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Scalable tools to efficiently identify individuals likely to have cognitive impairment (CI) are critical in the Alzheimer disease and related dementias field. The Everyday Cognition scale (ECog) and its short form (ECog12) assess subjective cognitive and functional changes and are useful in predicting CI. Recent advances in online technology have enabled the use of web-based cognitive tests and questionnaires to identify CI with greater convenience and scalability. While the effectiveness of the ECog has been demonstrated in clinical settings, its potential to detect CI in remote, unsupervised formats remains underexplored. This study aimed to compare the ability of the web-based ECog and the in-clinic ECog in distinguishing between individuals with CI and those who are cognitively unimpaired (CU), and to evaluate the effectiveness of the ECog12-the short version of the ECog-compared to the full-length ECog in a web-based setting. Participants were recruited from the Brain Health Registry (BHR; web-based) and Alzheimer's Disease Neuroimaging Initiative (ADNI; in-clinic) settings with available clinical diagnoses. The ability of the self-reported ECog (Self-ECog), study partner-reported ECog (SP-ECog), Self-ECog12, and SP-ECog12 to discriminate individuals with CI from CU was assessed using receiver operating characteristic (ROC) curves. Area under the ROC curves (AUCs) between BHR and ADNI were compared using the DeLong test, as were AUCs between ECog12 and ECog in BHR. Web-based Self-ECog and SP-ECog scores effectively discriminated CI from CU with AUCs of 0.722 and 0.818, respectively. Similarly, the abbreviated web-based versions, Self-ECog12 and SP-ECog12, also demonstrated discriminative ability (AUC=0.709 and 0.777, respectively). When compared to in-clinic ECog scores, there were no significant differences in the ability to distinguish CI from CU between web-based and in-clinic versions (BHR Self-ECog AUC=0.722 vs ADNI Self-ECog AUC=0.769, DeLong P=.06; BHR SP-ECog AUC=0.818 vs ADNI SP-ECog AUC=0.840, DeLong P=.50). Additionally, the comparison between web-based ECog and ECog12 showed no significant difference in AUCs (BHR Self-ECog AUC=0.722 vs BHR Self-ECog12 AUC=0.709, DeLong P=.18). Web-based ECog scores, both the full-length and short-form, were as valid as in-clinic ECog scores for identifying clinically diagnosed CI. In addition, Self-ECog12 was as effective as full-length Self-ECog to identify CI in a web-based setting, offering a cost-effective and accessible screening tool for large-scale studies. These results highlight the value of the web-based ECog as a valid tool for identifying older adults with CI in a remote clinical study, facilitating early detection and referral for comprehensive evaluations for identifying potential candidates for disease-modifying therapy.

Backgrounds Digital, online assessments are efficient means to detect early cognitive decline, but few studies have investigated the relationship between remotely collected subjective cognitive change and cognitive decline. We hypothesized that the Everyday Cognition Scale (ECog), a subjective change measure, predicts longitudinal change in cognition in the Brain Health Registry (BHR), an online registry for neuroscience research. Methods This study included BHR participants aged 55 + who completed both the baseline ECog and repeated administrations of the CANTAB ® Paired Associates Learning (PAL) visual learning and memory test. Both self-reported ECog (Self-ECog) and study partner-reported ECog (SP-ECog), and two PAL scores (first attempt memory score [FAMS] and total errors adjusted [TEA]) were assessed. We estimated associations between multiple ECog scoring outputs (ECog positive [same or above cut-off score], ECog consistent [report of consistent decline in any item], and total score) and longitudinal change in PAL. Additionally we assessed the ability of ECog to identify ‘decliners’, who exhibited the worst PAL progression slopes corresponding to the fifth percentile and below. Results Participants ( n  = 16,683) had an average age of 69.07 ± 7.34, 72.04% were female, and had an average of 16.66 ± 2.26 years of education. They were followed for an average of 2.52 ± 1.63 visits over a period of 11.49 ± 11.53 months. Both Self-ECog positive (estimate = -0.01, p  < 0.001, R²m = 0.56) and Self-ECog consistent (estimate=-0.01, p  = 0.002, R²m = 0.56) were associated with longitudinal change in PAL FAMS after adjusting demographics and clinical confounders. Those who were Self-ECog total (Odds ratio [95% confidence interval] = 1.390 [1.121–1.708]) and SP-ECog consistent (2.417 [1.591–3.655]) had higher probability of being decliners based on PAL FAMS. Conclusion In the BHR’s unsupervised online setting, baseline subjective change was feasible in predicting longitudinal decline in neuropsychological tests. Online, self-administered measures of subjective cognitive change might have a potential to predict objective subjective change and identify individuals with cognitive impairments.

