{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,31]],"date-time":"2026-07-31T06:00:59Z","timestamp":1785477659817,"version":"3.56.0"},"reference-count":28,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2026,6,11]],"date-time":"2026-06-11T00:00:00Z","timestamp":1781136000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/pages\/standard-publication-reuse-rights"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,6,11]]},"abstract":"Abstract<\/jats:title>\n \n Background<\/jats:title>\n Cognitive impairment is common in older adults, and its early detection in primary care remains challenging. The Clock Drawing Test (CDT) is a practical tool, but variability in its scoring limits standardization.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To evaluate artificial intelligence (AI)-based automated CDT scoring in primary care by examining its association with Mini-Mental State Examination (MMSE) scores, discriminative performance for cognitive impairment, and agreement with clinician rating.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n In this cross-sectional study, 207 adults aged \u226565 years were assessed in a primary care setting. CDT drawings were scored manually by a neurologist and automatically using a multimodal generative AI system based on the Manos and Wu 10-point method. Associations with MMSE were analyzed, and discriminative performance was assessed using receiver operating characteristic analysis. Agreement was evaluated using intraclass correlation coefficient and Bland\u2013Altman analysis.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n AI-based CDT scores demonstrated a moderate positive correlation with MMSE (\u03c1 = .437, P &lt; .001). Both methods significantly discriminated MMSE-defined cognitive impairment, although manual scoring yielded a significantly higher area under the receiver operating characteristic curve than AI-based scoring (.779 vs .715; DeLong P = .028). AI-based scoring provided higher sensitivity but lower specificity. Agreement between methods was good (intraclass correlation coefficient = .721), with AI tending to assign slightly higher scores (mean difference: 1.13).<\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n AI-based CDT scoring is associated with global cognitive performance and offers meaningful discrimination of cognitive impairment in primary care. However, given lower accuracy and individual-level variability, it should be considered a supportive tool rather than a replacement for clinician assessment.<\/jats:p>\n <\/jats:sec>","DOI":"10.1093\/fampra\/cmag051","type":"journal-article","created":{"date-parts":[[2026,7,23]],"date-time":"2026-07-23T08:29:18Z","timestamp":1784795358000},"source":"Crossref","is-referenced-by-count":0,"title":["Artificial intelligence\u2013based automated scoring of the Clock Drawing Test in older adults in primary care: association with Mini-Mental State Examination scores, discriminative performance, and agreement with clinician rating"],"prefix":"10.1093","volume":"43","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-6471-9516","authenticated-orcid":false,"given":"\u00d6zt\u00fcrk G","family":"Tutu","sequence":"first","affiliation":[{"name":"Department of Family Medicine, Osmaniye Training and Research Hospital , Osmaniye 80000 ,","place":["T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-1592-3083","authenticated-orcid":false,"given":"Veli","family":"Bilen","sequence":"additional","affiliation":[{"name":"Department of Family Medicine, Faculty of Medicine, Hatay Mustafa Kemal University , Hatay 31060 ,","place":["T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2859-5072","authenticated-orcid":false,"given":"Zeynep","family":"Ziro\u011flu","sequence":"additional","affiliation":[{"name":"Neurology Clinic, Ankara Training and Research Hospital , Ankara 06230 ,","place":["T\u00fcrkiye"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2026,7,23]]},"reference":[{"key":"2026073101312793600_cmag051-B1","volume-title":"Dementia","author":"World Health Organization","year":"2025"},{"key":"2026073101312793600_cmag051-B2","doi-asserted-by":"publisher","first-page":"757","DOI":"10.1001\/jama.2020.0435","article-title":"Screening for cognitive impairment in older adults: US Preventive Services Task Force recommendation statement","volume":"323","author":"Owens","year":"2020","journal-title":"JAMA"},{"key":"2026073101312793600_cmag051-B3","doi-asserted-by":"publisher","first-page":"239","DOI":"10.1093\/fampra\/cmx098","article-title":"The diagnostic accuracy of the Ascertain Dementia 8 questionnaire for detecting cognitive impairment in primary care in the community, clinics and hospitals: a systematic review and meta-analysis","volume":"35","author":"Chen","year":"2018","journal-title":"Fam Pract"},{"key":"2026073101312793600_cmag051-B4","doi-asserted-by":"publisher","first-page":"272","DOI":"10.1093\/fampra\/cmq100","article-title":"Use of cognitive screening instruments in primary care: the impact of national dementia directives (NICE\/SCIE, National Dementia Strategy)","volume":"28","author":"Menon","year":"2011","journal-title":"Fam Pract"},{"key":"2026073101312793600_cmag051-B5","doi-asserted-by":"publisher","first-page":"572","DOI":"10.1007\/s11606-005-0103-7","article-title":"Implementing a screening and diagnosis program for dementia in primary care","volume":"20","author":"Boustani","year":"2005","journal-title":"J Gen Intern Med"},{"key":"2026073101312793600_cmag051-B6","doi-asserted-by":"publisher","first-page":"1783","DOI":"10.1017\/S1041610214001082","article-title":"Cognitive screening for dementia in primary care: a systematic review","volume":"26","author":"Yokomizo","year":"2014","journal-title":"Int Psychogeriatr"},{"key":"2026073101312793600_cmag051-B7","doi-asserted-by":"publisher","first-page":"1242","DOI":"10.1002\/gps.2252","article-title":"Reliability and validity of revised Turkish version of Mini Mental State Examination (rMMSE-T) in community-dwelling educated and uneducated elderly","volume":"24","author":"Keskinoglu","year":"2009","journal-title":"Int J Geriatr Psychiatry"},{"key":"2026073101312793600_cmag051-B8","first-page":"273","article-title":"Reliability and validity of the standardized Mini Mental State Examination in the diagnosis of mild dementia in Turkish population","volume":"13","author":"G\u00fcngen","year":"2002","journal-title":"Turk Psikiyatri Derg"},{"key":"2026073101312793600_cmag051-B9","doi-asserted-by":"publisher","first-page":"189","DOI":"10.1016\/0022-3956(75)90026-6","article-title":"\u201cMini-mental state\u201d. 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