Memory screening: what the Mini-Cog and MoCA involve and what scores mean
A memory screen is a short set of tasks, such as recalling words or drawing a clock, that checks how memory and thinking are working. It cannot diagnose dementia. A low score is a reason to look further. (USPSTF, 2020)
Who is checked
- USPSTF: for adults 65 and older living at home without signs or symptoms, it found the evidence insufficient to assess the balance of benefits and harms of screening for cognitive impairment (I statement, 2020). (USPSTF, 2020) An update of this topic is in progress; no draft recommendation has been posted yet. (USPSTF update) An I statement is not advice against testing. More: USPSTF grades explained.
- When you or others notice a change: checking memory because of problems noticed by you, your family or your clinician is not screening, so the I statement does not apply. The USPSTF asks clinicians to stay alert to early signs such as problems with memory or language. (USPSTF, 2020)
- Medicare: every yearly wellness visit includes detection of any cognitive impairment. The rule defines this as your provider observing you directly and taking into account what you, your family, friends or caregivers report. (42 CFR 410.15) Your provider may give a cognitive assessment at that visit. Part B also covers a separate visit to fully review your thinking, confirm a diagnosis such as dementia and make a care plan; you pay 20% after the Part B deductible. (Medicare.gov) See Medicare wellness visit vs a physical.
- Alzheimer's Association: because Medicare named no single tool, its expert group set out a wellness visit approach: review the health risk questionnaire, watch for signs during the visit, ask questions, and use structured tests for the person and for someone who knows them well. (Cordell et al., 2013)
The common tests and what they involve
Screening tests ask you to do a series of tasks that each look at one or more parts of thinking. The USPSTF's review covered many of them, including the Mini-Mental State Examination (MMSE, the most studied), the clock drawing test, the Mini-Cog, the MoCA, the SLUMS and questionnaires answered by someone who knows you well. Most take 10 minutes or less. (USPSTF, 2020) The descriptions below are in our own words; the tests themselves are not reproduced here.
- Mini-Cog: you are asked to remember 3 words, draw a clock, and then recall the words. It takes under 5 minutes and is less affected by years of schooling than the MMSE and MoCA. (Mini-Cog review, 2024) The clock part may not work well for people who cannot read or write. (Adhikari et al., 2021)
- MoCA: a 10-minute test first built to pick up mild cognitive impairment. (Nasreddine et al., 2005) It covers short-term memory, visual and spatial skills, planning and problem solving, attention and concentration, language, and knowing the date and place. (Cochrane review, 2021)
- SLUMS: a 30-point questionnaire that tests orientation, memory, attention and planning skills, first compared with the MMSE in patients at a Veterans Affairs center in St. Louis. (Tariq et al., 2006)
- Questions for someone who knows you: NICE suggests adding a structured questionnaire for a family member or friend when memory problems are suspected. (NICE NG97) You can bring someone with you to a cognitive assessment to help listen and answer questions. (Medicare.gov)
How the scores are read
Score ranges and the usual cut-offs: (Mini-Cog review, 2024) (MoCA FAQ) (Cochrane review, 2021) (Tariq et al., 2006)
| Test | What it involves | Score range | How the score is read |
|---|---|---|---|
| Mini-Cog | Recall of 3 words plus drawing a clock; under 5 minutes | 0 to 5 | 0 to 2: high likelihood of cognitive impairment. 3 to 5: low likelihood. (Mini-Cog review, 2024) |
| MoCA (Montreal Cognitive Assessment) | Memory, visual and spatial skills, planning, attention, language and orientation; about 10 minutes | 0 to 30, with 1 point added for 12 or fewer years of formal schooling (up to 30). Some versions use a different adjustment. | 26 to 30: the normal range in the original study. 25 or below: suggests impairment. (MoCA FAQ)(Cochrane review, 2021) |
| SLUMS (Saint Louis University Mental Status) | Orientation, memory, attention and planning tasks | 0 to 30 | The original study read results separately for people who had and had not finished high school. (Tariq et al., 2006) |
- How accurate the Mini-Cog is: across studies, it picked up 76% of people with dementia and correctly cleared 83% of people without it. For mild cognitive impairment the figures were 84% and 79%. (Mini-Cog review, 2024)
- How accurate the MoCA is: in the first study, it picked up 90% of people with mild cognitive impairment. (Nasreddine et al., 2005) At the cut-off of 26, studies found it picked up 94% or more of people with dementia, but it correctly cleared 60% or fewer of people without dementia. (Cochrane review, 2021)
- Across all tests: accuracy was generally higher for dementia than for mild cognitive impairment, and cut-offs often varied between studies. (USPSTF, 2020)
- Schooling matters: someone who cannot read or write well may score lower without having dementia, and someone with more education may score higher and still have it. (NHS tests)
Where they differ: on who is checked, the USPSTF found too little evidence to recommend for or against screening older adults without symptoms. (USPSTF, 2020) Medicare still builds detection of cognitive impairment into every wellness visit, (42 CFR 410.15) and the Alzheimer's Association group recommends structured tests at that visit. (Cordell et al., 2013) On the MoCA cut-off, the original study used 26, (Nasreddine et al., 2005) while the Cochrane review found that cut-off gives many false positives and says thresholds lower than 26 are likely to be more useful for dementia, pending more studies. (Cochrane review, 2021) On a normal score, NICE advises not to rule out dementia on a normal test score alone. (NICE NG97)
A screening result is not a diagnosis. Your doctor decides what your result means for you.
