Digital Clock Assessment in South Asian Setting: Pilot study

Area of Science:

• Neurology
• Gerontology
• Digital Health

Background:

• Cognitive impairment poses a significant challenge in low- and middle-income countries.
• Scalable and accessible early detection tools are crucial for managing cognitive decline.
• The Clock Drawing Test is a widely used cognitive screening tool.

Purpose of the Study:

• To evaluate the feasibility and performance of a tablet-based digital Clock Drawing Test (DCTclock).
• To assess the DCTclock's utility for cognitive screening in a population-based cohort in urban India.

Main Methods:

• A pilot study involving 303 adults aged 50+ in urban India.
• Participants completed both DCTclock and paper-based Mini-Cog for cognitive status classification.
• Analyzed DCTclock scores, demographic factors, and discriminative accuracy against Mini-Cog results.

Main Results:

• DCTclock administration was rapid (<4 minutes) with high analyzable output (99.3%).
• Impaired participants scored significantly lower on DCTclock, particularly in spatial reasoning and information processing.
• DCTclock showed moderate accuracy (AUC=0.669) in identifying Mini-Cog-defined impairment, with specific score thresholds indicating higher impairment odds.

Conclusions:

• The tablet-based DCTclock is a feasible and potentially valuable tool for cognitive screening in resource-limited settings.
• Digital clock drawing can support aging surveillance and dementia risk stratification.
• Further application of DCTclock in diverse populations is warranted.