Efficient identification of cognitive decline and Alzheimer's disease (AD) risk in early stages of the AD disease continuum is a critical unmet need. Subjective cognitive decline is increasingly recognized as an early symptomatic stage of AD. Dyadic cognitive report, including subjective cognitive complaints (SCC) from a participant and an informant/study partner who knows the participant well, represents an accurate, reliable, and efficient source of data for assessing risk. However, the separate and combined contributions of self‐ and study partner report, and the dynamic relationship between the two, remains unclear. The Subjective Cognitive Decline Professional Interest Area within the Alzheimer's Association International Society to Advance Alzheimer's Research and Treatment convened a working group focused on dyadic patterns of subjective report. Group members identified aspects of dyadic‐report information important to the AD research field, gaps in knowledge, and recommendations. By reviewing existing data on this topic, we found evidence that dyadic measures are associated with objective measures of cognition and provide unique information in preclinical and prodromal AD about disease stage and progression and AD biomarker status. External factors including dyad (participant–study partner pair) relationship and sociocultural factors contribute to these associations. We recommend greater dyad report use in research settings to identify AD risk. Priority areas for future research include (1) elucidation of the contributions of demographic and sociocultural factors, dyad type, and dyad relationship to dyad report; (2) exploration of agreement and discordance between self‐ and study partner report across the AD syndromic and disease continuum; (3) identification of domains (e.g., memory, executive function, neuropsychiatric) that predict AD risk outcomes and differentiate cognitive impairment due to AD from other impairment; (4) development of best practices for study partner engagement; (5) exploration of study partner report as AD clinical trial endpoints; (6) continued development, validation, and optimization, of study partner report instruments tailored to the goals of the research and population.

INTRODUCTION Subjective cognitive complaints (SCC) can precede Alzheimer's disease and related dementias. SCC in the absence of objective impairment is termed subjective cognitive decline (SCD). This study aimed to characterize SCC and SCD among a sample of aging individuals with and without prior repetitive head impact (RHI) exposure, the former of whom are at risk for chronic traumatic encephalopathy (CTE). METHODS RHI‐exposed (N = 167) and non–RHI‐exposed (N = 317) Boston University Alzheimer's Disease Research Center (ADRC) participants and their informants completed subjective measures assessing memory and executive function. Participants completed objective tests of these domains. RESULTS RHI exposure was associated with greater self‐ and informant‐reported SCC and with over four‐fold increased odds of SCD among cognitively unimpaired participants (odds ratio = 4.10, p < 0.001). SCC was associated with objective measures in RHI and non‐RHI participants. DISCUSSION Among RHI‐exposed individuals, SCC align with objective cognitive performance. SCD warrants investigation as potential early indicator of RHI‐related neuropathologies. Highlights Subjective cognitive complaints (SCC) are common after repetitive head impacts (RHI). RHI status is associated with increased odds of subjective cognitive decline (SCD). Neuropsychiatric symptoms are associated with SCC in RHI‐exposed individuals. SCC may indicate underlying post‐traumatic neuropathology in RHI‐exposed individuals.

