A cognitive screening test is a short set of questions and tasks. It checks memory, attention, language and other thinking skills. The most common are the MoCA and MMSE (both out of 30), the ACE-III (out of 100) and the Mini-Cog (out of 5). Each has a cut-off. A score below it is a reason to look further. It is not a diagnosis.
A low score can come from dementia or mild cognitive impairment. It can also come from low mood, poor hearing, a medicine, an infection, fewer years at school, or a bad night's sleep. A normal score does not rule dementia out either. The UK's National Institute for Health and Care Excellence (NICE) says so directly.
This guide explains each test's score range, the cut-offs the authors and guidelines use, and how accurate the tests are. It also covers what happens next in Ireland, the UK and the US.
A screen is a quick first look, usually 3 to 20 minutes long. Its job is to sort people into "probably fine for now" and "needs a fuller assessment". It cannot tell you which condition is causing a problem, or whether there is one at all.
In Ireland, the HSE says your GP will ask about your concerns and examine you. They will ask about memory and thinking, and give you a pen-and-paper task. The GP may also review your medicines and order blood tests. The NHS describes the same first steps in the UK.
Still at the "is this normal?" stage? Our guide to memory worries and normal ageing covers what typical age-related change looks like.
The MoCA was designed as a 10-minute screen to help front-line doctors detect mild cognitive impairment. Its developers list these score ranges:
The developers say the moderate and severe bands were set by default, not derived from their validation study. One point is added for people with 12 or fewer years of education, up to the maximum of 30. They say the test has been validated for people aged 55 to 85, and that the paper version exists in nearly 100 languages.
The MMSE is the oldest of the four and is scored out of 30. A Cochrane review tested it at many cut-points, from 10 to 30. The most studied cut-point was 24.
You may also see MMSE bands used for people already diagnosed with Alzheimer's disease. The evidence review for a NICE drug appraisal defined mild Alzheimer's as MMSE 21 to 26, moderate as 10 to 20, and severe as below 10. Those bands describe severity after diagnosis. They are not a test for whether someone has dementia.
The ACE-III has 21 tasks and a total of 100. It covers five areas: attention, memory, verbal fluency, language and visuospatial skills. A Cochrane review describes the usual cut-offs as below 88 for mild cognitive impairment and below 82 for dementia. It takes about 15 to 20 minutes, so it is more common in memory clinics than in GP surgeries.
The Mini-Cog combines remembering three words with drawing a clock. Each word recalled scores a point (0 to 3). A normal clock scores 2. The official scoring form says a total below 3 has been validated for dementia screening. It adds that "many individuals with clinically meaningful cognitive impairment will score higher". A cut-off below 4 is recommended when greater sensitivity is wanted.
That depends on the clinic. NICE guidance for non-specialist settings names six brief tools, including the Mini-Cog and the 6-item cognitive impairment test (6CIT). The MoCA and MMSE are not on that list, though both remain in wide use.
Accuracy depends on the cut-off and on who is being tested. These are the figures from the reviews we checked:
The MoCA's own validation study is worth knowing about. In 94 people with mild cognitive impairment, the MoCA detected 90% at a cut-off of 26. The MMSE detected 18% at the same cut-off. The MoCA is more sensitive to milder problems. The trade-off is more false alarms.
Fewer years of formal education tend to mean lower scores, whatever is happening in the brain. This is why the MoCA adds a point. Some researchers think that is not enough. A 2018 meta-analysis of nine studies found a cut-off of 23 gave better overall accuracy than 26. It said 26 produced an "inflated rate of false positives", particularly in older people and people with less education.
A 2026 study from the Framingham Heart Study tested 2,637 adults judged cognitively unimpaired. Their average MoCA score was 24.69, below the original cut-off of 26. People over 60 averaged below 23. The authors call for norms that match a person's age and education.
A test taken in a second language, or with unfamiliar content, can underestimate ability. The Mini-Cog's developers reported that education and language both affected the MMSE's results in their mixed-language sample. NICE says doctors should not rely only on cognition scores when language, education, disability or communication problems would make them misleading.
