{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T06:30:52Z","timestamp":1790404252778,"version":"4.1.0"},"reference-count":47,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,8,26]],"date-time":"2024-08-26T00:00:00Z","timestamp":1724630400000},"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. Hum. Neurosci."],"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>Alzheimer\u2019s 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\u00a9 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.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>DCR was administered to 828 participants in the Bio-Hermes-001 clinical trial (age median\u2009\u00b1\u2009SD\u2009=\u200972\u2009\u00b1\u20096.7, IQR\u2009=\u200911; 58% female) independently classified as cognitively unimpaired (<jats:italic>n<\/jats:italic>\u2009=\u2009364) or as having mild cognitive impairment (MCI, <jats:italic>n<\/jats:italic>\u2009=\u2009274) or dementia likely due to AD (DLAD, <jats:italic>n<\/jats:italic>\u2009=\u2009190). 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 (<jats:italic>n<\/jats:italic>\u2009=\u2009508) and concordance between Mini-Cog rule-based and DCR scoring was calculated.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Inter-rater reliability of Mini-Cog scoring was good to excellent, but Rater 2\u2019s scores were significantly higher than Rater 1\u2019s due to variation in clock scores (<jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.0001). Mini-Cog and DCR scores were significantly correlated (<jats:italic>\u03c4<\/jats:italic><jats:sub>B<\/jats:sub>\u2009=\u20090.71, <jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.0001). However, using a Mini-Cog cut score of 4, the DCR identified more cases of cognitive impairment (<jats:italic>n<\/jats:italic>\u2009=\u200947; <jats:italic>\u03c7<\/jats:italic><jats:sup>2<\/jats:sup>\u2009=\u200913.26, <jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.0005) and Mini-Cog missed significantly more cases of cognitive impairment (<jats:italic>n<\/jats:italic>\u2009=\u200987). In addition, the DCR correctly classified significantly more cognitively impaired cases missed by the Mini-Cog (<jats:italic>n<\/jats:italic>\u2009=\u200944) than vice versa (<jats:italic>n<\/jats:italic>\u2009=\u20094; <jats:italic>\u03c7<\/jats:italic><jats:sup>2<\/jats:sup>\u2009=\u200921.69, <jats:italic>p<\/jats:italic>\u2009&amp;lt;\u20090.0001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>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.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fnhum.2024.1337851","type":"journal-article","created":{"date-parts":[[2024,8,26]],"date-time":"2024-08-26T05:04:34Z","timestamp":1724648674000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":11,"title":["Digital Clock and Recall: a digital, process-driven evolution of the Mini-Cog"],"prefix":"10.3389","volume":"18","author":[{"given":"Joyce","family":"Gomes-Osman","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Soo","family":"Borson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Claudio","family":"Toro-Serey","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Russell","family":"Banks","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marissa","family":"Ciesla","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ali","family":"Jannati","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"W. Isaiah","family":"Morrow","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rod","family":"Swenson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Libon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Bates","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Showalter","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sean","family":"Tobyne","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alvaro","family":"Pascual-Leone","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2024,8,26]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"327","DOI":"10.1002\/alz.12328","article-title":"Alzheimer\u2019s disease facts and figures","volume":"17","year":"2021","journal-title":"Alzheimers Dement."},{"key":"ref2","doi-asserted-by":"publisher","first-page":"1598","DOI":"10.1002\/alz.13016","article-title":"2023 Alzheimer\u2019s disease facts and figures","volume":"19","year":"2023","journal-title":"Alzheimers Dement."},{"key":"ref3","year":"2024"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"7992","DOI":"10.1038\/s41598-022-12024-8","article-title":"Variational autoencoder provides proof of concept that compressing CDT to extremely low-dimensional space retains its ability of distinguishing dementia","volume":"12","author":"Bandyopadhyay","year":"2022","journal-title":"Sci. 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