NeuroTrax Science Team and Glen M. Doniger, PhD
In cognitive assessment, the most meaningful insights are not limited to test scores – they are reflected in how individuals function in daily life. Ecological validity, or the degree to which an assessment relates to real-world outcomes, has become increasingly important in neurology and neurodegenerative disease management. NeuroTrax, a digital neuromarker, demonstrates strong ecological validity by consistent alignment of objective cognitive performance with patient-reported outcomes (PROs), quality of life (QoL), mobility, balance, and long-term functional change.
A clear example comes from recent work examining quality of life in people with multiple sclerosis (PwMS). A 2023 study evaluated 171 PwMS using a computerized cognitive assessment battery alongside validated PRO measures, including the MSIS-29 for QoL, fatigue, and depression scales [1]. While depression and fatigue were strongly associated with QoL, cognitive domains, particularly attention and executive functioning, remained significant predictors of QoL even after controlling for physical disability, fatigue, depression, and demographics. These findings highlight that cognitive impairment independently shapes how patients perceive their well-being and daily functioning, reinforcing the need to include objective cognitive neurometrics alongside PROs when evaluating disease burden and treatment impact.
The link between cognition and everyday physical function is further supported by research on gait variability in individuals with mild cognitive impairment (MCI) and dementia. A case study from 2024 demonstrated that visual–spatial abilities were the strongest cognitive predictor of gait variability during both normal and dual-task walking [2]. Importantly, gait variability is not just a laboratory metric, it is directly associated with fall risk, mobility limitations, and safety in daily life. This study reinforces the ecological relevance of domain-specific cognitive assessment, showing that deficits captured by digital neuromarkers like NeuroTrax translate into measurable changes in real-world movement and independence.
NeuroTrax has also shown sensitivity to long-term lifestyle-related cognitive change. In a longitudinal study of men with cardiovascular disease, adherence to the Mediterranean diet was associated with better baseline cognitive performance and reduced cognitive decline nearly two decades later [3]. Cognitive outcomes were measured using NeuroTrax with particularly strong effects observed in visual spatial processing. These results underscore NeuroTrax’s ability to detect meaningful cognitive differences that align with known lifestyle factors and long-term brain health, an important dimension of ecological validity that extends beyond short-term clinical endpoints.
Balance and postural control provide another real-world lens through which cognition impacts daily life. A study conducted in 2016 examined the relationship between static posturography and specific cognitive domains in PwMS, again using NeuroTrax. It was found that correlations between cognition and balance varied by disability level: executive function and motor skills were most relevant in mildly affected individuals, memory and verbal function in moderate disability, and attention in those with severe disability [4]. This nuanced relationship illustrates how NeuroTrax captures domain-specific cognitive changes that meaningfully relate to functional abilities patients rely on every day.
Taken together, these studies demonstrate that NeuroTrax does more than quantify cognition; it captures cognitive domains that matter to patients’ lived experiences. By aligning objective neurometric performance with PROs, mobility, balance, lifestyle factors, and quality of life, NeuroTrax supports a more patient-centered, ecologically valid approach to cognitive assessment. In clinical care and research alike, this alignment is essential for understanding disease impact, guiding interventions, and ultimately improving outcomes that patients truly feel.
References:
[1] Bergmann, C., Becker, S., Watts, A., Sullivan, C., Wilken, J., Golan, D., Zarif, M., Bumstead, B., Buhse, M., Kaczmarek, O., Covey, T.J., Doniger, G.M., Penner, I.K., Hancock, L.M., Bogaardt, H., Barrera, M.A., Morrow, S., and Gudesblatt, M. (2023). Multiple sclerosis and quality of life: The role of cognitive impairment on quality of life in people with multiple sclerosis. Multiple Sclerosis and Related Disorders, 79:104966. PMID: 37690436
[2] Ofori, E., Delgado, F., James, D.L., Wilken, J., Hancock, L.M., Doniger, G.M., and Gudesblatt, M. (2024). Impact of distinct cognitive domains on gait variability in individuals with mild cognitive impairment and dementia. Experimental Brain Research, 242, 1573–1581. PMID: 38753043
[3] Lutski M, Weinstein G, Ben-Zvi S, Goldbourt U, Tanne D. (2022). Adherence to Mediterranean diet and subsequent cognitive decline in men with cardiovascular disease. Nutritional Neuroscience, 25, 91–99. PMID: 31965911
[4] Kalron, A. (2016). The relationship between static posturography measures and specific cognitive domains in individuals with multiple sclerosis. International Journal of Rehabilitation Research, 39, 249–254. PMID: 27171608
