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INTRODUCTION With emergence of disease‐modifying therapies, efficient diagnostic pathways are critically needed to identify treatment candidates, evaluate disease severity, and support prognosis. A combination of plasma biomarkers and brief digital cognitive assessments could provide a scalable alternative to current diagnostic work‐up. METHODS We examined the accuracy of plasma biomarkers and a 10‐minute supervised tablet‐based cognitive assessment (Tablet‐based Cognitive Assessment Tool Brain Health Assessment [TabCAT‐BHA]) in predicting amyloid β positive (Aβ+) status on positron emission tomography (PET), concurrent disease severity, and functional decline in 309 older adults with subjective cognitive impairment (n = 49), mild cognitive impairment (n = 159), and dementia (n = 101). RESULTS Combination of plasma pTau181, Aβ42/40, neurofilament light (NfL), and TabCAT‐BHA was optimal for predicting Aβ‐PET positivity (AUC = 0.962). Whereas NfL and TabCAT‐BHA optimally predicted concurrent disease severity, combining these with pTau181 and glial fibrillary acidic protein was most accurate in predicting functional decline. DISCUSSION Combinations of plasma and digital cognitive markers show promise for scalable diagnosis and prognosis of ADRD. Highlights The need for cost‐efficient diagnostic and prognostic markers of AD is urgent. Plasma and digital cognitive markers provide complementary diagnostic contributions. Combination of these markers holds promise for scalable diagnosis and prognosis. Future validation in community cohorts is needed to inform clinical implementation.

Background β-amyloid (Aβ) and tau positron emission tomography (PET) detect the pathological changes that define Alzheimer’s disease (AD) in living people. Cognitive measures sensitive to Aβ and tau burden may help streamline identification of cases for confirmatory AD biomarker testing. Methods We examined the association of Brain Health Assessment (BHA) tablet-based cognitive measures with dichotomized Aβ -PET status using logistic regression models in individuals with mild cognitive impairment (MCI) or dementia ( N = 140; 43 Aβ-, 97 Aβ+). We also investigated the relationship between the BHA tests and regional patterns of tau-PET signal using voxel-wise regression analyses in a subsample of 60 Aβ+ individuals with MCI or dementia. Results Favorites (associative memory), Match (executive functions and speed), and Everyday Cognition Scale scores were significantly associated with Aβ positivity (area under the curve [AUC] = 0.75 [95% CI 0.66–0.85]). We found significant associations with tau-PET signal in mesial temporal regions for Favorites, frontoparietal regions for Match, and occipitoparietal regions for Line Orientation (visuospatial skills) in a subsample of individuals with MCI and dementia. Conclusion The BHA measures are significantly associated with both Aβ and regional tau in vivo imaging markers and could be used for the identification of patients with suspected AD pathology in clinical practice.

Introduction Composite scores based on psychometrically rigorous cognitive assessments are well suited for early diagnosis and disease monitoring. Methods We developed and cross‐validated the Brain Health Assessment‐Cognitive Score (BHA‐CS), based on a brief computerized battery, in 451 cognitively normal (CN) and 399 cognitively impaired (mild cognitive impairment [MCI] or dementia) older adults. We investigated its long‐term reliability and reliable change indices at longitudinal follow‐up (N = 340), and the association with amyloid beta (Aβ) burden in the CN subgroup with Aβ positron emission tomography (N = 119). Results The BHA‐CS was accurate at detecting cognitive impairment and exhibited excellent long‐term stability. Reliable decline over one year was detected in 75% of participants with dementia, 44% with MCI, and 3% of CN. Among CN, the Aβ‐positive group showed worse longitudinal performance on the BHA‐CS compared to the Aβ‐negative group. Discussion The BHA‐CS is sensitive to cognitive decline in preclinical and prodromal neurodegenerative disease.

