Technological neuropsychology: Assessing cognition in a digital world

Abstract

Clinical neuropsychology was forged in a pre-digital era, and many of its core instruments still bear that imprint. Patients are still commonly assessed with paper-and-pencil tests in quiet rooms, under conditions that only weakly approximate the technology-saturated environments in which cognition is now expressed. Over the past decade, the field has advanced substantially: tele-neuropsychology has broadened access, artificial intelligence has begun to support scoring and documentation, and calls to modernise neuropsychological assessment have intensified. Yet these developments, while important, largely optimise the delivery of existing practice rather than reconsidering what should be measured, why, and how. Here, I argue that three critical gaps remain. First, neuropsychology lacks a framework for assessing technological cognition. Second, candidate neuroimaging measures remain insufficiently integrated into multimodal diagnostic or prognostic modelling. Third, digital data from smartphones and wearables remain underused for capturing cognition in situ during everyday life, while virtual reality remains underexploited as a means of simulating ecologically relevant activities under controlled conditions. Drawing on preliminary evidence that digital technologies may recruit partly distinct neural systems, on the recent hub-and-processors model of technological cognition, and on research into cognitive offloading, attention fragmentation, technology-mediated navigation, as well as on recent meta-analytic evidence on technology use in cognitive ageing, I outline a roadmap for addressing these gaps. I propose that the field now requires a Cognitive Neuroscience of Technology programme, conceived as an interdisciplinary, lifespan-oriented research framework aimed at understanding how technologies recruit, extend, and reshape the human brain, and at translating this knowledge into clinical practice. The task is not to celebrate or condemn modern technologies, but to determine, patient by patient, when they augment cognition, compensate for impairment, or undermine cognitive function, and to redesign assessment, diagnosis, and rehabilitation accordingly.