Use a validated, brief cognitive test to detect cognitive impairment.

Brief cognitive screening tests, including those listed below, are used to determine whether an individual should receive a full diagnostic evaluation. There are multiple validated cognitive assessments beyond those listed here. Each assessment has its own benefits and limitations and may not be the best fit for all individuals or populations. For example, assessments that are designed for people living with sensory impairment (e.g., the MoCA for low vision or blindness) may be most appropriate for distinct populations.  

Factors to consider when selecting a cognitive screening instrument are:

  • The existing clinical structure.
  • Workflow.
  • Patient population.
  • The length of time to complete the test.
  • Training requirements. 
  • Whether there is any fee to use it. 
  • Whether it is a validated assessment.
  • Screening time may vary based on each patient’s functional and cognitive status and educational level.
Cognitive Assessment Considerations: Understanding the Evidence from the National Institute on Aging provides more information about assessing cognitive impairment.


Each screening instrument has a scoring system that should be used to evaluate individual performance and determine whether cognitive impairment is present. The presence of cognitive impairment is an indicator that further evaluation is necessary. Furthermore, depending on the clinical situation, additional evaluation may be warranted even if the overall score does not indicate cognitive impairment.

The Mini-Cog

The Mini-Cog is a free, validated assessment that is often used by primary care teams. The test includes a 3-word recall and clock-drawing test and is available in multiple languages.

  • Advantages of the Mini-Cog
  • Scoring the Mini-Cog
  • The Clock Drawing Test

Among its advantages are: 

  • Good sensitivity and specificity.
  • Can be completed in fewer than 5 minutes.
  • Easy to administer and interpret.
  • Does not require adjustment for low education level.

There are 5 total points that can be earned; a score of 0 to 2 indicates cognitive impairment. Detailed instructions are available for scoring the Mini-Cog.

The clock-drawing test can be administered as part of or separate from the Mini-Cog. It can be useful to assess executive function and as a quick screening to determine whether more detailed assessment is needed. People should be able to draw the clock with the numbers in roughly the correct location and with the hands of the clock pointed in the correct direction. Individuals must have had cultural exposure to analog clocks for this assessment to be appropriate. In addition, nonliterate individuals and those with fewer than 5 years of education may make more errors with the clock drawing test (Adhikari, 2021).

MoCA and SLUMS

These assessments:

  • Require more time to administer (7 to 10 minutes). 
  • Offer good sensitivity. 
  • Have the ability to adjust for individual level of education.  
  • Necessitate that providers meet training requirements and pay licensing fees to use the MoCA. 
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The SLUMS is available in multiple languages, and the MoCA also has multiple language options, an option for use with individuals with visual impairments, and a variety of other resources. 

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Racial and ethnic differences have been found to influence scoring for the MoCA, and measurement bias may inflate rates of cognitive impairment among historically underserved and marginalized populations (Ratcliffe, 2023). 

The Short Test of Mental Status

The Short Test of Mental Status (STMS) is an 8-item questionnaire that assesses for memory and executive function.

This assessment:

  • Can be completed in 5 minutes.
  • Has good sensitivity and specificity.
  • Does not adjust for education level.

The 5-Cog

Researchers evaluated the 5-Cog, a five-minute cognitive assessment including the Picture Memory Impairment Screen (PMIS), Motoric Cognitive Risk syndrome (MCR), and the Symbol Match test coupled with a decision tree embedded in electronic medical record.

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In June 2024, they reported that it improved dementia diagnosis and care, based on a clinical trial funded by the National Institutes of Health (NIH) and conducted in an urban primary care setting. The clinical trial confirmed that the 5-Cog is a non-literacy biased, culturally fair cognitive detection tool.

Learn more about the 5-Cog from Dr. Joe Verghese, principle investigator of the study, in the GSA Momentum Discussion Podcast episode, The 5-Cog Paradigm: An Innovation to Improve Detection and Management of Impaired Cognition in Primary Care.

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Albert Einstein College of Medicine makes the 5-Cog available free of cost to all researchers for academic pursuits under a simple letter agreement. Commercial entities wishing to incorporate the tool into a product or program are subject to fees and a copyright licensing agreement. For more information, please contact biotech@einsteinmed.edu with the subject headline ‘Enquiry to access the 5-Cog Battery for Detection of Cognitive Impairment test'.


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Strategies to Assess for Cognitive Impairment | Brief Cognitive Tests | Structured Assessment Instruments | Case Study | Assess References