{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,23]],"date-time":"2026-06-23T08:41:43Z","timestamp":1782204103298,"version":"3.54.5"},"reference-count":43,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2022,12,21]],"date-time":"2022-12-21T00:00:00Z","timestamp":1671580800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Digit. Health"],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>The Clinical Dementia Rating (CDR) and Mini-Mental State Examination (MMSE) are useful screening tools for mild cognitive impairment (MCI). However, these tests require qualified in-person supervision and the CDR can take up to 60\u2005min to complete. We developed a digital cognitive screening test (M-CogScore) that can be completed remotely in under 5\u2005min without supervision. We set out to validate M-CogScore in head-to-head comparisons with CDR and MMSE.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>To ascertain the validity of the M-CogScore, we enrolled participants as healthy controls or impaired cognition, matched for age, sex, and education. Participants completed the 30-item paper MMSE Second Edition Standard Version (MMSE-2), paper CDR, and smartphone-based M-CogScore. The digital M-CogScore test is based on time-normalised scores from smartphone-adapted Stroop (M-Stroop), digit-symbols (M-Symbols), and delayed recall tests (M-Memory). We used Spearman's correlation coefficient to determine the convergent validity between M-CogScore and the 30-item MMSE-2, and non-parametric tests to determine its discriminative validity with a CDR label of normal (CDR 0) or impaired cognition (CDR 0.5 or 1). M-CogScore was further compared to MMSE-2 using area under the receiver operating characteristic curves (AUC) with corresponding optimal cut-offs.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>72 participants completed all three tests. The M-CogScore correlated with both MMSE-2 (rho\u2009=\u20090.54, <jats:italic>p\u2009<\/jats:italic>&amp;lt;\u20090.0001) and impaired cognition on CDR (Mann Whitney <jats:italic>U<\/jats:italic>\u2009=\u2009187, <jats:italic>p\u2009<\/jats:italic>&amp;lt;\u20090.001). M-CogScore achieved an AUC of 0.85 (95% bootstrapped CI [0.80, 0.91]), when differentiating between normal and impaired cognition, compared to an AUC of 0.78 [0.72, 0.84] for MMSE-2 (<jats:italic>p\u2009<\/jats:italic>=\u20090.21).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>Digital screening tests such as M-CogScore are desirable to aid in rapid and remote clinical cognitive evaluations. M-CogScore was significantly correlated with established cognitive tests, including CDR and MMSE-2. M-CogScore can be taken remotely without supervision, is automatically scored, has less of a ceiling effect than the MMSE-2, and takes significantly less time to complete.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fdgth.2022.1029810","type":"journal-article","created":{"date-parts":[[2022,12,21]],"date-time":"2022-12-21T09:17:11Z","timestamp":1671614231000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":10,"title":["Validation of a rapid remote digital test for impaired cognition using clinical dementia rating and mini-mental state examination: An observational research study"],"prefix":"10.3389","volume":"4","author":[{"given":"Ali","family":"Alim-Marvasti","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Narayan","family":"Kuleindiren","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kirsten","family":"Harvey","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matteo","family":"Ciocca","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aaron","family":"Lin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hamzah","family":"Selim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammad","family":"Mahmud","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2022,12,21]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"321","DOI":"10.1016\/j.jalz.2019.01.010","article-title":"Association