NeuroTrax Science Team and Glen M. Doniger, PhD

Though cognition and motor function are often treated as separate, they are inextricably linked. Attention, executive control, and visual spatial processing are critical in enabling us to move about effectively – maintaining balance and stability while turning, negotiating obstacles, and dual tasking. Thus compromised mobility can be an indicator of cognitive changes, and motor stressors can sometimes expose cognitive vulnerability. Objective, repeatable cognitive measurement is a practical way to connect these dots, especially when considered along with mobility outcomes. NeuroTrax, a digital neuromarker, was built for exactly this purpose: standardized quantification of cognition so changes can be readily tracked over time. [1–3]

A case in point comes from research in people with mild cognitive impairment (MCI) and dementia: when multidomain cognitive function was analyzed in relation to gait variability, visual spatial ability emerged as the only domain with a meaningful predictive relationship, suggesting that gait instability may be driven by a specific deficit in how the brain processes space and visual context. [1] The crucial implication is that when visual spatial abilities are compromised, everyday navigation may become less efficient, potentially increasing the risk of missteps or falls.

The cognition-motor link becomes even more apparent while multitasking. Dual-task walking studies in Parkinson’s disease (PD) show that certain components of gait are attention-demanding, helping account for deterioration in performance when people must simultaneously walk and engage in a cognitive task. [4] Related work attributes freezing of gait to dysfunction in the prefrontal cortex and uses NeuroTrax to demonstrate how motor symptoms may reflect disruption in frontally mediated cognitive control. [5] A five-year prospective study found that although cognition generally declines over time across PD subtypes, executive function worsened more in the postural instability/gait difficulty phenotype than in tremor-dominant PD, highlighting the value of longitudinal, domain-level tracking in subtyping. [2] Critically, balance and gait measures predict longer-term cognitive outcomes, suggesting a central role for movement metrics in risk stratification. [6] 

NeuroTrax is widely used in neurologic research to quantify attention, executive function, memory, processing speed, visual spatial ability, verbal function, and motor skills with domain scores standardized for age and education. Versatility and uniformity of the platform are important because cognition and motor function can vary to differing degrees depending on such factors as health status, environment, and task demands. NeuroTrax gives clinicians and researchers a consistent cognitive metric to consider alongside mobility, balance, or functional outcomes, supporting three practical clinical needs: baseline characterization [1,3], change detection [2], and intervention measurement [7,8].

Brain health is functional health (see: https://neurotrax.com/news/30). When cognition is measured in tandem with motor performance, the clinical profile becomes more nuanced and relevant, indicating which domains change, under which real-world conditions, and with what practical consequences. The emergent specificity enables better monitoring, targeted therapy, and clearer conversations with patients and caregivers. NeuroTrax helps bridge cognition and motor function with reliable data that transforms subjective impression into measurable clinical trajectories. 

References:

[1] Ofori, E., Delgado, F., James, D.L., Wilken, J., Hancock, L.M., Doniger, G.M., 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. doi: 10.1007/s00221-024-06832-9. PMID: 38753043

[2] Arie, L., Herman, T., Shema-Shiratzky, S., Giladi, N., and Hausdorff, J.M. (2017). Do cognition and other non-motor symptoms decline similarly among patients with Parkinson’s disease motor subtypes? Findings from a 5-year prospective study. Journal of Neurology, 264, 2149–2157. doi: 10.1007/s00415-017-8605-x. PMID: 28879438

[3] Jacob, Y., Rosenberg-Katz, K., Gurevich, T., Helmich, R.C., Bloem, B.R., Orr-Urtreger, A., Giladi, N., Mirelman, A., Hendler, T., and Thaler, A. (2019). Network abnormalities among non-manifesting Parkinson disease related LRRK2 mutation carriers. Human Brain Mapping, 40, 2546–2555. doi: 10.1002/hbm.24543. PMID: 30793410

