Objective:

To examine the transition from traditional cognitive screening to digital cognitive phenotyping for early detection of cognitive impairment.

Approach:

• Review of Cognitive Assessment Tools: The article reviews established brief cognitive instruments and explores digital cognitive assessment methods, including digitized tests, speech and language-derived biomarkers, and multimodal platforms.
• Integration with Biomarkers: It discusses the integration of cognitive assessments with structural MRI, blood-based biomarkers, cerebrospinal fluid markers, and amyloid/tau PET imaging.

Key Findings:

• Traditional cognitive screening tools often fail to detect subtle cognitive decline and are limited by ceiling effects, educational and cultural biases, and examiner variability.
• Digital cognitive assessments can standardize administration, reduce scoring variability, and capture detailed cognitive process metrics, but they do not resolve diagnostic uncertainty or establish Alzheimer's disease etiology independently.
• A staged pathway combining analog instruments, informant measures, neuropsychiatric assessments, digital signals, and biological markers is proposed for better detection.

Interpretation:

Digital cognitive screening should be viewed as a triage and phenotyping layer rather than a definitive diagnostic tool.

Limitations:

• Current cognitive assessment tools primarily identify established impairment rather than early-stage conditions.
• Digital assessments do not resolve diagnostic uncertainty or establish Alzheimer's disease etiology independently.

Conclusion:

The article emphasizes the need for a comprehensive approach to cognitive assessment that incorporates both traditional and digital methods to enhance early detection of cognitive impairment.