What Is the Mini-Cog Test?

The Mini-Cog test is a three-minute dementia screening tool that combines two tasks: recalling three words and drawing a clock face. It is scored out of 5 points, and a total of 0 to 2 indicates a higher likelihood of clinically important cognitive impairment. The instrument was developed by Soo Borson and colleagues and published in 2000. Like every brief cognitive screen, it flags people who need a closer look; it does not diagnose dementia, and it is a screening tool, not an IQ test.

The examiner reads three unrelated words (the standardized instrument provides six validated lists, such as banana, sunrise, chair) and asks the patient to repeat them. Next comes the clock: draw a clock face, put in all the numbers, and "set the hands to 10 past 11." The clock serves two purposes at once. It is a genuine test of planning, visuospatial ability, and executive function, and it works as a "distractor," occupying attention so the final step, recalling the three words, measures real retention rather than rehearsal. The official instructions note that examiners may repeat the clock instructions as needed, because that step is not a memory test, and should move on if the clock is not complete within three minutes.

• Word recall (0-3 points): One point for each word recalled without prompting.

• Clock drawing (0 or 2 points): Two points for a normal clock, zero for an abnormal one. A normal clock has all twelve numbers in sequence and roughly correct position, with no missing or duplicated numbers, and hands pointing to the 11 and the 2.

• Total (0-5): A score of 0, 1, or 2 indicates a higher likelihood of clinically important cognitive impairment. A score of 3, 4, or 5 indicates a lower likelihood of dementia, though it does not rule out some degree of impairment.

The official guidance adds a useful nuance: the cut point of below 3 has been validated for dementia screening, but many people with clinically meaningful impairment score higher. When greater sensitivity is desired, clinicians use a cut point of below 4 as the trigger for further evaluation.

In the original 2000 study of 249 older adults, 129 of whom had probable dementia and 124 of whom were non-English speakers, the Mini-Cog had the highest "sensitivity" of the measures compared, 99 percent, and correctly classified 96 percent of participants. Its accuracy was not influenced by education or language, which set it apart from the MMSE, and it took about 3 minutes against 7 for the MMSE. Those properties are why it became a standard quick screen in primary care.

A five-point scale cannot measure intelligence, and it is not supposed to. The Mini-Cog samples episodic memory and executive function just enough to flag likely impairment; nearly all cognitively healthy adults score 4 or 5, so the test says nothing about whether someone's ability is average or exceptional. An IQ test does the opposite job, using dozens of items of graded difficulty, normed on the population, to place a person on a scale with a mean of 100.

A positive screen is the start of a process, not the end. The National Institute on Aging notes that results of brief tools "alone are insufficient to diagnose dementia." What follows is a medical history, laboratory work, possibly brain imaging, and comprehensive neuropsychological testing. For how researchers separate normal aging from decline, see our article on measuring cognitive aging.

The Mini-Cog optimizes for speed: three minutes, minimal language demands, easy scoring. The MoCA takes about 10 minutes, samples more domains, and is more sensitive to the mildest impairment. The SAGE test is self-administered at home and scored later by a physician. A clinician chooses among them based on time and setting; all three lead to the same next step when positive.

Out of 5 points: one point per word recalled from a three-word list, plus 2 points for a normally drawn clock and 0 for an abnormal one. A total of 0 to 2 indicates a higher likelihood of clinically important impairment; 3 to 5 indicates a lower likelihood of dementia.

There is no single fixed set. The standardized instrument provides six validated three-word lists, such as banana, sunrise, chair. Clinicians read one list, administer the clock drawing as a distractor, then ask for the three words again, and alternative lists are recommended for repeat testing.

No. It is a three-minute dementia screen with a five-point ceiling. It cannot distinguish average from high intelligence because virtually all cognitively healthy adults pass. IQ tests use many normed items to place you on a scale with a mean of 100.

In the original 2000 study of 249 multi-lingual older adults it showed 99 percent sensitivity and correctly classified 96 percent of subjects, and its accuracy was not influenced by education or language. Like any screen, a positive result requires follow-up evaluation.

A score of 0 to 2 means a higher likelihood of cognitive impairment and a need for detailed assessment: medical history, labs, possibly brain imaging, and comprehensive neuropsychological testing. The National Institute on Aging notes screening results alone are insufficient to diagnose dementia.

A screen tells you whether something may be wrong. It cannot tell you where you stand, because it has no norms across the ability range. If that is what you want to know, a normed assessment such as the Reasoning and Intelligence Online Test measures cognitive ability across the full adult distribution. You can take the free RIOT IQ test online.

1. Borson, S., Scanlan, J., Brush, M., Vitaliano, P., & Dokmak, A. (2000). The Mini-Cog: A cognitive "vital signs" measure for dementia screening in multi-lingual elderly. International Journal of Geriatric Psychiatry, 15(11), 1021-1027. pubmed.ncbi.nlm.nih.gov

2. Mini-Cog. (n.d.). Scoring the Mini-Cog. mini-cog.com

3. Mini-Cog. (n.d.). Mini-Cog: Screening for cognitive impairment in older adults. mini-cog.com

4. Mini-Cog. (2016). Mini-Cog instructions for administration & scoring (Standardized English version). mini-cog.com

5. National Institute on Aging. (n.d.). Assessing cognitive impairment in older patients. nia.nih.gov