{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"medRxiv"}],"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T21:19:25Z","timestamp":1792790365856,"version":"4.5.0"},"posted":{"date-parts":[[2026,9,25]]},"group-title":"Neurology","reference-count":62,"publisher":"openRxiv","license":[{"start":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T00:00:00Z","timestamp":1790294400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"name":"National Institute on Aging","award":["R01AG081955"],"award-info":[{"award-number":["R01AG081955"]}],"id":[{"id":"https:\/\/ror.org\/049v75w11","id-type":"ROR","asserted-by":"crossref"}]},{"name":"National Institute on Aging","award":["R21 AG073967"],"award-info":[{"award-number":["R21 AG073967"]}],"id":[{"id":"https:\/\/ror.org\/049v75w11","id-type":"ROR","asserted-by":"crossref"}]},{"name":"National Institute on Aging","award":["P30 AG062677"],"award-info":[{"award-number":["P30 AG062677"]}],"id":[{"id":"https:\/\/ror.org\/049v75w11","id-type":"ROR","asserted-by":"crossref"}]},{"name":"National Institute on Aging","award":["U01 AG006786"],"award-info":[{"award-number":["U01 AG006786"]}],"id":[{"id":"https:\/\/ror.org\/049v75w11","id-type":"ROR","asserted-by":"crossref"}]},{"name":"National Institute on Aging","award":["R01 AG034676"],"award-info":[{"award-number":["R01 AG034676"]}],"id":[{"id":"https:\/\/ror.org\/049v75w11","id-type":"ROR","asserted-by":"crossref"}]},{"name":"National Institute on Aging","award":["U19 AG102336"],"award-info":[{"award-number":["U19 AG102336"]}],"id":[{"id":"https:\/\/ror.org\/049v75w11","id-type":"ROR","asserted-by":"crossref"}]},{"name":"Kevin Merszei Career Development Award in Neurodegenerative Diseases Research","id":[{"id":"https:\/\/ror.org\/02xjhr934","id-type":"ROR","asserted-by":"crossref"}]},{"id":[{"id":"https:\/\/ror.org\/05ahavf04","id-type":"ROR","asserted-by":"publisher"}]},{"name":"Mayo Foundation for Medical Education and Research"},{"name":"Gates Ventures","id":[{"id":"https:\/\/ror.org\/04kxtb734","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2026,9,25]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                <jats:sec>\n                  <jats:title>INTRODUCTION<\/jats:title>\n                  <jats:p>Cognitive characterization is increasingly important for Alzheimer\u2019s disease treatment decisions, highlighting the need for scalable cognitive assessment. We evaluated the diagnostic accuracy of a remote self-administered cognitive screening battery, Mayo Test Drive (MTD), across clinically and biologically defined groups.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>METHODS<\/jats:title>\n                  <jats:p>In this prospectively designed study, 2,131 cognitively unimpaired (CU) and 118 cognitively impaired participants, including 96 with mild cognitive impairment and 22 with mild dementia (MCI\/DEM), were recruited from observational cohort studies and completed MTD remotely (mean age=70 years, SD=12; 48% male; mean education=16 years, SD=2). Clinical diagnoses were determined by multidisciplinary consensus independently of MTD. Amyloid- and tau-PET were available for 1,224 participants. Logistic regression estimated associations between MTD and CU versus MCI\/DEM, CU A-versus MCI\/DEM A+, and A-T-versus A+T+. MTD diagnostic accuracy was compared with person-administered cognitive measures. Sensitivity and specificity across score types and comparison groups were examined.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>RESULTS<\/jats:title>\n                  <jats:p>MTD showed excellent discrimination of CU versus MCI\/DEM (AUC=.89; 95% CI=.87-.92), and discriminability remained high for CU versus MCI (AUC=.88; 95% CI=.85-.92). Discriminability was highest when comparing CU A- and MCI\/DEM A+ groups (AUC=.95; 95% CI=.92-.97). MTD outperformed estimated MMSE (p=.02) and was comparable to Mayo-PACC (p=.71) for A-T-versus A+T+ discrimination (AUC=.76; 95% CI=.71-.81). Combining both raw score and normative score cutoffs helped balance sensitivity and specificity relative to use of either cutoff in isolation. A two-stage interpretation framework further improved sensitivity while maintaining clinically useful specificity and informed development of an interpretation guide.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>DISCUSSION<\/jats:title>\n                  <jats:p>A remote self-administered digital cognitive assessment showed strong diagnostic accuracy for detecting MCI and mild dementia in a large, primarily population-based cohort. The remote, self-administered MTD composite also showed comparable performance to established in-person cognitive composites for differentiating amyloid and tau-defined biomarker groups. Remote self-administered digital cognitive assessment may complement existing cognitive evaluation approaches and support scalable cognitive characterization.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Highlights<\/jats:title>\n                  <jats:list list-type=\"bullet\">\n                    <jats:list-item>\n                      <jats:p>Remote self-administered cognitive assessment showed strong differentiation of cognitively unimpaired and cognitively impaired participants.<\/jats:p>\n                    <\/jats:list-item>\n                    <jats:list-item>\n                      <jats:p>Diagnostic accuracy improved when amyloid PET biomarker status was incorporated.<\/jats:p>\n                    <\/jats:list-item>\n                    <jats:list-item>\n                      <jats:p>Remote assessment demonstrated sensitivity to amyloid and tau PET-defined Alzheimer\u2019s disease.<\/jats:p>\n                    <\/jats:list-item>\n                    <jats:list-item>\n                      <jats:p>Performance was comparable to established in-person composites and better than an in-person mental status screening measure.<\/jats:p>\n                    <\/jats:list-item>\n                    <jats:list-item>\n                      <jats:p>Digital cognitive screening may support scalable treatment and clinical trial workflows.<\/jats:p>\n                    <\/jats:list-item>\n                  <\/jats:list>\n                <\/jats:sec>","DOI":"10.64898\/2026.09.20.26362296","type":"posted-content","created":{"date-parts":[[2026,9,26]],"date-time":"2026-09-26T00:40:41Z","timestamp":1790383241000},"source":"Crossref","is-referenced-by-count":0,"title":["Diagnostic accuracy of remote self-administered digital cognitive assessment by clinical diagnosis and Alzheimer\u2019s disease PET imaging biomarkers"],"prefix":"10.64898","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9034-1252","authenticated-orcid":false,"given":"Nikki H.","family":"Stricker","sequence":"first","affiliation":[{"name":"Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth A.","family":"Boots","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rita","family":"Taylor","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Psychology, Mayo Clinic, Rochester, Minnesota, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Winnie Z.","family":"Fan","sequence":"additional","affiliation":[{"name":"Department of Quantitative Health Sciences, Mayo Clinic, Rochester, Minnesota, 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