[4] Yogev, G., Giladi, N., Peretz, C., Springer, S., Simon, E.S., and Hausdorff, J.M. (2005). Dual tasking, gait rhythmicity, and Parkinson’s disease: Which aspects of gait are attention demanding? European Journal of Neuroscience, 22, 1248–1256. doi: 10.1111/j.1460-9568.2005.04298.x. PMID: 16176368

[5] Dagan, M., Herman, T., Mirelman, A., Giladi, N., and Hausdorff, J.M. (2017). The role of prefrontal cortex in freezing of gait in Parkinson’s disease: Insights from a deep repetitive transcranial magnetic stimulation exploratory study. Experimental Brain Research, 235, 2463–2472. doi: 10.1007/s00221-017-4981-9. PMID: 28509934

[6] Ben Assayag, E., Shenhar-Tsarfaty, S., Korczyn, A.D., Kliper, E., Hallevi, H., Shopin, L., Auriel, E., Giladi, N., Mike, A., Halevy, A., Weiss, A., Mirelman, A., Bornstein, N.M., and Hausdorff, J.M. (2015). Gait measures as predictors of poststroke cognitive function: Evidence from the TABASCO study. Stroke, 46, 1077–1083. doi: 10.1161/STROKEAHA.114.007346. PMID: 25677599

[7] Dunsky, A., Unger, L., Carasso, R., and Fox, O. (2023). The effect of a single session of balance and coordination training on cognitive function in older adults. Applied Sciences, 13:3598. doi: 10.3390/app13063598.

[8] Milman, U., Atias, H., Weiss, A., Mirelman, A., and Hausdorff, J.M. (2014). Can cognitive remediation improve mobility in patients with Parkinson’s disease? Findings from a 12 week pilot study. Journal of Parkinson’s Disease, 4, 37–44. doi: 10.3233/JPD-130321. PMID: 24322063

NeuroTrax Science Team and Glen M. Doniger, PhD

Cognitive impairment is one of the most disruptive and persistent consequences of cancer and its treatment. Across tumor types, including non-central nervous system (non-CNS) cancers, breast cancer, pediatric leukemia, glioma, and glioblastoma multiforme (GBM), patients frequently report changes in attention, executive function, memory, visual spatial perception, and information processing speed. These deficits can interfere with work, independence, and overall health-related quality of life (HRQoL).

In non-CNS cancer survivors, it was found that up to 40% report persistent neuropsychological difficulties years after treatment [1]. Their six-month vocational rehabilitation program did not significantly change objective cognitive scores, yet emotional functioning improved and 67% of participants returned to employment compared to 33% of controls. This underscores a critical point: measurable cognitive change and functional recovery do not always move in parallel; both must be assessed.

Among breast cancer survivors, cognitive concerns affect up to 75% of patients [2]. Objective testing has shown that obesity is associated with poorer information processing speed and higher odds of impairment [2], while moderate-to-vigorous physical activity correlates positively with faster processing speed, particularly in overweight and obese survivors [3]. Further, longer sleep duration in survivors is linked to better verbal functioning [2]. However, randomized trials of weight loss and metformin have not demonstrated broad cognitive improvement, although baseline BMI may modify outcomes in verbal domains [4]. These findings highlight the importance of domain-specific measurement rather than relying on subjective complaints alone.

Long-term survivors of pediatric leukemia similarly demonstrate persistent cognitive and HRQoL deficits, with nearly 28% impaired in at least one neuropsychological domain [5]. In neuro-oncology, cognitive tracking has clarified treatment effects: after resection and stereotactic radiosurgery for brain metastases, global cognitive performance remained stable at three months [6]; after low-grade glioma surgery, postoperative ischemic complications were associated with transient but measurable domain-specific changes [7]. In advanced palliative settings, such as anterior cingulotomy for refractory oncologic pain, significant pain relief occurred without meaningful global cognitive decline when assessed objectively [8]. In GBM, longitudinal neuropsychological testing has demonstrated postoperative cognitive improvement with parallel HRQoL gains [9].

