(Remote) Digital Cognitive Testing: Measuring Brain Health from Anywhere
August 6, 2025
What is Remote Cognitive Testing?
Remote digital cognitive testing refers to assessments of memory, attention, processing speed, and other thinking skills that can be completed on a computer, tablet, or smartphone, without visiting a clinic. The core idea is the same as with traditional in-person “paper-and-pencil” neuropsychological tests, but here the delivery is digital. These tasks can be done independently, often at home, at any time of day, using the participant’s own device.
Digital cognitive assessments encompass a wide range of tools, from brief reaction-time games to more intricate memory tasks. Many of these tools have been validated against established in-clinic tests. Some are adaptations of existing measures, while others are newly designed to leverage digital features such as precise timing, automated scoring, and adaptive difficulty levels. The variety and development of these tools are illustrated in the Venn diagram below from a recent review by Polk et al. (2025, npj Digit. Med.), which categorizes digital cognitive assessments based on the type of cognitive metrics they quantify.
Why Are These Tests Important?
In Alzheimer’s disease (AD), changes in the brain, such as the disease-specific buildup of proteins (amyloid-β plaques and tau tangles), begin years or even decades before dementia symptoms appear. This period is termed the “preclinical” stage of AD and offers a critical window for disease monitoring and interventions that may slow or prevent the disease progression (2). However, the traditional in-clinic based neuropsychological assessments have several shortcomings that prevent them from being widely used and frequently tested in such preclinical stages.
- More frequent, flexible, and sensitive
Remote digital tests can be repeated regularly (daily, weekly, or monthly), allowing researchers and clinicians to track gradual changes over time. This higher “sampling rate” improves measurement reliability and helps detect small shifts that might be missed in a one-off clinic visit. For example, studies have shown that high-frequency home testing can reveal learning curves, day-to-day variability, and even effects of the time of day on performance (2,3). - Convenience and scalability
Remote digital testing removes travel, scheduling, and in-clinic wait times. This is especially valuable for people in rural areas, those with mobility limitations, or large-scale research efforts. It also reduces the demand on healthcare institutions by freeing up staff time, clinic space, and other resources that would otherwise be required for traditional paper-and-pencil testing. - Potential for early intervention
With the first therapeutics gradually becoming available worldwide, reliable and accessible tools for detecting and monitoring the earliest changes in cognition will be essential. Since current treatments such as Lecanemab and Donanemab (see our other articles on Lecanemab here and Donanemab here) are specifically recommended for early-stage AD, identifying these initial changes as soon as possible is crucial.
Strengths and Challenges of Remote Digital Cognitive Testing
Strengths:
- Precision: Digital tools can measure reaction times very accurately and score the results automatically.
- Real-life relevance: Testing at home may show how thinking skills work in everyday life and can avoid the “white-coat effect,” where people feel nervous or perform differently in a clinic.
- Adaptable tests: The system can create new versions of the same test so people do not improve simply because they have practiced it before.
Challenges:
- Keeping people engaged: It can be difficult to keep participants motivated over long periods, and some may stop or skip tests.
- Testing environment: Background noise, interruptions, or poor lighting at home can affect results.
- Technology access and skills: Some people, especially older adults or those in remote areas, may not have the right devices, internet connection, or confidence using technology.
Examples in the REAL AD study
In the REAL-AD study, we use two complementary platforms:
- Neotiv — Focuses on a specific cognitive domain (episodic memory – which is the ability to remember specific events from your own life) and is designed to engage brain regions affected early in AD, such as the medial temporal lobe. Tasks are short, repeatable, and optimised for detecting subtle memory changes over time. Neotiv has been used in both research and healthcare settings, for example in Germany, where it is available to physicians as part of a clinical work-up.
- Cognitron — Offers a broader range of cognitive tasks, including attention, reasoning, and memory, resembling traditional neuropsychological batteries but optimized for online use. Cognitron has been deployed in large studies such as the UK Biobank, where it has tested hundreds of thousands of participants.
Both platforms have undergone extensive validation in research cohorts, including biomarker-defined preclinical AD populations, and their performance has been linked to established in-person cognitive composites and to measures of amyloid and tau burden.
Looking Ahead
Remote cognitive testing is moving from a proof-of-concept to practical application. The latest evidence shows it can:
- Distinguish between people with and without early AD pathology (with moderate to large effect sizes in some cases)
- Track changes over months or years
- Integrate novel features like speech analysis or augmented reality tasks to capture richer data
The brain changes first, long before symptoms appear.
In Alzheimer’s disease, certain proteins linked to the condition begin to build up quietly in the brain. This gradual buildup interfere with the normal brain cells communication. Research suggests these biological changes can start many years, even a decade or more, before noticeable memory problems (2).
Early detection means early opportunity.
During this “preclinical” stage, memory and thinking skills may still appear normal in standard clinic tests. However, more sensitive tools can sometimes detect small shifts such as slightly slower learning, more variable reaction times, or needing extra practice to remember new information (1).
Why this matters:
- Tracking these subtle changes over time can help identify people at higher risk of future decline
- In clinical trials, they can show whether a treatment is having an effect before symptoms become obvious
- They could one day guide prevention strategies tailored to each individual
Key point:
The earlier we detect changes, the earlier we can take action, whether that means joining a trial, increasing monitoring, or making targeted lifestyle changes.
If you would like to learn more about this topic, our colleague Dr. Fredrik Öhman has written his PhD thesis on advancements in the neuropsychology of AD. You can read it here.