What is the cut off for the mini cog? A Guide to Scoring

The Mini-Cog is a rapid, 3-minute screening tool widely used to quickly assess cognitive impairment in older adults. The results are easy to interpret, but knowing what is the cut off for the mini cog and what the scores imply is crucial for understanding next steps.

Quick Summary

The primary Mini-Cog cut off for dementia screening is a score of 0-2, indicating a higher likelihood of cognitive impairment, while a score of 3-5 is a negative screen. However, a stricter cut point of less than 4 is sometimes recommended for higher sensitivity to subtler issues.

Key Points

• Standard Cut Off: A Mini-Cog score of 0, 1, or 2 suggests a higher likelihood of cognitive impairment and requires further evaluation.

• Negative Screen: A score of 3, 4, or 5 indicates a lower likelihood of dementia but does not rule out all cognitive issues.

• Two Components: The test consists of a 3-word recall (0-3 points) and a clock-drawing task (0 or 2 points), with the total score determining the outcome.

• Not Diagnostic: The Mini-Cog is a screening tool, not a diagnostic test, and a positive result mandates further medical investigation.

• Milder Impairment: In some cases, a cut off of less than 4 may be used to increase sensitivity for milder cognitive issues.

• Easy to Administer: The test is quick (approx. 3 minutes) and can be administered by various healthcare personnel with minimal training.

Understanding the Mini-Cog Scoring System

The Mini-Cog is a dual-component assessment tool combining a 3-item recall test and a clock-drawing task. This makes it a quick and effective method for screening for dementia in a variety of healthcare settings. The total score ranges from 0 to 5 points.

The Two Components of the Mini-Cog

1. 3-Item Recall: This component tests short-term memory. The person is given three unrelated words and later asked to recall them.
   • Scoring: One point is awarded for each word correctly recalled, totaling 0–3 points.
2. Clock-Drawing Test (CDT): This component assesses various cognitive functions, including executive function and visual-motor skills. The person draws a clock face and sets the hands to a specific time, usually "ten past eleven".
   • Scoring: The clock is scored as either normal (2 points) or abnormal (0 points). A normal clock includes all numbers in the correct sequence and the hands set to the correct time. The simplified scoring is suitable for rapid screening.

The Standard Cut Off for the Mini-Cog

The final Mini-Cog score is the sum of the recall and clock-drawing scores. A score of 0, 1, or 2 suggests a higher likelihood of significant cognitive impairment or dementia, considered a positive screen. A score of 3, 4, or 5 is a negative screen for dementia, though it may not exclude milder issues. A score of less than 4 may be used for identifying milder cognitive impairment.

What Happens After Screening?

The Mini-Cog is a screening tool, not a diagnostic test. A positive screen (0-2) requires further assessment by a specialist. A negative screen (3-5) is reassuring, but memory concerns should still be investigated.

Limitations of the Mini-Cog

The Mini-Cog has limitations, including its inability to diagnose mild cognitive impairment and varying accuracy based on the population screened. It is not a standalone diagnostic tool. Additional information is available on the {Link: Mini-Cog website https://mini-cog.com/}.

Comparison of Cognitive Screening Tools

Feature	Mini-Cog	MoCA	MMSE
Administration Time	~3 minutes	10–15 minutes	~5–10 minutes
Scoring	0–5 points, dichotomous CDT	0–30 points, more complex	0–30 points, traditional
Screening for	Dementia	MCI, Dementia	Dementia
Influenced by Education/Literacy	Less influenced	Correctable with education adjustment	Significantly influenced

Conclusion

The Mini-Cog offers a quick way to screen for potential cognitive impairment. A standard cut off of 0-2 signals the need for further evaluation for dementia, while 3-5 is a negative screen. The Mini-Cog is a valuable initial step but requires follow-up for accurate diagnosis and care.

Frequently Asked Questions

How is the Mini-Cog score calculated?

The Mini-Cog score is a sum of two parts: the 3-word recall and the clock-drawing test. You get 1 point for each word recalled correctly (up to 3 points) and 2 points if the clock drawing is normal (0 points if abnormal), for a total maximum of 5 points.

What does a Mini-Cog score of 3 mean?

A Mini-Cog score of 3 is typically considered a negative screen for dementia according to the standard cut off. However, if cognitive concerns are present, a score of 3 could still warrant further investigation, particularly if the clock-drawing portion was abnormal.

What should I do if my parent fails the Mini-Cog test?

If your parent receives a positive screen (a score of 0-2) on the Mini-Cog, you should arrange for a more comprehensive medical and cognitive evaluation with a qualified healthcare professional. This screening result helps confirm the need for further assessment to reach an accurate diagnosis.

Does a negative Mini-Cog screen mean I have no cognitive problems?

Not necessarily. While a score of 3-5 is a negative screen for dementia, it does not rule out milder cognitive impairment. If you or a loved one still have concerns about memory or thinking, it is important to discuss them with a doctor and potentially seek a more detailed assessment.

Is the Mini-Cog test as accurate as a neurologist's evaluation?

No, the Mini-Cog is a screening tool designed for rapid, initial assessment, not a definitive diagnostic test. A neurologist's evaluation is a more thorough diagnostic process that would likely include additional tests and clinical judgment to make a diagnosis.

Can low education levels affect a Mini-Cog score?

Research has shown that the Mini-Cog is less influenced by a person's education, culture, or language compared to some other cognitive tests like the MMSE. This makes it a more accessible screening tool for diverse populations.

Who can administer the Mini-Cog?

The Mini-Cog can be administered by a variety of healthcare personnel, including medical assistants and other staff, after minimal training. Its simple scoring system is designed for use in general practice and other non-specialist settings.