as. Alzheimer's Disease facts and figures","volume":"15","year":"2019","journal-title":"Alzheimer's & Dementia"},{"key":"B2","doi-asserted-by":"publisher","first-page":"4919","DOI":"10.1073\/pnas.0501157102","article-title":"Methods to improve the detection of mild cognitive impairment","volume":"102","author":"Shankle","year":"2005","journal-title":"Proc Natl Acad Sci United States"},{"key":"B3","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1186\/s12877-021-02658-0","article-title":"Practice effect and test-retest reliability of the Mini-mental state examination-2 in people with dementia","volume":"22","author":"Lee","year":"2022","journal-title":"BMC Geriatr"},{"key":"B4","doi-asserted-by":"crossref","DOI":"10.4324\/9781003076391-38","article-title":"MMSE-2: mini-mental state examination","author":"Folstein","year":""},{"key":"B5","doi-asserted-by":"publisher","first-page":"44","DOI":"10.1097\/WAD.0b013e31817634a0","article-title":"The \u201cportable\u201d CDR: translating the clinical dementia rating interview into a PDA format","volume":"23","author":"Galvin","year":"2009","journal-title":"Alzheimer Dis Assoc Disord"},{"key":"B6","doi-asserted-by":"publisher","first-page":"e28368","DOI":"10.2196\/28368","article-title":"A new remote guided method for supervised web-based cognitive testing to ensure high-quality data: development and usability study","volume":"24","author":"Leong","year":"2022","journal-title":"J Med Internet Res"},{"key":"B7","doi-asserted-by":"publisher","first-page":"131","DOI":"10.1159\/000497800","article-title":"Technology and dementia: the future is now","volume":"47","author":"Astell","year":"2019","journal-title":"Dement Geriatr Cogn Disord"},{"key":"B8","doi-asserted-by":"publisher","first-page":"693","DOI":"10.1017\/S1041610218001023","article-title":"Comparing the Mini-mental state examination and the modified Mini-mental state examination in the detection of mild cognitive impairment in older adults","volume":"31","author":"Van Patten","year":"2019","journal-title":"Int Psychogeriatr"},{"key":"B9","doi-asserted-by":"publisher","first-page":"315","DOI":"10.1212\/WNL.53.2.315","article-title":"Norms for the Mini-mental state examination in a healthy population","volume":"53","author":"Grigoletto","year":"1999","journal-title":"Neurology"},{"key":"B10","doi-asserted-by":"publisher","first-page":"13","DOI":"10.1177\/1533317514522852","article-title":"Computerized cognitive testing for older adults: a review","volume":"30","author":"Zygouris","year":"2015","journal-title":"Am J Alzheimer's Dis & Other Demen"},{"key":"B11","author":"Folstein","year":""},{"key":"B12","author":"Strauss","year":""},{"key":"B13","doi-asserted-by":"publisher","first-page":"557","DOI":"10.3389\/fpsyg.2017.00557","article-title":"The stroop color and word test","volume":"8","author":"Scarpina","year":"2017","journal-title":"Front Psychol"},{"key":"B14","doi-asserted-by":"publisher","first-page":"643","DOI":"10.1037\/h0054651","article-title":"Studies of interference in serial verbal reactions","volume":"18","author":"Stroop","year":"1935","journal-title":"J Exp Psychol"},{"key":"B15","doi-asserted-by":"publisher","first-page":"313","DOI":"10.3233\/ADR-200194","article-title":"Normative data for the symbol digit modalities test in older white Australians and Americans. African-Americans, and Hispanic\/Latinos","volume":"4","author":"Ryan","year":"2020","journal-title":"J Alzheimer's dis Rep"},{"key":"B16","author":"Smith","year":""},{"key":"B17","doi-asserted-by":"publisher","first-page":"122","DOI":"10.1097\/WAD.0b013e3181f883b7","article-title":"Adding delayed recall to the Alzheimer disease assessment scale is useful in studies of mild cognitive impairment but not Alzheimer disease","volume":"25","author":"Sano","year":"2011","journal-title":"Alzheimer Dis Assoc Disord"},{"key":"B18","doi-asserted-by":"publisher","first-page":"1588","DOI":"10.1212\/WNL.43.11.2412-a","article-title":"The