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The Mini-Cog is a 3-minute cognitive screening test that combines a three-word recall task with a clock-drawing test to flag possible dementia and cognitive impairment in older adults. This page covers the exact administration steps, the 0-5 point scoring rule, the validated positive-screen cutoff, and where it fits alongside longer tools like the Montreal Cognitive Assessment (MoCA). For related functional and bedside assessment tools, see CASRAI’s Katz ADL Index and Glasgow Coma Scale pages.
What the Mini-Cog is, and who built it
The Mini-Cog was developed by Dr. Soo Borson specifically to give primary care and other non-specialist settings a validated cognitive screen that takes only a few minutes and requires no special equipment. It is free, in the public domain, and takes under 10 minutes to learn to administer — a deliberate design choice aimed at settings (routine wellness visits, community health screenings, busy primary care) where a longer instrument like the MoCA is impractical to add to every visit.
Administration and scoring
The Mini-Cog has three steps, scored on a 0-to-5 scale:
| Step | What happens | Points |
|---|---|---|
| 1. Three-word registration | The examiner names three unrelated words (e.g., banana, sunrise, chair) and the patient repeats them back | — |
| 2. Clock drawing | The patient draws a clock face from memory, places all 12 numbers correctly, and sets the hands to a specified time (commonly 10 past 11) | 2 (normal clock) or 0 (abnormal clock) |
| 3. Three-word recall | The patient recalls the three words from Step 1 without prompting | 1 point per word recalled (0–3) |
A correctly drawn clock is scored as a single pass/fail item (2 or 0 points), not partial credit per element, which is part of what keeps administration and scoring fast relative to instruments with per-item point breakdowns.
Interpreting the score
Total scores range from 0 to 5:
- 0–2: positive screen — indicates a higher likelihood of clinically important cognitive impairment and warrants further, more detailed evaluation.
- 3–5: negative screen — indicates a lower likelihood of dementia, though it does not fully rule out mild cognitive impairment on its own.
Because the Mini-Cog is a brief triage instrument rather than a diagnostic one, a positive screen is a prompt to pursue a longer instrument (MoCA or formal neuropsychological testing), not a diagnosis in itself.
Mini-Cog vs. the MoCA
The Mini-Cog and the MoCA serve different points in a cognitive-screening pathway rather than competing head-to-head. The Mini-Cog’s 3-minute administration time and lack of any certification requirement make it well suited as a fast first-pass triage tool across an entire patient population (e.g., a wellness-visit or pre-operative screening protocol applied broadly); its tradeoff is a coarser 6-point scale that cannot characterize which cognitive domain is affected. The MoCA’s 10-15 minutes and 30-point, 7-domain scoring give a more granular picture once a patient is already flagged for closer evaluation, at the cost of being impractical to administer to every patient at every visit. Many hospital cognitive-screening protocols use the two in sequence: Mini-Cog as the universal screen, MoCA (or full neuropsychological testing) for anyone who screens positive.
Where the Mini-Cog fits in hospital and primary-care workflows
Beyond dementia screening in primary care, the Mini-Cog is used as a quick pre-operative cognitive baseline, in delirium-risk screening protocols, and by the U.S. Department of Veterans Affairs as part of broader cognitive-impairment identification efforts in older veterans. As with any brief screen that triggers a downstream referral or care-plan decision, chart audits should confirm the actual recalled-word count and clock result were documented (not just a summary “positive”/”negative” label) and that the three words used were drawn from a validated word list rather than improvised at the bedside, since word difficulty affects the recall task’s sensitivity.
Frequently asked questions
What is a normal Mini-Cog score?
A total score of 3 to 5 (out of 5) is considered a negative screen, indicating a lower likelihood of dementia.
What does a Mini-Cog score of 2 mean?
A score of 0, 1, or 2 is a positive screen, indicating a higher likelihood of clinically important cognitive impairment and the need for further evaluation — it is not itself a dementia diagnosis.
How long does the Mini-Cog take to administer?
About 3 minutes to administer, and under 10 minutes for a clinician to learn to administer correctly.
Is the Mini-Cog the same as the 3-question or 30-question dementia test some patients ask about?
No. The Mini-Cog uses a three-word recall plus a clock-drawing task (5 points total), which is sometimes informally described online as a “3-word” or “3-question” test. It is a distinct, shorter instrument from the 30-point MoCA or the Mini-Mental State Exam.
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