Mini-Cog Calculator
Score three word recall and a clock drawing, then see whether the Mini-Cog screen is positive.
What it does
The Mini-Cog is a short cognitive screen that combines three word recall with a clock drawing. It was designed for busy clinics, hospital wards, and home visits where a full neuropsychological battery is not practical. The two tasks take a few minutes and need only paper, a pen, and three unrelated words.
Recall tests short term memory, while the clock drawing checks visuospatial skills, planning, and the ability to follow a sequence. Combining the two tasks catches more meaningful impairment than either task alone. A person who remembers all three words but draws a disorganized clock still raises concern, and so does a person who draws a good clock but recalls none of the words.
Scoring is simple. Recall earns 0 to 3 points. A normal clock earns 2 points and an abnormal clock earns 0. The total runs from 0 to 5, and a score below 3 is positive. The same cutoff can be stated another way: recall of 0 is positive, recall of 1 or 2 is positive when the clock is abnormal, and recall of 3 is negative regardless of the clock.
The tool is used in primary care, geriatrics, neurology, oncology, and preoperative settings. It is also common in research as a first pass before longer testing. It performs best when the person can hear the words, see the paper, and hold a pen. Sensory loss, language differences, and low education can lower the score for reasons unrelated to cognition.
The Mini-Cog is a screen, not a diagnostic test. A positive result should lead to a structured history, medication review, laboratory work, and a fuller cognitive assessment. A negative result is reassuring but does not rule out mild cognitive impairment, especially when a family member reports a decline. Document the exact words, the clock time, and any barriers so the next clinician can repeat the test fairly.
How to use
- Check that the person can hear the three words and see the paper. Use a quiet room and remove distractions.
- Say three unrelated words, such as banana, sunrise, and chair. Ask the person to repeat them once so you know they were heard.
- Ask the person to draw a clock. Give a blank sheet and say: draw a circle, put all the numbers in the right places, and set the hands to 10 past 11.
- After the clock is finished, ask the person to repeat the three words. Do not give hints or multiple choice prompts.
- Score recall from 0 to 3. Score the clock as normal (2 points) or abnormal (0 points). A clock is normal when the numbers 1 to 12 are present, in order, and the hands show the requested time.
- Add the two parts. A total below 3 is a positive screen. Record the score, the words used, the clock time, and any sensory or language barriers.
Formula
- Recall
- Number of the three words recalled without cues, from 0 to 3.
- Clock
- 2 points for a normal clock drawing, 0 points for an abnormal drawing.
- Total
- Sum from 0 to 5. A value below 3 is a positive screen.
A normal clock has all 12 numbers in the correct order and position, with hands that show the requested time. Minor spacing errors are acceptable. The test uses the same three words for the recall and the delayed recall. The cutoff of 3 is equivalent to the rule that recall of 0 is positive, recall of 1 or 2 with an abnormal clock is positive, and recall of 3 is negative. Do not change the cutoff for education or language without a validated local protocol.
Worked example
Example: recall 1 with an abnormal clock
A 78 year old patient recalls one of three words. The clock has most numbers but the hands do not show 10 past 11.
- Recall is 1 word out of 3, so the recall score is 1.
- The clock is abnormal because the hands do not show the requested time, so clock points are 0.
- Add the parts: 1 + 0 = 1.
- The cutoff is below 3, and 1 is below 3, so the screen is positive.
- The score is 2 points below the cutoff.
- Document the positive screen and refer for a fuller cognitive assessment.
Reference table
| Total | Typical pattern | Interpretation |
|---|---|---|
| 0 to 2 | Recall 0 with any clock, or recall 1 to 2 with an abnormal clock | Positive screen |
| 3 | Recall 1 to 2 with a normal clock, or recall 3 with an abnormal clock | Negative screen |
| 4 to 5 | Recall 2 to 3 with a normal clock | Negative screen |
| 1 (worked example) | Recall 1 with an abnormal clock | Positive screen |
Limits
- The Mini-Cog does not diagnose dementia or identify its cause. A positive screen needs a fuller clinical assessment.
- A negative screen does not rule out mild cognitive impairment, especially when a reliable informant reports a decline.
- Hearing loss, vision loss, tremor, language differences, and low education can lower the score for reasons unrelated to cognition.
- One administration can be affected by anxiety, poor sleep, pain, infection, or medication, so repeat testing may be needed.
Common mistakes
- Scoring the clock as 1 point. It is scored as 2 for normal or 0 for abnormal.
- Giving hints or a multiple choice list during the delayed recall.
- Treating a negative screen as proof that cognition is normal.
- Choosing a clock time with hands close together, which makes the drawing harder to interpret.
- Forgetting to record sensory, language, or education factors that affect the score.
Try it yourself
Quick checks. Answers sit tucked under each question.
Recall 2, clock normal. What is the total and result?
2 + 2 = 4. The total is 4 of 5, which is a negative screen.
Recall 0, clock normal. What is the total and result?
0 + 2 = 2. The total is 2 of 5, which is below 3, so the screen is positive.
Recall 3, clock abnormal. What is the total and result?
3 + 0 = 3. The total is 3 of 5, which is a negative screen.
Questions
Is the Mini-Cog a diagnosis?
No. It is a short screen that flags people who need a fuller cognitive assessment. Diagnosis requires history, examination, and often laboratory or imaging tests.
How long does the Mini-Cog take?
Usually two to four minutes. Most of the time is spent drawing the clock, not explaining the test.
What counts as a normal clock?
All 12 numbers are present in the correct order and position, and the hands show the requested time. Small spacing errors do not make the clock abnormal.
Does a positive screen mean dementia?
No. Delirium, depression, medication effects, hearing loss, and low education can also produce a positive screen. The result guides further testing.
Can the Mini-Cog be used in hospital?
Yes, but acute illness and delirium can distort the result. Repeat after recovery when possible, and note the setting.
Does language affect the score?
Yes. The words must be familiar in the person's preferred language, and instructions may need a trained interpreter.
Sources
- Oregon Health and Science University: Mini-Cog assessment tool and scoring
- Cochrane review: Mini-Cog for detection of dementia in secondary care