Agentic neurotechnology: A multi-agent AI framework for next-generation dementia care

Dementia care is reaching a technological turning point as rapid advances in artificial intelligence (AI), digital biomarkers, and sensor-based monitoring continue to outpace current clinical practice. Yet most tools remain episodic and disconnected from the everyday environments where cognitive change unfolds. Early cognitive drift often goes unnoticed, the mild cognitive impairment (MCI) window remains a major diagnostic gap, and care teams lack continuous, actionable insights. In this perspective, we introduce Agentic Neurotechnology, an integrated framework that combines adaptive multi-agent AI systems with longitudinal cognitive modeling to support proactive and individualized dementia care. We define a five-layer agentic stack consisting of (1) sensing and digital biomarker agents, (2) interpretation and reasoning agents, (3) longitudinal cognitive trajectory models, (4) care navigation agents, and (5) population-level forecasting agents. We further outline the Cognitive Continuum Loop, a closed-cycle process in which detection, interpretation, reasoning, monitoring, intervention, and adaptation occur continuously across the care environment. This framework highlights three actionable windows for cognitive intervention: the Preclinical Risk Detection window, the MCI Detection window, and the Functional Instability Response window. Each stage presents unique opportunities for agentic AI systems that operate continuously rather than through isolated assessments. We conclude by presenting a translational pathway for deploying agentic neurotechnologies across assisted living, primary care, telehealth, and home-based settings. The goal is to enable earlier detection, greater clinical efficiency, and more personalized cognitive support. Agentic Neurotechnology reframes AI not as a passive screening tool but as an active partner in continuous cognitive care.