Cognitive Tests Via Smartphone Help Identify Early Amyloid Changes Associated With Alzheimer Disease


The pattern for the diminished learning curve, associated with elevated amyloid levels, was consistent across 3 memory tasks, with strongest results for recalling digit-signs and groceries prices.

Assessing learning via a smartphone-based cognitive test could help to identify early changes in β-amyloid (Aβ) associated with Alzheimer disease (AD), according to results of a study published in Annals of Neurology.1,2 Investigators from Mass General Brigham aimed to determine of the assessment of learning over a period of several days could show AD-related cognitive changes in older adults.1

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“This gives us some insight into the type of memory that declines at the earliest stages of disease,” Kathryn Papp, PhD, from the Department of Neurology at Brigham and Women’s Hospital, said in the press release. “The findings could have a direct benefit on improving the way we measure treatment effects in clinical trials and how we will monitor risk for cognitive decline in a large, aging population in the future.”1

In the study, investigators used daily testing on smartphones, which they believe could be a less time consuming and less intensive way to determine amyloid-related changes in memory for older adults, especially in early stages of AD, according to the press release. They said that these quicker methods of testing are important during the preclinical stages of disease since individuals could have different levels of risk or have undetectable signs of decline.1

Investigators used data from 164 cognitively unimpaired individuals aged 60 to 91 years from 3 affiliated cohorts, including 98 from the Harvard Aging Brain Study, 33 from the Instrumental Activities of Daily Living Study, and 33 from the Subjective Cognitive Decline study. Approximately 21.9% were Aβ-positive and the rest were Aβ-negative.2

The study authors reported no significant differences in the performance between those who were Aβ-positive and -negative on any standard in-clinic cognitive tests, or on the first day of multi-day Boston Remote Assessment for Neurocognitive Health (BRANCH). The mean number of days for completion of BRANCH was 8.1 days, with a maximum of 14 days, with no differences in the groups. There were also no differences in completion time in the groups, with Aβ-positive individuals completing BRANCH in 12.23 minutes, and Aβ-negative individuals completing it in 12.11 minutes, according to the results.2 There were 3 tasks, including the Digit Sign Test (6 street signs paired with digits and assessment on the correct digit-sign pairing), the Groceries Test (prices paired with a picture of a grocery item for individuals to recall), and FNAME (a series of faces and names for individuals to choose the correct name via multiple choice).1

3 Key Takeaways

  1. The study suggests that a smartphone-based cognitive test, conducted over several days, can be a valuable tool for identifying early changes in β-amyloid associated with Alzheimer's disease (AD).
  2. By assessing learning over a period of several days, researchers observed diminished 7-day learning curves in individuals with elevated amyloid levels, indicating potential AD-related memory declines.
  3. The investigators plan to use the BRANCH paradigm in a clinical trial to identify individuals eligible for AD secondary prevention trials.

The results showed that those who were Aβ-positive had diminished 7-day learning curves after 4 days of testing compared to Aβ-negative individuals. Further, the decline in learning curves were also associated with greater annual PACC-5 decline, according to the results.2

The study authors concluded that learning over repeated evaluation could demonstrate AD-related memory declines. They added that this would show the decline in preclinical AD, which is not easily observed during a single time point assessment.2

The pattern for the diminished learning curve, which was associated with elevated amyloid, was consistent across 3 memory tasks and was strongest for digit signs and groceries prices.2

The investigators plan to conduct a clinical trial using the BRANCH paradigm and help identify those eligible for AD secondary prevention trials.1


  1. Mass General Brigham study finds daily learning test can detect Alzheimer’s disease-related changes in memory among cognitively normal older adults. News release. EurekAlert. December 26, 2023. Accessed January 2, 2024.
  2. Papp KV, Jutten RJ, Soberanes D, Weizenbaum E, et al. Early Detection of Amyloid-Related Changes in Memory among Cognitively Unimpaired Older Adults with Daily Digital Testing. Ann Neurol. 2023. doi:10.1002/ana.26833
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