Digital Clock and Recall: a digital, process-driven evolution of the Mini-Cog.

Introduction: Alzheimer's disease and related dementias (ADRD) represent a substantial global public health challenge with multifaceted impacts on individuals, families, and healthcare systems. Brief cognitive screening tools such as the Mini-Cog© can help improve recognition of ADRD in clinical practice, but widespread adoption continues to lag. We compared the Digital Clock and Recall (DCR), a next-generation process-driven adaptation of the Mini-Cog, with the original paper-and-pencil version in a well-characterized clinical trial sample.

Methods: DCR was administered to 828 participants in the Bio-Hermes-001 clinical trial (age median ± SD = 72 ± 6.7, IQR = 11; 58% female) independently classified as cognitively unimpaired ( = 364) or as having mild cognitive impairment (MCI,  = 274) or dementia likely due to AD (DLAD,  = 190). MCI and DLAD cohorts were combined into a single impaired group for analysis. Two experienced neuropsychologists rated verbal recall accuracy and digitally drawn clocks using the original Mini-Cog scoring rules. Inter-rater reliability of Mini-Cog scores was computed for a subset of the data ( = 508) and concordance between Mini-Cog rule-based and DCR scoring was calculated.

Results: Inter-rater reliability of Mini-Cog scoring was good to excellent, but Rater 2's scores were significantly higher than Rater 1's due to variation in clock scores ( < 0.0001). Mini-Cog and DCR scores were significantly correlated (  = 0.71,  < 0.0001). However, using a Mini-Cog cut score of 4, the DCR identified more cases of cognitive impairment ( = 47;  = 13.26,  < 0.0005) and Mini-Cog missed significantly more cases of cognitive impairment ( = 87). In addition, the DCR correctly classified significantly more cognitively impaired cases missed by the Mini-Cog ( = 44) than vice versa ( = 4;  = 21.69,  < 0.0001).

Discussion: Our findings demonstrate higher sensitivity of the DCR, an automated, process-driven, and process-based digital adaptation of the Mini-Cog. Digital metrics capture clock drawing dynamics and increase detection of diagnosed cognitive impairment in a clinical trial cohort of older individuals.