Dementia is a syndrome characterized by a decline in cognitive function, affecting memory, thinking, and judgment severely enough to interfere with daily life. Early detection is important for timely intervention, support planning, and accessing treatments. Therefore, primary care settings often incorporate brief cognitive screening tests into routine wellness visits for older adults.
Identifying the 3-Word Recall Test
The “3-word test” is the memory component of the Mini-Cog, a widely used, rapid screening instrument. The Mini-Cog combines this verbal memory task with a clock drawing task, which assesses visuospatial and executive function. The purpose of the three words is to evaluate the brain’s ability to register new information and successfully retrieve it after a distraction.
The words chosen are deliberately unrelated to prevent test-takers from using logical associations to aid recall. Examples include “river, nation, finger” or “banana, sunrise, chair.” These must be simple, concrete nouns that are easy for the person to visualize. This portion specifically assesses delayed recall, which is often one of the first cognitive domains affected by conditions like Alzheimer’s disease.
How the Test is Administered and Scored
Administration
The word recall component begins by ensuring the person has registered the words. The examiner tells the person the three words and immediately asks them to repeat them back. This initial step confirms the person is capable of immediate memory registration. If the person cannot repeat the words correctly, the examiner may repeat the list up to three times to confirm the words have been learned.
Delayed Recall and Scoring
The main purpose of the delayed recall test is to challenge short-term memory. To create a delay, the person is immediately given the intervening task: drawing a clock face set to a specific time, which typically takes about three minutes. This clock drawing acts as a mental distraction to prevent rehearsal. Once the clock drawing is finished, the person is asked to recall the three words from the beginning of the test.
Scoring for the word recall is numerical, with one point awarded for each word spontaneously recalled. Only words retrieved without any hints or cues are counted, resulting in a possible score of zero to three points for this task. The final Mini-Cog score combines this word recall score with the clock drawing score (typically zero or two points), for a total possible score of five.
Significance of Screening Results and Next Steps
A brief screening tool like the Mini-Cog is not designed to provide a medical diagnosis of dementia. It functions as a filter to flag individuals who need a more in-depth clinical evaluation. A low score on the combined test, typically two points or less, suggests a higher likelihood of clinically significant cognitive impairment and warrants immediate follow-up. Further investigation is often recommended for any score below four, especially if memory concerns have been expressed by the person or a family member.
Comprehensive Diagnostic Workup
When screening results suggest possible impairment, the next step is a comprehensive diagnostic workup performed by a medical professional. This process includes a detailed cognitive assessment, such as the Montreal Cognitive Assessment (MoCA) or the Saint Louis University Mental Status (SLUMS) examination. Professionals also conduct a thorough physical and neurological exam to check for other symptoms.
Additional Testing
Additional testing includes laboratory blood tests to rule out reversible causes of cognitive decline, such as thyroid problems, vitamin B12 deficiency, or infections. Brain imaging, often using magnetic resonance imaging (MRI) or computed tomography (CT) scans, is ordered to look for structural changes like strokes, tumors, or patterns of brain atrophy. The final diagnosis requires careful consideration of the medical history, all test results, and the person’s functional abilities, emphasizing the need to consult a specialist.