Abstract INTRODUCTION We investigated whether a multi‐day learning curve (MDLC), derived from remote digital cognitive assessments over 1 week, adds prognostic value to plasma phosphorylated tau at threonine 217 (p‐tau217) for predicting cognitive decline in cognitively unimpaired (CU) older adults. METHODS A total of 183 CU participants (mean age 73.3; 70% female) completed multi‐day digital cognitive tests and provided plasma p‐tau217. Linear mixed‐effects models evaluated the independent and combined effects of baseline p‐tau217 and MDLC on longitudinal cognitive decline over 2.5 years. RESULTS Adding MDLC to p‐tau217 significantly explained longitudinal cognitive trajectory beyond p‐tau217 alone. Although higher p‐tau217 and lower MDLC were independently associated with steeper decline, individuals with both risk factors declined the fastest. Notably, those with elevated p‐tau217 level but preserved MDLC remained stable, distinguishing them from those at imminent risk. DISCUSSION Combining digital learning metrics with plasma p‐tau217 enables precise risk stratification. This approach identifies individuals most vulnerable to imminent decline, potentially enhancing screening for early preventive interventions.
Kim et al. (2026) studied this question.