Stricker, Nikki H

Abstract INTRODUCTION Cognitive characterization is increasingly important for Alzheimer’s disease treatment decisions, highlighting the need for scalable cognitive assessment. We evaluated the diagnostic accuracy of a remote self-administered cognitive screening battery, Mayo Test Drive (MTD), across clinically and biologically defined groups. METHODS In this prospectively designed study, 2,131 cognitively unimpaired (CU) and 118 cognitively impaired participants, including 96 with mild cognitive impairment and 22 with mild dementia (MCI/DEM), were recruited from observational cohort studies and completed MTD remotely (mean age=70 years, SD=12; 48% male; mean education=16 years, SD=2). Clinical diagnoses were determined by multidisciplinary consensus independently of MTD. Amyloid- and tau-PET were available for 1,224 participants. Logistic regression estimated associations between MTD and CU versus MCI/DEM, CU A-versus MCI/DEM A+, and A-T-versus A+T+. MTD diagnostic accuracy was compared with person-administered cognitive measures. Sensitivity and specificity across score types and comparison groups were examined. RESULTS MTD showed excellent discrimination of CU versus MCI/DEM (AUC=.89; 95% CI=.87-.92), and discriminability remained high for CU versus MCI (AUC=.88; 95% CI=.85-.92). Discriminability was highest when comparing CU A- and MCI/DEM A+ groups (AUC=.95; 95% CI=.92-.97). MTD outperformed estimated MMSE (p=.02) and was comparable to Mayo-PACC (p=.71) for A-T-versus A+T+ discrimination (AUC=.76; 95% CI=.71-.81). Combining both raw score and normative score cutoffs helped balance sensitivity and specificity relative to use of either cutoff in isolation. A two-stage interpretation framework further improved sensitivity while maintaining clinically useful specificity and informed development of an interpretation guide. DISCUSSION A remote self-administered digital cognitive assessment showed strong diagnostic accuracy for detecting MCI and mild dementia in a large, primarily population-based cohort. The remote, self-administered MTD composite also showed comparable performance to established in-person cognitive composites for differentiating amyloid and tau-defined biomarker groups. Remote self-administered digital cognitive assessment may complement existing cognitive evaluation approaches and support scalable cognitive characterization. Highlights Remote self-administered cognitive assessment showed strong differentiation of cognitively unimpaired and cognitively impaired participants. Diagnostic accuracy improved when amyloid PET biomarker status was incorporated. Remote assessment demonstrated sensitivity to amyloid and tau PET-defined Alzheimer’s disease. Performance was comparable to established in-person composites and better than an in-person mental status screening measure. Digital cognitive screening may support scalable treatment and clinical trial workflows.

Abstract Introduction Remote cognitive assessments offer an accessible, scalable way to support clinical characterization and longitudinal monitoring of cognition. This study evaluates the feasibility of implementing Mayo Test Drive (MTD), a remote, self-administered digital cognitive assessment, within a specialized clinic focused on eligibility assessments for anti-amyloid therapies for Alzheimer’s disease (AD). Method Two-hundred and nine ( N =209) patients (M age =71.2, 53% female) were evaluated through the Mayo Clinic Rochester Alzheimer’s Disease Treatment Clinic (ADTC) and had the opportunity to complete MTD, either as a remote, patient-initiated session through a patient-facing healthcare portal or during an in-clinic neuropsychological evaluation. Results Clinical diagnoses included 55.2% mild cognitive impairment (MCI), 31.0% mild dementia, and 11.6% moderate dementia, in addition to 2.2% cognitively unimpaired (CU), as determined by neurology consensus at a multidisciplinary case conference. Among those who initiated MTD ( n =197/209), 97.5% completed a session (70.6% remotely, 26.9% in clinic). Completion rates were high across diagnostic groups and did not significantly differ by clinical severity ( p =.12): CU (100%), MCI (99.1%), mild dementia (97.0%), and moderate dementia (89.5%). Remote completion rates overall were high (97.9%). Among completers, administration setting (remote vs. in-clinic) did not significantly differ by clinical stage, χ²(3)=2.37, p =.49. Reasons for non-initiation included not receiving or opening portal messages and other/unknown factors. Discussion Remote digital cognitive assessment is feasible within the context of clinic eligibility evaluations for AD therapies. The high completion rates of MTD across clinical impairment levels in this setting support development of paths for broader use in cognitive characterization in AD care.