Evaluating the Mini-Cog Scale and its Socio-demographic Correlations in an Egyptian Context: Results from the Together Against Dementia Initiative at the Alexandria Main University Hospital

Abstract

Introduction:The rising burden of dementia highlights the need for rapid, accessible cognitive screening tools, particularly in resource-limited settings. The Mini-Cog scale is widely used due to its brevity and ease of administration. In Egypt, where educational attainment among older adults is highly heterogeneous, evaluating the reliability of such tools is essential. This study examines the utility of the Mini-Cog in an Egyptian elderly population, focusing on the impact of educational background on its performance.Methods:A cross-sectional study was conducted on 507 Egyptian adults aged ≥60 years recruited through the Together Against Dementia (TAD) community initiative. Participants underwent cognitive screening using the Mini-Cog alongside a structured demographic and clinical questionnaire. The Mini-Cog was administered by trained medical interns using a standardized protocol. Statistical analyses, including logistic regression, were performed to evaluate the association between Mini-Cog results and educational level, and to estimate its diagnostic utility across different educational strata.Results:While word recall performance was relatively stable across groups, illiteracy was strongly associated with failure on the Clock Drawing Task (p < 0.001). A "Memory-Executive Discrepancy" (perfect recall but failed clock) was nearly three times more frequent in illiterate participants (20.8%) compared to literate ones (7.1%; p < 0.001). Prevalence of cognitive impairment was 23.67% at the standard threshold and 42.80% at the high-sensitivity threshold. Impairment was significantly higher in rural residents (p = 0.012), illiterate individuals (p < 0.001), and those with low self-rated socioeconomic status (p < 0.001). Gender became a significant factor only at the high-sensitivity threshold, with females representing 60.83% of the impaired group.Conclusions:The TAD project demonstrates that a university-led, intern-powered framework is a feasible and impactful solution for dementia surveillance in resource-limited settings. Importantly, the Mini-Cog may exhibit significant educational bias in low-literacy settings, potentially inflating impairment rates.