clinical dementia rating (cdr): current version and scoring rules","volume":"41","author":"Morris","year":"1991","journal-title":"Young"},{"key":"B19","doi-asserted-by":"publisher","first-page":"282","DOI":"10.1002\/gps.2334","article-title":"Diagnosis and staging of mild cognitive impairment, using a modification of the clinical dementia rating scale: the mCDR","volume":"25","author":"Duara","year":"2010","journal-title":"Int J Geriatr Psychiatry"},{"key":"B20","doi-asserted-by":"publisher","first-page":"566","DOI":"10.1192\/bjp.140.6.566","article-title":"A new clinical scale for the staging of dementia","volume":"140","author":"Hughes","year":"1982","journal-title":"Br J Psychiatry"},{"key":"B21","doi-asserted-by":"publisher","first-page":"303","DOI":"10.1001\/archneur.56.3.303","article-title":"Mild cognitive impairment: clinical characterization and outcome","volume":"56","author":"Petersen","year":"1999","journal-title":"Arch Neurol"},{"key":"B22","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1016\/B978-0-12-804832-0.00002-X","article-title":"Chapter 2 - clinical diagnosis of Alzheimer's Disease","volume-title":"Biomarkers in Alzheimer's Disease","author":"Khan","year":"2016"},{"key":"B23","doi-asserted-by":"publisher","DOI":"10.1136\/bmjinnov-2021-000780","article-title":"Preliminary validation study of the Mindset4Dementia application: assessing\u00a0remote collection of dementia risk factors and cognitive performance","author":"Rifkin-Zybutz","year":"2021","journal-title":"BMJ Innov"},{"key":"B24","doi-asserted-by":"publisher","first-page":"e31209","DOI":"10.2196\/31209","article-title":"Optimizing existing mental health screening methods in a dementia screening and risk factor app: observational machine learning study","volume":"6","author":"Kuleindiren","year":"2022","journal-title":"JMIR Formative Research"},{"key":"B25","doi-asserted-by":"publisher","year":"","DOI":"10.1080\/02699052.2022.2158229"},{"key":"B26","doi-asserted-by":"publisher","first-page":"153","DOI":"10.1016\/j.neurobiolaging.2016.03.034","article-title":"Clinical validity of delayed recall tests as a gateway biomarker for Alzheimer's\u00a0Disease in the context of a structured 5-phase development framework","volume":"52","author":"Cerami","year":"2017","journal-title":"Neurobiol Aging"},{"key":"B27","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1038\/s41598-018-37186-2","article-title":"Integrated cognitive assessment: speed and accuracy of visual processing as a reliable proxy to cognitive performance","volume":"9","author":"Khaligh-Razavi","year":"2019","journal-title":"Sci Rep"},{"key":"B28","doi-asserted-by":"publisher","first-page":"837","DOI":"10.2307\/2531595","article-title":"Comparing the areas under two or more correlated receiver operating characteristic curves: a nonparametric approach","author":"DeLong","year":"1988","journal-title":"Biometr"},{"key":"B29","doi-asserted-by":"publisher","DOI":"10.1038\/s41592-019-0686-2","article-title":"Scipy 1.0: fundamental algorithms for scientific computing in python","author":"Virtanen","year":"","journal-title":"Nat Methods"},{"key":"B30","doi-asserted-by":"publisher","first-page":"156","DOI":"10.1097\/WAD.0000000000000008","article-title":"Comparison of two informant questionnaire screening tools for dementia and mild cognitive impairment: aD8 and IQCODE","volume":"28","author":"Razavi","year":"2014","journal-title":"Alzheimer Dis Assoc Disord"},{"key":"B31","doi-asserted-by":"publisher","first-page":"173","DOI":"10.1017\/S1041610297004870","article-title":"Clinical dementia rating: a reliable and valid diagnostic and staging measure for dementia of the Alzheimer type","volume":"9","author":"Morris","year":"1997","journal-title":"Int Psychogeriatr"},{"key":"B32","author":"Zeltzer","year":""},{"key":"B33","doi-asserted-by":"publisher","first-page":"392","DOI":"10.1159\/000092808","article-title":"Brief informant screening test for mild cognitive impairment and early