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Cognitive screening biases in a secondary prevention Alzheimer’s disease clinical trial
Sai I, Grill JD, Younes K, Winer JR, Cody KA, Sperling R, Mormino EC, Young CB.. medRxiv, 2025-12-04
Topic: Brain imaging, connectivity and assessment
INTRODUCTION Alzheimer’s disease (AD) prevention trials have multiple screening steps to identify cognitively unimpaired individuals with AD biomarker evidence. Cognitive/functional screening tests may be biased in underrepresented groups, thereby impacting trial eligibility. METHODS 6669 participants screened for the Anti-Amyloid Treatment in Asymptomatic Alzheimer’s (A4) study were grouped by ethnoracial background and testing language. Ethnoracial/language differences in ineligibility reason, cognitive/functional test performance, and amyloid positivity rates were examined. RESULTS Ethnoracial minorities were least likely to meet eligibility criteria. Patterns of incorrect Mini-Mental State Examination items and impaired Clinical Dementia Rating functional domains differed between groups excluded for impaired cognition/function, suggesting test biases. The Free and Cued Selective Reminding Test yielded more similar exclusion rates across groups than Logical Memory. Cognitive/functional screening biases may impact subsequent biomarker screening as amyloid positivity rates were lowest in ethnoracial minorities. DISCUSSION Biases in cognitive/functional screening tests may disproportionately exclude ethnoracial minorities in AD prevention trials.
Key findings
- RESULTS Ethnoracial minorities were least likely to meet eligibility criteria.
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Study details
- Participants6,669
- Evidence strengthLow
How this study scored 16/100
Preprint — not yet peer-reviewed. It scored 29 on the same rubric, but non-peer-reviewed sources are capped at 16, so it shows as 16. Scored zero for study design, effect reported and randomised / blinded because the record does not state it. We have no data on times cited, citations per year, impact for its field and year, cited by studies here, still being cited, senior author's track record, institution's track record and multi-centre collaboration, so those were left out: it earned 18 of the 62 points we could judge it on, which is 29 out of 100.
| Component | Points | Why |
|---|---|---|
| Journal tier | 2 / 10 | Tier 4 — not a peer-reviewed journal (medRxiv) |
| Journal's citation record | 0 / 4 | Not a journal article, so the journal's record does not count |
| Study design | 0 / 12 | No study design recorded — scores zero, not guessed (not stated in the record — scored 0) |
| Strength of evidence | 1 / 5 | Rated “low” in our summary |
| Peer-review validation | 4 / 10 | Preprint — not yet peer-reviewed. Hosted on a preprint server. |
| How recent | 4 / 5 | 2025 — within 3 year(s) of the newest study here |
| Sample size | 3 / 4 | 6,669 participants |
| Effect reported | 0 / 3 | No effect size reported — scores zero (not stated in the record — scored 0) |
| Studied in people | 3 / 3 | Studied in people (participant count stated) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | — / 7 | No citation count (not found in OpenAlex) — left out of this score |
| Citations per year | — / 5 | No citation count or no year — left out of this score |
| Impact for its field and year | — / 6 | No field-weighted citation impact (OpenAlex has none yet) — left out of this score |
| Cited by studies here | — / 6 | Not yet checked against this library's citation graph — left out of this score |
| Still being cited | — / 4 | No yearly citation counts — left out of this score |
| Senior author's track record | — / 4 | Senior author's record not available — left out of this score |
| Institution's track record | — / 3 | No institution listed in OpenAlex — left out of this score |
| Multi-centre collaboration | — / 3 | Institutions not listed — left out of this score |
| Indexed in PubMed | 1 / 2 | Not in PubMed, but has a DOI |
| Free to read | 0 / 2 | Behind a paywall — scores zero |
| Points | 18 / 62 | Scored on 12 of 20 parts. We have no data for the rest, so they are left out: 18 of the 62 points we could judge it on is 29 out of 100. |
| Total | 29 / 100 | Capped to 16 because this is not a peer-reviewed article. |
What each of these 20 components measures, and what this score is not →
Read the original
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Cite this study APA, Vancouver, BibTeX · download .bib or .ris
Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. The record names 8 authors; APA and Vancouver show the first six, BibTeX and the downloads carry all of them. Check the citation against the original before you use it.
APA 7th
Sai, I., Grill, J. D., Younes, K., Winer, JR., Cody, K. A., Sperling, R., et al. (2025). Cognitive screening biases in a secondary prevention Alzheimer’s disease clinical trial. medRxiv. https://doi.org/10.64898/2025.11.28.25341235
Vancouver
Sai I, Grill JD, Younes K, Winer JR, Cody KA, Sperling R, et al. Cognitive screening biases in a secondary prevention Alzheimer’s disease clinical trial. medRxiv. 2025. doi:10.64898/2025.11.28.25341235.
BibTeX
@article{sai2025-a28a08bc,
author = {Sai, I. and Grill, J. D. and Younes, K. and Winer, JR. and Cody, K. A. and Sperling, R. and Mormino, E. C. and Young, C. B.},
title = {{Cognitive screening biases in a secondary prevention Alzheimer’s disease clinical trial}},
journal = {medRxiv},
year = {2025},
doi = {10.64898/2025.11.28.25341235},
url = {https://doi.org/10.64898/2025.11.28.25341235}
}
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