NeuroTrax Science Team and Glen M. Doniger, PhD
Cognitive decline often first becomes evident with poorer job performance. Before a formal diagnosis of mild cognitive impairment or dementia, employees may struggle with tasks that were previously routine, making the workplace a critical context for understanding early cognitive change. Research shows that difficulties completing work tasks are frequently among the earliest indicators of emerging cognitive impairment, particularly in cognitively demanding roles.
Using the Job Demands and Accommodation Planning Tool framework, a qualitative analysis of interviews with adults living with mild cognitive impairment or young onset dementia identified four broad domains of job demands with reported increased difficulty: cognitive demands, physical demands, working with others, and working conditions [1]. With regard to cognitive demands, employees described challenges with tasks involving recall, sustained concentration, planning and organization, and handling time pressure, all areas that map to core cognitive processes including memory, attention, executive function, and processing speed, even though the study assessed real world experience rather than standardized test performance.
Cognitive decline can also affect physical functioning at work, even in roles that are primarily sedentary. Employees reported increased fatigue, reduced stamina, and difficulty sustaining computer-based tasks for extended periods. This reflects the increased physical cost of cognitive effort, whereby tasks that require sustained attention or concentration become more exhausting over time. In safety-sensitive roles involving driving, machinery, or prolonged vigilance, this combination of cognitive strain and fatigue can raise safety concerns.
Beyond task execution, decline affects workplace interpersonal skills. Employees described increased anxiety, difficulty communicating with colleagues or supervisors, and challenges managing social expectations at work. These interpersonal tensions often accelerate cognitive difficulties, delaying disclosure and consequent accommodation, including clearer communication of expectations and more frequent supervisory check-ins. Also, working conditions, including noisiness, open-plan offices, rigid deadlines, and performance evaluations, intensify cognitive load, accelerating functional decline in real-world job settings [1]. Empirical research further shows that when employers remain unaware of cognitive changes, accommodation is delayed, leaving employees to manage emerging difficulties without adequate organizational support [2].
Notably, cognitively demanding jobs are linked to greater cognitive resilience in older adults, supporting the idea that mentally engaging work may help preserve cognitive function over time. Beyond qualitative analyses of job demands, population studies show that greater mental demands at work are associated with better cognitive performance even in older adults with elevated dementia risk, supporting the idea that cognitively engaging work promotes cognitive resilience [3]. Similarly, research on occupational complexity indicates that roles requiring complex interaction with data, people, or tasks are linked to better long-term cognitive outcomes and slower decline, emphasizing the impact of job design on cognitive aging [4].
Objective measurement of workplace-related cognitive changes is an essential tool for optimizing workplace cognitive health and productivity. Digital neuromarkers like NeuroTrax provide a direct way to quantify decline across cognitive domains that impact job performance, including memory, attention, executive function, and processing speed. In a study of junior physicians, NeuroTrax revealed declines in global cognition, attention, and processing speed after extended work hours and sleep deprivation, illustrating how grueling work conditions can impair cognitive performance even in young healthcare professionals [5].
In sum, cognitive decline manifests across multiple, measurable dimensions of job performance. By combining structured frameworks for understanding job demands with digital neuromarkers like NeuroTrax, organizations and clinicians can identify early changes and leverage the information to tailor workplace accommodations, job adjustments, and support strategies. This approach enables employees to remain productive and engaged while reducing the risk that cognitive challenges will escalate into more serious performance or employment disruptions.
References:
[1] Bak, K., Kokorelias, K., Boger, J., Nygård, L., Issakainen, M., Mäki-Petäjä-Leinonen, A., Nedlund, A.-C., Ryd, C., and Astell, A. (2025). Potential of the Job Demands and Accommodation Planning Tool for individuals working with mild cognitive impairment or dementia. Dementia. DOI: 10.1177/14713012251374204.
[2] Egdell, V., Cook, M., Stavert, J., Ritchie, L., Tolson, D., and Danson, M. (2021). Dementia in the workplace: Are employers supporting employees living with dementia? Aging & Mental Health, 25(1):134–141. DOI: 10.1080/13607863.2019.1667299.
[3] Zülke, A. E., Luppa, M., Röhr, S., Weißenborn, M., Bauer, A., Samos, F.-A. Z., Brettschneider, C., König, H.-H., Scherer, M., Maier, W., and Riedel-Heller, S. G. (2021). Association of mental demands in the workplace with cognitive function in older adults at increased risk for dementia. BMC Geriatrics, 21:688. DOI: 10.1186/s12877-021-02653-5.
[4] Andel, R., Silverstein, M., Kareholt, I., and Parker, M. G. (2015). Complexity of work and risk of Alzheimer’s disease: A population-based study of Swedish twins. Alzheimer’s & Dementia, 11(10):1145–1152. DOI: 10.1016/j.jalz.2014.09.005.
[5] Flinn, F., Armstrong, C., and Walsh, K. (2011). Cognitive performance consequences of sleep deprivation in junior doctors. International Journal for Quality in Health Care, 23(4):346–353. DOI: 10.1093/intqhc/mzr041.
