AI-Enhanced Mobile APP to Aid in Early Detection of Cognitive Impairment

Importance: The diagnosis of Alzheimer's disease (AD) often relies on a "rule out" approach, yielding only a 60% accuracy rate [1].Recent studies have shown that AI-based assessments can outperform traditional clinical testing in predicting disease progression [2].With advancements in diagnostic tools for early cognitive impairment, there is a critical need for an accessible screening method to detect pre-clinical changes and improve patient outcomes.Digital technologies combined with artificial intelligence (AI) offer a novel strategy for early detection [3,4].Objective: To determine the utility of a novel, currently available remote quantified neurologic assessment of cognitive and neurologic function on a mobile phone app in detecting cognitive impairment.Design, Setting, and Participants: This cohort study of screening tests examined BeCare Neuro App data collected from user-reported symptoms and quantitative measures of neurologic function via quantified activities and questionnaires.The app assesses cognition across four domains using tasks similar to comprehensive in-clinic neuropsychological exams, reporting performance against normative scores of time and accuracy metrics [5,6].tasks include: the "Cognitive Test" (decoding messages by pairing symbols with letters), the "Stroop Test" (naming the color of displayed words), the "Memory Test" (recalling a disappearing animal), and the "Tap Test" (tapping randomly appearing coins).The participants included users with subjective complaints of memory loss and/ or cognitive impairment and users with neurologic complaints other than cognitive impairment.Results: Data from sixty-five users who reported "cognitive" or "memory loss" and 212 users who did not report "cognitive" or "memory loss" and who completed all tests was analyzed.Users reporting cognitive impairment consistently scored in the bottom third of the population.Specifically, 90.8% (59/65) had at least one activity in the bottom third, 66.2% (43/65) had two or more, and 30.8% had three or more activities in that range.In contrast, users not complaining of memory loss or cognitive impairment, 21.7% (46/212) had at least one test in the bottom third, 9.0% (19/212) had two or more.and 2.4% (5/212) had three or more. Conclusions and Relevance:The BeCare Neuro App demonstrates potential as a screening tool for early cognitive impairment, identifying patients who require further evaluation.Given the recent advances in new treatments for early-stage AD, early detection will greatly affect patient outcomes [7].The expense of standard of care diagnostic tools and the rapidly increasing prevalence of AD makes an inexpensive, effective, and accessible screening tool such as BeCare Neuro App invaluable.