![]() More comprehensive analysis of the CDT does not improve detection of dementia and would increase complexity of the currently simple training requirements for clinicians and perhaps decreases its attractiveness as a simple screening tool. The clock drawing component of the test is scored simply as normal or abnormal for the purpose of the Mini-CogTM and specific scoring rules are included with the tool. STRENGTHS AND LIMITATIONS: The Mini-CogTM takes up to 3 minutes to administer. For further assessment of mild cognitive impairment, consider administering the Montreal Cognitive Assessment (MoCA) (See Try this:® MoCA). The Mini CogTM by itself is not considered a valid tool for this use. A score of 0-2 out of 5 is a positive screen for dementia, 3-5 out of 5 is a negative screen for dementia (Borson et al., 2006), but a cut score of 4-5 out of 5 may increase detection of mild cognitive impairment (McCarten et al., 2012). Research suggests that a 5-point numerical scoring system based on the original algorithm may be easier to apply: repeating three items (0 points), a clock drawing distractor (CDT) (0-2 points), and recall of the earlier three items after the CDT (0-3 points). This tool has strong predictive value in multiple clinical settings (Borson et al., 2003). A chi square test reported 234.4 for Alzheimer’s dementia and 118.3 for other dementias (p<0.001). Depending on the prevalence of dementia in the target population, the Mini-CogTM has sensitivity ranging from 76-99%, and specificity ranging from 89-93% with 95% confidence interval. VALIDITY AND RELIABILITY: The Mini-CogTM was developed as a brief screening tool to differentiate patients with dementia from those without dementia. It is appropriate to be used with older adults at various heterogeneous language, culture, and literacy levels. TARGET POPULATION: The Mini-CogTM is appropriate for use in all health care settings. The Clock Drawing Test (CDT) component of the Mini-CogTM allows clinicians to quickly assess numerous cognitive domains including cognitive function, memory, language comprehension, visual-motor skills, and executive function and provides a visible record of both normal and impaired performance that can be tracked over time. The Mini-CogTM serves as an effective triage tool to identify individuals in need of more thorough evaluation. This tool can be used to detect cognitive impairment quickly during both routine visits and hospitalizations. The Mini-CogTM is one of three tools endorsed by the Alzheimer’s Association for use in the Medicare AWV.īEST TOOL: The Mini-CogTM is a simple screening tool that is well accepted and takes up to only 3 minutes to administer. The Centers for Medicare & Medicaid Services has included routine cognitive screening as a required component of the Medicare Annual Wellness Visit (AWV). Preventative Services Task Force (USPSTF) does not recommend routine cognitive screening in asymptomatic community-dwelling older adults, the Alzheimer’ s Association and the American Geriatrics Society do recommend incorporation of assessment of cognitive impairment into the Medicare AWV. Early identification and intervention in the form of medication and behavioral therapy may slow disease progression, delay functional decline, allow for pre-planning, and postpone nursing home placement. Using a reliable and valid tool that clinicians can quickly implement facilitates early identification and allows the person to receive prompt treatment. The increased availability of successful interventions for dementia and dementia-related illnesses means there is a substantial need for increased early identification of cognitive impairment, particularly in the older adult population. One in ten individuals over 65 and 32% of those over 85 are affected (2017 Alzheimer’s Disease Facts and Figures, 2017). WHY: Five and a half (5.5) million Americans of all ages have Alzheimer’s disease or other dementias (2017 Alzheimer’s Disease Facts and Figures, 2017). ![]()
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