How Technology Is Reshaping Cognitive Assessment: Lessons From the Framingham Heart Study

Objective: This article elucidates how the Boston process approach (BPA) can amplify the role of neuropsychology in the study of preclinical and clinical dementia, particularly Alzheimer's disease (AD), and how advancements in technology expand BPA capacity objectively and exponentially. Method: The BPA is based on a conceptualization of cognition as being comprised of multiple processes, the nature of which could not possibly be captured by a single score on a test or battery of tests. Identification of these processes is only possible with careful observation of an individual during the entire testing process to determine how, when, and why a person fails, which helps to reveal the integrity of the cognitive processes underlying the behavior. Results: BPA use within the Framingham Heart Study is described, including how digital technology has been incorporated to enhance the sensitivity of BPA to detect insidious onset changes even earlier than had been previously possible. The digital technology movement will dramatically alter the means by which cognitive function is assessed going forward. Conclusions: Technological advances will catalyze groundbreaking discoveries for effective treatments of neurodegenerative cognitive disorders, such as AD, and inform novel strategies for dementia prevention and sustained lifelong cognitive health. General Scientific Summary This article discusses how the Boston process approach enhances the ability to detect changes associated with dementia, particularly Alzheimer's disease (AD). Technology is changing what we do and how we do it, which is expected to catalyze groundbreaking discoveries for effective treatments and prevention of neurodegenerative cognitive disorders, such as AD.