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A Metadata Extraction Approach for Clinical Case Reports to Enable Advanced Understanding of Biomedical Concepts
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Clinical Manifestations.

Jackson C Thompson1, Jessie Fanglu Fu1,2, Michelle E Farrell3

  • 1Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.

Alzheimer'S & Dementia : the Journal of the Alzheimer'S Association
|December 26, 2025
PubMed
Summary
This summary is machine-generated.

Digital cognitive assessments like the DCTclock show promise for detecting early Alzheimer's disease (AD) changes. Longitudinal studies reveal DCTclock captures unique information on amyloid spread, while PACC remains superior for later-stage cognitive decline.

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Area of Science:

  • Neuroscience
  • Gerontology
  • Biomedical Engineering

Background:

  • Digital cognitive assessments offer potential for early detection of Alzheimer's disease (AD) pathology.
  • Spatial extent (EXT) of amyloid-beta (Ab) spread may be more sensitive to early Ab burden than traditional measures.
  • Previous cross-sectional data linked worsening digital clock drawing test (DCTclock) performance to amyloid and tau in cognitively normal (CN) individuals.

Purpose of the Study:

  • To longitudinally evaluate the relationship between amyloid spread (EXT) and entorhinal tau with cognitive decline in cognitively normal older adults.
  • To assess the utility of the digital clock drawing test (DCTclock) in capturing early cognitive changes related to preclinical Alzheimer's disease.

Main Methods:

  • 195 cognitively normal older adults underwent annual DCTclock and PACC5 assessments for up to 6 years.
  • Amyloid PET ([11C]Pittsburgh Compound B) and entorhinal tau PET (Flortaucipir SUVR) were measured at baseline.
  • Amyloid spread was quantified by spatial extent (EXT), categorizing participants into EXT-, EXT+, and EXT++ groups.

Main Results:

  • Individuals in EXT+ and EXT++ groups exhibited significantly faster cognitive decline on PACC5 and DCTclock information processing subscore (DCT-IP) compared to the EXT- group.
  • Elevated entorhinal tau and amyloid spread (EXT+/EXT++) independently predicted faster PACC5 decline.
  • Faster DCT-IP decline was significant in the EXT+ group, suggesting sensitivity to early amyloid spread.

Conclusions:

  • Longitudinal DCTclock assessment provides unique insights into cognitive decline during the early stages of amyloid spread.
  • The PACC remains a more robust measure for assessing severe cognitive decline associated with amyloid and tau pathology in later preclinical AD stages.