{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T04:57:24Z","timestamp":1781672244751,"version":"3.54.5"},"reference-count":91,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T00:00:00Z","timestamp":1781654400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Neurol."],"abstract":"<jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Disease-modifying therapies for Alzheimer\u2019s disease (AD) heighten demand for scalable tools enabling primary care providers (PCPs) to detect cognitive impairment and triage patients for appropriate evaluation. The brief tablet-based Linus Health Core Cognitive Evaluation (CCE) integrates the Digital Clock and Recall (DCR) and Life and Health Questionnaire (LHQ) to generate clinical decision support (CDS) and decision-tree pathways.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective specialist content-validity study (June 15\u201327, 2023) using a modified RAND\/UCLA Appropriateness Method. Five board-certified cognitive\/behavioral neurologists independently rated CDS recommendations and nine predefined pathway parts for patients aged \u226555 across 21 de-identified reports. Items scored 1\u20139 were summarized as pooled medians with interquartile ranges; medians \u22657 indicated appropriateness. Agreement among experts was quantified using ICC [2,k] and ICC [2,1].<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>All cognitive-impairment recommendations met the threshold. All seven borderline\/impaired-DCR pathways were appropriate (median 7\u20138). Two pathways fell below threshold: cognitively unimpaired individuals with Green DCR scores (median 6) and a preliminary anti-amyloid treatment referral pathway (median 5). Agreement was moderate per patient [median ICC(2,k)\u202f=\u202f0.61] and lower for individual diagnostic-concern recommendations [median ICC(2,k)\u202f=\u202f0.25], reflecting specialist heterogeneity on borderline non-cognitive items and ceiling effects on high-rated items.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Cognitive neurologists judged CCE-derived CDS appropriate for PCP workup and referral decisions in older adults with suspected cognitive impairment. Findings support initial content validity of assessment-linked CDS, identify refinement priorities in low-risk and emerging-therapy pathways, and motivate planned PCP appropriateness and prospective implementation studies.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fneur.2026.1806000","type":"journal-article","created":{"date-parts":[[2026,6,17]],"date-time":"2026-06-17T04:45:26Z","timestamp":1781671526000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Initial specialist validation of clinical decision support recommendations from a machine learning-enabled digital cognitive assessment"],"prefix":"10.3389","volume":"17","author":[{"given":"Ali","family":"Jannati","sequence":"first","affiliation":[{"name":"Linus Health, Inc.","place":["Boston, MA, United States"]},{"name":"Department of Neurology, Harvard Medical School","place":["Boston, MA, United 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