Technological Advances in Detecting and Managing Cognitive Impairment in Older Adults: Trends, Challenges, and Future Directions
As populations age, cognitive decline from mild cognitive impairment (MCI) to dementia is a defining health challenge of the coming decades, yet routine assessment often misses its earliest signs. This article critically synthesizes recent technological advances for detecting and managing cognitive impairment in older adults, spanning neurophysiological signals (chiefly electroencephalography, EEG), structural and molecular neuroimaging (MRI and amyloid/tau PET), blood-based biomarkers, and digital markers, integrated through artificial intelligence (AI), machine learning (ML), and deep learning (DL). Beyond summarizing, it contributes a cross-disciplinary taxonomy, a methodological-rigor lens foregrounding subject- and site-independent validation, an integrative early-detection framework linking tiered screening to intervention, and comparison tables of detection methods, interventions, and risk and protective factors. EEG markers (alpha/theta changes, P300 latency) and deep models (CNNs, LSTM/BiLSTM, transformers, self-supervised EEG foundation models) report strong accuracy, yet many rest on small, single-site datasets unlikely to survive rigorous external validation. Elsewhere, gains are tangible: plasma p-tau217 has reached clinical utility, with the first blood test cleared to aid Alzheimer's diagnosis in 2025; anti-amyloid therapies (lecanemab, donanemab) are approved despite modest, contested benefits; and multidomain lifestyle prevention has matured. Wearable, remote, speech, and virtual-reality tools enable continuous, ecologically valid monitoring, and multimodal fusion improves sensitivity and specificity. Barriers remain: standardization, explainability, data privacy, and equitable, externally validated deployment. The field's near-term promise lies in trustworthy, multimodal, longitudinally validated systems linking early detection to actionable, personalized care.