Performance of Older Adults on the Digital Clock and Recall Test Compared to the Montreal Cognitive Assessment in Primary Care Settings
Bibliographic record
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.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.002 | 0.012 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.001 | 0.000 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".