Mini-Cog
Brief Cognitive Screen (Geriatric)
<3 → possible impairment; proceed to MoCA or full dementia workup.
Clinicians lean on this acronym when a Medicare wellness visit needs a cognitive screen and the schedule allows three minutes, not thirty. Mini-Cog scores 3-word recall (0, 1, or 2 of 3) plus a clock draw (0 abnormal, 2 normal). Total runs 0-5; under 3 flags possible impairment and prompts a fuller assessment with MoCA, MMSE, or full dementia workup. The AANP exam treats Mini-Cog as the screen, not the diagnosis, and rewards candidates who escalate appropriately rather than stopping at the score. Watch for distractor answers that anchor on the clock alone — both components carry weight, and word recall is the more sensitive piece.
- 13-word registrationSay three unrelated words (e.g., banana, sunrise, chair). Patient repeats to confirm encoding.
- 2Clock-draw testDraw a clock face, put in all the numbers, and set the hands to ten past eleven. 2 points if normal (all numbers correct + hands at 11:10); 0 points if abnormal.
- 33-word recallAsk patient to recall the three words without prompting. 1 point per word (0-3).
Clinical Context
Scores 0-5 (3 recall + 2 clock). <3 flags possible cognitive impairment and warrants MoCA (scores 0-30, <26 abnormal) or MMSE for more detail. Takes ~3 minutes and fits any primary-care visit — designed for the 15-minute slot where MoCA doesn't fit.
Medicare Annual Wellness Visit requires cognitive screening; Mini-Cog or the GPCOG are acceptable. A failed Mini-Cog is not a dementia diagnosis — it triggers further workup: rule out reversible causes (B12, TSH, depression, medications — especially anticholinergics), get imaging if focal findings or rapid progression, and then formal neuropsych testing.
AANP geriatric stem: 78-year-old with "forgetfulness" for a year, normal labs, Mini-Cog 2/5 — next step is MoCA + depression screen + medication review, not starting donepezil empirically.
Practice Questions
During a routine annual wellness visit, an 81-year-old woman is screened with the Mini-Cog. She is given the three words "banana, sunrise, chair" to remember. She is then asked to draw a clock showing 11:10. After the clock-drawing task, she is unable to recall any of the three words. Her clock is drawn with all numbers placed correctly in the proper sequence and the hands accurately positioned at 11 and 2. Her daughter reports she has noticed her mother becoming more forgetful and occasionally getting lost driving to familiar places over the past 6 months. Which of the following is the priority next step?
Related Mnemonics
- ABCD² — TIA Stroke Risk (ABCD² Score)
- AEIOU-TIPS — Causes of Altered Mental Status
- BE FAST — Stroke Recognition (Extended)
- CAM — Delirium Diagnosis (Confusion Assessment Method)
- FAST — Stroke Recognition
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