One-Hour Cognitive Battery Supports Disease Staging in Memory Clinic Practice

Background and Objectives The aims of this study were to evaluate the utility of a one-hour cognitive battery relative to traditional screening measures and to examine its role in clinical decision making in a real-world memory clinic cohort. Methods We conducted a retrospective analysis of 1,858 patients evaluated in a Veterans Affairs memory disorders clinic from 2017 to 2025. Cognitive performance was assessed using the Montreal Cognitive Assessment (MoCA) and/or Mini-Mental State Examination (MMSE), and a one-hour neurobehavioral status examination (NBSE). Performance was quantified as the proportion of impaired tests. Agreement between screener-derived categories and post-NBSE staging (i.e., subjective cognitive decline, mild cognitive impairment [MCI], and dementia) was assessed using Cohen κ and Shannon entropy; MoCA/MMSE discrimination of dementia was assessed using receiver operating characteristic analyses. NBSE-associated mood screening was examined for previously undocumented symptoms. Testing modality (in-person, video, telephone) and temporal trends were also examined. Results Agreement between MoCA-derived categories and post-NBSE staging was modest (Cohen κ = 0.35, p < 0.001), with substantial uncertainty in the normal and mild impairment MoCA ranges (entropy ≈ 0.93) relative to the dementia range (entropy ≈ 0.59). In a subsample with amyloid PET imaging (n = 482), MoCA concordance remained modest (Cohen κ = 0.26, p < 0.001). Among amyloid-positive patients, MoCA ranges suggested a less severe stage than post-NBSE staging in 33.6% and a more severe stage in 8.5%. NBSE mood scales identified previously undocumented symptoms in 30.4% of patients. Cognitive performance did not meaningfully differ by testing modality (in-person, video, or telephone) (OR = 1.03, 95% CI [0.99–1.06]). NBSE results informed clinical decision making, including referral for biomarker testing in 31.9% of patients and neuropsychological evaluation (beyond the NBSE) in 7.1%. Discussion A one-hour, multidomain cognitive battery provides clinically meaningful information beyond traditional screeners and may support disease staging in memory clinic practice. In the era of disease-modifying therapies, accurate identification of patients in the MCI and early dementia range is increasingly important for biomarker referral, treatment evaluation, and patient counseling. Requiring just 1 hour, this battery is feasible for routine clinical use by specialists and can be administered in person or by video or telephone.