How to Administer the Mini-Cog as part of the CAM in Delirium Assessment–with Video

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Administering and Interpreting the Mini-Cog from Hartford Institute – NYU on Vimeo.

See the above video on how to administer the Mini-Cog published by the Hartford Institute. If the video doesn’t work go to link It’s a bit on the long side at over 30 minutes, but I suggest you try to focus mainly on the demonstration of the Mini-Cog itself, a
quick cognitive assessment meant to be done prior to conducting the Confusion Assessment Method (CAM) as part of screening for Delirium. It’s a composed mainly of a recall and Clock Drawing tasks. Recall the Mini-Cog is not an assessment specifically for delirium. It’s a screen for cognitive impairment [1].

The CAM-ICU and the CAM have been criticized in a recent study for having very low sensitivity[2]. The main reason why the CAM performs so poorly most of the time in the hands of many nurses and even clinician researchers is the tendency to administer the CAM without a cognitive assessment[3]. Some would argue that even the Mini-Cog is not enough.

Neuropsychologists have suggested trying to add RBANS subtests such as the Coding test to delirium screening instruments such as the CAM[4].

I wonder if the performance of the original CAM would improve if there were a way to consistently ensure nurses are administering it along with cognitive assessments and documenting that.


Mini-Cog instructions

1.            Borson, S., et al., The mini-cog: a cognitive ‘vital signs’ measure for dementia screening in multi-lingual elderly. Int J Geriatr Psychiatry, 2000. 15(11): p. 1021-7.

2.            Neufeld, K.J., et al., Evaluation of Two Intensive Care Delirium Screening Tools for Non-Critically Ill Hospitalized Patients. Psychosomatics, 2011. 52(2): p. 133-140.

3.            Wei, L.A., et al., The Confusion Assessment Method: a systematic review of current usage. J Am Geriatr Soc, 2008. 56(5): p. 823-30.

4.            Beglinger, L.J., et al., The neuropsychological course of acute delirium in adult hematopoietic stem cell transplantation patients. Arch Clin Neuropsychol, 2011. 26(2): p. 98-109.