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Publications

Journal Article Ppublish 1 citation

PubMed: 42598272 DOI: 10.1038/s44400-025-00056-6

Digital clock assessment in South Asian setting: pilot study.

NPJ Dement 2

Authors: Ram Jagannathan, Deepa Mohan, Rani Komal, Dimple Kondal, Poongothai Subramani, Priyanka Menon, Rima Pai, Ranjith Mohan Anjana, Mohammed K Ali, Sailesh Mohan, Suvarna Alladi, Nikhil Tandon, Dorairaj Prabhakaran, Viswanathan Mohan, Allan I Levey, K M Venkat Narayan, Felicia C Goldstein

Affiliations

  • Emory Global Diabetes Research Center, Woodruff Health Sciences Center and Emory University, Atlanta, GA, USA.
  • Hubert Department of Global Health, Emory University, Atlanta, GA, USA.
  • Madras Diabetes Research Foundation (ICMR Collaborating Centre of Excellence) and Dr Mohan's Diabetes Specialities Centre, IDF Centre of Excellence in Diabetes Care, Chennai, India.
  • Centre for Chronic Disease Control, New Delhi, India.
  • University of Augusta, Augusta, GA, USA.
  • Emory Global Diabetes Research Center, Woodruff Health Sciences Center and Emory University, Atlanta, GA, USA. Hubert Department of Global Health, Emory University, Atlanta, GA, USA. Department of Family and Preventive Medicine, Emory University School of Medicine, Atlanta, GA, USA.
  • National Institute of Mental Health and Neurosciences, Bangalore, India.
  • All India Institute of Medical Sciences, New Delhi, India.
  • Department of Neurology, Emory University School of Medicine, Atlanta, GA, USA.
  • Emory Goizueta Alzheimer's Disease Research Center, Atlanta, GA, USA.

Abstract

As cognitive impairment increasingly burdens low- and middle-income countries, scalable tools for early detection are pivotal. This pilot study evaluated the feasibility and performance of a tablet-based digital Clock Drawing Test (DCTclock) in 303 adults aged ≥ 50 years from the population-based CARRS cohort in urban India. Participants completed both the tablet-based DCTclock and the paper-based Mini-Cog, which was used to classify cognitive status (impaired: ≤2 vs. unimpaired: ≥3). The DCTclock required under four minutes to administer, and 99.3% of tests yielded analyzable data. Compared with cognitively unimpaired participants (n = 252), those classified as impaired (n = 51) scored significantly lower on the DCTclock total score and subdomains, particularly spatial reasoning and information processing. Performance was lower with older age and lower educational attainment (both p < 0.001) but did not differ by sex. The DCTclock demonstrated moderate discriminative accuracy for Mini-Cog-defined impairment (AUC = 0.669), and each interquartile range higher total score was associated with 52% lower odds of impairment (OR = 0.48; 95% CI, 0.32-0.70). Similar patterns were observed using FDA-recommended thresholds, while in this cohort, a ROC-derived cut point of 38 yielded slightly stronger discrimination (3.95-fold greater odds). These findings support the DCTclock's feasibility and potential as a scalable digital tool for community-based cognitive screening.

MeSH

Pilot Projects, Pilots, Tablets