Research Article Can a novel computerized cognitive screening test provide additional information for early detection of Alzheimer’s disease? Ioannis Tarnanas a,b, *, Magda Tsolaki c , Tobias Nef a,d , Ren e M. M€ uri a,e , Urs P. Mosimann a,f a Gerontechnology and Rehabilitation Group, University of Bern, Bern, Switzerland b Clinical & Biological Psychology, Institute of Psychology and Education, University of Ulm, Ulm, Germany c 3rd Department of Neurology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece d ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland e Perception and Eye Movement Laboratory, Department of Clinical Research, University Hospital Inselspital, University of Bern, Bern, Switzerland f University Hospital of Old Age Psychiatry, University of Bern, Bern, Switzerland Abstract Background: Virtual reality testing of everyday activities is a novel type of computerized assess- ment that measures cognitive, executive, and motor performance as a screening tool for early demen- tia. This study used a virtual reality day-out task (VR-DOT) environment to evaluate its predictive value in patients with mild cognitive impairment (MCI). Methods: One hundred thirty-four patients with MCI were selected and compared with 75 healthy control subjects. Participants received an initial assessment that included VR-DOT, a neuropsycho- logical evaluation, magnetic resonance imaging (MRI) scan, and event-related potentials (ERPs). Af- ter 12 months, participants were assessed again with MRI, ERP, VR-DOT, and neuropsychological tests. Results: At the end of the study, we differentiated two subgroups of patients with MCI according to their clinical evolution from baseline to follow-up: 56 MCI progressors and 78 MCI nonprogressors. VR-DOT performance profiles correlated strongly with existing predictive biomarkers, especially the ERP and MRI biomarkers of cortical thickness. Conclusions: Compared with ERP, MRI, or neuropsychological tests alone, the VR-DOT could pro- vide additional predictive information in a low-cost, computerized, and noninvasive way. Ó 2014 The Alzheimer’s Association. All rights reserved. Keywords: Computerized cognitive assessment; Computerized testing; Early detection; Dementia; Psychometrics 1. Introduction Age is a strong risk factor for the most common cause of dementia, sporadic Alzheimer’s disease (AD) [1,2]. Because of the growing numbers of older individuals in many societies, the prevalence of AD is increasing at an alarming rate [3,4]. It is believed that, by the time AD is diagnosed, sufficient neuronal injury has occurred to the extent that reversal of the disease is unlikely [5]. This has therefore raised considerable interest in the prodromal stage of AD involving subjects with mild cognitive impairment (MCI), who are in the predementia stage of cognitive dysfunction and could therefore be targeted for early interventions that may potentially provide beneficial ef- fects [6]. MCI, which indicates early cognitive aging beyond the normal range according to respective age and level of educa- tion, is a clinical syndrome that commonly arises as a result of neurodegenerative pathology [7]. In clinical trials and epidemiologic studies, the annual rate of conversion of MCI subjects to dementia was found to be in the range of 6% to 25%, which is much higher than the incidence rate of dementia of 1% to 2% seen in the general population [8]. Recently described MCI diagnostic criteria require *Corresponding author. Tel.: 141-31-632-7582; Fax: 141-31-632- 8944. E-mail address: ioannis.tarnanas@artorg.unibe.ch 1552-5260/$ - see front matter Ó 2014 The Alzheimer’s Association. All rights reserved. http://dx.doi.org/10.1016/j.jalz.2014.01.002 Alzheimer’s & Dementia - (2014) 1–9