The Mini-Cog, A Memory Assessment Tool

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Have you heard of the “Mini-Cog”? I had read about it several years ago but a recent front page feature in the Star Tribune, our major daily newspaper in the Twin Cities, piqued my interest. The story focused on Dr. Michael Rosenbloom, clinical director of the HealthPartners Center for Memory and Aging, in St. Paul, Minnesota.
Rosenbloom and his colleagues believe that primary-care physicians are frequently missing signs of cognitive issues in their age 55 and over patients. Instead of relying solely on observation and a short conversation during patient appointments, Dr. Rosenbloom instead urges primary-care doctors to use an easy-to-administer test that could identify the early stages of Alzheimer’s disease and other dementia’s.
The Mini-Cog (Cog is short for cognition) can be performed during an annual exam or another appointment. Its a simple, pen and paper screening that takes only a few minutes and does not require any special equipment or training.

Here’s how it works:

The Mini-Cog has a five-point total score and is performed in two parts. First, the doctor tells the patient three words, and asks the patient to remember the words and repeat them later. Next, the patient is asked to draw the face of a clock and place the hands of the clock at a specific time. After the clock is completed, the patient is asked to repeat the three words.

A correctly drawn clock scores two points and each recalled word is one point. Those patients scoring three points or less have not passed the screening and may need additional evaluation.
Here is link to a sample of the actual Mini-Cog Assessment Instrument http://www.neurosciencecme.com/library/rating_scales/alzheimers_mini-cog.pdf.

Created by Dr. Soo Borson at the University of Washington, the Mini-Cog is a screening and does not provide a diagnosis. However, it is an indicator that something may be amiss.

The first task would be to determine if an underlying medical conditions, like thyroid disease, severe depression or a vitamin B12 deficiency, could be causing the patient’s memory issues. If other medical conditions are ruled out, then the physician decides how to best follow up.

Personally, I’m excited about the Mini-Cog for two reasons.

First, if the Mini-Cog is part of an annual exam, physicians may detect brain changes that are not apparent to family members or even the patient. Additionally, the test is easy to implement and costs virtually nothing, yet it provides a benchmark in a person’s chart. Doctors have the ability to look at the Mini-Cog test results year-after-year and note changes.

Sadly, the Mini-Cog isn’t widely used by physicians, specifically internists and general practitioners, who are on the front line of patient care. Dr. Rosenbloom of the Center for Aging and Memory wants to change that fact. He believes these primary care doctors are in a unique position to catch memory loss in its earlier stages.
There is so much about Alzheimer’s disease and other dementias that we have no control over. The Mini-Cog is a terrific assessment tool that can make a difference to patients and their families.

Personally, I think the Mini-Cog is a no-brainer and must be incorporated into patient annual screenings. The most effective change always seems to come from the top down and the bottom up. As a patient and health consumer, I’m asking you to please share this information with others and encourage your own physician to begin using it.

Nancy Wurtzel, a communications professional, is the editor of the blog DatingDementia.com, about midlife issues, including divorce, dating and caring for an elderly parent with Alzheimer’s.