A screening tool for early mental decline
On this page: The Test | Results | Interpretation | References



About the Mini-Cog

The Mini-Cog is a very simple and relatively quick screening tool carried out by a health care provider to identify early mental decline. It takes about 3 minutes to administer and is often used in office visits and emergency rooms as a screening tool to identify those who require further investigation into their clinical presentation.

The test

The Mini-Cog consists of a three item recall and a clock drawing test. A Functional Activities Questionnaire is used in combination with the Mini-Cog.

(1) First the person is asked to repeat three unrelated words, such as penny, apple, table. This is the same as in the Mini Mental State Examination (MMSE).

(2)The person is then asked to draw a clock showing a specific time. Instructions: Draw the face of a clock and put the numbers in the correct positions. Then draw in the hands at ten minutes after eleven. (This is the same as the Clock Drawing Test).

(3)The patient is then asked to recall the three words. (This should be done after one minute, or after the Clock Drawing Test is complete)

Results of the Mini-Cog

Results of the 3-item recall:

Anything other than perfect recall after one minute, or after the clock drawing test, means that further testing, such as the MMSE, should be done. Medical testing should be performed and current medications should be reviewed. There are numerous medications that can cause adverse neurological side effects.

Results of The Clock Drawing Test Scoring:

  1. Draws closed circle: Score 1 point
  2. Places numbers in correct positions: Score 1 point
  3. Includes all 12 correct numbers: Score 1 point
  4. Places hands in correct positions: Score 1 point


A score of less than 4 indicates the need for further evaluation, such as performing the Mini-Mental Status Exam.

Test results are only one part of the tools used in the diagnosis of dementia. The test cannot be used alone as a diagnostic test for Alzheimer's disease.

Memory loss is typically the first sign of dementia, but it can also be due to a number of other conditions that require medical attention, as well.

1)The Clock Drawing Test in: Palmer RM, Meldon SW. Acute Care. In: Principles of Geriatric Medicine and Gerontology, 5th edition, 2003. Eds. Hazzard WR et al. McGraw-Hill Pub. pp 157-168. Inouye SK. Delirium in hospitalized olderpatients. Clin Geriatr Med 1998; 14:745-764

2) The Mini-Cog in: Borson S, Scanlan J, Brush M, Vitaliano P, Dokmak A. The mini-cog: a
cognitive “vital signs” measure for dementia screening in multi-lingual elderly. Int J Geriatr Psychiatry 2000;15(11): 1021–1027.

Written by N Thompson, RN, MSN, ARNP, Last updated November 2008

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