Jun 16, 2014

Have You Heard About the "Mini-Cog"?

Nancy Wurtzel
Alzheimer's Reading Room

Have you heard about the "Mini-Cog" test for memory loss?

Brain Memory Test

It’s a deceptively simple little test that could make a big difference in the Alzheimer’s world -- if we can get physicians to use it.

The Mini-Cog is a simple three part test that is useful in detecting Alzheimer's and related dementia.

The test is part of an early assessment that can lead to a diagnosis of Alzhemer's or a related dementia. Or even better, lead to the identification of  causes of memory loss other than dementia.

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Recently, the Minneapolis Star Tribune, the daily newspaper in the Twin Cities, ran a front page story, featuring the Mini-Cog. The story focused on Dr. Michael Rosenbloom, clinical director of the HealthPartners Center for Memory and Aging in St. Paul, Minnesota.

Dr. Rosenbloom and his colleagues believe primary-care physicians frequently miss signs of cognitive problems in their older patients.

Instead of relying solely on observation and a short conversation during patient appointments, Dr. Rosenbloom instead urges primary-care doctors to use the Mini-Cog, 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 a patient’s annual exam or another appointment. It’s a pen and paper screening and it only takes a few minutes to administer. Best of all, physicians and their staff are not required to complete any special training and no equipment is necessary.

To give some background, the Mini-Cog was created by Dr. Soo Borson at the University of Washington. A sample of the actual Mini-Cog Assessment Instrument can be seen at this link.

Dr. Borson designed the Mini-Cog as a cognitive screening, but cautions the test does not provide a diagnosis nor is it a substitute for a comprehensive diagnostic exam.

It is, however, widely accepted that the screening can be an indicator that something is amiss with short-term memory and other brain functions.

The Mini-Cog has a five-point total score and is performed in two parts.

The doctor tells the patient three unrelated words, and asks the patient to remember those words and repeat them in a few minutes.

Next, the patient draws the face of a clock and places the hands of the clock at a designated time. When 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 need additional evaluation.

If a patient does not pass the Mini-Cog, the physician should determine if an underlying medical condition, like normal pressure hydrocephalus (NPH), thyroid disease, adverse drug interaction, or a vitamin B12 deficiency, could be causing the patient's memory issues. If these and other conditions are ruled out, then the physician, patient and family decide how to best follow up with further testing.

Personally, I'm excited about the Mini-Cog for several 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. Consider it as a “vital signs” test for the brain.

Additionally, the Mini-Cog is easy to implement and costs virtually nothing, yet it provides an important benchmark in a patient’s chart. Doctors who administer the test annually have the ability to look at the Mini-Cog results year-after-year and note any changes.

Surprisingly, 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 wants to change that fact. Along with his colleagues at the Center for Memory and Aging, he is putting pressure on primary care doctors to use the test and catch memory loss in its earlier stages.

So how can we get primary-care docs to use it?

 The most effective change always seems to come from a combination of the top down and the bottom up. You can do your part (from the bottom up) as a health consumer. Please share this information with others and urge your own physician to begin using the Mini-Cog for patients over 65 or for anyone showing cognitive changes.

As an Alzheimer’s caregiver for both of my parents and other relatives (all of whom are deceased), I know how little we can control about this disease.

We often feel powerless.

 But here is an assessment tool that can detect memory problems at an early stage and therefore make a huge difference for many patients and their families.

Let’s step up and tell our primary doctors to incorporate the Mini-Cog in patient exams.

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