Abstract
As the number of older adults is expected to rise, there exists a need for accessible tools that capture nuanced changes in cognition. Modern digital assessment tools provide a flexible, cost-effective framework that captures the trajectories, dynamics, and dimensionality of individual cognitive profiles, which can be employed both in clinics and even in home environments. These next-generation tools allow for early and accurate identification of preclinical indicators of dementia. Elucidated through the experiences of Alex and his wife Isabella, modern technology unveils an alternative model that will undoubtedly play a major role in promoting and monitoring cognitive health across the lifespan.
Similar content being viewed by others
References
Abbate, S., Avvenuti, M., Bonatesta, F., Cola, G., Corsini, P., & Vecchio, A. (2012). A smartphone-based fall detection system. Pervasive and Mobile Computing, 8(6), 883–899. https://doi.org/10.1016/j.pmcj.2012.08.003
Alzheimer’s and Related Dementias Resources for Professionals. (2023). National Institute on Aging. https://www.nia.nih.gov/health/health-care-professionals-information/alzheimers-and-related-dementias-resources
Amieva, H., & Ouvrard, C. (2020). Does treating hearing loss in older adults improve cognitive outcomes? A review. Journal of Clinical Medicine, 9(3). https://doi.org/10.3390/jcm9030805
Amini, S., Hao, B., Zhang, L., Song, M., Gupta, A., Karjadi, C., Kolachalama, V. B., Au, R., & Paschalidis, I. Ch. (2023). Automated detection of mild cognitive impairment and dementia from voice recordings: A natural language processing approach. Alzheimer’s & Dementia, 19(3), 946–955. https://doi.org/10.1002/alz.12721
Anderson, M. & Perrin, A. (2017). Tech Adoption Climbs Among Older Adults. Pew Research Center: Internet, Science & Tech. https://www.pewresearch.org/internet/2017/05/17/tech-adoption-climbs-among-older-adults/
Barnett, J. H., Blackwell, A. D., Sahakian, B. J., & Robbins, T. W. (2016). The paired associates learning (PAL) test: 30 years of CANTAB translational neuroscience from laboratory to bedside in dementia research. Current Topics in Behavioral Neurosciences, 28, 449–474. https://doi.org/10.1007/7854_2015_5001
Bastawrous, A., Rono, H. K., Livingstone, I. A. T., Weiss, H. A., Jordan, S., Kuper, H., & Burton, M. J. (2015). Development and validation of a smartphone-based visual acuity test (Peek Acuity) for clinical practice and community-based fieldwork. JAMA Ophthalmology, 133(8), 930. https://doi.org/10.1001/jamaophthalmol.2015.1468
Berron, D., Ziegler, G., Vieweg, P., Billette, O., Güsten, J., Grande, X., Heneka, M. T., Schneider, A., Teipel, S., Jessen, F., Wagner, M., & Düzel, E. (2022). Feasibility of digital memory assessments in an unsupervised and remote study setting. Frontiers in Digital Health, 4, 892997. https://doi.org/10.3389/fdgth.2022.892997
Bertone, A., Bettinelli, L., & Faubert, J. (2007). The impact of blurred vision on cognitive assessment. Journal of Clinical and Experimental Neuropsychology, 29(5), 467–476.
Betancourt, J. R., Green, A. R., & Carrillo, J. E. (2002). Cultural competence in health care: Emerging frameworks and practical approaches (Vol. 576). Commonwealth Fund, Quality of Care for Underserved Populations New York, NY.
