Performance of Older Adults on the Digital Clock and Recall Test Compared to the Montreal Cognitive Assessment in Primary Care Settings

Abstract

Background: Digital cognitive assessment solutions can overcome some barriers to cognitive screening in primary care by providing rapidly obtained objective insights without requiring specialty trained examiners. Real-world comparison of digital assessments to standard screenings in primary care is limited. Objective: Our objective was to compare performance on the Linus Health Digital Clock and Recall (DCR™) to the Montreal Cognitive Assessment (MOCA), which is a traditional "gold standard" cognitive screening test in primary care. Participants: A total of 114 primary care patients ≥ 65 years old completed a DCR as part of routine primary care and scored in the "Borderline" or "Impaired" ranges, and subsequently completed a MOCA at a follow-up primary care visit. Design: Criterion and convergent validity analyses were conducted using Mann-Whitney U tests, concordance (agreement) rates, polychoric or polyserial correlations, and exploratory factor analysis. Main measures: DCR and MOCA Total Scores and subcomponent scores. Key results: DCR Total Score and select process scores successfully discriminated impairment on the MOCA using traditional cutoffs, and both agreement rates and correlations were strong between DCR and MOCA components-especially Total Scores comparisons. Exploratory factor analysis revealed a five-factor model whereby one factor was comprised of memory subtests from both the DCR and MOCA, and another was comprised of non-memory MOCA subtests and Information Processing/Spatial Reasoning subcomponents of the DCR. Conclusions: Screening in primary care using the DCR is feasible, and shows criterion and convergent validity with a "gold standard" screening tool for detecting cognitive impairment-the MOCA. When paired with parallel advancements in detection of plasma-based biomarkers and recent FDA approvals for disease-modifying treatments for Alzheimer's disease, the DCR and similar digital cognitive assessment tools have the potential to triage patients for both Alzheimer's disease diagnostic workups and subsequent treatments beyond specialty care.