Abstract:

Background: Adults with Down syndrome (DS) face a genetic predisposition to early-onset Alzheimer’s disease (AD), requiring frequent neuropsychological monitoring that is often hindered by geographical and mobility barriers. While remote assessment offers a potential solution to improve clinical accessibility, the reliability of digital administration for specialized DS tools has not been fully established. This study evaluated whether the Cambridge Cognitive Examination modified for use in people with Down syndrome (CAMCOG-DS) and the modified Cued Recall Test (mCRT: total immediate free recall scores) maintain their psychometric integrity when administered via videoconference.

Methods: We enrolled 51 adults with DS (28 females; mean age 49.17 ± 9.02 years) presenting with mild to moderate intellectual disability. Based on clinical evaluation, participants were categorized as asymptomatic (cognitively stable) or symptomatic (prodromal and AD dementia; see Table 1). The CAMCOG-DS and mCRT were digitized for remote application. Using a within-subjects design, participants underwent two neuropsychological evaluations—one in-person and one via a standardized videoconferencing platform—with a two-month interval between sessions to minimize practice effects. Total CAMCOG-DS and total immediate free recall mCRT scores from both modalities were compared using paired-sample t and Wilconson tests, and linear-mixed models to determine inter-modal reliability.

Results: Statistical analysis revealed no significant differences between the scores obtained in the remote and face-to-face modalities (see Figures 1 and 2). Specifically, the mean scores for the remote CAMCOG-DS (69.3 ± 17.3) were highly consistent with in-person results (68.6 ± 16.2; t(96.96) = 0.21, p > .05). Similarly, the mCRT showed no significant variance between remote (16.3 ± 7.39) and in-person (15.4 ± 8.51; t(84.59) = 0.56, p > .05) administrations. These findings demonstrate that cognitive performance remains stable across delivery formats in this population.

Conclusion: Tele-neuropsychology is a reliable and valid method for screening and longitudinal monitoring of AD in adults with DS. By confirming that the CAMCOG-DS and mCRT retain their diagnostic utility remotely, this study supports the integration of telehealth into standard clinical practice. This transition is essential for improving health equity, ensuring continuity of care, and facilitating larger, more diverse recruitment for future AD clinical trials within the DS community.