Bot, B. M., Suver, C., Neto, E. C., Kellen, M., Klein, A., Bare, C., Doerr, M., Pratap, A., Wilbanks, J., Dorsey, E. R., Friend, S. H., & Trister, A. D. (2016). The mPower study, Parkinson disease mobile data collected using ResearchKit. Scientific Data, 3(1), 160011. https://doi.org/10.1038/sdata.2016.11
Casanova, R., Saldana, S., Lutz, M. W., Plassman, B. L., Kuchibhatla, M., & Hayden, K. M. (2020). Investigating predictors of cognitive decline using machine learning. The Journals of Gerontology: Series B, 75(4), 733–742. https://doi.org/10.1093/geronb/gby054
Chan, J. Y. C., Yau, S. T. Y., Kwok, T. C. Y., & Tsoi, K. K. F. (2021). Diagnostic performance of digital cognitive tests for the identification of MCI and dementia: A systematic review. Ageing Research Reviews, 72, 101506. https://doi.org/10.1016/j.arr.2021.101506
Christianson, K., Prabhu, M., Popp, Z. T., Rahman, M. S., Drane, J., Lee, M., Lathan, C., Lin, H., Au, R., & Sunderaraman, P. (2023). Adherence type impacts completion rates of frequent mobile cognitive assessments among older adults with and without cognitive impairment. Research Square.
Dahmen, J., Cook, D., Fellows, R., & Schmitter-Edgecombe, M. (2017). An analysis of a digital variant of the Trail Making Test using machine learning techniques. Technology and Health Care, 25(2), 251–264. https://doi.org/10.3233/THC-161274
Ding, H., Mandapati, A., Hamel, A. P., Karjadi, C., Ang, T. F. A., Xia, W., Au, R., & Lin, H. (2023). Multimodal machine learning for 10-year dementia risk prediction: The Framingham heart study. Journal of Alzheimer’s Disease, 96(1), 277–286. https://doi.org/10.3233/JAD-230496
Duke Han, S., Nguyen, C. P., Stricker, N. H., & Nation, D. A. (2017). Detectable neuropsychological differences in early preclinical Alzheimer’s disease: A meta-analysis. Neuropsychology Review, 27(4), 305–325. https://doi.org/10.1007/s11065-017-9345-5
Fox, R. S., Manly, J. J., Slotkin, J., Devin Peipert, J., & Gershon, R. C. (2021). Reliability and validity of the Spanish-language version of the NIH Toolbox. Assessment, 28(2), 457–471. https://doi.org/10.1177/1073191120913943
Gammon, K. (2023). Undiagnosed: More than 7 million Americans u | EurekAlert! https://www.eurekalert.org/news-releases/1005499
Gates, N., Valenzuela, M., Sachdev, P., & Singh, F. (2014). Psychological well-being in individuals with mild cognitive impairment. Clinical Interventions in Aging, 779. https://doi.org/10.2147/CIA.S58866
Ghazirad, M., Hewitt, O., & Walden, S. (2022). What outcome measures are most useful in measuring the effectiveness of anti-dementia medication in people with intellectual disabilities and dementia? Advances in Mental Health and Intellectual Disabilities, 16(2), 87–101. https://doi.org/10.1108/AMHID-10-2021-0038
Goetz, C. G., Tilley, B. C., Shaftman, S. R., Stebbins, G. T., Fahn, S., Martinez‐Martin, P., Poewe, W., Sampaio, C., Stern, M. B., Dodel, R., Dubois, B., Holloway, R., Jankovic, J., Kulisevsky, J., Lang, A. E., Lees, A., Leurgans, S., LeWitt, P. A., Nyenhuis, D., … LaPelle, N. (2008). Movement Disorder Society‐sponsored revision of the Unified Parkinson’s Disease Rating Scale (MDS‐UPDRS): Scale presentation and clinimetric testing results. Movement Disorders, 23(15), 2129–2170. https://doi.org/10.1002/mds.22340
Gold, M., Amatniek, J., Carrillo, M. C., Cedarbaum, J. M., Hendrix, J. A., Miller, B. B., Robillard, J. M., Rice, J. J., Soares, H., Tome, M. B., Tarnanas, I., Vargas, G., Bain, L. J., & Czaja, S. J. (2018). Digital technologies as biomarkers, clinical outcomes assessment, and recruitment tools in Alzheimer’s disease clinical trials. Alzheimer’s & Dementia: Translational Research & Clinical Interventions, 4(1), 234–242. https://doi.org/10.1016/j.trci.2018.04.003
