Advancing cognitive testing

Traditional cognitive assessments

Cognitive assessments have traditionally been paper and pencil-based and administered only after a patient has started experiencing symptoms of cognitive impairment. While these assessments are well-known, traditional testing methods present several challenges for providers, including being typically time-consuming and manual in nature; susceptible to subjectivity and potential inter-rater reliability issues; and focused only on the output of the cognitive task — limiting the clinical insights available.

Three of the most commonly used cognitive assessments include:

Mini-Mental State Exam (MMSE)

The Mini-Mental State Exam (MMSE) is a commonly-used cognitive test — developed nearly 50 years ago — that assesses five areas of cognitive function. The MMSE consists of 11 questions or tasks, such as orientation questions, word recall, and drawing a copy. It typically requires 7-8 minutes to administer. Research indicates that the MMSE is not as sensitive as the MoCA in detecting mild cognitive impairment. Additionally, the MMSE test requires administration by a healthcare professional and scoring is a manual process.

Montreal Cognitive Assessment (MoCA)

The Montreal Cognitive Assessment (MoCA) is another well-established cognitive assessment — developed over 20 years ago — that assesses seven areas of cognition. The MoCA consists of 30 questions or tasks, such as animal naming, clock drawing, and word recall. It typically requires 10-12 minutes to administer on paper.  Research has shown it to be more sensitive than the MMSE in detecting mild cognitive impairment. Training and certification are mandatory to administer and analyze results from the paper-based MoCA, both of which are manual processes.

Mini-Cog

The Mini-Cog consists of three questions across two test components — a three-item word recall and clock drawing — to assess four areas of cognitive function. The test typically requires 3-4 minutes to administer. Research has indicated that the Mini-Cog is more sensitive than MMSE in detecting mild cognitive impairment. However, it faces the same general limitations and subjectivity concerns of other paper-based tests and, similarly, only evaluates final test outputs.

Modern cognitive testing

Digital technology is transforming traditional pencil and paper approaches to cognitive testing into more objective, efficient, and sensitive methods. Modern digital cognitive assessments, like Linus Health’s Digital Clock and Recall (DCR™) leverage familiar digital devices to streamline test administration while enhancing the clinical insights available to providers.

* Depending on particular solution

Next-generation digital assessments

AI-enabled solutions go a step beyond traditional digital cognitive assessments, incorporating machine learning to enhance sensitivity and the insights available to providers — while requiring less time. Leveraging AI, Linus Health's digital platform uniquely incorporates The Boston Process Approach, analyzing the patient’s process of completing a task (e.g., drawing a clock) as well as the final output versus only the latter — all in just a few minutes. This yields a more robust assessment of cognitive functioning and richer insights to inform next steps for patients — within an iPad-based solution that’s fast, objective, and easy to use. For more on how this digital cognitive assessment compares with traditional tests, visit our scientific publications page.

Linus Health's brain health software offerings are discussed in more detail below.

DCTclock™

Our flagship software assessment, DCTclock™, is a scientifically-validated digital upgrade to the long-established pen-and-paper Clock Drawing Test. Named to TIME’s Best Inventions of 2021 list, DCTclock surfaces subtle signs of cognitive impairment that could otherwise go undetected for years, while enhancing assessment objectivity and efficiency. Earlier versions of the product arose from over a decade of R&D at Lahey Hospital & Medical Center and MIT. 

Core Cognitive Evaluation

The CCE™ — which stands for the Core Cognitive Evaluation — combines quantitative insights from our next-generation digital assessment with qualitative insights from a life and health survey, helping providers understand both a patient’s current cognitive status and future dementia risk. To make these insights actionable, the platform provides clinical decision support alongside patient results and generates personalized action plans for patients — making it easier for providers to navigate next steps and support patients with evidence-based guidance.