Remote Screening for Early Alzheimer Holds Promise Amid Key Challenges

Iris Bosch, MS

(Credit: LinkedIn)

A fully remote screening study for preclinical Alzheimer disease (AD), known as the REAL AD study, has successfully recruited nearly 5000 participants in its initial phase, demonstrating both the promise and areas of potential challenges of a decentralized diagnostic approach.¹

Launched in April 2024, the REAL AD study aims to assess whether a combination of blood-based biomarkers and digital cognitive tests can effectively screen for early AD.² Researchers designed the study to operate in the existing healthcare infrastructure of West Sweden, utilizing regional primary care units for blood sample collection whereas cognitive assessments would be completed remotely. The recruitment goal ranged from 3000 to 10,000 participants aged 50 to 80 years, simulating a real-world population screening scenario.

At the time of reporting, 4953 participants (mean age, 63.7 years; women, n = 3420) had enrolled over 5 months, with the study still actively recruiting. Researchers identified several factors to focus on in the initial phase that may influence the study’s execution, including the necessity of strong collaboration with primary healthcare providers and the logistical complexities of conducting large-scale remote screening. Maintaining participant engagement was also noted as a focus, which could require targeted strategies to ensure sustained participation in the study. Additionally, researchers noted that participant feedback may potentially help them provide more insights on the study from the patient perspective.

By analyzing both obstacles and successes, the REAL AD study could provide valuable insights into the feasibility of integrating remote screening into AD diagnostic pathways. Presented at the 2025 International Conference on Alzheimer’s and Parkinson’s Disease (AD/PD), held April 1-5 in Vienna, Austria, by lead author Iris Bosch, MS, project leader of the study, researchers noted that they hope the future findings from the study will help streamline additional studies and support the broader implementation of biomarker-based screening in routine clinical care.

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A recent investigation into digital cognitive assessments published in Frontiers in Digital Health has reinforced the potential of remote testing and identifying key factors that influence its success. Conducted as a Citizen Science project across Germany, this study examined the feasibility of fully unsupervised memory assessments via mobile devices—an approach that could further enhance early detection of cognitive impairment at scale.³

Researchers aimed to evaluate how well digital memory tests function outside of controlled environments by recruiting 1407 participants aged 18 to 89 for up to 12 weeks. Participants completed weekly memory assessments alongside brief questionnaires on sleep, cognitive complaints, and cold symptoms. The study also explored factors affecting participant retention, test-retest reliability, and potential practice effects while assessing the influence of external variables such as time of day and screen size.

The study demonstrated a high degree of compliance (77.5%) despite the absence of direct contact with researchers, financial incentives, or feedback. On average, participants remained engaged for 44 days, completing 4 test sessions. Minor practice effects were observed, but overall, the digital memory tasks showed acceptable-to-good reliability across repeated assessments. Importantly, older participants and those with self-reported cognitive concerns exhibited lower memory performance, underscoring the potential of remote digital tools in detecting cognitive decline.

As efforts like the REAL AD study continue to explore remote diagnostic strategies, findings from the previous research highlighted potentially crucial design factors for future digital cognitive assessments, including optimizing session timing and minimizing practice effects. Together, these advancements may pave the way for more scalable and accessible screening methods in AD research and broader cognitive health monitoring.

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REFERENCES
1. Bosch I, Lenér F, Kern S, et al. Challenges and achievements of a remote preclinical Alzheimer's screening study: insights from the real AD study. Presented at: 2025 International Conference on Alzheimer’s and Parkinson’s Disease (AD/PD); April 1-5. Vienna, Austria. Abstract 2413.
2. Leuzy A, Heeman F, Bosch I, et al. REAL AD-Validation of a realistic screening approach for early Alzheimer's disease. Alzheimers Dement. 2024;20(11):8172-8182. doi:10.1002/alz.14219
3. Berron D, Ziegler G, Vieweg P, et al. Feasibility of Digital Memory Assessments in an Unsupervised and Remote Study Setting. Front Digit Health. 2022;4:892997. Published 2022 May 26. doi:10.3389/fdgth.2022.892997