Abstract
Objectives The Mini-Cog, a rapid, valid, and reliable screening tool for cognitive impairment, consists of 3-word recall and an executive clock drawing test (CDT). However, CDT requires at least basic literacy and cultural exposure to analog clocks, conditions not met in many population groups around the world. We developed a modification of the Mini-Cog (MMC) for use with nonliterate and literate individuals. Methods Participants were adults (≥60 years) with no neurological diagnosis, with known cognitive impairment due to stroke, Parkinsonism, traumatic brain injury, or Alzheimer's disease, and whose family members were able to read and write. We replaced the CDT with two tasks of everyday life: a serial subtraction task or a multistep performance task. Family members rated the acceptability and feasibility of the Mini-Cog versions using a 6-point scale and completed a proxy-rated cognitive staging tool, the Dementia Severity Rating Scale (DSRS). Spearman's rho, Mann-Whitney U, and chi-square tests were used to evaluate group differences and associations between measures. Results Data were collected from 63 participants (75% ≥ 60 years, 67% nonliterate). Literacy was associated with CDT (chi-square strength 0.9, p < 0.001). Both MMC versions correlated with DSRS in healthy adults and patients (rho 0.6-0.7, p < 0.05). In literate individuals, the acceptability and feasibility of CDT and both alternate distractors were similarly high (5/6). Conclusions Two alternate distractor tasks may successfully replace CDT in the Mini-Cog. The MMC versions are promising and deserve further study as screening tools for cognitive impairment in larger and more fully characterized samples.
Highlights
The Mini-Cog (MC) is a short screening tool for clinically important cognitive impairment, originally developed by Borson et al in 2000 by combining a short memory test and an executive clock drawing test (CDT) [1]
The choice of 3-item recall as the memory test was based on research showing that this element in the Mini-Mental State Examination (MMSE) is the first to be impaired in early Alzheimer’s disease [1, 2]
The CDT serves as an informative distractor: it creates a short recall delay and itself functions as a cognitive test, since it relies on multiple integrated cognitive functions commonly impaired in neurocognitive disorders
Summary
The Mini-Cog (MC) is a short screening tool for clinically important cognitive impairment, originally developed by Borson et al in 2000 by combining a short memory test and an executive clock drawing test (CDT) [1]. The MC is feasible, reliable, valid, and time saving for settings in which rapid detection of cognitive impairment is desirable, since it takes just 3 minutes to administer [1, 3]. It has acceptable sensitivity and specificity for dementia in both clinical and population samples, detects mild cognitive impairment (with less sensitivity and specificity), and has been widely implemented in western clinical settings [1, 2, 4]. Both components of the MC contribute to the detection of dementia [2]
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