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Diagnostic accuracy of remote self-administered digital cognitive assessment by clinical diagnosis and Alzheimer's disease PET imaging biomarkers
Stricker, N. H.; Boots, E. A.; Taylor, R. L.; Fan, W. Z.; Frank, R. D.; Christianson, T. J.; Stricker, J. L.; Kremers et al.. medRxiv (preprint), 2026-09-25
Topic: Amyloid, tau and blood-test diagnosis
MTD showed excellent discrimination of CU versus MCI/DEM (AUC=.89; 95% CI=.87-.92), and discriminability remained high for CU versus MCI (AUC=.88; 95% CI=.85-.92). Discriminability was highest when comparing CU A- and MCI/DEM A+ groups (AUC=.95; 95% CI=.92-.97). MTD outperformed estimated MMSE (p=.02) and was comparable to Mayo-PACC (p=.71) for A-T- versus A+T+ discrimination (AUC=.76; 95% CI=.71-.81). Combining both raw score and normative score cutoffs helped balance sensitivity and specificity relative to use of either cutoff in isolation. A two-stage interpretation framework further improved sensitivity while maintaining clinically useful specificity and informed development of an interpretation guide. A remote self-administered digital cognitive assessment showed strong diagnostic accuracy for detecting MCI and mild dementia in a large, primarily population-based cohort. The remote, self-administered MTD composite also showed comparable performance to established in-person cognitive composites for differentiating amyloid and tau-defined biomarker groups. Remote self-administered digital cognitive assessment may complement existing cognitive evaluation approaches and support scalable cognitive characterization.
Key findings
- MTD showed excellent discrimination of CU versus MCI/DEM (AUC=.89; 95% CI=.87-.92), and discriminability remained high for CU versus MCI (AUC=.88; 95% CI=.85-.92).
- Discriminability was highest when comparing CU A- and MCI/DEM A+ groups (AUC=.95; 95% CI=.92-.97).
- MTD outperformed estimated MMSE (p=.02) and was comparable to Mayo-PACC (p=.71) for A-T- versus A+T+ discrimination (AUC=.76; 95% CI=.71-.81).
- Combining both raw score and normative score cutoffs helped balance sensitivity and specificity relative to use of either cutoff in isolation.
- A two-stage interpretation framework further improved sensitivity while maintaining clinically useful specificity and informed development of an interpretation guide.
Why it matters
A remote, self-administered digital cognitive test detected mild cognitive impairment and mild dementia with strong accuracy, and performed similarly to established in-person tests for distinguishing biomarker groups. This could help make cognitive testing more widely available, but it is a diagnostic tool and does not treat or prevent Alzheimer's.
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Study details
- Study designcohort study
- Participants1,224
- Evidence strengthModerate
How this study scored 16/100
Preprint — not yet peer-reviewed. It scored 38 on the same rubric, but non-peer-reviewed sources are capped at 16, so it shows as 16. Scored zero for effect reported and randomised / blinded because the record does not state it. We have no data on impact for its field and year and senior author's track record, so those were left out: it earned 34 of the 90 points we could judge it on, which is 38 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 | 7 / 12 | A cohort study following people over time |
| Strength of evidence | 3 / 5 | Rated “moderate” 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 | 1,224 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 | 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 Ronald C Petersen holds only 1 work(s), too few to judge a track record — left out of this score |
| Institution's track record | 2 / 3 | Washington University in St. Louis: institution h-index 1,962 (OpenAlex) |
| Multi-centre collaboration | 2 / 3 | OpenAlex lists 7 institution(s) in 1 country |
| Indexed in PubMed | 1 / 2 | Not in PubMed, but has a DOI |
| Free to read | 2 / 2 | Free to read |
| Points | 34 / 90 | Scored on 18 of 20 parts. We have no data for the rest, so they are left out: 34 of the 90 points we could judge it on is 38 out of 100. |
| Total | 38 / 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
Full text: free to read — OpenAlex lists this copy as free to read: the link above (checked 6 Feb 1020).
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's author list ends in “et al.”, so not every author is named. Check the citation against the original before you use it.
APA 7th
Stricker, N. H., Boots, E. A., Taylor, R. L., Fan, W. Z., Frank, R. D., Christianson, T. J., et al. (2026). Diagnostic accuracy of remote self-administered digital cognitive assessment by clinical diagnosis and Alzheimer's disease PET imaging biomarkers. medRxiv (preprint). https://doi.org/10.64898/2026.09.20.26362296
Vancouver
Stricker NH, Boots EA, Taylor RL, Fan WZ, Frank RD, Christianson TJ, et al. Diagnostic accuracy of remote self-administered digital cognitive assessment by clinical diagnosis and Alzheimer's disease PET imaging biomarkers. medRxiv (preprint). 2026. doi:10.64898/2026.09.20.26362296.
BibTeX
@article{stricker2026-315dfeac,
author = {Stricker, N. H. and Boots, E. A. and Taylor, R. L. and Fan, W. Z. and Frank, R. D. and Christianson, T. J. and Stricker, J. L. and Kremers and others},
title = {{Diagnostic accuracy of remote self-administered digital cognitive assessment by clinical diagnosis and Alzheimer's disease PET imaging biomarkers}},
journal = {medRxiv (preprint)},
year = {2026},
doi = {10.64898/2026.09.20.26362296},
url = {https://doi.org/10.64898/2026.09.20.26362296}
}
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