Fall 2025

Fall 2025 Issue

Technology: Technology and the Aging Brain
By Keith Loria
Today’s Geriatric Medicine
Vol. 18 No. 4 P. 28

Can Apps and AI Tools Delay Cognitive Decline?

For many older adults, the fear of memory loss and dementia looms large. In fact, with the number of mild cognitive impairment (MCI) cases climbing alongside the aging population, researchers, clinicians, and technology developers are exploring whether digital interventions can help preserve mental sharpness.

Currently, a great deal of research is being done on brain-training apps, virtual assistants, and wearable trackers. While some of these studies show early promise, many experts caution that enthusiasm should not outpace the actual evidence.

“Research shows that high-quality cognitive training apps can enhance short-term memory, information processing speed, and planning skills,” explains John Showalter, chief operating officer of Boston-based Linus Health. “But not all brain-training tools are created equal. Many available apps lack the scientific rigor needed to deliver measurable benefits, making it essential for users to choose wisely.”

The big question then is whether these digital tools can truly alter the trajectory of cognitive decline or whether the benefits remain limited to small, short-term improvements. Many stress the need for careful evaluation before older adults invest time, money, and hope into technologies that may or may not deliver on their promises.

Brain-Training Apps
Brain-training apps have become one of the most visible interventions marketed to older adults. After all, the idea is appealing; you just spend a few minutes a day on structured cognitive exercises designed to keep the mind sharper for longer. Still, the scientific record has so far been mixed.

A 2023 meta-analysis cited by Guadalupe Hayes-Mota, a biotech innovator at the Markkula Center for Applied Ethics, found “statistically significant improvements in global cognition, as well as in specific domains such as attention, memory, and visuospatial perception” for older adults using computerized cognitive training. However, the effects varied by skill, with little evidence for gains in executive function.

“These findings highlight brain-training apps as a promising, evidence-based, and scalable approach to help slow cognitive decline in older adults with MCI,” Hayes-Mota notes. “But the improvements are domain-specific and we don’t yet know how long they last.”

William Mansbach, CEO of Counter-Point Health Services, notes there needs to be caution not to confuse engagement with efficacy. “Just because someone enjoys an app doesn’t mean it has a measurable impact on slowing decline,” he says.

Consistency is the most critical part, Showalter says, explaining even with top-tier platforms, studies suggest that cognitive training must be used consistently, typically for at least 60 minutes, four or more times per week to achieve meaningful results.

Even so, many trials show only modest improvements, and critics argue that getting better at an app is not the same as improving daily functioning.

Michelle Dees, a psychiatrist and geriatric expert and owner of Luxury Psychiatry in Orlando, believes the limitations are clear. “Digital interventions alone have shown limited efficacy, particularly when it comes to long-term slowing of cognitive decline,” she says. “While some short-term gains in attention and memory have been observed, they often fail to translate into meaningful improvements in daily functioning.”

Newer approaches try to overcome these limits by combining digital training with other interventions. For instance, Dees points to research pairing repetitive transcranial magnetic stimulation (rTMS) with computerized training.

“Working memory improvements were observed only in the group receiving both rTMS and cognitive training,” she says. “That suggests neural stimulation may enhance responsiveness to digital tools.”

Wearables and Virtual Assistants
While brain-training apps focus on specific cognitive skills, wearable devices and virtual assistants have been designed to support daily routines, which are necessary for maintaining independence. These tools offer reminders, monitoring, and prompts that can reduce the burden on memory and executive function.

“Virtual assistants and wearable devices offer valuable support for cognitive health by helping older adults manage routines, medication adherence, sleep, and physical activity,” Dees says. “However, these tools primarily address behavioral components rather than targeting the underlying neural mechanisms of cognitive decline.”

Still, they are both valuable and could be game changers of the future. After all, virtual assistants provide 24/7 support, medication reminders, and mood tracking, while wearables deliver real-time biofeedback and early detection of cognitive decline.

“Compared to traditional methods like cognitive behavioral therapy or physical therapy, digital tools can reach more people at lower cost but may lack the depth of therapeutic connection and long-term validation,” Hayes-Mota says.

According to Showalter, parallels can be drawn from other conditions. “Remote patient monitoring and virtual assistant programs have proven effective in managing chronic conditions such as hypertension and diabetes,” he shares. “Given that lifestyle modification remains the most effective approach for mitigating cognitive impairment, it’s reasonable to expect these digital tools could offer similar benefits in supporting cognitive health.”

Some of the most promising tools that are out there build on the evidence for physical activity. For instance, virtual programs such as Moving Together, a platform combining movement, mindfulness, music, and social interaction, have shown improvements in stress levels and quality of life for people with cognitive decline.

