At Forrest Medical Centre in Coventry, we have been keen over many years to improve our rate of detection of patients suffering from dementia. To do this we ideally need a test that can be used with a consultation and preferably one that can be used by different members of the primary health care team.
Originally we had the “Mini Mental state” test, but this takes such a long time to administer that it did not fit in well with the pattern of work in a general practice – so, in the 1990s, when we when we learnt of the 6 item Cognitive Impairment Test (6CIT), we changed to using this as it was much quicker and simpler to use.
A few years later, we came to hear of the Mini-Cog test, and saw the evidence that it was 99% sensitive at picking up cases of dementia, with only 7% false positives. We decided to change to using this, and found that we made much more use of it during consultations than we had with the 6CIT.
Details of how to do the Mini Cog Assessment are below:
The Mini Cog is a quick, sensitive screening test for dementia, which can be administered by either trained or untrained staff
It consists of 2 parts: a 3 item recall test and a clock-drawing test.
At the start of the test, tell the patient that you are going to give them 3 words, which you will ask them to repeat straight away and then again after 1 minute (during which time you will have done something else, or had some other conversation to distract the patient).
The 3 words normally used are: APPLE, PENNY, TABLE (an alternative would be car ball man)
The number of words correctly recalled is given as a score: 0, 1, 2 or 3.
The patient is then asked to draw a large circle and fill in numbers as on a clock face, then add hands to the clock indicating a time of 8.20.
The drawing is scored as “normal” or “abnormal”
The patient can be judged to be demented* if:
- the 3 item recall score is 0; or
- the 3 item recall score is 1 or 2 and the clock drawing test abnormal.
Using the Mini Cog, the rate at which we accurately diagnosed new cases of dementia rose more than 50% from its previous baseline and has remained higher. The trials of the Mini Cog showed that it could be reliably used by staff who did not have medical training, so we have been happy to encourage other members of our team to use it.
We would encourage other GPs and their teams to make use of this test and would be interested to hear from other practitioners who have seen diagnosis rates improve as a result of using the Mini Cog.
Dr Peter O’Brien is the GP Dementia Champion for Coventry and works out of Forrest Medical Centre in Coventry.