INTRODUCTION Previous culturally informed digital inclusion efforts in English effectively enrolled Latino adults into the Brain Health Registry (BHR), an online Alzheimer's disease (AD)–related registry. Because these efforts were in English only, we did not successfully reach individuals from the U.S. Latino community whose language preference is Spanish. The English‐language effort had limited success enrolling Latino participants from diverse sociodemographic backgrounds (e.g., gender, education, nativity). Therefore, we tested the hypothesis that Spanish‐language efforts would increase the sociodemographic diversity of enrolled Latino participants. METHODS The BHR is an online registry that collects longitudinal cognitive and health data. We worked in partnership with a Latino Community Science Partnership Board to develop Spanish‐language, culturally informed digital inclusion efforts, including a Spanish translation of BHR, Facebook advertisements, and culturally informed recruitment websites. Here, we (1) report on the Spanish‐language digital advertisement results, (2) compare the characteristics of participants enrolled through Spanish (July 2021 through June 2022) versus English (September 2020 to June 2022) advertisements, and (3) compare the characteristics of those using the BHR assessment portal in Spanish versus in English. RESULTS Culturally informed Spanish‐language advertisements enrolled 1059 participants, including 986 who identify as Latino. Compared to participants enrolled through culturally informed English‐language efforts (N = 6985), participants enrolled via Spanish‐language efforts were significantly older, had less education, and had a higher percentage of male participants and those born outside the United States. Compared to participants who opted to use the BHR website in English (N = 37,199), those who opted to use the website in Spanish (n = 1088), were significantly younger, reported fewer years of education, and more frequently self‐identified as male and Latino. However, these efforts failed to increase BHR task completion. DISCUSSION Culturally informed digital efforts in Spanish are effective at increasing sociodemographic diversity of a Latino, digital research cohort. Similar efforts can be adapted to other studies and settings to improve the generalizability of AD research. Highlights Implemented culturally informed, Spanish‐language digital enrollment efforts. The efforts enrolled 986 Latino individuals in 12 months. Compared demographics of those enrolled through Spanish versus English advertising. Spanish efforts increased enrollment of older Latino adults born outside the United States. Efforts increased enrollment but did not increase completion of study tasks.

INTRODUCTION This study aimed to understand whether older adults’ longitudinal completion of assessments in an online Alzheimer's disease and related dementias (ADRD)–related registry is influenced by self‐reported medical conditions. METHODS Brain Health Registry (BHR) is an online cognitive aging and ADRD‐related research registry that includes longitudinal health and cognitive assessments. Using logistic regressions, we examined associations between longitudinal registry completion outcomes and self‐reported (1) number of medical conditions and (2) eight defined medical condition groups (cardiovascular, metabolic, immune system, ADRD, current psychiatric, substance use/abuse, acquired, other specified conditions) in adults aged 55+ (N = 23,888). Longitudinal registry completion outcomes were assessed by the completion of the BHR initial questionnaire (first questionnaire participants see at each visit) at least twice and completion of a cognitive assessment (Cogstate Brief Battery) at least twice. Models included ethnocultural identity, education, age, and subjective memory concern as covariates. RESULTS We found that the likelihood of longitudinally completing the initial questionnaire was negatively associated with reporting a diagnosis of ADRD and current psychiatric conditions but was positively associated with reporting substance use/abuse and acquired medical conditions. The likelihood of longitudinally completing the cognitive assessment task was negatively associated with number of reported medical conditions, as well as with reporting cardiovascular conditions, ADRD, and current psychiatric conditions. Previously identified associations between ethnocultural identity and longitudinal assessment completion in BHR remained after accounting for the presence of medical conditions. DISCUSSION This post hoc analysis provides novel, initial evidence that older adults’ completion of longitudinal assessments in an online registry is associated with the number and types of participant‐reported medical conditions. Our findings can inform future efforts to make online studies with longitudinal health and cognitive assessments more usable for older adults with medical conditions. The results need to be interpreted with caution due to selection biases, and the under‐inclusion of minoritized communities.

