Developing a Home Cognitive Vital Sign to Detect Cognitive Changes 

For the first time, patients with Early Alzheimer’s disease (AD) are beginning disease modifying therapies such as lecanemab in large numbers. With the advent of these therapies, there is a critical need to monitor their cognitive function more closely as they are both at risk for acute cognitive decline, caused by amyloid related imaging abnormality (ARIA), and for chronic decline, to accurately measure disease progression. Unfortunately, there are no clinical tools currently in use to monitor cognition daily at home. Such a tool could not only detect acute changes, such as from ARIA or delirium, but might also be able to accurately measure disease progression over longer time scales, to personalize therapies. We have designed a simple spatial working memory test, the SWiM test, a 1-minute task in the form of a “serious game” that can be performed daily at home and potentially measure disease progression. In addition, this test can act as a “cognitive vital sign”, allowing patients and their caregivers to monitor attentional ability daily to detect the cognitive changes that presage either symptomatic ARIA or delirium. We intend to assess the feasibility and the utility of the task in its first “at home” use in 25 patients with early AD, most in our Disease-modifying Immunotherapies for Alzheimer’s Disease (DiAD) program. Participants and their caregivers will perform the task daily for six months. We are using a combination of standard (Item Response Theory) analytics and advanced machine learning algorithms to assess patient performance.