Haque, R. U., Pongos, A. L., Manzanares, C. M., Lah, J. J., Levey, A. I., & Clifford, G. D. (2021). Deep Convolutional Neural Networks and Transfer Learning for Measuring Cognitive Impairment Using Eye-Tracking in a Distributed Tablet-Based Environment. IEEE Transactions on Biomedical Engineering, 68(1), 11–18. https://doi.org/10.1109/TBME.2020.2990734
Honea, R. A., Vidoni, E. D., Swerdlow, R. H., & Burns, J. M. (2012). Maternal Family History is Associated with Alzheimer’s Disease Biomarkers. Journal of Alzheimer’s Disease : JAD, 31(3), 659–668. https://doi.org/10.3233/JAD-2012-120676
Houts, C. R., Patrick-Lake, B., Clay, I., & Wirth, R. J. (2020). The Path Forward for Digital Measures: Suppressing the Desire to Compare Apples and Pineapples. Digital Biomarkers, 4(Suppl. 1), 3–12. https://doi.org/10.1159/000511586
Ichii, S., Nakamura, T., Kawarabayashi, T., Takatama, M., Ohgami, T., Ihara, K., & Shoji, M. (2020). CogEvo, a cognitive function balancer, is a sensitive and easy psychiatric test battery for age‐related cognitive decline. Geriatrics & Gerontology International, 20(3), 248–255. https://doi.org/10.1111/ggi.13847
Jayakumar, S., Maniglia, M., Guan, Z., Green, S., & Aaron, S. (2024). PLFest: A new platform for accessible, reproducible and open perceptual learning research. https://doi.org/10.31234/osf.io/kmh87
Kandiah, N., Zhang, A., Bautista, D. C., Silva, E., Ting, S. K. S., Ng, A., & Assam, P. (2016). Early detection of dementia in multilingual populations: Visual Cognitive Assessment Test (VCAT). Journal of Neurology, Neurosurgery, and Psychiatry, 87(2), 156–160. https://doi.org/10.1136/jnnp-2014-309647
Korolev, I. O., Symonds, L. L., Bozoki, A. C., & Alzheimer’s Disease Neuroimaging Initiative. (2016). Predicting progression from mild cognitive impairment to Alzheimer’s dementia using clinical, MRI, and plasma biomarkers via probabilistic pattern classification. PloS One, 11(2), e0138866.
Krafka, K., Khosla, A., Kellnhofer, P., Kannan, H., Bhandarkar, S., Matusik, W., & Torralba, A. (2016). Eye tracking for everyone. 2016 IEEE Conference on Computer Vision and Pattern Recognition (CVPR), 2176–2184. https://doi.org/10.1109/CVPR.2016.239
Lee, A. T. C., Richards, M., Chan, W. C., Chiu, H. F. K., Lee, R. S. Y., & Lam, L. C. W. (2020). Higher dementia incidence in older adults with poor visual acuity. The Journals of Gerontology: Series A, 75(11), 2162–2168. https://doi.org/10.1093/gerona/glaa036
Lelo de Larrea-Mancera, E. S., Stavropoulos, T., Hoover, E. C., Eddins, D. A., Gallun, F. J., & Seitz, A. R. (2020). Portable Automated Rapid Testing (PART) for auditory assessment: Validation in a young adult normal-hearing population. The Journal of the Acoustical Society of America, 148(4), 1831–1851. https://doi.org/10.1121/10.0002108
Livingston, G., Huntley, J., Sommerlad, A., Ames, D., Ballard, C., Banerjee, S., Brayne, C., Burns, A., Cohen-Mansfield, J., Cooper, C., Costafreda, S. G., Dias, A., Fox, N., Gitlin, L. N., Howard, R., Kales, H. C., Kivimäki, M., Larson, E. B., Ogunniyi, A., … Mukadam, N. (2020). Dementia prevention, intervention, and care: 2020 report of the Lancet Commission. The Lancet, 396(10248), 413–446. https://doi.org/10.1016/S0140-6736(20)30367-6
Loughrey, D. G., Kelly, M. E., Kelley, G. A., Brennan, S., & Lawlor, B. A. (2018). Association of age-related hearing loss with cognitive function, cognitive impairment, and dementia: A systematic review and meta-analysis. JAMA Otolaryngology–Head & Neck Surgery, 144(2), 115–126. https://doi.org/10.1001/jamaoto.2017.2513
