Cognitive Testing | Alzheimer's Association

Preliminary cognitive testing: three-word recall, “mini-cog” and coin counting

The following three tests can help gauge memory function when patients express concern. The tests also may help identify patients who need more thorough evaluation. All of these tests are relatively free of influence by educational level:

1. A three-word delayed recall exercise

Tell your patient to remember three words.
Give three common nouns, such as horse, pencil and rose, and ask the patient to repeat them.
About five minutes later, ask the patient to recall them.
Individuals without impairment should be able to remember all three words, especially with such prompts as, “The first word was the name of an animal.”
Remembering only one or two words indicates a need for further evaluation.

2. The “mini-cog” test, combining three-word recall with clock-drawing

Give three simple nouns and ask the patient to repeat them.
Ask the patient to draw the face of a clock on a sheet of paper, showing the time as 10 minutes past 11.
After the clock has been drawn, ask the patient to repeat the three words.
- Patients who remember all three words have no dementia.
- Patients who remember none of the words should receive further evaluation.
- If the patient remembers one or two words, the physician should refer to the score on the clock drawing to help interpret this result.
  - normal clock = nondemented
  - abnormal clock = further evaluation needed
- Patients who recall all three words but have a problem with the clock may also require further evaluation.

More about clock-drawing and scoring

When stating the time to be shown on the clock, avoid referring to the “hands” of the clock to avoid prompting. Rather, say “Show the time as 10 past 11.”
- “10 past 11” tests the ability to translate “10 past” into the right numerical value.
- It also requires the use of both halves of the clock face.
There are several scoring systems. A simple one is based on four points, with a lower score suggesting further evaluation.
- One point is given for drawing a closed circle. Some clinicians prefer to give patients a pre-drawn circle, so that any accidental distortions in shape do not affect the placement of the numbers.
- One point is awarded for including the 12 correct numbers.
- One point is given for putting the numbers in the correct position.
- One point is awarded for drawing the hands to show the correct time. The degree of difficulty in producing a correct time may be factored into the score.

3. Coin-counting exercise

Ask your patient, “If I give you a nickel, a quarter, a dime and a penny, how much money have I given you?”
When you avoid naming the coins in ascending or descending order of value, this task calls upon comprehension, working (or task completion) memory, planning and calculating skills.
Inability to arrive at the correct total of 41 cents may indicate a need for further evaluation.

Tools patients can use to monitor their own function

If informal testing does not suggest a need for further evaluation, you can give your patients some general guidelines for self-monitoring.

The Aha! factor is a widely accepted yardstick for distinguishing “benign” from problematic lapses in memory. It argues that “benign” incidents generally involve temporary inability to recall or retrieve information that is remembered later, often with an “Aha!” sense of recognition and satisfaction. With more serious lapses, there is often no recollection of ever having encountered the forgotten information.
- For example, it is “normal” occasionally to forget a lunch date until your friend stops by to pick you up. It is a cause for concern to wonder why your friend has dropped by and to forget your plans even with reminding.
10 Warning Signs: The Alzheimer’s Association has developed “10 Warning Signs of Alzheimer’s Disease” as a guide to distinguishing “normal” lapses from those that may be more worrisome.
- More information about the 10 Warning Signs

More information about earlier diagnosis.