Background Cognitive impairment and dementia are frequently under-recognized. Health system strategies anchored in primary care are essential to address gaps in timely, comprehensive diagnosis. The goal of this paper is to describe the adaptation of a tablet-based brain health assessment (TabCAT-BHA) intervention and the study protocol to test its effectiveness in improving the detection of cognitive impairment, including dementia. Methods This mixed-methods, pragmatic, cluster randomized, hybrid effectiveness-implementation trial is being conducted in two 18-month waves with 26 Kaiser Permanente Southern California primary care clinics, with 13 serving as intervention clinics and 13 as usual care clinics. Patients 65 years and older with memory concerns ( n  ~ 180,000) receiving care at the 26 clinics will be included in the analyses. Primary care clinics are provided the following practice supports as part of the TabCAT-BHA intervention: brief education and training on neurocognitive disorders and study workflows; digital tools to assess cognitive function and support clinician decision making and documentation; and registered nurse support during the work-up and post-diagnosis periods for primary care providers, patients, and families. The intervention was adapted based on engagement with multiple levels of clinical and operational leaders in the healthcare system. Effectiveness outcomes include rates of cognitive impairment diagnosis in primary care and rates of completed standardized cognitive assessments and specialist referrals with incident diagnoses. Implementation outcomes include acceptability-appropriateness-feasibility, adoption, and fidelity. Results We identified seven themes organized by system-, provider-, and patient-level domains that were used to adapt the TabCAT-BHA intervention. Accordingly, changes were made to the provider education, diagnostic work-up, and post-diagnostic support. Results will be reported in fall of 2027. Conclusions Our engagement with multiple primary and specialty care clinical and operational leaders to adapt the TabCAT-BHA intervention to these primary care clinics has informed the protocol to evaluate the intervention’s effectiveness for improving the detection of cognitive impairment, including dementia, in an integrated healthcare system. Trial Registation Clinicaltrials.gov: NCT06090578 (registered 10/24/23).

Background [beta]-amyloid (A[beta]) and tau positron emission tomography (PET) detect the pathological changes that define Alzheimer's disease (AD) in living people. Cognitive measures sensitive to A[beta] and tau burden may help streamline identification of cases for confirmatory AD biomarker testing. Methods We examined the association of Brain Health Assessment (BHA) tablet-based cognitive measures with dichotomized A[beta] -PET status using logistic regression models in individuals with mild cognitive impairment (MCI) or dementia (N = 140; 43 A[beta]-, 97 A[beta]+). We also investigated the relationship between the BHA tests and regional patterns of tau-PET signal using voxel-wise regression analyses in a subsample of 60 A[beta]+ individuals with MCI or dementia. Results Favorites (associative memory), Match (executive functions and speed), and Everyday Cognition Scale scores were significantly associated with A[beta] positivity (area under the curve [AUC] = 0.75 [95% CI 0.66-0.85]). We found significant associations with tau-PET signal in mesial temporal regions for Favorites, frontoparietal regions for Match, and occipitoparietal regions for Line Orientation (visuospatial skills) in a subsample of individuals with MCI and dementia. Conclusion The BHA measures are significantly associated with both A[beta] and regional tau in vivo imaging markers and could be used for the identification of patients with suspected AD pathology in clinical practice. Keywords: Alzheimer's disease, Mild cognitive impairment, Neuropsychology, Psychometrics, Positron emission tomography, Biomarkers

Background Cognitive assessment ideally is a critical element of clinical evaluations for individuals with dementia and Alzheimer's disease in Primary Health Care (PHC) settings. To examine the feasibility and demographic determinants of performance for a tablet‐based cognitive screening tool (TabCAT) battery, which includes subtests for four cognitive domains, among older PHC patients in southeast Nigeria. Method A cross‐sectional mixed‐method descriptive study evaluating the useability and performance of TabCAT. Result A total of 207 participants were enrolled (mean age of 64.7±13.5 years; 52% with only primary, 41% secondary, and 7% tertiary education). Most (91%) who initiated the assessment were able to complete it, requiring 10‐15 minutes to complete. More years of education was associated with better test scores across all tests (p < 0.001). Living in a rural location was also associated with better performance (p < 0.05). Male compared to female sex did not associate with performance on any of the tests (all ps >0.05). Conclusion Tablet‐based cognitive assessment was feasible in rural and urban settings of Nigeria. Better performance on cognitive subtests linked to more education and residing in a rural area; however, sex did not predict performance. Digital cognitive assessment tools hold the potential for widespread use in healthcare and educational contexts, particularly in regions with varying levels of urbanization and educational access for early detection of cognitive impairments at the PHC levels.