“By making physical activity more accessible and trackable, digital tools may help more patients take critical steps toward improving their brain health,” Showalter says.

Barriers to Adoption
Despite a lot of enthusiasm throughout the health care industry, evaluating digital interventions for cognitive health remains challenging. One problem is that traditional tools for classifying impairment—like the Mini-Mental State Examination or Montreal Cognitive Assessment—often reduce cognitive status to a simple “impaired or not impaired” score.

“This oversimplification can yield misleading results and obscure meaningful insights,” Showalter explains. “For instance, individuals with memory impairment present very different symptoms from those with deficits in executive function or planning. If a study includes too few participants with memory-specific issues, interventions targeting memory loss may appear ineffective when in reality, the study is underpowered for that subgroup.”

Hayes-Mota highlights a few other methodological blind spots that people need to be aware of. “Many trials involve small sample sizes, inconsistent protocols, and short follow-ups, which limit our understanding of long-term efficacy,” he says. “Blinding is another concern; expectancy effects can easily influence outcomes.”

Then, the tools themselves may impose cognitive burdens. Many older adults, especially those with MCI, struggle with short-term memory or difficulty processing complex instructions.

“Virtual platforms often require time-consuming explanations, and even then, digital literacy can be a major barrier,” Dees shares.

Finally, accessibility can also shape outcomes. Features such as voice navigation, adjustable text sizes, and simplified interfaces can make tools easier to adopt, but support from caregivers and clinicians is often just as important.

“One of the overlooked risks is frustration,” says Jennifer Smith, director of aging services at the National Council on Aging. “If a tool is too complicated or doesn’t deliver immediate value, many older adults will abandon it quickly. Simplicity is key.”

Risks and Ethical Considerations
Looking past the questions of efficacy, many experts warn that there are risks tied to over-reliance on AI-driven health tools. What’s more, many apps lack rigorous validation and aggressive marketing, which is happening more and more, and can raise false expectations.

“The greatest concerns lie in wasted time, effort, and financial resources,” Showalter says. “Despite being safe and widely accessible, many digital platforms are unproven, time-consuming, and costly.”

Hayes-Mota warns that risks extend beyond effectiveness. “AI and app-based tools hold promise, but without strong safeguards for privacy, accuracy, equity, and human oversight, they risk doing more harm than good,” he shares. “These technologies can lead to diagnostic inaccuracies and undermine the therapeutic alliance essential in mental health care.”

Over-reliance on these technologies can delay clinical diagnosis or treatment if users assume the apps alone are sufficient. The quality and scientific validation of these tools vary widely, and sustained use demands motivation and cognitive capacity, which can be challenging for individuals experiencing decline.

“Technology can be a bridge, but not a replacement for human interaction,” Smith says. “Older adults often benefit most when digital tools are combined with regular social engagement.”

Keep in mind, large-scale, independent validation studies are rare in this space, which is why Mansbach cautions that until those are more common, clinicians should be careful about recommending specific products.

Guidelines for Moving Forward
A balanced, evidence-based approach is needed if apps and AI are going to become more prominent in the field.

“The most important step is understanding how an individual’s brain is functioning so that cognitive health strategies can be tailored to that person’s needs,” Showalter says. “Establishing a baseline through digital cognitive assessments in primary care can help detect changes early and match patients with the right tools.”

That’s why tools with proven efficacy should be recommended based on individual needs and goals and clearly positioned as supplements rather than substitutes for foundational health practices like exercise, sleep, and social engagement.

“Pairing digital tools with evidence-based clinical practices such as structured exercise programs and medication management will consistently yield the best results,” Dees says.

Cautious Optimism
The research landscape is still evolving. As larger, longer-term trials emerge, a clearer picture will form of which digital interventions truly help slow cognitive decline and which merely improve test scores without real-world impact.

“There’s no question that technology is one of the most promising frontiers in cognitive health,” Showalter asserts. “But it has to be grounded in rigorous science and integrated into comprehensive care.”

Hayes-Mota agrees, noting that digital tools can enhance cognitive and social well-being for older adults, but their success hinges on accessibility, literacy, and engagement. “Without thoughtful design and safeguards, the very people who need them most risk being left behind,” he says.

For older adults and caregivers navigating this growing marketplace of apps and devices, the best advice is to stay cautious but open-minded.

“Use technology to reinforce proven habits—like movement, social connection, and routine—rather than replace them,” Dees shares. “Seek out tools backed by independent research and consult clinicians before making them central to a care plan. Digital tools offer many benefits but also present potential risks. The key is not to see them as replacements, but as complementary supports in a broader strategy to maintain brain health and quality of life.”

— Keith Loria is a freelance writer based in Oakton, Virginia.