Printable Mini Cog Test Form First put in all of the numbers where they go When that is completed say Now set the hands to 10 past 11 Use preprinted circle see next page for this exercise Repeat instructions as needed as this is not a memory test Move to Step 3 if the clock is not complete within three minutes
The Mini Cog a cognitive vital signs measure for dementia screening in multi lingual elderly Int J Geriatr Psychiatry 2000 15 11 1021 1027 and Borson S Scanlan JM Watanabe J Tu SP Lessig M Improving identification of cognitive impairment in primary care Int J Geriatr Psychiatry 2006 21 4 349 355 Mini CogTM Copyright 2000 2004 2006 The Mini Cog can be used as a cognitive vital sign and administered reliably with a little practice Instructions for administration are provided on the test form available here Once you start complete the Mini Cog in one unit choose a time when interruptions and distractions are unlikely TM TM 1
Printable Mini Cog Test Form
Printable Mini Cog Test Form
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1 of 2 The Mini Cog Assessment Instrument for Dementia The Mini Cog assessment instrument combines an uncued 3 item recall test with a clock drawing test CDT The Mini Cog can be administered in about 3 minutes requires no special equipment and is relatively uninfluenced by level of education or language variations Administration The Mini Cog test is a 3 minute instrument to screen for cognitive impairment in older adults in the primary care setting The Mini Cog uses a three item recall test for memory and a simply scored clock drawing test CDT The latter serves as an informative distractor helping to clarify scores when the memory recall score is intermediate
A cut point of 3 on the Mini Cog has been validated for dementia screening but many individuals with clinically meaningful cognitive impairment will score higher When greater sensitivity is desired a cut point of 4 is recommended as it may indicate a need for further evaluation of 1 of 2 What is the Mini Cog Test The Mini Cog is a tool for seeing whether someone shows signs of dementia It tests cognition or thinking ability in a way that has been scientifically demonstrated to help determine if someone might be in the early stages of Alzheimer s disease or related dementia
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Note If the patient scores less than 8 on Part 1 of the test additional information is needed and Part 2 of the test should be completed The Mini Cog is a three minute test consisting of a recall test for memory and a scored clock drawing test It can be used effectively after brief training and results are evaluated by a health provider to The mini cog a cognitive vital signs measure for dementia screening in multi lingual elderly Int J Geriatr Psychiatry 2000 15 11 1021 1027 Borson S Scanlan JM Chen P Ganguli M The Mini Cog as a screen for dementia validation in a population based sample J Am Geriatr Soc 2003 51 10 1451 1454
The Mini Cog a composite of three item recall and clock drawing was developed as a brief test for discriminating demented from non demented persons in a community sample of culturally linguistically and educationally heterogeneous older adults the Mini Cog uses a three item recall test for memory and a simply scored clock drawing test CDT A cut point of 3 on the Mini Cog has been validated for dementia screening but many individuals with clinically meaningful cognitive impairment will score higher When greater sensitivity is desired a cut point of 4 is recom mended as it may indicate a need for further evaluation of cognitive status Version 1 Banana Sunrise Chair
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First put in all of the numbers where they go When that is completed say Now set the hands to 10 past 11 Use preprinted circle see next page for this exercise Repeat instructions as needed as this is not a memory test Move to Step 3 if the clock is not complete within three minutes
https://www.healthcare.uiowa.edu/familymedicine/fpinfo/Docs/MiniCogAssessmentForm.pdf
The Mini Cog a cognitive vital signs measure for dementia screening in multi lingual elderly Int J Geriatr Psychiatry 2000 15 11 1021 1027 and Borson S Scanlan JM Watanabe J Tu SP Lessig M Improving identification of cognitive impairment in primary care Int J Geriatr Psychiatry 2006 21 4 349 355 Mini CogTM Copyright 2000 2004 2006
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Printable Mini Cog Test Form - 1 of 2 The Mini Cog Assessment Instrument for Dementia The Mini Cog assessment instrument combines an uncued 3 item recall test with a clock drawing test CDT The Mini Cog can be administered in about 3 minutes requires no special equipment and is relatively uninfluenced by level of education or language variations Administration
