OBJECTIVES: The study aimed to develop and assess the performance of the Simplified Cognitive Assessment (SPCog), a cognitive assessment tool designed to detect mild cognitive impairment in the Indian population with minimal education. SPCog was developed to overcome literacy and educational barriers that might confound existing cognitive screening results by incorporating culturally sensitive and literacy-independent tasks. METHODS: Conducted in a tertiary care hospital in suburban India, our study recruited 120 participants, 60 with MCI and 60 controls. Demographic data, cognitive assessments, and neuroimaging were collected and analyzed. SPCog's performance was compared to traditional cognitive assessment tools, including MMSE, MoCA, SLUMS, and MiniCog. Performance was assessed using ROC analysis. RESULTS: SPCog demonstrated an accuracy of 0.80 (95 % CI: 0.70-0.92), a sensitivity of 0.83 (95 % CI: 0.70-0.92), and a specificity of 0.77 (95 % CI: 0.68-0.90) in detecting MCI, outperforming MMSE, SLUMS, and MiniCog, and showing comparable performance to MoCA (p <
0.05). Reliability analyses demonstrated strong inter-rater reliability for SPCog, with Kappa values ranging from 0.48 to 0.74 across various cognitive domains, indicating substantial agreement. The highest Kappa value was observed for Memory Recall (Kappa = 0.74), and the lowest for Registration (Kappa = 0.48). Test-retest reliability was also robust, as evidenced by intraclass correlation coefficients (ICC) ranging from 0.47 to 0.97, indicating high stability across different domains. CONCLUSION: A robust, culturally sensitive cognitive assessment to screen for cognitive impairment was developed to cater specifically to the Indian population. The current assessment outperforms traditional cognitive screening tests and could serve as a viable alternative for routine use.