Remote, unsupervised assessment of cognitive impairment and decline in Alzheimer's disease using the Cogstate Brief Battery in ADNI-3

Introduction: Remote neuropsychological testing can monitor brain health in individuals with or at risk of Alzheimer's disease (AD). We evaluated acceptability and validity of the Cogstate Brief Battery (CBB) for remote administration. Methods: Non-demented adults from the Alzheimer's Disease Neuroimaging Initiative (ADNI) completed the CBB in-clinic under supervision, then remotely every six months, with annual in-clinic reassessments. Groups included cognitively unimpaired (CU) adults with normal amyloid (CU Aβ-) or elevated amyloid (CU Aβ+), and individuals with mild cognitive impairment with or without amyloid (MCI Aβ+, MCI Aβ-). Performance was compared across contexts and longitudinal changes were examined. Results: At baseline, MCI Aβ+ participants performed worse than CU Aβ-. CBB performance was similar across contexts, with consistent group differences. Over time, MCI Aβ+ participants showed greater decline on remote CBB measures than CU Aβ- adults. Discussion: Remote unsupervised CBB assessments are valid, reliable, and sensitive to AD-related cognitive impairment.