Alzheimer's Disease","volume":"21","author":"Li","year":"2006","journal-title":"Dement Geriatr Cogn Disord"},{"key":"B34","doi-asserted-by":"publisher","first-page":"1450","DOI":"10.1001\/jamainternmed.2015.2152","article-title":"Cognitive tests to detect dementia: a systematic review and meta-analysis","volume":"175","author":"Tsoi","year":"2015","journal-title":"JAMA Intern Med"},{"key":"B35","doi-asserted-by":"publisher","first-page":"e042863","DOI":"10.1002\/alz.042863","article-title":"Early diagnosis of Alzheimer's Dementia with the artificial intelligence-based integrated cognitive assessment: neuropsychology\/computerized neuropsychological assessment","volume":"16","author":"Modarres","year":"2020","journal-title":"Alzheimer's & Dementia"},{"key":"B36","doi-asserted-by":"publisher","first-page":"139","DOI":"10.1097\/01.JGP.0000192478.82189.a8","article-title":"Mapping scores onto stages: mini-mental state examination and clinical dementia rating","volume":"14","author":"Perneczky","year":"2006","journal-title":"Am J Geriatr Psychiatry"},{"key":"B37","doi-asserted-by":"publisher","first-page":"558","DOI":"10.1111\/j.1532-5415.2000.tb05004.x","article-title":"Interrater reliability of the clinical dementia rating in a multicenter trial","volume":"48","author":"Rockwood","year":"2000","journal-title":"J Am Geriatr Soc"},{"key":"B38","doi-asserted-by":"publisher","first-page":"638","DOI":"10.1001\/archneurol.2009.55","article-title":"Cerebrospinal fluid biomarkers and rate of cognitive decline in very mild dementia of the Alzheimer type","volume":"66","author":"Snider","year":"2009","journal-title":"Arch Neurol"},{"key":"B39","doi-asserted-by":"publisher","first-page":"458","DOI":"10.1016\/j.neuroimage.2008.07.013","article-title":"Tensor-based morphometry as a neuroimaging biomarker for Alzheimer's Disease: an MRI study of 676 AD, MCI, and Normal subjects","volume":"43","author":"Hua","year":"2008","journal-title":"Neuroimage"},{"key":"B40","doi-asserted-by":"publisher","first-page":"239","DOI":"10.1002\/gps.5436","article-title":"Diagnostic accuracy of the clinical dementia rating scale for detecting mild cognitive impairment and dementia: a bivariate meta-analysis","volume":"36","author":"Huang","year":"2021","journal-title":"Int J Geriatr Psychiatry"},{"key":"B41","doi-asserted-by":"publisher","first-page":"e12217","DOI":"10.1002\/dad2.12217","article-title":"Current advances in digital cognitive assessment for preclinical Alzheimer's Disease. Alzheimer's & dementia: diagnosis","volume":"13","author":"\u00d6hman","year":"2021","journal-title":"Assessment & Disease Monitoring"},{"key":"B42","doi-asserted-by":"publisher","first-page":"267","DOI":"10.14283\/jpad.2021.11","article-title":"Current state of self-administered brief computerized cognitive assessments for detection of cognitive disorders in older adults: a systematic review","volume":"8","author":"Tsoy","year":"2021","journal-title":"The J Prev of Alzheimer's dis"},{"key":"B43","doi-asserted-by":"publisher","first-page":"416","DOI":"10.1097\/01.JGP.0000310780.04465.13","article-title":"Mild cognitive impairment and everyday function: evidence of reduced speed in performing instrumental activities of daily living","volume":"16","author":"Wadley","year":"2008","journal-title":"Am J Geriatr Psychiatry"}],"container-title":["Frontiers in Digital Health"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fdgth.2022.1029810\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,12,21]],"date-time":"2022-12-21T09:17:15Z","timestamp":1671614235000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fdgth.2022.1029810\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,12,21]]},"references-count":43,"alternative-id":["10.3389\/fdgth.2022.1029810"],"URL":"https:\/\/doi.org\/10.3389\/fdgth.2022.1029810","relation":{},"ISSN":["2673-253X"],"issn-type":[{"value":"2673-253X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,12,21]]},"article-number":"1029810"}}