Comparative Value of Cognitive and Functional Assessments for Predicting 24-Month Progression from Mild Cognitive Impairment to Alzheimer's Disease: An ADNI Cohort Study
Choe, S.. medRxiv (preprint), 2026-09-04
Topic: Amyloid, tau and blood-test diagnosis
BackgroundAccurate prediction of progression from mild cognitive impairment (MCI) to Alzheimers disease (AD) is important for prognosis, patient management, and clinical trial enrollment. ObjectiveCognitive and functional assessments are routinely used in memory clinics, but their relative predictive value remains unclear. We sought to identify which assessments are most predictive of 24-month progression from MCI to AD. MethodsWe analyzed 2,430 participants with baseline MCI from the Alzheimers Disease Neuroimaging Initiative (ADNI) who were classified by 24-month progression to AD. Extreme Gradient Boosting (XGBoost) models were trained using repeated stratified 5-fold cross-validation with 10 repetitions. We compared demographic and genetic variables, global cognitive measures (MMSE, ADAS-Cog13, CDR-SB, MoCA), episodic memory, executive function, functional status, and Everyday Cognition (ECog) questionnaires. ResultsThe baseline clinical model (age, sex, education, APOE {varepsilon}4 status) achieved an area under the receiver operating characteristic curve (AUC) of 0.692. Episodic memory showed the highest predictive performance (AUC = 0.915), followed by the Functional Activities Questionnaire (AUC = 0.913). Combining episodic memory, functional assessment, and executive function achieved the best performance (AUC = 0.943, sensitivity = 0.857, specificity = 0.889). Among individual memory measures, Logical Memory Delayed Recall achieved the highest standalone performance (AUC = 0.896), whereas RAVLT Learning provided minimal incremental value. ConclusionsEpisodic memory is the strongest predictor of 24-month progression from MCI to AD, with functional assessment providing substantial complementary value. Streamlined assessment batteries emphasizing episodic memory and functional status may improve efficient risk stratification in memory clinics and AD clinical trials.
Key findings
- Episodic memory showed the highest predictive performance (AUC = 0.915), followed by the Functional Activities Questionnaire (AUC = 0.913).
- Combining episodic memory, functional assessment, and executive function achieved the best performance (AUC = 0.943, sensitivity = 0.857, specificity = 0.889).
- Among individual memory measures, Logical Memory Delayed Recall achieved the highest standalone performance (AUC = 0.896), whereas RAVLT Learning provided minimal incremental value.
- ConclusionsEpisodic memory is the strongest predictor of 24-month progression from MCI to AD, with functional assessment providing substantial complementary value.
- Streamlined assessment batteries emphasizing episodic memory and functional status may improve efficient risk stratification in memory clinics and AD clinical trials.
Why it matters
This study found that episodic memory and functional assessment were the strongest individual predictors of 24-month progression from mild cognitive impairment to Alzheimer's, and that combining episodic memory, functional assessment and executive function performed best. It is about prediction and does not test any treatment, cure or prevention.
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Study details
- Participants2,430
- Effect sizeAUC = 0.915; AUC = 0.913; AUC = 0.943
- Evidence strengthLow
How this study scored 16/100
Preprint — not yet peer-reviewed. It scored 28 on the same rubric, but non-peer-reviewed sources are capped at 16, so it shows as 16. Scored zero for study design and randomised / blinded because the record does not state it. We have no data on impact for its field and year, senior author's track record and institution's track record, so those were left out: it earned 24 of the 87 points we could judge it on, which is 28 out of 100.
| Component | Points | Why |
|---|---|---|
| Journal tier | 2 / 10 | Tier 4 — not a peer-reviewed journal (medRxiv (preprint)) |
| 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 | 5 / 5 | 2026 — within 1 year(s) of the newest study here |
| Sample size | 3 / 4 | 2,430 participants |
| Effect reported | 3 / 3 | Effect reported with a statistic (interval, p-value, ratio or similar) |
| 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 | 0 / 7 | Cited 0 times (OpenAlex, 2026-10-10) |
| Citations per year | 0 / 5 | 0.0 citations a year over 2 year(s) since 2026 |
| 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 | 0 / 6 | No other study in this library cites it |
| Still being cited | 0 / 4 | Cited 0 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | — / 4 | OpenAlex's profile for last-listed author Sophie Choe holds only 4 work(s), too few to judge a track record — left out of this score |
| Institution's track record | — / 3 | No institution listed in OpenAlex — left out of this score |
| Multi-centre collaboration | 0 / 3 | OpenAlex lists 0 institution(s) in 0 countries — scores zero (affiliation lists can be incomplete) |
| Indexed in PubMed | 1 / 2 | Not in PubMed, but has a DOI |
| Free to read | 2 / 2 | Free to read |
| Points | 24 / 87 | Scored on 17 of 20 parts. We have no data for the rest, so they are left out: 24 of the 87 points we could judge it on is 28 out of 100. |
| Total | 28 / 100 | Capped to 16 because this is not a peer-reviewed article. |
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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. Check the citation against the original before you use it.
APA 7th
Choe. (2026). Comparative Value of Cognitive and Functional Assessments for Predicting 24-Month Progression from Mild Cognitive Impairment to Alzheimer's Disease: An ADNI Cohort Study. medRxiv (preprint). https://doi.org/10.64898/2026.09.01.26360561
Vancouver
Choe. Comparative Value of Cognitive and Functional Assessments for Predicting 24-Month Progression from Mild Cognitive Impairment to Alzheimer's Disease: An ADNI Cohort Study. medRxiv (preprint). 2026. doi:10.64898/2026.09.01.26360561.
BibTeX
@article{choe2026-4acee6a6,
author = {Choe},
title = {{Comparative Value of Cognitive and Functional Assessments for Predicting 24-Month Progression from Mild Cognitive Impairment to Alzheimer's Disease: An ADNI Cohort Study}},
journal = {medRxiv (preprint)},
year = {2026},
doi = {10.64898/2026.09.01.26360561},
url = {https://doi.org/10.64898/2026.09.01.26360561}
}
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