NeuroTrax Science Team and Glen M. Doniger, PhD
Video Summary: https://youtu.be/Xt8amo6sZBI
Among the most consequential barriers to early detection of cognitive decline is the patient’s inability to recognize that a problem exists. Impaired self-awareness, often referred to as anosognosia, is the diminished ability to recognize one’s own cognitive, memory, or functional deficits. In a recent randomized controlled trial of older adults with mild cognitive impairment (MCI), 54 participants demonstrated impaired awareness at baseline. Patients who overestimate their abilities may delay seeking care or resist strategies intended to protect their safety and independence (1). Impaired self-awareness is also observed across neurodegenerative conditions, including Parkinson’s disease, reinforcing its broader clinical relevance (2).
This creates a fundamental challenge for clinicians. When subjective self-report is compromised, informal questioning alone may not provide an accurate picture of cognitive health. The problem is particularly important in primary care, where the Medicare Annual Wellness Visit creates an opportunity for early detection. Although approximately 80% of surveyed beneficiaries reported completing an Annual Wellness Visit, only 31% reported receiving a structured cognitive assessment (3). Patients at elevated risk were no more likely to receive one.
Objective digital neurometrics can help close this gap. NeuroTrax quantifies performance across multiple cognitive domains and compares results with age- and education-adjusted normative data. A validated 30-minute battery has demonstrated the ability to distinguish cognitively healthy adults, individuals with MCI, and those with mild dementia, providing clinicians with an efficient and interpretable cognitive profile (4). Rather than depending exclusively on what a patient notices or reports, clinicians gain an objective benchmark for discussing cognitive strengths, weaknesses, and changes over time.
The clinical value of that benchmark is highlighted by Dwolatzky and colleagues’ 2026 randomized controlled trial. The study assigned 114 older adults with MCI to the Feuerstein Instrumental Enrichment (FIE) metacognitive training program or one of two active control groups. Self-awareness was measured as the absolute discrepancy between objective NeuroTrax memory performance and subjective symptom appraisal on the CogSym questionnaire. A larger discrepancy indicated that the participant’s perception was less consistent with objective performance.
Among participants with impaired awareness at baseline, 15 weeks of FIE training reduced the discrepancy score from 1.58 to 0.87, a statistically significant improvement with a large effect size. The improvement was maintained at the two-month follow-up, while gains in the active control groups were minimal and not sustained (1). The clinical implication is important: self-awareness in MCI may be modifiable, but recalibration requires an objective, standardized benchmark against which personal perceptions can be evaluated.
NeuroTrax provides that benchmark through standardized multidomain testing, automated scoring, and immediately available clinical reports. Its established validity supports the detection of MCI, while alternate forms support repeated assessment with reduced practice effects (5,6). Periodic testing can therefore help clinicians distinguish subjective concern from measurable impairment and identify change before it becomes obvious through a major functional failure.
Making cognitive change visible can support earlier evaluation of reversible contributors, timely referral for specialist assessment, initiation of cognitive or lifestyle interventions, and informed conversations about medication management, financial decisions, driving, and fall prevention. Digital neurometrics do more than identify cognitive decline. They provide an objective anchor that can help patients, families, and clinicians recognize it, respond to it, and preserve autonomy for as long as possible.
References:
[1] Dwolatzky, T., Devisheim, H., Feuerstein, R.S., and Cohen, S. (2026). Enhancing self-awareness in older adults with mild cognitive impairment: A preliminary randomized controlled trial of the Feuerstein Instrumental Enrichment program. International Journal of Geriatric Psychiatry, 41(9), e70256. DOI: 10.1002/gps.70256
[2] Maier, F., Greuel, A., Hoock, M., Kaur, R., Tahmasian, M., Schwartz, F., Csoti, I., Jessen, F., Drzezga, A., van Eimeren, T., Timmermann, L., and Eggers, C. (2023). Impaired self-awareness of cognitive deficits in Parkinson’s disease relates to cingulate cortex dysfunction. Psychological Medicine, 53(4), 1244–1253. DOI: 10.1017/S0033291721002875
[3] Liu, Y., Ozawa, T., and Mattke, S. (2025). Usage patterns of cognitive assessments during Medicare’s Annual Wellness Visit: A national survey. Alzheimer’s & Dementia, 21(2), e14539. DOI: 10.1002/alz.14539
[4] Doniger, G.M., Zucker, D.M., Schweiger, A., Dwolatzky, T., Chertkow, H., Crystal, H., and Simon, E.S. (2005). Towards practical cognitive assessment for detection of early dementia: A 30-minute computerized battery discriminates as well as longer testing. Current Alzheimer Research, 2(2), 117–124. DOI: 10.2174/1567205053585792
[5] Dwolatzky, T., Whitehead, V., Doniger, G.M., Simon, E.S., Schweiger, A., Jaffe, D., and Chertkow, H. (2003). Validity of a novel computerized cognitive battery for mild cognitive impairment. BMC Geriatrics, 3, 4. DOI: 10.1186/1471-2318-3-4
[6] Schweiger, A., Doniger, G.M., Dwolatzky, T., Jaffe, D., and Simon, E.S. (2003). Reliability of a novel computerized neuropsychological battery for mild cognitive impairment. Acta Neuropsychologica, 1(4), 407–413.
