PROJECT SUMMARY/ABSTRACTThis patient-oriented research R21 application will provide funding support for validating a novel approach forscreening older adults for mild cognitive impairment (MCI of the Alzheimers type) and Alzheimers disease (AD)an area of substantial and increasing significance. Unlike common questionnaires that are subjective and oftenstressful our proposed innovative screening method is objective quick and based on combined biomechanicalmotor and cognitive performance dual-tasking assessment inclusive of low-cost wearable sensor technology.By assessing sensor based differences between an individuals upper-extremity single-task motor performanceand dual-task motor plus cognitive task performance we will determine dual-task cost. We will determine dual-task cost for both traditional measures of motor performance in addition to nonlinear dynamics of the motion.We have previously developed an upper-extremity function (UEF) test to obviate the need for walking tasks inhigh risk elders. The UEF test involves repetitive elbow flexion measured using low-cost sensors which is easilyperformed (standing sitting or in bed) in less than one minute. Post-processing and scoring is performed inless than one minutes. We have patented and validated the functional component of this test based on frailtyscales for older adults.The proposed approach builds upon pilot research performed by an excellent group of interdisciplinaryinvestigators at the Banner Sun Health Research Institute in collaboration with the University of Arizona Centeron Aging and the Arizona Alzheimers Consortium demonstrating significant associations between UEF dual-task performance/cost (i.e. elbow flexion accompanied by counting backwards) with both the Mini Mental StateExamination (MMSE) and Montreal Cognitive Assessment (MoCA) scores both common gold standard cognitionscreening questionnaires for older adults ( 65 years).The goal of the proposed R21 is to further develop refine and validate a UEF cognitive index in older adultswith clinically confirmed MCI and AD. Of note we will use three groups of neuropsychologically and diagnosticallyconfirmed participants: 1) those who are free of cognitive impairment 2) those with MCI and 3) those with earlystage AD. We will explore the association of specific cognition domains (e.g. memory attention executivefunctioning etc.) that are known to be associated with dual-tasking performance.We expect to extend scientific knowledge regarding the nature of dual-tasking based on neuropsychologicalevidence focusing on a novel upper-extremity function measure (rather than gait assessment). From a clinicalviewpoint we expect to validate a quick and accurate objective tool for screening of MCI and AD with the ultimategoal of supporting the triple aim and the increasingly incidence of AD by providing a quick and cost-effectivescreening tool to support the quality of life and independence of older adults.