[Use of the Mini-Cog test as a screening method for dementia in the Italian population: the Argento Study results]

This article describes the use of the Mini Cog test in a sample of elderly subjects participating in a multicentre Italian study on the healthcare needs of older adults. The Mini Cog is a simple screening test for cognitive impairment. It combines a brief memory test and a simply scored clock-drawing test and allows rapid screening for short term memory defects, learning and different cognitive abilities that are impaired in dementia patients. Various studies have shown that the Mini-Cog, which can be administered in as little as 3 minutes, is as effective in detecting dementia as longer screening tests. In addition, it can be easily administered by personnel that is unfamiliar with cognitive testing.

The Mini-Cog test was administered to 2,186 elderly subjects participating in the Argento study, a study conducted in 11 Italian regions. Clocks were rated as abnormal (0 points) or normal (1 point) and 1 point was given for each recalled word in the memory test. A total score of 0-2 was considered positive for dementia. Two training courses were organized for the 11 regional coordinators who were responsible for rating the clock drawing test. In order to validate the study results, 300 clocks were rated by expert raters who had developed the test.

The test was acceptable to study subjects and less than 1% refused to perform the clock drawing test. Ratings by expert and local raters were found to be 90% concordant. The estimated prevalence of persons with a score >or=2 was 23.1% and double in persons over 75 years of age (65-74: 16,4%; >or=75: 31,2%). No gender differences were observed. On the other hand large differences were observed between persons with different educational levels; in fact while 63.1% of illiterate subjects scored positive for dementia, only 8.9% of university educated persons had positive tests.

The Mini-Cog test was found to be easy to administer by Italian Local Health Unit personnel in the context of evaluating healthcare needs of older persons. Study results were consistent with other population studies that evaluated cognitive impairment in elderly subjects in developed countries. In view of its high acceptability and reliability the Mini-Cog can be a valid screening tool for use in outpatient services and by general practitioners and in the planning and management of healthcare services.