Current advances in digital cognitive assessment for preclinical Alzheimer's disease

• Published in: Alzheimer's & dementia 2021, Vol.13 (1), p.e12217-n/a
• Main Authors: Öhman, Fredrik, Hassenstab, Jason, Berron, David, Schöll, Michael, Papp, Kathryn V.
• Format: Article
• Language: English
• Subjects: Alzheimer's disease; amyloid deposition; assessment; Biomarkers; clinical assessment; Clinical Medicine; clinical trials; cognition; Cognition & reasoning; Cognitive & Behavioral Assessment; cogstate brief battery; computerized; computerized assessment; decline; Dementia; digital cognitive biomarkers; Geriatrics; Geriatrik; home-based assessment; impairment; Klinisk medicin; medial temporal-lobe; Medical and Health Sciences; Medicin och hälsovetenskap; memory; neurodegeneration; Neurologi; Neurology; Neurosciences; Neurosciences & Neurology; Neurovetenskaper; nih toolbox; Pathology; pattern separation; preclinical Alzheimer's disease; Psychiatry; Psykiatri; Review; smartphone-based assessment; tau pathology
• ISSN: 2352-8729; 1552-5260; 1552-5279; 2352-8729
• DOI: 10.1002/dad2.12217

There is a pressing need to capture and track subtle cognitive change at the preclinical stage of Alzheimer's disease (AD) rapidly, cost‐effectively, and with high sensitivity. Concurrently, the landscape of digital cognitive assessment is rapidly evolving as technology advances, older adult tech‐adoption increases, and external events (i.e., COVID‐19) necessitate remote digital assessment. Here, we provide a snapshot review of the current state of digital cognitive assessment for preclinical AD including different device platforms/assessment approaches, levels of validation, and implementation challenges. We focus on articles, grants, and recent conference proceedings specifically querying the relationship between digital cognitive assessments and established biomarkers for preclinical AD (e.g., amyloid beta and tau) in clinically normal (CN) individuals. Several digital assessments were identified across platforms (e.g., digital pens, smartphones). Digital assessments varied by intended setting (e.g., remote vs. in‐clinic), level of supervision (e.g., self vs. supervised), and device origin (personal vs. study‐provided). At least 11 publications characterize digital cognitive assessment against AD biomarkers among CN. First available data demonstrate promising validity of this approach against both conventional assessment methods (moderate to large effect sizes) and relevant biomarkers (predominantly weak to moderate effect sizes). We discuss levels of validation and issues relating to usability, data quality, data protection, and attrition. While still in its infancy, digital cognitive assessment, especially when administered remotely, will undoubtedly play a major future role in screening for and tracking preclinical AD.