The Clinical Utility of a Computerized Cognitive Assessment to Predict Incident Amnestic Mild Cognitive Impairment and Alzheimer’s Disease

Abstract

Detecting the initial signs of neurodegeneration is integral for early diagnosis and intervention. Computerized cognitive assessments are accessible, efficient, and precise tools for identifying cognitive impairment and risk of neurodegeneration. While computerized instruments can be feasibly administered repeatedly for longitudinal cognitive monitoring, their clinical utility compared to conventional paper-and-pencil tools is yet unknown. The present study examined the utility of a computerized task, the One Card Learning (OCL) test, to detect conversion to dementia and associate with amyloid (Aβ) imaging markers using single and repeated test administration compared to the Montreal Cognitive Assessment (MoCA) and Rey Auditory Verbal Learning Test (RAVLT). The primary and secondary outcomes were conversion from cognitively normal (CN) to amnestic mild cognitive impairment (aMCI) or Alzheimer’s disease (AD) over a four-year study period and positron emission tomography estimates of Aβ, respectively. Data were collected from the Alzheimer’s Disease Neuroimaging Initiative 3 longitudinal cohort study. Participants were older adults aged 56 to 98 years who were CN at baseline. Results showed that the OCL did not better predict conversion to aMCI or AD from cognitive health compared to the MoCA or RAVLT when assessed at baseline or over repeated administrations. Unadjusted baseline OCL performance associated with Aβ status comparably to the MoCA and RAVLT. While repeated MoCA scores provided the strongest estimate of Aβ accumulation, OCL score trajectories uniquely detected diminished practice effects associated with pathological Aβ accumulation. The OCL may offer distinct clinical utility to detect preclinical AD biomarker accumulation. Future research is needed to examine the application of computerized assessments before they are fully integrated into clinical practice.