The Mini-Cog, A Memory Assessment Tool

by Nancy Wurtzel on July 24, 2014

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Have you heard of the “Mini-Cog”?  I had read about it several years ago but a recent front page feature in the Star Tribune, our major daily newspaper in the Twin Cities, piqued my interest.  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 that primary-care physicians are frequently missing signs of cognitive issues in their age 55 and over patients.  Instead of relying solely on observation and a short conversation during patient appointments, Dr. Rosenbloom instead urges primary-care doctors to use 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 an annual exam or another appointment.  Its a simple, pen and paper screening that takes only a few minutes and does not require any special equipment or training.

Here’s how it works:

The Mini-Cog has a five-point total score and is performed in two parts.  First, the doctor tells the patient three words, and asks the patient to remember the words and repeat them later.  Next, the patient is asked to draw the face of a clock and place the hands of the clock at a specific time.  After 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 may need additional evaluation.

Here is a sample of the actual Mini-Cog Assessment Instrument.

Created by Dr. Soo Borson at the University of Washington, the Mini-Cog is a screening and does not provide a diagnosis.  However, it is an indicator that something may be amiss.

The first task would be to determine if an underlying medical conditions, like thyroid disease, severe depression or a vitamin B12 deficiency, could be causing the patient’s memory issues.  If other medical  conditions are ruled out, then the physician decides how to best follow up.

Personally, I’m excited about the Mini-Cog for two 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.  It could be described as a vitals signs test for the brain.

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

Sadly, 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 of the Center for Aging and Memory wants to change that fact.  He believes these primary care doctors are in a unique position to catch memory loss in its earlier stages.

There is so much about Alzheimer’s disease and other dementias that we have no control over.  The Mini-Cog is a terrific assessment tool that can make a difference to patients and their families.

Personally, I think the Mini-Cog is a no-brainer and must be incorporated into patient annual screenings.  The most effective change always seems to come from the top down and the bottom up.  As a patient and health consumer, I’m asking you to please share this information with others and encourage your own physician to begin using it.

*Photo Purchased from iStockPhoto


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Post image for Mayo Clinic Identifies New Brain Protein That May Cause Dementia Symptoms

Another day, another Alzheimer’s announcement.  This news was announced by a team from the Mayo Clinic at the recent Alzheimer’s Association International Conference in Copenhagen.  Could it be a big discovery?  The Mayo team seemed to think the answer is yes.

The four-year study has uncovered a third component — another protein — to the hallmark sticky plaques and tangles found in the brain of Alzheimer’s patients.

The research found that when TDP-43, a protein occurring naturally in the brain, becomes bunched up and chemically altered the result is a person will be more apt to show dementia symptoms.  Abnormal TDP-43 brain protein has already been linked to Lou Gehrig’s disease.

Researchers caution it will take several years before there is a valid test to identify the abnormal TDP-43 in living people and even more years before a course of treatment.  Still, this could be a vital clue in finding ways to treat, manage and eventually find a cure for Alzheimer’s disease.  For many years, researchers have been focused intently on the amyloid and tau protein build up in the brain.  This discovery may open up some new doors.

“It gives us a new target and possible additional treatment,” said Dr. Ronald Petersen, director of the Mayo Clinic Alzheimer’s disease Research Center in Rochester, Minnesota.

For more information, visit ABC News at this link and The Washington Post at this link.

*Photo From iStockPhoto


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