A study on the Mini-cog scale in the general screening of cognitive status among the elderly in Putian city

<title>Abstract</title> <p>Background Early detection of cognitive impairment is critical to reduce dementia burden, but feasible screening tools are lacking in dialect-dominant, illiterate, resource-limited regions. The Mini-cog is a brief, simple instrument; its performance in such populations remains unclear. Methods This cross-sectional study enrolled 450 elderly (≥ 60 years) Putian dialect speakers in Fujian Province. Participants underwent Mini-cog, Hong Kong Brief Cognitive Test (HKBC), Montreal Cognitive Assessment (MoCA), and comprehensive neuropsychological batteries. Final diagnoses (cognitively normal [CN], mild cognitive impairment [MCI], dementia) followed NIA-AA 2011 criteria. Sensitivity, specificity, and area under the ROC curve (AUC) were calculated and compared overall and by education (≤ 6 vs. &gt;6 years). Results Among 450 participants, 161 were CN, 158 MCI, and 131 dementia. For MCI vs. CN, Mini‑Cog showed sensitivity 90.51%, specificity 95.65%, AUC 0.90—significantly outperforming HKBC (AUC 0.82, P = 0.0027) and MoCA (AUC 0.84, P = 0.02). For dementia vs. CN, all three tools performed excellently (AUC ≥ 0.95, P &gt; 0.05). In the lower-education subgroup (≤ 6 years), Mini-cog maintained robust MCI detection (AUC 0.90) while HKBC and MoCA had lower AUCs (0.87 and 0.85). Mini-cog achieved 100% sensitivity for dementia across all education strata. Conclusions In dialect-dominant, educationally diverse elderly, Mini-cog provides superior diagnostic accuracy for MCI versus HKBC and MoCA, and comparable accuracy for dementia. Its brevity, minimal literacy requirement, and dialect insensitivity make it ideal for large-scale cognitive screening in resource-limited, linguistically complex settings.</p>