The past and future of neuropsychological assessment: Back to the origins to face digital technological changes.

Clinical Snapshot

Key Findings

• P Value: Not applicable — no statistical analyses performed

• Effect Size: Not applicable — no quantitative effect sizes reported

• Primary Outcome: Conceptual synthesis arguing that digital and AI-based neuropsychological assessment tools must be integrated within a comprehensive, clinician-supervised framework rather than deployed autonomously; historical review demonstrates that the core principles of neuropsychological assessment — clinical observation, individualised testing, and multimodal data integration — remain foundational regardless of technological advances

• Nnt Or Sensitivity: Not applicable — narrative review; no diagnostic accuracy, NNT, or hazard ratio data presented

• Confidence Interval: Not applicable — no confidence intervals reported

Clinical Application

The conceptual framework proposed is feasible to implement in well-resourced clinical settings with access to trained neuropsychologists. However, the recommendation for expert clinician oversight of all digital assessments may be challenging in primary care, rural, and resource-limited settings where specialist access is constrained. The paper does not provide implementation guidance or resource requirements. In Australia, neuropsychological assessment for dementia is supported through Medicare Benefits Schedule (MBS) items for cognitive assessment and specialist consultations. The RACGP and Dementia Australia advocate for comprehensive, multidisciplinary assessment approaches consistent with the paper's recommendations. The TGA regulates software as a medical device (SaMD), including digital cognitive assessment tools, under the Therapeutic Goods Act 1989, and the 2021 SaMD framework is directly relevant to the risks the authors identify. The Australian Digital Health Agency's work on AI in healthcare and the National Dementia Action Plan 2024–2034 provide policy context. Workforce shortages in neuropsychology, particularly in regional and remote Australia, make the tension between digital scalability and expert oversight especially pertinent. PBS does not currently list pharmacological agents specifically for digital assessment facilitation, but cholinesterase inhibitors and memantine remain PBS-listed for Alzheimer's disease management, underscoring the clinical importance of accurate diagnostic assessment. Neuropsychologists, neurologists, geriatricians, and allied health professionals involved in the cognitive assessment of patients with suspected or confirmed dementia; also relevant to clinicians evaluating digital cognitive screening tools for use in memory clinics and primary care settings

Abstract

BACKGROUND: The procedures used for the neuropsychological assessment of patients with dementia have been undergoing significant transformations relating to technological developments and the diffusion of artificial intelligence tools. OBJECTIVES: The integration of a theoretical position and a practical approach is needed in clinical contexts so that newly available tools can enhance the fundamental principles underlying neuropsychological assessment. METHODS: Following a historical review of the various approaches to neuropsychological assessment, an analysis of the risks associated with the introduction of digital techniques, when not supervised by expert clinicians, is presented. The need to integrate new technologies in a comprehensive assessment involving clinical observation, ad-hoc tests, and other sources of information such as neuroimaging and neurophysiological data is discussed. RESULTS: The integration of new technologies with a clinical, personalised approach to the patient represents a challenge for neuropsychology that deserves ad-hoc research and discussion.

References

1. 1.Gasparini, M., Vanacore, N., & Moro, V. (2026). The past and future of neuropsychological assessment: Back to the origins to face digital technological changes. Neurological Sciences: Official Journal of the Italian Neurological Society and of the Italian Society of Clinical Neurophysiology. Advance online publication. https://doi.org/10.1007/s10072-025-08234-5