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Clinical Manifestations.

Moonil Kang1,2, Cody Karjadi1,3, Ting Fang Alvin Ang3,4,5

  • 1Framingham Heart Study, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA.

Alzheimer'S & Dementia : the Journal of the Alzheimer'S Association
|December 25, 2025
PubMed
Summary
This summary is machine-generated.

Digital cognitive tests, like the digital clock drawing test (dCDT), show promise in detecting early Alzheimer's disease (AD) and related dementias (ADRD). Better dCDT performance in cognitively unimpaired individuals is linked to less subjective cognitive decline (SCD) and future dementia risk.

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Area of Science:

  • Neurology
  • Cognitive Science
  • Digital Health

Background:

  • Digital cognitive assessments offer potential for earlier detection of Alzheimer's disease (AD) and related dementias (ADRD) compared to traditional methods.
  • Subjective cognitive decline (SCD) is a recognized preclinical marker for AD/ADRD.
  • This study investigated the utility of the digital clock drawing test (dCDT) in identifying cognitive changes in individuals without objective impairment.

Purpose of the Study:

  • To determine if the dCDT is associated with subjective cognitive decline (SCD) in cognitively unimpaired (CU) individuals.
  • To assess if dCDT performance predicts future objective cognitive impairment, including mild cognitive impairment (MCI) and dementia.
  • To evaluate if dCDT detects subtle cognitive changes missed by traditional neuropsychological (NP) tests.

Main Methods:

  • Longitudinal study of Framingham Heart Study participants assessed for SCD, NP tests, and dCDT.
  • Analysis included CU participants (age ≥ 60) matched for SCD status.
  • Cross-sectional and longitudinal models analyzed associations between dCDT performance and SCD, MCI, AD, and all-cause dementia, adjusting for NP performance and other covariates.

Main Results:

  • Better dCDT performance, particularly in drawing efficiency and information processing, was associated with reduced odds of SCD.
  • Improved dCDT scores independently predicted a lower hazard of developing MCI and all-cause dementia.
  • Traditional NP tests did not show the same associations with SCD or future cognitive decline.

Conclusions:

  • The dCDT is associated with SCD and predicts future cognitive decline (MCI, dementia) in CU individuals.
  • dCDT may identify subtle cognitive changes indicative of preclinical AD/ADRD missed by traditional NP tests.
  • Digital cognitive assessments hold potential for early detection and monitoring of neurodegenerative diseases.