What a positive screen leads to
These tests are not meant to diagnose mild cognitive impairment or dementia. A positive result should lead to more testing, which can include blood tests, imaging and a medical and neuropsychological evaluation. (USPSTF, 2020)
- Other causes come first: memory problems can come from depression and anxiety, sudden confusion (delirium) from an illness such as an infection, an underactive thyroid, or side effects of some medicines. (NHS) NICE lists delirium, depression, problems with sight or hearing, and some medicines as reversible causes to look into before a specialist referral. (NICE NG97)
- Blood tests: in the NHS these usually check liver, kidney and thyroid function, HbA1c for diabetes, and vitamin B12 and folate. (NHS tests) MedlinePlus also names low vitamin B12 and thyroid disease among the blood tests that may be done. (MedlinePlus) Related pages: thyroid test results and hearing tests by age.
- Your medicines: the doctor reviews what you take, including over-the-counter products and supplements. (NHS tests) Do not stop a medicine on your own; talk to your doctor first.
- A specialist: if other causes are ruled out and the picture is still unclear, you may see a specialist, sometimes in a memory clinic, who may arrange a brain scan or more detailed memory tests. (NHS)
Mild cognitive impairment is not the same as dementia: it does not stop a person living on their own. One review found 32% of people with it developed dementia over 5 years, while other studies found 10% to 40% returned to normal thinking over about 4 to 5 years. (USPSTF, 2020)
The USPSTF notes that evidence on the harms of screening is limited. One possible harm is the label of an illness that usually gets worse over time, and little is known about the effect of false-positive results. (USPSTF, 2020) This page does not give medicine, supplement or treatment advice.
Questions people ask
What is a normal Mini-Cog score?
The Mini-Cog is scored from 0 to 5: up to 3 points for the words you recall and a normal or abnormal clock drawing. A total of 3 to 5 means a low likelihood of cognitive impairment, and 0 to 2 a high likelihood that should be looked at further. (Mini-Cog review, 2024)
What MoCA score is normal?
The MoCA is scored out of 30. The original study gave 26 to 30 as the normal range, so 25 or below suggests impairment. The developers add 1 point for people with 12 or fewer years of formal schooling, up to the maximum of 30; some versions use a different adjustment. A Cochrane review found this cut-off flags many people who do not have dementia. (MoCA FAQ) (Cochrane review, 2021)
Does the USPSTF recommend memory screening?
For adults 65 and older living at home with no signs or symptoms, the USPSTF found the evidence insufficient to weigh the benefits and harms of screening (an I statement, 2020). An update is in progress. Checking memory because you, your family or your clinician noticed a change is not screening and is not covered by that statement. (USPSTF, 2020) (USPSTF update)
Does the Medicare wellness visit include a memory test?
The yearly wellness visit must include detection of any cognitive impairment, which means your provider observes you directly and considers what you and the people close to you report. A structured test is not required by the rule. Medicare also covers a separate, fuller cognitive assessment visit. (42 CFR 410.15) (Medicare.gov)
Does a low score mean I have dementia?
No. These tests are not meant to diagnose mild cognitive impairment or dementia. A low score leads to further testing, which looks for other causes such as depression, a thyroid problem, low vitamin B12 or medicine side effects. Your doctor decides what your result means for you. (USPSTF, 2020) (NHS) (NHS tests)