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This study presents a novel approach to MCI screening through multimodal behavioral analysis during the Clock Drawing Test (CDT), implementing a comprehensive data collection system using standard tablet devices. Our approach analyzes three behavioral dimensions: drawing trajectories, facial expressions, and hand motion patterns. We developed an integrated framework combining Convolutional Neural Networks with multi-head attention mechanisms for drawing analysis, alongside specialized feature extraction methods for facial and motion data. To effectively integrate these behavioral markers, we proposed a Higher-order Canonical Correlation Analysis (HCCA) algorithm that models complex relationships between modalities. In our primary study with 69 MCI participants and 133 age-matched controls, we identified distinct behavioral patterns: temporal drawing anomalies, altered facial behaviors including increased gaze variability, and distinctive motion patterns reflecting changes in movement stability. Our multimodal approach achieved an AUC of 0.92 (accuracy: 92.68%, sensitivity: 90.91%), with HCCA further improving performance to an AUC of 0.97. External validation with 76 additional participants demonstrated good generalizability (AUC: 0.86). These findings reveal how cognitive impairment manifests across multiple behavioral channels offer clinicians precise, interpretable quantification of cognitive function for more accurate MCI screening.<\/jats:p>","DOI":"10.1145\/3770684","type":"journal-article","created":{"date-parts":[[2025,12,2]],"date-time":"2025-12-02T19:42:32Z","timestamp":1764704552000},"page":"1-30","update-policy":"https:\/\/doi.org\/10.1145\/crossmark-policy","source":"Crossref","is-referenced-by-count":1,"title":["Beyond the Clock: Exploring Multimodal Behavior Markers of Mild Cognitive Impairment in Older Adults during Clock Drawing Test"],"prefix":"10.1145","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2297-4434","authenticated-orcid":false,"given":"Lingjie","family":"Fan","sequence":"first","affiliation":[{"name":"College of Computer Science, Sichuan University, Chengdu, Sichuan, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0316-8365","authenticated-orcid":false,"given":"Junhan","family":"Zhao","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, University of Chicago, Chicago, Illinois, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-4329-6296","authenticated-orcid":false,"given":"Yongji","family":"Wu","sequence":"additional","affiliation":[{"name":"Shenzhen University, Shenzhen, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8137-1975","authenticated-orcid":false,"given":"Fengyi","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Rehabilitation Medicine, West China Hospital of Sichuan University, Chengdu, Sichuan, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3597-9090","authenticated-orcid":false,"given":"Xiyue","family":"Wang","sequence":"additional","affiliation":[{"name":"College of Computer Science, Sichuan University, Chengdu, Sichuan, China"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-6383-5175","authenticated-orcid":false,"given":"Tao","family":"Lin","sequence":"additional","affiliation":[{"name":"College of Computer Science, Sichuan University, Chengdu, Sichuan, China"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"320","published-online":{"date-parts":[[2025,12,2]]},"reference":[{"key":"e_1_2_2_1_1","volume-title":"The clock-drawing test. 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