Across these contexts, one conclusion is consistent: oncology care requires precise, longitudinal cognitive measurement. Cancer-related cognitive impairment (“chemo brain”) cannot be reliably monitored by subjective report alone. NeuroTrax provides a standardized, computerized neuropsychological battery capable of quantifying: memory, executive function, attention, information processing speed, visual spatial, and other cognitive domains with age- and education-adjusted norms.

In oncology settings, NeuroTrax is a digital neuromarker that can:

• Establish baseline cognitive function before treatment, facilitating differentiation between pre-existing vulnerability and treatment-related decline.
• Monitor cognitive changes during chemotherapy, radiation, or neurosurgical care, detecting subtle domain-specific shifts that may not appear on brief screening tools.
• Document recovery during survivorship, providing objective data that supports return-to-work decisions, rehabilitation planning, and patient reassurance.

Instead of relying solely on clinical impression, clinicians can track chemo brain with precision, measuring change over time and grounding case management decisions in data rather than perception alone. For patients, this offers clarity, validation, and confidence. For clinicians, it provides actionable insights across the cancer trajectory.

As survivorship becomes more prevalent and quality of life central to oncology care, integrating objective neurocognitive measurement with HRQoL assessment ensures that cognitive health is treated as a measurable, manageable component of comprehensive cancer care.

References:

[1] Bloch A, Sharoni L, Shany-Ur T, Maril S, Margalit D. Feasibility and initial assessment of a holistic neuropsychological day program for vocational rehabilitation following non-central nervous system cancer. Front Psychol. 2025;16:1415038. doi:10.3389/fpsyg.2025.1415038.

[2] Hartman SJ, Marinac CR, Natarajan L, Patterson RE. Lifestyle factors associated with cognitive functioning in breast cancer survivors. Psychooncology. 2015;24(6):669–675. doi:10.1002/pon.3626.

[3] Marinac CR, Godbole S, Kerr J, Natarajan L, Patterson RE, Hartman SJ. Objectively measured physical activity and cognitive functioning in breast cancer survivors. J Cancer Surviv. 2015;9(2):230–238. doi:10.1007/s11764-014-0404-0.

[4] Hartman SJ, Nelson SH, Marinac CR, Natarajan L, Parker BA, Patterson RE. The effects of weight loss and metformin on cognition among breast cancer survivors: Evidence from the Reach for Health study. Psychooncology. 2019;28(8):1640–1646. doi:10.1002/pon.5129.

[5] Chiou SS, Jang RC, Liao YM, Yang P. Health-related quality of life and cognitive outcomes among child and adolescent survivors of leukemia. Support Care Cancer. 2010;18(12):1581–1587. doi:10.1007/s00520-009-0781-5.

[6] Berger A, Strauss I, Ben Moshe S, Corn BW, Limon D, Shtraus N, Shahar T, Kanner AA. Neurocognitive evaluation of brain metastases patients treated with post-resection stereotactic radiosurgery: A prospective single arm clinical trial. J Neurooncol. 2018;140(2):307–315. doi:10.1007/s11060-018-2954-x.

[7] Berger A, Tzarfati G, Costa M, Serafimova M, Korn A, Vendrov I, Alfasi T, Krill D, Aviram D, Ben Moshe S, Kashanian A, Ram Z, Grossman R. Incidence and impact of stroke following surgery for low-grade glioma resection. J Neurosurg. 2019;134(1):153–161. doi:10.3171/2019.10.JNS192301.

[8] Strauss I, Berger A, Ben Moshe S, et al. Double anterior stereotactic cingulotomy for intractable oncological pain. Stereotact Funct Neurosurg. 2017;95(6):400–408. doi:10.1159/000484613.

[9] Morga R, Moskała M, Adamek D, Góral-Półrola J, Herman-Sucharska I, Pąchalska M. Health-related quality of life following neurosurgery on glioblastoma multiforme (GBM). Acta Neuropsychol. 2018;16(3):307–319. doi:10.5604/01.3001.0012.7452.

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.