Comparative Performance of Conventional, Informant-Based, and Digital Cognitive Screening Tools in Community-Dwelling Older Adults: A Cross-Sectional Study

Background Early identification of cognitive impairment is increasingly important in aging societies. Multiple cognitive screening tools are available, but their diagnostic strengths and clinical roles may differ according to healthcare setting and screening purpose. This study aimed to provide quantitative evidence for selecting and combining conventional, informant-based, and digital cognitive assessment tools in different clinical scenarios. Methods This cross-sectional community-based cognitive screening study included 250 community-dwelling older adults aged 65 years or older who were recruited between March 2025 and June 2025. Participants underwent cognitive assessment using the Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), reverse-scored AD8, Clinical Dementia Rating (CDR), and CogMate™ digital cognitive tests. Participants were classified into cognitively normal and cognitively impaired groups according to CDR status. Group differences, Spearman rank correlations, and receiver operating characteristic curve analyses were performed. Results Among 250 participants, 195 were classified as CDR = 0 and 55 as CDR ≥ 0.5. Cognitive impairment was significantly associated with older age and lower educational level. Participants with CDR ≥ 0.5 had significantly lower scores on MMSE, MoCA, reverse-scored AD8, CogMate™ memory, and CogMate™ attention. MoCA and MMSE showed the highest AUC values, both 0.778. MoCA had the highest sensitivity, whereas MMSE had the highest Youden index. CogMate™ memory and attention showed moderate diagnostic performance. Conclusions This study provides quantitative evidence supporting the complementary use of multiple cognitive assessment tools. MoCA may be useful for broad initial screening, MMSE may provide a balanced profile for outpatient assessment, CogMate™ may serve as a convenient supplementary digital tool that works together with established cognitive assessments to support early clinical identification of possible cognitive concerns, and AD8 may add informant-based functional information. These findings support a flexible, scenario-based strategy for earlier recognition, timely referral, and clinical management of cognitive impairment. Trial registration: Not applicable.