Examining a Preclinical Alzheimer’s Cognitive Composite for Telehealth Administration, the tPACC, for Reliability between In-Person and Remote Cognitive Testing with Neuroimaging Biomarkers

INTRODUCTION We defined a telehealth preclinical Alzheimer’s cognitive composite (tPACC) derived from remotely administered cognitive assessments and examined its relationship with neuroimaging biomarkers. METHODS We examined neuroimaging and in-person and remote cognitive testing data from the Wake Forest Alzheimer’s Disease Research Center’s Clinical Core cohort and a pilot study to form a modified PACC (PACC5-RAVLT) and tPACC. We performed intraclass correlation coefficient (ICC) analysis for reliability of tPACC and linear regression models to evaluate associations between tPACC and neuroimaging. Bland-Altman plots for agreement were constructed across cognitively normal (NC) and impaired participants. RESULTS There was a significant positive relationship between in-person tPACC and PACC5-RAVLT (ICC=0.88), in-person PACC5-RAVLT and remote tPACC (ICC=0.73), and in-person tPACC and remote tPACC (ICC=0.82). Overall, tPACC showed significant associations with imaging biomarkers. DISCUSSION There is a good agreement between tPACC and PACC5-RAVLT for NC and impaired individuals. The tPACC is associated with common neuroimaging markers. Research in Context 1. Systematic Review: We reviewed the literature to identify the reliability of remote cognitive testing, concordance of in-person and remote cognitive testing, and remote Preclinical Alzheimer’s Cognitive Composite (PACC) to differentiate cognitive functioning in older adults with or without cognitive impairment. We searched studies to examine relationships between remote PACC score and neuroimaging biomarkers related to early stages of Alzheimer’s Disease. We found no studies simultaneously examining a telehealth PACC (tPACC) score with neuroimaging biomarkers that provide crucial implications for detecting cognitive differences. 2. Interpretation: Our findings reveal that a tPACC score can serve as a harmonized composite measure for heterogeneous cognitive data to discriminate those with or without cognitive impairment and inform neuroimaging outcomes. 3. Future Directions: Future work is necessary to test tPACC performance in larger longitudinal studies and relationships with other neuroimaging (e.g., PET) or plasma biomarkers in older adults across the cognitive spectrum.