Cumulus Neuroscience (Cumulus), a global digital health company dedicated to improving neuroscience research and patient care through advanced digital data collection, has unveiled new findings on its Symbol Swap digital cognitive assessment at the Alzheimer's Association International Conference (AAIC) 2026.
The poster, "A Brief Digital Symbol-Coding Task Outperforms Clinical Benchmarks for Alzheimer's Trial Pre-enrichment," presents interim results demonstrating the effectiveness of Symbol Swap—a two-minute, tablet-based adaptation of the traditional Digit Symbol Substitution Test used to assess executive function. The analysis combines data from one completed home-based study and two ongoing large-scale clinic-based studies.
Across all three independent studies, Symbol Swap equaled or surpassed the performance of widely used cognitive screening tools for identifying suitable participants for Alzheimer's clinical trials. Despite requiring only two minutes to complete, the assessment successfully distinguished between healthy individuals, those with mild cognitive impairment (MCI), and patients with Alzheimer's dementia. By significantly reducing both participant burden and site workload, the tool offers a practical alternative for large-scale screening.
The findings also revealed a strong relationship between Symbol Swap performance and Alzheimer's-related pathology measured through blood plasma pTau-217 biomarkers. Notably, the assessment identified subtle cognitive changes even in clinically normal participants who typically perform well on conventional cognitive tests. This suggests the tool could help pinpoint individuals more likely to test positive for amyloid or tau pathology, improving the efficiency of follow-up blood tests, PET imaging, or cerebrospinal fluid (CSF) analysis. Because the assessment is delivered digitally and scored automatically, it can be easily deployed across large, multi-center clinical trials in both home and clinic settings, serving as an effective initial screening step or as part of composite digital endpoints.
"It is remarkable that a patient-friendly test lasting just two minutes can perform as well as—or better than—traditional assessments requiring 10 to 45 minutes of clinician time, while also detecting Alzheimer's pathology in participants who appear cognitively normal using standard methods," said Brian Murphy, PhD, Co-Founder and Chief Scientific Officer of Cumulus. "These findings reinforce Symbol Swap's potential as an efficient first-line screening tool that complements biomarker testing and multimodal digital assessments. We sincerely thank all study participants and collaborators whose contributions made this research possible."
Symbol Swap was assessed across three studies: CNS-101, the first home-based validation study using the NeuLogiq Platform to measure functional neurophysiology in individuals with mild Alzheimer's dementia and healthy controls, benchmarked against the ADAS-Cog assessment; the Fastball i4i clinic-based study, compared with the Montreal Cognitive Assessment (MoCA); and the Global Alzheimer's Platform (GAP) BioHermes-002 trial conducted across 20 sites in the United States, Canada, and Europe, where it was evaluated against the Mini-Mental State Examination (MMSE). Alzheimer's pathology in the CNS-101 and Fastball i4i studies was confirmed using the AlzPath phosphorylated-tau 217 assay. The Fastball i4i and BioHermes-002 findings presented at AAIC represent interim analyses.
"The BioHermes-002 study is evaluating individuals with and without memory concerns to determine how blood-based and digital tools can identify the presence of amyloid plaques and tau tangles, which are defining characteristics of Alzheimer's disease," said Lammert Albers, Chief Commercial Officer of the Global Alzheimer's Platform. "The Cumulus data indicate that digital assessments such as Symbol Swap could help identify participants with underlying Alzheimer's pathology more efficiently, enabling more targeted biomarker testing while reducing screening costs and accelerating trial enrollment."
Cumulus also presented a second poster, "Multi-domain Digital Endpoints for Decentralized Alzheimer's Trials: Experience from the CNS-101 Study (NeuLogiq)," led by Dr. James Rowe, Professor of Cognitive Neurology at the University of Cambridge and Principal Investigator of CNS-101. The research demonstrated that the NeuLogiq Platform's digital cognitive and EEG assessments were well accepted by participants and offered sufficient sensitivity to detect meaningful clinical changes, supporting the development of smaller and more efficient Alzheimer's trials.
"Alzheimer's clinical research has traditionally relied on assessments that place considerable demands on both participants and research sites," said Dr. James Rowe.
"Our CNS-101 findings show that the NeuLogiq Platform's combined cognitive and EEG measures are not only well tolerated by individuals living with Alzheimer's disease but also sensitive enough to capture clinically meaningful changes. This level of sensitivity opens the door to designing smaller, faster, and more cost-effective studies."
According to Tina Sampath, Chief Executive Officer of Cumulus, participant recruitment remains one of the greatest challenges in Alzheimer's drug development. "A low-cost, easy-to-use digital assessment that can be completed either at home or in the clinic, automatically scored, and capable of identifying individuals most likely to be biomarker-positive has tremendous potential to reduce screening failures while easing the burden on patients and study sites," she said. "Together, the two AAIC presentations demonstrate how Symbol Swap can improve participant selection at the start of a study, while NeuLogiq's cognitive and EEG endpoints provide sensitive measures for tracking outcomes. Combined, these capabilities could substantially reduce both the cost and duration of Alzheimer's clinical trials."
