Mini cog pdf 2026

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  1. Click ‘Get Form’ to open the mini cog PDF in the editor.
  2. Begin by entering the patient's name, the assessor's name, and the date completed in the designated fields at the top of the form.
  3. Instruct the patient to listen carefully and remember the three words: Ocean, Desk, and Tractor. Ensure they understand they will need to repeat these words back to you.
  4. Next, ask the patient to draw a clock face on a blank area of the form. They should include all numbers and position the hands to indicate 8:20. Remind them that no additional instructions can be given.
  5. After completing the clock drawing, ask the patient to repeat the three words again. Record their responses in your notes.
  6. For scoring, circle each word remembered for a maximum score of 3 points. Evaluate the clock drawing for normalcy (2 points) or abnormality (0 points) and calculate total scores accordingly.

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The words are banana, sunrise, chair. Please say them now. Give the patient three tries to repeat the words. You may repeat the words to them for each try. If they are unable to repeat the words back to you after three tries, go directly to the clock drawing.
The Mini-Cog is a three-minute instrument for the patient that consists of two components: a three-item recall test for memory and a clock drawing test. This is a free tool and is available in many languages.
Understanding the 5 Word Memory Test Word Presentation: The examiner presents five unrelated words to the individual. These words are chosen to be common and easily understood, such as apple, table, penny, carpet, and watch.

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