Background Cognitive assessment should be actively incorporated into the clinical evaluation of patients in Primary Health Care (PHC) settings. This is because of the imminent demand with the changing demographics especially in low‐ and middle‐income countries (LMICs) concerning dementia and Alzheimer’s disease. Method A cross‐sectional mixed‐method descriptive study was conducted to evaluate the useability and performance of a tablet‐based cognitive assessment tool (TabCAT) for use in geriatric primary healthcare settings in southeast Nigeria. Result In our study involving 207 participants, with an average age of 64.69 years, educational levels varied, with 51.8% having primary education, 41.2% secondary, and 6.6% tertiary. The research found that education had a significant positive impact on associative memory, processing speed, executive function, language skills, and visuospatial skills (p<0.001). Rural residents exhibited higher scores in associative memory, processing speed, executive function, language, and visuospatial skills (p<0.000). However, gender and location did not show significant contributions to cognitive performance across the examined domains. Conclusion There is an urgent need to deploy and routinely conduct cognitive assessments in primary healthcare clinics for elderly patients for early detection of cognitive changes to improve healthy living.

Background Cognitive assessment should be actively incorporated into the clinical evaluation of patients in Primary Health Care (PHC) settings. This is because of the imminent demand with the changing demographics especially in low‐ and middle‐income countries (LMICs) concerning dementia and Alzheimer’s disease. Method A cross‐sectional mixed‐method descriptive study was conducted to evaluate the useability and performance of a tablet‐based cognitive assessment tool (TabCAT) for use in geriatric primary healthcare settings in southeast Nigeria. Result In our study involving 207 participants, with an average age of 64.69 years, educational levels varied, with 51.8% having primary education, 41.2% secondary, and 6.6% tertiary. The research found that education had a significant positive impact on associative memory, processing speed, executive function, language skills, and visuospatial skills (p<0.001). Rural residents exhibited higher scores in associative memory, processing speed, executive function, language, and visuospatial skills (p<0.000). However, gender and location did not show significant contributions to cognitive performance across the examined domains. Conclusion There is an urgent need to deploy and routinely conduct cognitive assessments in primary healthcare clinics for elderly patients for early detection of cognitive changes to improve healthy living.

INTRODUCTION As dementia cases increase and new therapies become available, timely diagnosis is critical yet challenging in primary care. We evaluated the TabCAT‐Brain Health Assessment (TabCAT‐BHA) digital paradigm to assist with early detection and diagnosis. METHODS This implementation study involved 21 primary care providers (PCPs) serving 2733 eligible patients in a family medicine clinic. PCPs initiated cognitive screening using the TabCAT‐BHA, administered by medical assistants, with results integrated into the electronic health record. The study assessed changes in PCP cognitive diagnoses, specialist referrals, and implementation metrics. RESULTS TabCAT‐BHA was adopted by 95% of PCPs, who were more likely to diagnose cognitive disorders (adjusted odds ratio: 1.72, 95% confidence interval: 1.13–2.62, p = 0.01). Practice‐wide diagnosis rates remained elevated after research support ended. PCPs reported increased confidence, reduced stress in diagnosing dementia, and preferred TabCAT‐BHA over traditional assessments. DISCUSSION TabCAT‐BHA was well accepted and sustained, offering a scalable solution for cognitive impairment diagnosis in primary care. Highlights A digital test paradigm increased cognitive impairment diagnoses in primary care. Increased diagnoses across minority groups may mitigate healthcare disparities. Clinicians preferred the digital cognitive assessment over alternative tests. The paradigm decreased clinician stress and increased confidence around diagnosis. Integration with clinic staff workflow yielded high adoption and sustainability.

Cognitive assessment ideally is a critical element of clinical evaluations for individuals with dementia and Alzheimer's disease in Primary Health Care (PHC) settings. To examine the feasibility and demographic determinants of performance for a tablet-based cognitive screening tool (TabCAT) battery, which includes subtests for four cognitive domains, among older PHC patients in southeast Nigeria. A cross-sectional mixed-method descriptive study evaluating the useability and performance of TabCAT. A total of 207 participants were enrolled (mean age of 64.7±13.5 years; 52% with only primary, 41% secondary, and 7% tertiary education). Most (91%) who initiated the assessment were able to complete it, requiring 10-15 minutes to complete. More years of education was associated with better test scores across all tests (p < 0.001). Living in a rural location was also associated with better performance (p < 0.05). Male compared to female sex did not associate with performance on any of the tests (all ps >0.05). Tablet-based cognitive assessment was feasible in rural and urban settings of Nigeria. Better performance on cognitive subtests linked to more education and residing in a rural area; however, sex did not predict performance. Digital cognitive assessment tools hold the potential for widespread use in healthcare and educational contexts, particularly in regions with varying levels of urbanization and educational access for early detection of cognitive impairments at the PHC levels.