Lumsden, J., Edwards, E. A., Lawrence, N. S., Coyle, D., & Munafò, M. R. (2016). Gamification of cognitive assessment and cognitive Ttaining: A systematic review of applications and efficacy. JMIR Serious Games, 4(2), e5888. https://doi.org/10.2196/games.5888
Manly, J. J., Jones, R. N., Langa, K. M., Ryan, L. H., Levine, D. A., McCammon, R., Heeringa, S. G., & Weir, D. (2022). Estimating the prevalence of dementia and mild cognitive impairment in the US: the 2016 health and retirement study harmonized cognitive assessment protocol project. JAMA Neurology, 79(12), 1242–1249. https://doi.org/10.1001/jamaneurol.2022.3543
Martyr, A., Nelis, S. M., Quinn, C., Wu, Y.-T., Lamont, R. A., Henderson, C., Clarke, R., Hindle, J. V., Thom, J. M., Jones, I. R., Morris, R. G., Rusted, J. M., Victor, C. R., & Clare, L. (2018). Living well with dementia: A systematic review and correlational meta-analysis of factors associated with quality of life, well-being and life satisfaction in people with dementia. Psychological Medicine, 48(13), 2130–2139. https://doi.org/10.1017/S0033291718000405
Matthews, K. A., Xu, W., Gaglioti, A. H., Holt, J. B., Croft, J. B., Mack, D., & McGuire, L. C. (2019). Racial and ethnic estimates of Alzheimer’s disease and related dementias in the United States (2015–2060) in adults aged ≥65 years. Alzheimer’s & Dementia, 15(1), 17–24. https://doi.org/10.1016/j.jalz.2018.06.3063
Medici, A. C. (2021). Health sector challenges and policies in the context of ageing populations. United Nations Department of Economic and Social Affairs.
Molitor, R. J., Ko, P. C., & Ally, B. A. (2015). Eye movements in Alzheimer’s disease. Journal of Alzheimer’s Disease, 44(1), 1–12.
Ng, K. P., Chiew, H. J., Lim, L., Rosa-Neto, P., Kandiah, N., & Gauthier, S. (2018). The influence of language and culture on cognitive assessment tools in the diagnosis of early cognitive impairment and dementia. Expert Review of Neurotherapeutics, 18(11), 859–869. https://doi.org/10.1080/14737175.2018.1532792
Nichols, E., Steinmetz, J. D., Vollset, S. E., Fukutaki, K., Chalek, J., Abd-Allah, F., Abdoli, A., Abualhasan, A., Abu-Gharbieh, E., Akram, T. T., Al Hamad, H., Alahdab, F., Alanezi, F. M., Alipour, V., Almustanyir, S., Amu, H., Ansari, I., Arabloo, J., Ashraf, T., … Vos, T. (2022). Estimation of the global prevalence of dementia in 2019 and forecasted prevalence in 2050: An analysis for the Global Burden of Disease Study 2019. The Lancet Public Health, 7(2), e105–e125. https://doi.org/10.1016/S2468-2667(21)00249-8
Öhman, F., Hassenstab, J., Berron, D., Schöll, M., & Papp, K. V. (2021). Current advances in digital cognitive assessment for preclinical Alzheimer’s disease. Alzheimer’s & Dementia: Diagnosis, Assessment & Disease Monitoring, 13(1), e12217. https://doi.org/10.1002/dad2.12217
Opwonya, J., Doan, D. N. T., Kim, S. G., Kim, J. I., Ku, B., Kim, S., Park, S., & Kim, J. U. (2022). Saccadic eye movement in mild cognitive impairment and Alzheimer’s disease: A systematic review and meta-analysis. Neuropsychology Review, 32(2), 193–227. https://doi.org/10.1007/s11065-021-09495-3
Parsey, C. M., & Schmitter-Edgecombe, M. (2013). Applications of technology in neuropsychological assessment. The Clinical Neuropsychologist, 27(8), 1328–1361. https://doi.org/10.1080/13854046.2013.834971
Peek, S. T., Luijkx, K. G., Rijnaard, M. D., Nieboer, M. E., Van Der Voort, C. S., Aarts, S., Van Hoof, J., Vrijhoef, H. J., & Wouters, E. J. (2016). Older adults’ reasons for using technology while aging in place. Gerontology, 62(2), 226–237.
