Intra- and Inter-Rater Reliability Analysis of MMSE-K and Tablet PC-Based MMSE-K Kit in Patients with Neurologic...

Background: The increasing prevalence of dementia and mild cognitive impairment (MCI) underscores the need for reliable and scalable digital cognitive screening tools. Although several studies have validated smartphone- or tablet-based assessments in community-dwelling older adults, few have examined their reliability in clinical populations with neurological disorders. This study aimed to evaluate the intra- and inter-rater reliability and agreement between the traditional paper-based Mini-Mental State Examination-Korean version (MMSE-K) and a tablet PC-based MMSE-K kit in patients with neurologic diseases undergoing rehabilitation. Methods: A total of 32 patients with neurological conditions-including stroke-related, encephalitic, and myelopathic disorders-participated in this study. Two occupational therapists (OT-A and OT-B) independently administered both the paper- and tablet-based MMSE-K versions following standardized digital instructions and fixed response rules. The intra- and inter-rater reliabilities of the tablet version were analyzed using intraclass correlation coefficients (ICCs) with a two-week retest interval, while Bland-Altman plots were used to assess agreement between the paper and tablet scores. Results: The tablet-based MMSE-K showed strong agreement with the paper-based version (r = 0.969, 95% CI 0.936-0.985, p = 1.05 × 10^-19). Intra- and inter-rater reliabilities were excellent, with ICCs ranging from 0.89 to 0.98 for domain scores and 0.98 for the total score, and the Bland-Altman plots showing acceptable agreement without systematic bias. Minor variability was observed in the Attention/Calculation and Comprehension/Judgment domains. Conclusions: The tablet PC-based MMSE-K kit provides a standardized, examiner-independent, and reliable alternative to the traditional paper version for assessing cognitive function in patients with neurologic diseases. These findings highlight the tool's potential for clinical deployment in hospital and rehabilitation settings, bridging the gap between traditional paper assessments and automated digital screening. Future multicenter studies with larger, disease-diverse cohorts are warranted to establish normative data and validate its diagnostic precision for broader clinical use.