INTRODUCTION Many longitudinal Alzheimer's disease studies fail to retain Black American adults once enrolled. This limits the generalizability of research findings. METHODS The Community‐Engaged Digital Alzheimer's Research (CEDAR) study developed digital, culturally‐informed, community‐engaged efforts to increase longitudinal registry task completion of Black American Brain Health Registry (BHR) participants. Difference‐in‐differences analysis was conducted to compare longitudinal registry task completion rates within groups (before vs. after CEDAR referral) and between groups (enrolled in CEDAR vs. not enrolled). RESULTS Of 3888 invited Black American BHR participants, 420 (10.8%) enrolled in CEDAR. For CEDAR participants, we found significant increases in enrollment rate into referral studies and BHR timepoint completion rate after enrollment into CEDAR. Compared to those not enrolled, CEDAR participants had higher rates of: enrollment in referral studies, timepoint completion, initial questionnaire completion, and neuropsychological test completion. DISCUSSION The results provide preliminary evidence that CEDAR's culturally‐informed, community‐engaged research efforts were effective at improving engagement of Black American adults in an online longitudinal study. This is evidenced by increased registry engagement before and after enrollment and in comparison to Black American BHR participants not enrolled in CEDAR. These results need to be interpreted cautiously due to selection biases. This strategy can be adapted to other studies and settings. Highlights CEDAR is an online AD/ADRD registry engagement intervention for Black participants. The intervention is community‐engaged, digital, culturally‐informed, and multifaceted. Engagement rates increased before versus during the intervention for enrollees. Engagement rates decreased over the same time period for non‐enrolled participants. Results need to be interpreted with caution due to selection biases.

BACKGROUND The Everyday Cognition scale (ECog‐39) scores are associated with future cognitive decline. We investigated whether the 12‐item ECog (ECog‐12), which is being collected in Alzheimer's Disease Neuroimaging Initiative (ADNI)4, can predict progression. METHODS Baseline self (PT)‐ and study partner (SP)‐ECog‐12 data were extracted from the 39‐item version collected in the ADNI. Weibull analysis examined the relationship between baseline ECog‐12 and future clinical progression (change in Clinical Dementia Rating Sum of Boxes [CDR‐SB] scores and diagnostic conversion). RESULTS Higher PT‐ and SP‐ECog‐12 scores were associated with faster CDR‐SB worsening, with hazard ratios in cognitively unimpaired (CU) 3.34 and 9.61, mild cognitive impairment (MCI) 1.44 and 2.82, and dementia 0.93 and 1.82. They were associated with conversion from CU to MCI 3.01 and 6.24 and MCI to dementia 1.61 and 3.07. DISCUSSION SP‐ECog‐12 provided a higher prognostic value for predicting clinical progression, so this can help identify and monitor patients at risk in research and health‐care settings. Highlights The 12‐item Everyday Cognition scale (ECog‐12) data obtained from both raters increased diagnostic conversion risk from cognitively unimpaired to mild cognitive impairment (MCI) and from MCI to dementia. ECog‐12, rated by study partners, was associated with an increased risk of Clinical Dementia Rating Sum of Boxes worsening in all diagnostic groups. Our results provide novel information about the specific scoring outputs and rater types (participant vs. study partner) of ECog‐12 that can facilitate screening, prioritization, and longitudinal monitoring of the clinical progression of participants in Alzheimer's Disease Neuroimaging Initiative 4 and other Alzheimer's disease clinical studies, clinical trials, and in health‐care settings.

