering the Mini-Cog™
The Mini-Cog can be used as a ‘cognitive vital sign’ and administered reliably with a little practice. Instructions for administration are provided on the test
form available here. Once you start, complete the Mini-Cog in one unit – choose a time when interruptions and distractions are unlikely.
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1. Make sure you have the patient’s attention.
Instruct the patient to listen carefully to and remember three unrelated words and then to repeat the words back to you so then you will know they
heard the words correctly. You may want to say something like, “What we’re going to do next will take some concentration. Ready?”
2. Ask the patient to repeat the words to ensure understanding.
Once you are sure the patient is paying attention, say, “I am going to say three words that I want you to remember now and later. The words are banana,
sunrise, chair. Please say them now.” Give the patient three tries to repeat the words. You may repeat the words to them for each try. If they are unable to
repeat the words back to you after three tries, go directly to the clock drawing.
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FAQs of Mini-Cog Instrument Administration and Scoring Guide

What is the purpose of the Mini-Cog Instrument?
The Mini-Cog Instrument is designed to screen for cognitive impairment in older adults. It helps healthcare providers quickly assess memory and executive function through a simple three-word recall and a clock-drawing task. By identifying individuals at risk for cognitive decline, the Mini-Cog facilitates early intervention and further evaluation when necessary.
How is the Mini-Cog scored?
The Mini-Cog is scored based on two components: the three-word recall and the clock-drawing task. Each correctly recalled word earns one point, with a maximum of three points possible. The clock-drawing task can earn two points if done correctly, resulting in a total score ranging from zero to five. A score of less than three indicates a potential cognitive impairment.
What are the key components of the Mini-Cog assessment?
The Mini-Cog assessment consists of three main components: three-word registration, clock drawing, and three-word recall. During the registration phase, the administrator states three unrelated words for the participant to remember. The clock drawing requires the participant to draw a clock and set the hands to a specific time. Finally, the participant must recall the three words after completing the clock task.
Who can benefit from using the Mini-Cog?
The Mini-Cog is beneficial for healthcare professionals working with older adults, particularly in geriatric settings. It is a quick and effective tool for identifying cognitive impairment, making it useful for primary care physicians, neurologists, and geriatric specialists. Additionally, caregivers and family members can use the Mini-Cog to monitor cognitive changes in elderly individuals.
What does a low score on the Mini-Cog indicate?
A low score on the Mini-Cog, typically less than three, suggests potential cognitive impairment and may indicate the need for further evaluation. It is important to note that while the Mini-Cog is a useful screening tool, it is not a definitive diagnosis of dementia or other cognitive disorders. A comprehensive assessment by a healthcare professional is necessary for an accurate diagnosis.

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