Digital tools and biomarkers for cognitive screening: A systematic review

Area of Science:

• Gerontology
• Digital Health
• Cognitive Science

Background:

• Cognitive impairment affects a growing older adult population.
• Early detection and continuous monitoring are crucial for managing cognitive decline.
• Digital tools offer novel approaches to cognitive assessment.

Purpose of the Study:

• To systematically review and compare digitized traditional tests, new digital tools, and digital biomarkers for cognitive assessment.
• To evaluate their validity, feasibility, and potential for integration into community-based healthcare.
• To explore clinical utility and implementation challenges of digital cognitive assessment.

Main Methods:

• Systematic review following PRISMA guidelines, searching nine electronic databases.
• Inclusion of 48 studies on digital cognitive assessment tools or biomarkers in older adults.
• Narrative synthesis of data and extraction of diagnostic accuracy metrics (sensitivity, specificity, AUC).

Main Results:

• Digital cognitive tools demonstrated promising diagnostic accuracy across categories: digitized traditional tests (AUC: 0.65-1.0), new digital tools (AUC: 0.75-0.94), and digital biomarkers (AUC: 0.59-0.95).
• Most studies were conducted in controlled settings with limited real-world validation.
• Potential for community-based implementation exists, particularly with self-administered and remote assessments, though evidence for healthcare professionals is limited.

Conclusions:

• Digital cognitive assessments and biomarkers can enhance early screening and monitoring of cognitive impairment.
• Tool selection should be context-specific, with digital biomarkers complementing assessments in community nursing.
• Guidelines are needed for the safe and effective adoption of digital cognitive tools in healthcare settings.