Detecting Alzheimer's disease using digital virtual reality cognitive tests.

INTRODUCTION: Digital biomarkers for detecting Alzheimer's disease (AD) remain controversial due to inconsistent accuracy and unclear relationships with AD core biomarkers. METHODS: This study recruited 428 Chinese older adults to determine the associations of artificial intelligence (AI)-assisted virtual reality (VR) cognitive scores with plasma amyloid beta (Aβ)42/Aβ40, phosphorylated tau (p-tau)217, glial fibrillary acidic protein (GFAP), neurofilament light chain (NfL), Aβ positron emission tomography (PET), tau PET, neurodegeneration, and cognition using generalized linear models, including age, sex, education, and apolipoprotein E ε4 as covariates. RESULTS: The AI-VR cognitive scores were significantly correlated with plasma Aβ42/Aβ40, p-tau217, GFAP, NfL, Aβ PET, tau PET, hippocampal atrophy, temporal meta-region of interest cortical thinning, and cortical mean diffusivity increases, accurately identifying cognitively impaired patients from unimpaired individuals (area under curve [AUC]: 0.908-0.969) as well as classifying Aβ PET-positive individuals from negative group (AUC: 0.771-0.991). DISCUSSION: This study comprehensively examined the capacity of a 5-minute AI-VR cognitive test for identifying abnormal cognition and AD biomarkers, offering a reliable digital marker for early AD detection in community settings. HIGHLIGHTS: Digital virtual-reality cognitive tests correlate with AD biomarkers Digital virtual-reality cognitive tests can identify cognitive impairment Digital virtual-reality cognitive tests can classify those who are amyloid beta positron emission tomography positive from negative.