Peng, Z. E., Waz, S., Buss, E., Shen, Y., Richards, V., Bharadwaj, H., Stecker, G. C., Beim, J. A., Bosen, A. K., Braza, M. D., Diedesch, A. C., Dorey, C. M., Dykstra, A. R., Gallun, F. J., Goldsworthy, R. L., Gray, L., Hoover, E. C., Ihlefeld, A., Koelewijn, T., … Venezia, J. H. (2022). FORUM: Remote testing for psychological and physiological acoustics. The Journal of the Acoustical Society of America, 151(5), 3116–3128. https://doi.org/10.1121/10.0010422
Popp, Z. T., Low, S., Kolachalama, V. B., Lin, H., Rahman, M. S., Prabhu, M., Chan, C., Salgado, M., & Au, R. (2023). Multimodal, longitudinal digital brain health platform using participant-driven study design. Alzheimer’s & Dementia, 19(S4), e066121. https://doi.org/10.1002/alz.066121
Possin, K. L., Moskowitz, T., Erlhoff, S. J., Rogers, K. M., Johnson, E. T., Steele, N. Z. R., Higgins, J. J., Stiver, J., Alioto, A. G., Farias, S. T., Miller, B. L., & Rankin, K. P. (2018). The Brain Health Assessment for detecting and diagnosing neurocognitive disorders. Journal of the American Geriatrics Society, 66(1), 150–156. https://doi.org/10.1111/jgs.15208
Pywell, J., Vijaykumar, S., Dodd, A., & Coventry, L. (2020). Barriers to older adults’ uptake of mobile-based mental health interventions. DIGITAL HEALTH, 6, 205520762090542. https://doi.org/10.1177/2055207620905422
Rajan, K. B., Weuve, J., Barnes, L. L., McAninch, E. A., Wilson, R. S., & Evans, D. A. (2021). Population estimate of people with clinical Alzheimer’s disease and mild cognitive impairment in the United States (2020–2060). Alzheimer’s & Dementia, 17(12), 1966–1975. https://doi.org/10.1002/alz.12362
Rasmussen, J., & Langerman, H. (2019). Alzheimer’s disease – Why we need early diagnosis. Degenerative Neurological and Neuromuscular Disease, Volume 9, 123–130. https://doi.org/10.2147/DNND.S228939
Reitan, R. M. (1971). Trail making test results for normal and brain-damaged children. Perceptual and Motor Skills, 33(2), 575–581. https://doi.org/10.2466/pms.1971.33.2.575
Rentz, D. M., Parra Rodriguez, M. A., Amariglio, R., Stern, Y., Sperling, R., & Ferris, S. (2013). Promising developments in neuropsychological approaches for the detection of preclinical Alzheimer’s disease: A selective review. Alzheimer’s Research & Therapy, 5(6), 58. https://doi.org/10.1186/alzrt222
Rodríguez-Salgado, A. M., Llibre-Guerra, J. J., Tsoy, E., Peñalver-Guia, A. I., Bringas, G., Erlhoff, S. J., Kramer, J. H., Allen, I. E., Valcour, V., Miller, B. L., Llibre-Rodríguez, J. J., & Possin, K. L. (2021). A brief digital cognitive assessment for detection of cognitive impairment in Cuban older adults. Journal of Alzheimer’s Disease, 79(1), 85–94. https://doi.org/10.3233/JAD-200985
Romano, M. F., Shih, L. C., Paschalidis, I. C., Au, R., & Kolachalama, V. B. (2023). Large language models in neurology research and future practice. Neurology, 101(23), 1058–1067. https://doi.org/10.1212/WNL.0000000000207967
