The computerised PROTECT Cognitive Test System is sensitive to dementia and correlates with Alzheimer-related blood biomarkers

Early detection of cognitive impairment is essential for timely diagnosis and to support recruitment of pre-clinical patients into trials of disease-modifying therapies. Current clinically used tools have limited sensitivity for early cognitive deficit and require in-person assessments. Computerised assessment systems offer a means of addressing these challenges with scalable self-administered domain-specific assessments for use in the community and primary care. This study presents further validation of the PROTECT Cognitive Test System of eight assessments of memory, attention and executive function in 113 patients with dementia and 9197 cognitively healthy controls. PROTECT shows robust separation of dementia and non-dementia patients in all cognitive tests and domains (P<0.001), and a Receiver Operator Characteristic analysis also shows excellent discriminative ability (>0.9), >90% sensitivity and >89% specificity in all domains. The system also correlates strongly with the plasma biomarker p-tau217 (P<0.001, AUC 0.885) and with the MoCA (P=0.006). The self-administered online delivery means it offers a means of triaging large numbers of patients for early diagnostics and trials and the strength of correlation with an AD biomarker is very favourable compared to other assessment instruments.