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Also: MMSE · MoCA · SLUMS · Mini-Cog · mini-mental state exam
A brief in-office test of cognition. Common versions: Mini-Cog (3-minute screen), MoCA (Montreal Cognitive Assessment, ~10 minutes, more sensitive to mild impairment), SLUMS, MMSE (older standard, still widely used but copyrighted). Screening is the entry point — not a diagnosis — and is followed by more detailed evaluation when concerning.
Cognitive screening is the first formal step in a dementia workup. The PCP or geriatrician administers a brief in-office test, scores it against a normative reference, and decides whether to refer for more detailed neuropsychological testing.
The four most-used tests:
• **Mini-Cog** (3 minutes): the simplest. Patient repeats 3 words, draws a clock face with hands at 11:10, then recalls the 3 words. Cutoff: recall of 0-1 words OR an abnormal clock = positive screen. Fast and convenient; less sensitive to mild changes.
• **MoCA — Montreal Cognitive Assessment** (10-12 minutes): the modern standard for detecting mild cognitive impairment. Scored 0-30; <26 suggests impairment. Tests visuospatial, naming, memory, attention, language, abstraction, recall, orientation. More sensitive than MMSE; free and openly available (since 2020 a brief certification is required for administrators).
• **SLUMS — Saint Louis University Mental Status** (7-10 minutes): similar to MoCA in scope, scored 0-30. Designed at SLU; free for non-commercial use. Often preferred when MoCA isn't available.
• **MMSE — Mini-Mental State Exam** (5-7 minutes): the original, still widely used. Scored 0-30; <24 suggests impairment. Copyrighted since 2001, which restricted distribution and pushed many practices toward MoCA. Less sensitive to mild impairment than MoCA.
Key practical points families should know: • Bring the patient on a calm morning. Fatigue, hunger, anxiety, and poor sleep all depress scores artificially. • Hearing aids and glasses must be on. Many "cognitive deficits" caught on screening are actually sensory deficits. • A single test is a snapshot, not a diagnosis. Multiple tests over time, plus collateral history from family (most important), plus neuropsychological testing and brain imaging when warranted, build the diagnostic picture. • Cultural and language factors matter. Standardized cutoffs were developed in English-speaking, college-educated populations. Use language-validated versions (MoCA has translations in ~100 languages); adjust interpretation for education and cultural context. • A normal screen does not rule out cognitive impairment. If the family is seeing functional changes, push for more detailed evaluation regardless of screening result.
At the visit where you've asked the PCP to evaluate possible memory changes. Ask which test they use; MoCA is more sensitive to mild changes than the older MMSE. Bring the patient on a calm morning, not after a long drive when they're tired.
Terms families frequently confuse with cognitive screening.
Cognitive screening evaluates baseline cognitive function — for detecting dementia or MCI. Delirium is an acute disturbance assessed with a different tool (CAM — Confusion Assessment Method). A patient can have a normal MoCA at baseline and develop severe delirium in the ICU — they're different conditions assessed with different instruments.
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