Detection of Early Alzheimer’s disease at AdventHealth: A Davos Alzheimer’s Collaborative flagship site

Abstract

AbstractBackgroundEarly identification of Alzheimer’s disease (AD) is critical for disease‐modifying therapies. The Davos Alzheimer’s Collaborative flagship program tested the feasibility of implementing a digital cognitive assessment (DCA) followed by a blood biomarker (BBM) for early detection of cognitive impairment (CI).MethodIndividuals ≥65 years without dementia were approached via their primary care provider (PCP) or through direct‐to‐consumer (DTC) social media. After consenting, participants completed the Cogstate Brief Battery (CBB) DCA. Participants with an abnormal or borderline CBB score were offered the Montreal Cognitive Assessment (MoCA) and the PrecivityAD® blood test, a CLIA‐certified laboratory developed test that uses mass spectrometry to analyze biomarkers to identify brain amyloid plaques (reported by the Amyloid Probability Score‐APS) in individuals with CI.ResultOver 2300 participants expressed interest. Of 2001 eligible, 1076 (96% social media, 4% PCP) e‐consented. 742 completed the CBB of which 211 (28%) were borderline, 113 (15%) abnormal, and 418 (56%) were negative for CI. Of the 324 with borderline or abnormal CBB scores, 219 (67%) completed the MoCA (59% Normal range, 38% Mild CI range, 2% Moderate CI range, and 0.5% Severe CI range). Of the 324, 218 (67%) received BBM: 18.8% had High APS, 67.9% Low APS, and 13.3% Intermediate (e.g. non‐informative) APS. The APS result for participants with a normal MoCA showed 20% with High APS, 12% with an Intermediate APS, and 69% with Low APS. Of those with an impaired MoCA 18% had High APS, 15% Intermediate and 67% low APS. A Fisher’s Exact test determined there was no statistically significant relationship between MoCA impairment and APS category (p‐value 0.68).ConclusionThis study highlights the success of a DTC approach. The MoCA, alone, is insufficient to identify risk of AD in individuals with CI. A more comprehensive clinical evaluation of AD can be enhanced with the addition of a BBM leading to better disease‐modifying strategies.