Cumulus Neuroscience continues to support pharmaceutical and biotechnology partners by providing remote, multi-domain monitoring of brain function, helping advance more precise and efficient CNS clinical trials.
Click here to know more.
The poster, "A Brief Digital Symbol-Coding Task Outperforms Clinical Benchmarks for Alzheimer's Trial Pre-enrichment," presents interim results demonstrating the effectiveness of Symbol Swap—a two-minute, tablet-based adaptation of the traditional Digit Symbol Substitution Test used to assess executive function. The analysis combines data from one completed home-based study and two ongoing large-scale clinic-based studies.
Across all three independent studies, Symbol Swap equaled or surpassed the performance of widely used cognitive screening tools for identifying suitable participants for Alzheimer's clinical trials. Despite requiring only two minutes to complete, the assessment successfully distinguished between healthy individuals, those with mild cognitive impairment (MCI), and patients with Alzheimer's dementia. By significantly reducing both participant burden and site workload, the tool offers a practical alternative for large-scale screening.
The findings also revealed a strong relationship between Symbol Swap performance and Alzheimer's-related pathology measured through blood plasma pTau-217 biomarkers. Notably, the assessment identified subtle cognitive changes even in clinically normal participants who typically perform well on conventional cognitive tests. This suggests the tool could help pinpoint individuals more likely to test positive for amyloid or tau pathology, improving the efficiency of follow-up blood tests, PET imaging, or cerebrospinal fluid (CSF) analysis. Because the assessment is delivered digitally and scored automatically, it can be easily deployed across large, multi-center clinical trials in both home and clinic settings, serving as an effective initial screening step or as part of composite digital endpoints.
"It is remarkable that a patient-friendly test lasting just two minutes can perform as well as—or better than—traditional assessments requiring 10 to 45 minutes of clinician time, while also detecting Alzheimer's pathology in participants who appear cognitively normal using standard methods," said Brian Murphy, PhD, Co-Founder and Chief Scientific Officer of Cumulus. "These findings reinforce Symbol Swap's potential as an efficient first-line screening tool that complements biomarker testing and multimodal digital assessments. We sincerely thank all study participants and collaborators whose contributions made this research possible."
Symbol Swap was assessed across three studies: CNS-101, the first home-based validation study using the NeuLogiq Platform to measure functional neurophysiology in individuals with mild Alzheimer's dementia and healthy controls, benchmarked against the ADAS-Cog assessment; the Fastball i4i clinic-based study, compared with the Montreal Cognitive Assessment (MoCA); and the Global Alzheimer's Platform (GAP) BioHermes-002 trial conducted across 20 sites in the United States, Canada, and Europe, where it was evaluated against the Mini-Mental State Examination (MMSE). Alzheimer's pathology in the CNS-101 and Fastball i4i studies was confirmed using the AlzPath phosphorylated-tau 217 assay. The Fastball i4i and BioHermes-002 findings presented at AAIC represent interim analyses.
"The BioHermes-002 study is evaluating individuals with and without memory concerns to determine how blood-based and digital tools can identify the presence of amyloid plaques and tau tangles, which are defining characteristics of Alzheimer's disease," said Lammert Albers, Chief Commercial Officer of the Global Alzheimer's Platform. "The Cumulus data indicate that digital assessments such as Symbol Swap could help identify participants with underlying Alzheimer's pathology more efficiently, enabling more targeted biomarker testing while reducing screening costs and accelerating trial enrollment."
Cumulus also presented a second poster, "Multi-domain Digital Endpoints for Decentralized Alzheimer's Trials: Experience from the CNS-101 Study (NeuLogiq)," led by Dr. James Rowe, Professor of Cognitive Neurology at the University of Cambridge and Principal Investigator of CNS-101. The research demonstrated that the NeuLogiq Platform's digital cognitive and EEG assessments were well accepted by participants and offered sufficient sensitivity to detect meaningful clinical changes, supporting the development of smaller and more efficient Alzheimer's trials.
"Alzheimer's clinical research has traditionally relied on assessments that place considerable demands on both participants and research sites," said Dr. James Rowe.
"Our CNS-101 findings show that the NeuLogiq Platform's combined cognitive and EEG measures are not only well tolerated by individuals living with Alzheimer's disease but also sensitive enough to capture clinically meaningful changes. This level of sensitivity opens the door to designing smaller, faster, and more cost-effective studies."
According to Tina Sampath, Chief Executive Officer of Cumulus, participant recruitment remains one of the greatest challenges in Alzheimer's drug development. "A low-cost, easy-to-use digital assessment that can be completed either at home or in the clinic, automatically scored, and capable of identifying individuals most likely to be biomarker-positive has tremendous potential to reduce screening failures while easing the burden on patients and study sites," she said. "Together, the two AAIC presentations demonstrate how Symbol Swap can improve participant selection at the start of a study, while NeuLogiq's cognitive and EEG endpoints provide sensitive measures for tracking outcomes. Combined, these capabilities could substantially reduce both the cost and duration of Alzheimer's clinical trials."
Cumulus Neuroscience continues to support pharmaceutical and biotechnology partners by providing remote, multi-domain monitoring of brain function, helping advance more precise and efficient CNS clinical trials.
Click here to know more.