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Beyond the Clock: Exploring Multimodal Behavior Markers of Mild Cognitive Impairment in Older Adults during Clock Drawing Test
Lingjie Fan, Junhan Zhao, Yongji Wu, Fengyi Wang, Xiyue Wang, Tao Lin. Proceedings of the ACM on Interactive Mobile Wearable and Ubiquitous Technologies, 2025-12-02
Topic: Risk, prevention and care in population studies
Early detection of Mild Cognitive Impairment (MCI) offers a critical window for intervention before progression to dementia. This study presents a novel approach to MCI screening through multimodal behavioral analysis during the Clock Drawing Test (CDT), implementing a comprehensive data collection system using standard tablet devices. Our approach analyzes three behavioral dimensions: drawing trajectories, facial expressions, and hand motion patterns. We developed an integrated framework combining Convolutional Neural Networks with multi-head attention mechanisms for drawing analysis, alongside specialized feature extraction methods for facial and motion data. To effectively integrate these behavioral markers, we proposed a Higher-order Canonical Correlation Analysis (HCCA) algorithm that models complex relationships between modalities. In our primary study with 69 MCI participants and 133 age-matched controls, we identified distinct behavioral patterns: temporal drawing anomalies, altered facial behaviors including increased gaze variability, and distinctive motion patterns reflecting changes in movement stability. Our multimodal approach achieved an AUC of 0.92 (accuracy: 92.68%, sensitivity: 90.91%), with HCCA further improving performance to an AUC of 0.97. External validation with 76 additional participants demonstrated good generalizability (AUC: 0.86). These findings reveal how cognitive impairment manifests across multiple behavioral channels offer clinicians precise, interpretable quantification of cognitive function for more accurate MCI screening.
Key findings
- External validation with 76 additional participants demonstrated good generalizability (AUC: 0.86).
- These findings reveal how cognitive impairment manifests across multiple behavioral channels offer clinicians precise, interpretable quantification of cognitive function for more accurate MCI screening.
Why it matters
This study used multimodal behavioral analysis during the Clock Drawing Test to screen for mild cognitive impairment, achieving high accuracy in distinguishing participants from controls. It is about improving screening and does not test any treatment, cure, or prevention.
Study details
- Effect size92.68%; 90.91%; AUC: 0.86
- Evidence strengthLow
How this study scored 38/100
Published in a peer-reviewed journal. Scored zero for study design, sample size, studied in people and randomised / blinded because the record does not state it. We have no data on senior author's track record, so that was left out: it earned 36 of the 96 points we could judge it on, which is 38 out of 100.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (Proceedings of the ACM on Interactive Mobile Wearable and Ubiquitous Technologies) |
| Journal's citation record | 1 / 4 | Proceedings of the ACM on Interactive Mobile Wearable and Ubiquitous Technologies: journal h-index 92 (OpenAlex, 2026-10-29) |
| Study design | 0 / 12 | No study design recorded — scores zero, not guessed (not stated in the record — scored 0) |
| Strength of evidence | 1 / 5 | Rated “low” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 4 / 5 | 2025 — within 3 year(s) of the newest study here |
| Sample size | 0 / 4 | Participant count not stated — scores zero (not stated in the record — scored 0) |
| Effect reported | 3 / 3 | Effect reported with a statistic (interval, p-value, ratio or similar) |
| Studied in people | 0 / 3 | Not stated whether this was studied in people — scores zero (not stated in the record — scored 0) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 1 / 7 | Cited 3 times (OpenAlex, 2026-10-10) |
| Citations per year | 1 / 5 | 1.0 citations a year over 3 year(s) since 2025 |
| Impact for its field and year | 2 / 6 | Cited 1.9× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 0 / 6 | No other study in this library cites it |
| Still being cited | 1 / 4 | Cited 3 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | — / 4 | Senior author's record not available — left out of this score |
| Institution's track record | 2 / 3 | University of Chicago: institution h-index 1,769 (OpenAlex) |
| Multi-centre collaboration | 2 / 3 | OpenAlex lists 4 institution(s) in 2 countries |
| Indexed in PubMed | 1 / 2 | Not in PubMed, but has a DOI |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Points | 36 / 96 | Scored on 19 of 20 parts. We have no data for the rest, so they are left out: 36 of the 96 points we could judge it on is 38 out of 100. |
| Total | 38 / 100 | — |
What each of these 20 components measures, and what this score is not →
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Cite this study APA, Vancouver, BibTeX · download .bib or .ris
Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. Check the citation against the original before you use it.
APA 7th
Fan, L., Zhao, J., Wu, Y., Wang, F., Wang, X., & Lin, T. (2025). Beyond the Clock: Exploring Multimodal Behavior Markers of Mild Cognitive Impairment in Older Adults during Clock Drawing Test. Proceedings of the ACM on Interactive Mobile Wearable and Ubiquitous Technologies. https://doi.org/10.1145/3770684
Vancouver
Fan L, Zhao J, Wu Y, Wang F, Wang X, Lin T. Beyond the Clock: Exploring Multimodal Behavior Markers of Mild Cognitive Impairment in Older Adults during Clock Drawing Test. Proceedings of the ACM on Interactive Mobile Wearable and Ubiquitous Technologies. 2025. doi:10.1145/3770684.
BibTeX
@article{fan2025-2981775f,
author = {Fan, Lingjie and Zhao, Junhan and Wu, Yongji and Wang, Fengyi and Wang, Xiyue and Lin, Tao},
title = {{Beyond the Clock: Exploring Multimodal Behavior Markers of Mild Cognitive Impairment in Older Adults during Clock Drawing Test}},
journal = {Proceedings of the ACM on Interactive Mobile Wearable and Ubiquitous Technologies},
year = {2025},
doi = {10.1145/3770684},
url = {https://doi.org/10.1145/3770684}
}
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