# Computerized tests of cognitive decline in presymptomatic Alzheimer's disease

> **NIH NIH R44** · NEUROBEHAVIORAL SYSTEMS, INC. · 2021 · $848,084

## Abstract

Patients who develop Alzheimer's disease (AD) show performance declines in tests of episodic memory,
executive functioning, and attention more than a decade before symptoms become apparent to their physician
or family. The rate of this performance decline is the primary outcome measure in ongoing clinical trials
evaluating interventions aimed at delaying AD onset. However, current clinical trials rely on measures from
“paper and pencil” tests of cognition that are manually-administered and scored, costly, inefficient, subject to
examiner bias, and fail to comprehensively record and quantify test performance. Moreover, because of the
limited number of licensed examiners, manual tests will be increasingly unable to meet the demand for
cognitive assessments as the population ages. Although computerized tests help meet this demand by
increasing the sensitivity, efficiency, comprehensiveness, and objectivity of cognitive testing, existing
commercial test batteries lack the sensitivity, validity, and reliability of “gold standard” manual assessments
now used in clinical trials. In this “fast-track” application, we propose to enhance the computerized tests of the
California Cognitive Assessment Battery (CCAB), a set of empirically-validated, computerized versions of “gold
standard” manual tests. CCAB tests are more efficient, reliable, objective, and precise than their manual-test
counterparts, while providing more detailed, comprehensive, and easily accessible archival records of
longitudinal test performance. We will then test the enhanced CCAB’s sensitivity to longitudinal cognitive
decline in older individuals, including those at increased risk of cognitive decline based on their APOE
genotype. During Phase I, we will restructure the individual CCAB tests for self-administration on tablets and
add automatic speech recognition to objectively score verbal responses and measure verbal-response
latencies. We will also incorporate telemedical capabilities to enable examiners to interact with patients and
administer tests at remote sites. During Phase II, we will develop a secure, encrypted database for hosting
and analyzing anonymized data. We will compare performance on CCAB tests and equivalent manual tests,
and develop regression functions for translating CCAB scores to equivalent manual test scores, and vice
versa. Finally, we will evaluate the sensitivity of the CCAB tests to cognitive decline in 420 older paid
volunteers, tested at six-month intervals over a two-year period. We will identify baseline performance
measures, including practice effects (incidental improvements that occur when tests are repeated), that predict
subsequent cognitive decline in individuals with and without genotype risk factors for AD. In addition, we will
create CCAB licensing and data-management tools to provide researchers with free access to CCAB tests and
anonymized data during the 4-year SBIR. Summary: Enhanced versions of the California Cognitive
Assessment Battery ...

## Key facts

- **NIH application ID:** 10224087
- **Project number:** 5R44AG062076-04
- **Recipient organization:** NEUROBEHAVIORAL SYSTEMS, INC.
- **Principal Investigator:** Peter Pebler
- **Activity code:** R44 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2021
- **Award amount:** $848,084
- **Award type:** 5
- **Project period:** 2018-09-30 → 2023-08-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10224087

## Citation

> US National Institutes of Health, RePORTER application 10224087, Computerized tests of cognitive decline in presymptomatic Alzheimer's disease (5R44AG062076-04). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10224087. Licensed CC0.

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