Background Repetitive head impact exposure (RHI) is the only known risk factor for chronic traumatic encephalopathy (CTE), a distinct neurodegenerative tauopathy. Most aging studies ask participants about prior traumatic brain injury (TBI), but not common sources of RHI. Understanding the public health footprint of RHI requires targeted questioning of lifetime exposure. To set the stage for our Featured Research Session on CTE, we report RHI prevalence using gold standard methods across independent aging and dementia cohorts. Method The Boston University Repetitive Head Impact Exposure Assessment (BU‐RHIEA) was administered across three cohorts: BU Alzheimer's Disease Research Center (ADRC), UCSF ADRC, and 1Florida ADRC. Participants recruited explicitly with concerns about cognitive effects of prior head trauma were excluded. The BU‐RHIEA queries participation in contact/collision sports (e.g., American football, soccer, ice hockey, boxing) and military service as well as prior TBI. We report RHI and TBI prevalence estimates from the BU‐RHIEA relative to estimates from the National Alzheimer's Coordinating Center Uniform Data Set (NACC UDS). In a subset of participants with frontotemporal dementia, we evaluated the clinical relevance of prior RHI through associations with age of symptom onset and rate of disease progression. Result Data come from 736 participants (age 70.4±9.6, 44.3% male, 43.1% cognitively impaired). Based on NACC UDS, 223 (30.2%) reported any prior TBI (Figure 1). When providing a formal TBI definition, frequency increased to 300 (40.8%). Sport and military history are not known through NACC UDS. Based on the BU‐RHIEA, 221 (30.0%) participants reported any prior contact/collision sport play. Among males, 92 (28.2%) previously played American football and 98 (30.1%) served in the military. In participants with frontotemporal dementia, prior RHI related to younger symptom onset and more rapid cognitive decline (Figure 2). Conclusion There is a high risk of underestimating the scope of RHI influence on brain aging. Among older adults, history of TBI and RHI from popular contact/collision sports is exceedingly common but unrecognized. RHI may contribute to the wide variability observed in the onset and progression of neurodegenerative conditions. Studying head trauma exposure relevant for later‐life brain health, such as sport‐ and military‐related RHI, requires dedicated questioning.

Background Repetitive head impacts (RHI) from contact and collision sports have been associated with later‐life cognitive and neuropsychiatric changes. However, findings have been limited by small sample sizes of college and/or professional American football players. Here, we examined associations between football play across four levels (youth, high school, college, professional) and cognitive and neuropsychiatric outcomes in a large sample. Method The sample included 3,968 male American football players enrolled in the Head Impact & Trauma Surveillance Study (HITSS), a national online study of former American football and soccer players, aged 40+ years. Participants complete computerized cognitive tests, and self‐report cognitive, mood, sports history, and behavioral questionnaires. Cognitive outcomes for this study included the Cambridge Neuropsychological Test Automated Battery (CANTAB) Paired Associates Learning First Attempt Memory Score (PALFAMS) and PAL Total Errors adjusted (PALTEA), BRIEF‐A Meta‐Cognition Index (MI), and the Everyday Cognition Scale (ECog). Neuropsychiatric outcomes included the BRIEF‐A Behavioral Regulation Index (BRI) and the Geriatric Depression Scale‐15 (GDS‐15). For each outcome, multivariable linear regressions examined associations for continuous proxies of RHI (total years of football play, age of first exposure); ANCOVAs were used for categorical predictors (linemen vs non‐linemen; highest level of football play). Models controlled for age, education, race, and vascular risk. p ‐values were false discovery rate adjusted. Result Table 1 provides sample characteristics. Among the participants (mean age 55.95, 12% Black), 46% played at the youth/high school level (youth combined with high school due to small sample size), 39% played at the college and 15% at the professional level. Utilizing omnibus test, the ANCOVA models demonstrated a significant effect for highest level of play on the PALTEA, PALFAMs, ECog, and BRI (padj<0.05), meaning professional players had worse scores compared to college and high school/youth; college players had worse scores than high school/youth players (Figure 1). Multivariable linear regressions revealed significant associations between total years of football play and higher (worse) BRI and ECog scores (Table 2). Conclusion In this sample of 3,968 former American football players, findings support a dose‐response relationship between football play and cognitive and neuropsychiatric function.