Beyond brain scans: verbal memory testing as an efficient cognitive biomarker for preclinical Alzheimer's disease

Timely and accessible tools for detecting preclinical Alzheimer's disease (AD) are essential for early intervention, yet reliance on MRI biomarkers limits scalability. Using longitudinal data from 210 cognitively normal older adults in ADNI, we compared the predictive value of verbal episodic memory, hippocampal volume, and a visuospatial composite. Over a 7-year window, 106 participants progressed to mild cognitive impairment (MCI), while 104 remained stable. At baseline, Immediate Recall on the Rey Auditory Verbal Learning Test was the strongest predictor of progression (AUC = 0.71), outperforming hippocampal volume (AUC = 0.66) and visuospatial scores (AUC = 0.57). Longitudinal models confirmed a steeper decline in converters (p < 0.001), underscoring its sensitivity to preclinical disease dynamics. Immediate recall accurately detected subtle functional changes, achieving predictive performance highly comparable to MRI-based hippocampal measurements. Immediate Recall is brief, low-cost, and has the potential for digital adaptation, making it a scalable tool for early detection and monitoring of cognitive changes. It could be deployed online or in community-based care where advanced diagnostics are limited. ONE SENTENCE SUMMARY: Immediate verbal recall outperforms hippocampal volume and visuospatial measures in predicting conversion to mild cognitive impairment, offering a scalable, low-cost tool for early detection in aging populations.