From feasibility to neuroanatomic validity of remote cognitive smartphone assessments in early Alzheimer’s disease

ABSTRACT Digital health technologies (DHT) offer a promising solution to the timely identification of early Alzheimer’s disease (eAD) to enable early treatment. This study evaluated the feasibility, acceptability, adherence, reliability, and preliminary clinical and content validity of the novel AD Digital Assessment Suite (AD-DAS). 123 individuals (32 healthy controls (HC), 31 amyloid-PET negative (SCDn), 30 amyloid-PET positive (SCDp) with subjective cognitive decline, and 30 early AD (eAD)) participated. AD-DAS was remotely deployed for 28 days. Remote testing was feasible (97.6% completers), acceptable (>85% “good”), and associated with high adherence (96%). Metrics showed moderate to excellent test-retest reliability (ICC 0.53–0.91), associations with clinical comparators (adjusted R 2 0.01-0.24), differentiated eAD from other known groups (absolute log odds differences 0.6–3.28), and correlated with brain atrophy in expected regions. Episodic and working memory AD-DAS metrics differentiated SCDp from SCDn participants. These preliminary findings suggest that AD-DAS may be a promising tool for detecting cognitive impairments in early AD stages.