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Among the MMSE items, the pentagon copying test (PCT) requires participants to accurately replicate a sample of two interlocking pentagons. While the PCT is traditionally scored on a binary scale, there have been limited developments of granular scoring scale to assess task performance. In this paper, we present a novel three-stage algorithm, called Quantification of Interlocking Pentagons (QIP) which quantifies PCT performance by computing the areas of individual pentagons and their intersection areas, and a balance ratio between the areas of the two individual pentagons. The three stages of the QIP algorithm include: (1) detection of line segments, (2) unraveling of the interlocking pentagons, and (3) quantification of areas. A set of 497 PCTs from 84 participants including their baseline and follow-up PCTs from the Rush Memory and Aging Project was selected blinded about their cognitive and clinical status. Analysis of the quantified data revealed a significant inverse relationship between age and balance ratio  (beta\u2009=\u2009\u2212\u20090.49, <jats:italic>p<\/jats:italic>\u2009=\u20090.0033), indicating that older age was associated with a smaller balance ratio. In addition, balance ratio was associated with  perceptual speed (r\u2009=\u20090.71, <jats:italic>p<\/jats:italic>\u2009=\u20090.0135), vascular risk factors (beta\u2009=\u2009\u2212\u20093.96, <jats:italic>p<\/jats:italic>\u2009=\u20090.0269), and medical conditions (beta\u2009=\u2009\u2212\u20092.78, <jats:italic>p<\/jats:italic>\u2009=\u20090.0389). The QIP algorithm can serve as a useful tool for enhancing the scoring of performance in the PCT.<\/jats:p>","DOI":"10.1038\/s41598-024-59194-1","type":"journal-article","created":{"date-parts":[[2024,4,21]],"date-time":"2024-04-21T22:09:12Z","timestamp":1713737352000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Digital quantification of the MMSE interlocking pentagon areas: a three-stage algorithm"],"prefix":"10.1038","volume":"14","author":[{"given":"Namhee","family":"Kim","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy","family":"Truty","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"Duke Han","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Moonseong","family":"Heo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aron S.","family":"Buchman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David A.","family":"Bennett","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shinya","family":"Tasaki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2024,4,19]]},"reference":[{"key":"59194_CR1","doi-asserted-by":"crossref","unstructured":"Folstein, M. 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