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Adaptive pathways for multimodal community-based detection of cognitive impairment: the CogScreen I study.

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Τίτλος: Adaptive pathways for multimodal community-based detection of cognitive impairment: the CogScreen I study.
Συγγραφείς: Kurz C; Technical University of Munich, TUM School of Medicine and Health, Department of Psychiatry and Psychotherapy, TUM University Hospital, Munich, Ismaninger Str. 22, 81675, Munich, Germany. carolin.kurz@mri.tum.de.; Department of Psychiatry and Psychotherapy, LMU Hospital, LMU Munich, Munich, Germany. carolin.kurz@mri.tum.de., Wüsten NC; Department of Psychiatry and Psychotherapy, LMU Hospital, LMU Munich, Munich, Germany., Tegethoff P; Department of Psychiatry and Psychotherapy, LMU Hospital, LMU Munich, Munich, Germany., Taute M; Department of Psychiatry and Psychotherapy, LMU Hospital, LMU Munich, Munich, Germany., Kehrls M; Department of Psychiatry and Psychotherapy, LMU Hospital, LMU Munich, Munich, Germany., Hufnagel A; Department of Psychiatry and Psychotherapy, LMU Hospital, LMU Munich, Munich, Germany., de Jonge S; Department of Psychiatry and Psychotherapy, LMU Hospital, LMU Munich, Munich, Germany., Deckert A; Davos Alzheimer's Cooperative, Wayne, PA, USA., Suchsland MZ; Davos Alzheimer's Cooperative, Wayne, PA, USA., König A; Ki:Elements GmbH, Saarbrücken, Germany., Feustel E; Johanniter-Unfall-Hilfe E.V., Munich, Germany.; Department of Public Health (Gesundheitsreferat), City of Munich, Munich, Germany., Heindl P; Johanniter-Unfall-Hilfe E.V., Munich, Germany.; Department of Public Health (Gesundheitsreferat), City of Munich, Munich, Germany., Mattke S; The USC Brain Health Observatory, USC Dornsife, Los Angeles, CA, USA., Perneczky R; German Center for Neurodegenerative Diseases (DZNE), Munich, Germany.; Munich Cluster for Systems Neurology (SyNergy), Munich, Germany.; Ageing Epidemiology (AGE) Research Unit, School of Public Health, Imperial College, London, UK.; International Registry for Alzheimer´S Disease and Other Dementias (InRAD) Foundation, Deventer, The Netherlands.
Πηγή: Scientific reports [Sci Rep] 2026 Jul 23; Vol. 16 (1). Date of Electronic Publication: 2026 Jul 23.
Τύπος έκδοσης: Journal Article; Randomized Controlled Trial
Γλώσσα: English
Στοιχεία περιοδικού: Publisher: Nature Publishing Group Country of Publication: England NLM ID: 101563288 Publication Model: Electronic Cited Medium: Internet ISSN: 2045-2322 (Electronic) Linking ISSN: 20452322 NLM ISO Abbreviation: Sci Rep Subsets: MEDLINE
Imprint Name(s): Original Publication: London : Nature Publishing Group, copyright 2011-
Ιατρικοί όροι (MeSH): Cognitive Dysfunction*/diagnosis , Cognitive Dysfunction*/blood, Biomarkers/blood ; Dementia/diagnosis ; Amyloid beta-Peptides/blood ; Humans ; Female ; Aged ; Male ; Surveys and Questionnaires ; Aged, 80 and over ; Early Diagnosis ; Independent Living
Περίληψη: Early detection of cognitive impairment is essential for dementia prevention and timely care. However, implementation in primary care and community settings remains limited. Building dementia-prepared health systems requires scalable and adaptive pathways that integrate subjective, digital and biological indicators, while accounting for heterogeneity in risk, education and age. CogScreen I was a cluster-randomized trial conducted in Munich senior centers from March 2023 to March 2024. Recruitment focused on community-dwelling adults aged ≥ 60 years reporting subjective cognitive concerns. Centers were randomized to: (A) the Subjective Cognitive Decline Questionnaire (SCD-Q) only, (B) SCD-Q plus digital cognitive testing, or (C) SCD-Q plus digital testing plus blood biomarkers (Aβ1-42/1-40, pTau181, GFAP, NfL). The primary endpoints were feasibility and acceptability, assessed through structured questionnaires and follow-up interviews with participants and general practitioners. Secondary endpoints examined latent cognitive structures and biomarker associations. Exploratory factor and clustering analyses revealed multimodal subgroups across subjective, digital, and biological measures, which informed a hypothesis-generating three-tier adaptive detection framework (low, medium, high intensity). Among the 473 participants (mean age 74.1 ± 7.6 years; 66% female; 63% with tertiary education), both feasibility and acceptability were high: Participants described the assessments as personally relevant, clearly communicated, and medically meaningful, and appreciated the added value of digital testing and biomarkers. Digital cognitive testing and biomarkers captured distinct latent dimensions of learning/working memory, psychomotor attention, and glial and amyloid pathology. Exploratory multimodal clustering identified three dementia risk profiles-low concern, intermediate, and at risk-which informed an adaptive, tiered detection model. Notably, subjective cognitive concerns assessed by the SCD-Q were strongly associated with overall subjective symptom burden, supporting the use of brief self-report questionnaires as a pragmatic and scalable first-step stratification approach in community-based dementia detection. Community-based, tiered detection pathways for cognitive decline are feasible, acceptable, and meaningful to older adults. Exploratory multimodal profiling suggests that combining subjective, digital, and biological measures may support individualized assessment strategies. However, limited GP engagement highlights the need for stronger integration with primary care to ensure downstream diagnostics and prevention pathways. The proposed framework remains hypothesis-generating and requires prospective validation.Clinical trials registeredCogScreen has been registered at clinical trials (NCT06191952, 2023-12-20).
(© 2026. The Author(s).)
Competing Interests: Declarations. Competing interests: The authors declare no competing interests.
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Contributed Indexing: Keywords: Alzheimer disease / diagnosis; Alzheimer’s disease; Biological markers / blood; Cognitive dysfunction / diagnosis; Community health services; Dementia; Dementia / diagnosis; Early diagnosis / methods; Feasibility studies; Holistic health; Primary health care; Public health; Speech analysis
Molecular Sequence: ClinicalTrials.gov NCT06191952
Substance Nomenclature: 0 (Biomarkers)
0 (Amyloid beta-Peptides)
Entry Date(s): Date Created: 20260722 Date Completed: 20260722 Latest Revision: 20260729
Update Code: 20260729
PubMed Central ID: PMC13392269
DOI: 10.1038/s41598-026-61868-x
PMID: 42486877
Βάση Δεδομένων: MEDLINE
Περιγραφή
ISSN:2045-2322
DOI:10.1038/s41598-026-61868-x