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Alzheimer's & Dementia
Volume 19, Issue S18 e079034
CLINICAL MANIFESTATIONS
Free Access


COMPARATIVE PERFORMANCE OF THE DIGITAL CLOCK AND RECALL™ TEST, MONTREAL
COGNITIVE ASSESSMENT, AND SAINT LOUIS UNIVERSITY MENTAL STATUS AMONG PATIENTS IN
PRIMARY CARE


Dustin B. Hammers, 

Corresponding Author

Dustin B. Hammers

 * hammersd@iu.edu

Department of Neurology, Indiana University School of Medicine, Indianapolis,
IN, USA

Correspondence

Dustin B. Hammers, Department of Neurology, Indiana University School of
Medicine, Indianapolis, IN, USA.

Email: hammersd@iu.edu

Search for more papers by this author
Nicole R Fowler, 

Nicole R Fowler

Indiana University Center for Aging Research, Indianapolis, IN, USA

Search for more papers by this author
Jared R. Brosch, 

Jared R. Brosch

Indiana University School of Medicine, Indianapolis, IN, USA

Search for more papers by this author
Kristen L Swartzell, 

Kristen L Swartzell

Indiana University School of Medicine, Indianapolis, IN, USA

Search for more papers by this author
Russell E Banks, 

Russell E Banks

Linus Health, Boston, MA, USA

Search for more papers by this author
Ali Jannati, 

Ali Jannati

Linus Health, Boston, MA, USA

Search for more papers by this author
Judy Mullavey, 

Judy Mullavey

Linus Health, Boston, MA, USA

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Joyce Rios Gomes-Osman, 

Joyce Rios Gomes-Osman

Linus Health, Boston, MA, USA

Search for more papers by this author
James F Murray, 

James F Murray

Davos Alzheimer’s Collaborative, Philadelphia, PA, USA

Search for more papers by this author
Deanna R Willis, 

Deanna R Willis

Indiana University School of Medicine, Indianapolis, IN, USA

Search for more papers by this author
Dustin B. Hammers, 

Corresponding Author

Dustin B. Hammers

 * hammersd@iu.edu

Department of Neurology, Indiana University School of Medicine, Indianapolis,
IN, USA

Correspondence

Dustin B. Hammers, Department of Neurology, Indiana University School of
Medicine, Indianapolis, IN, USA.

Email: hammersd@iu.edu

Search for more papers by this author
Nicole R Fowler, 

Nicole R Fowler

Indiana University Center for Aging Research, Indianapolis, IN, USA

Search for more papers by this author
Jared R. Brosch, 

Jared R. Brosch

Indiana University School of Medicine, Indianapolis, IN, USA

Search for more papers by this author
Kristen L Swartzell, 

Kristen L Swartzell

Indiana University School of Medicine, Indianapolis, IN, USA

Search for more papers by this author
Russell E Banks, 

Russell E Banks

Linus Health, Boston, MA, USA

Search for more papers by this author
Ali Jannati, 

Ali Jannati

Linus Health, Boston, MA, USA

Search for more papers by this author
Judy Mullavey, 

Judy Mullavey

Linus Health, Boston, MA, USA

Search for more papers by this author
Joyce Rios Gomes-Osman, 

Joyce Rios Gomes-Osman

Linus Health, Boston, MA, USA

Search for more papers by this author
James F Murray, 

James F Murray

Davos Alzheimer’s Collaborative, Philadelphia, PA, USA

Search for more papers by this author
Deanna R Willis, 

Deanna R Willis

Indiana University School of Medicine, Indianapolis, IN, USA

Search for more papers by this author
First published: 25 December 2023
https://doi.org/10.1002/alz.079034
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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. The Linus Health Digital Clock
and Recall (DCR™) is a three-part test consisting of three-word immediate verbal
acquisition, the Digital Clock Test (DCTclock™), and delayed recall of the three
words. Our objective was to compare performance on the DCR to the Montreal
Cognitive Assessment (MoCA; Nasreddine et al., 2005) and the Saint Louis
University Mental Status (SLUMS; Tariq et al., 2006), two commonly used
screening tests in primary care.


METHOD

Comparative analyses of DCR, MoCA (Total Score and Memory Index Score [MIS]),
and SLUMS results were conducted among 80 primary care patients – 65 years and
older presenting for any reason – whose DCR performance was indicative of
cognitive impairment.


RESULT

Of the 80 patients (mean age 74.0 [±7.8]; 60% female) performing as impaired or
borderline impaired on the DCR, 67 completed the MoCA and 13 completed the
SLUMS. Comparison between the DCR and MoCA Total Score included 78% (52/67)
concordance for identifying impairment (cutoff <26). While the remaining 15 of
67 patients (22%) had normal MoCA Total Scores (≥26), 13 (87%) missed points in
at least one MoCA cognitive domain and 8 (53%) missed points in multiple MoCA
domains (often language and delayed recall). Comparison between DCR and SLUMS
revealed that all 13 patients receiving SLUMS assessment had DCR scores 0-1 and
SLUMS scores <27 (indicating cognitive impairment). See Tables 1 and 2 for
breakdown of MoCA, MIS, and SLUMS stratified by DCR performance. Logistic
regression found that DCTclock metrics of information processing (z = 2.00, p =
.045) and spatial reasoning (z = 2.82 p = .005) discriminated cognitive
impairment on MoCA Total Score (cutoff <26). Overall, ROC analysis revealed good
accuracy of DCR to identify MoCA performance (AUC = .84; Figure 1).


CONCLUSION

Screening in primary care using the DCR is feasible, takes less time to
administer than MoCA or SLUMS, and shows concordant results with these more
established screening tools in detecting cognitive impairment. Future research
aims to investigate the criterion validity of the DCR among biomarkers for
neurodegenerative disease.








Volume19, IssueS18

Supplement: Clinical Manifestations

December 2023

e079034





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© 2023 the Alzheimer's Association.



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PUBLICATION HISTORY

 * Issue Online: 25 December 2023
 * Version of Record online: 25 December 2023




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