Many tasks have to be heard or seen. In a study of 301 older adults, people with normal hearing and vision passed the MoCA more often than people with sensory loss. This held even after adjusting scores for sensory factors. Bring your glasses and hearing aids. If hearing is a problem, our page on hearing loss and dementia risk explains why it is worth getting checked anyway.
NICE lists the causes to rule out before referring someone to a memory service. They include delirium, depression, hearing or sight loss, and medicines with anticholinergic effects. The HSE adds stress, alcohol and drugs, and other health problems. Depression in particular affects concentration and recall. Our guide to depression treatment covers what helps.
Some everyday medicines can dull thinking. Our page on anticholinergic burden lists common ones. Do not stop any prescribed medicine on your own. Bring a full list, including anything bought over the counter, to your appointment.
Delirium is a sudden confusion caused by a medical problem such as an infection. Confusion that came on over days, or comes and goes, needs urgent medical attention, not a memory screen.
NICE is explicit. "Do not rule out dementia solely because the person has a normal score on a cognitive instrument." The Cochrane MMSE authors said the test "should not be used in isolation to confirm or exclude disease". The ACE-III review said it should only support a diagnosis alongside a full clinical assessment.
Scores also move. A single low result can reflect a bad day. Our article on mild cognitive impairment explains how often people later test as normal.
A low score is a reason for a fuller assessment. That usually starts with ruling out treatable causes, such as thyroid problems or low B12. Our page on blood tests to ask about covers the common ones.
Your GP is usually the first step. The HSE says the GP may refer you to a specialist if they are unsure, often through a memory assessment service. The specialist may be a geriatrician, a psychiatrist or a neurologist.
The Alzheimer Society of Ireland says there are 25 memory clinics in Ireland. All but one need a GP referral. People under 65 are referred to a neurologist or a memory clinic.
Further tests may include blood tests and a CT, MRI or PET scan. Some people have a lumbar puncture to measure amyloid and tau proteins in spinal fluid. That is according to the HSE's diagnosis page.
The NHS says a GP will examine you and may arrange blood and urine tests. You will also be asked to do a memory or cognitive test. If other causes are ruled out, the GP may refer you to a memory clinic, an old-age psychiatrist or a neurologist. A CT or MRI scan may follow.
Medicare says the yearly Wellness visit includes a cognitive assessment to look for signs of dementia. If your provider suspects impairment, Medicare covers a separate visit for a fuller review. That visit can check for dementia, depression, anxiety or delirium.
NICE says specialists should consider fuller neuropsychological testing in three situations. These are when it is unclear whether there is impairment, whether dementia is the cause, or which type it is. That is a much longer assessment than a screen.
If waiting for answers is weighing on you, the Alzheimer Society of Ireland's helpline is 1800 341 341. If you are struggling to cope or thinking about harming yourself, call Samaritans free on 116 123. It is open day and night in Ireland and the UK. In the US, call or text 988.
It is below the developers' normal range of 26 and above, so it is a reason to look further. It does not mean you have dementia. Reviews suggest 26 flags many people who turn out to be fine, especially older people and people with less education. Ask what else could explain the score.
Anxiety, tiredness and illness can all affect how people perform on tests. That is one reason a single result is never a diagnosis. Tell the person testing you if you were unwell or very anxious that day.
Practising defeats the purpose, because the result would no longer reflect how you usually function. The MoCA has alternative versions so that retesting within a few months is not skewed by remembering the answers.
There is no single official pass mark. The cut-point most often studied is 24, and a higher score is better. The MMSE is less sensitive to mild problems than the MoCA. A normal MMSE score does not rule out early change.
Almost always. The Alzheimer Society of Ireland says all but one of Ireland's 25 memory clinics need a GP referral.
This article is general information, not medical advice. It cannot assess anyone's memory or thinking. If you are worried about yourself or someone close to you, talk to your GP.
Reviewed by: Proco Team
Last updated: November 2026