Silverstein, S. M., Harms, M. P., Carter, C. S., Gold, J. M., Keane, B. P., MacDonald, A., Daniel Ragland, J., & Barch, D. M. (2015). Cortical contributions to impaired contour integration in schizophrenia. Neuropsychologia, 75, 469–480. https://doi.org/10.1016/j.neuropsychologia.2015.07.003
Valladares-Rodriguez, S., Fernández-Iglesias, M. J., Anido-Rifón, L., Facal, D., Rivas-Costa, C., & Pérez-Rodríguez, R. (2019). Touchscreen games to detect cognitive impairment in senior adults. A user-interaction pilot study. International Journal of Medical Informatics, 127, 52–62. https://doi.org/10.1016/j.ijmedinf.2019.04.012
Veneziani, I., Marra, A., Formica, C., Grimaldi, A., Marino, S., Quartarone, A., & Maresca, G. (2024). Applications of artificial intelligence in the neuropsychological assessment of dementia: A systematic review. Journal of Personalized Medicine, 14(1), Article 1. https://doi.org/10.3390/jpm14010113
Verghese, J., Noone, M. L., Johnson, B., Ambrose, A. F., Wang, C., Buschke, H., Pradeep, V. G., Salam, K. A., Shaji, K. S., & Mathuranath, P. S. (2012). Picture-based memory impairment screen for dementia. Journal of the American Geriatrics Society, 60(11), 2116–2120. https://doi.org/10.1111/j.1532-5415.2012.04191.x
Wang, L., Zhang, Z., McArdle, J. J., & Salthouse, T. A. (2008). Investigating ceiling effects in longitudinal data analysis. Multivariate Behavioral Research, 43(3), 476–496. https://doi.org/10.1080/00273170802285941
Ward, A., Tardiff, S., Dye, C., & Arrighi, H. M. (2013). Rate of conversion from prodromal Alzheimer’s disease to Alzheimer’s dementia: A systematic review of the literature. Dementia and Geriatric Cognitive Disorders Extra, 3(1), 320–332. https://doi.org/10.1159/000354370
Wolf, A., Tripanpitak, K., Umeda, S., & Otake-Matsuura, M. (2023). Eye-tracking paradigms for the assessment of mild cognitive impairment: A systematic review. Frontiers in Psychology, 14, 1197567. https://doi.org/10.3389/fpsyg.2023.1197567
Wouters, H., Zwinderman, A. H., Van Gool, W. A., Schmand, B., & Lindeboom, R. (2009). Adaptive cognitive testing in dementia. International Journal of Methods in Psychiatric Research, 18(2), 118–127. https://doi.org/10.1002/mpr.283
Funding
This work was supported by the Canadian Institutes of Health Research (CIHR) Postdoctoral Fellowship (#176576; Canada), the Fonds de recherche du Québec – Santé (FRQS) Postdoctoral Fellowship (#305855; Canada) awarded to DT. The other authors have no conflict of interest to disclose.
Author information
Authors and Affiliations
Rights and permissions
Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.
About this article
Cite this article
Coppola, Q., Yangüez, M., Tullo, D. et al. Advancing Cognitive Health in Aging Populations by Leveraging Digital Assessment. J Health Serv Psychol 50, 47–58 (2024). https://doi.org/10.1007/s42843-024-00102-6
Published:
Issue Date:
DOI: https://doi.org/10.1007/s42843-024-00102-6