As the global population ages, the challenges associated with cognitive decline become more prominent. Beyond economic implications and labor shortages, issues such as dementia and postoperative delirium — a debilitating condition associated with cognitive decline, dementia, and increased risk of mortality — present immediate, real-world concerns.

However, cutting-edge technologies are emerging to address these challenges, with companies developing novel tools designed to detect, prevent, and manage cognitive decline.

In Japan, where 29% of the population is over 65 and more than 6 million people live with dementia, the impact of an aging society on road safety is a growing concern. To address this issue, the UK software company Mind Foundry, in collaboration with the insurance giant Aioi Nissay Dowa Insurance, is building artificial-intelligence tools to detect cognitive decline in older drivers.

Through an analysis of ANDI's extensive dashcam data covering 9 million miles of road and using Mind Foundry's machine-learning models, the two companies have developed an AI system to identify subtle patterns indicative of cognitive decline. This not only has the potential to aid in preventing road accidents but also allows for personalized insurance plans based on a person's cognitive age.

By identifying the 5% of customers responsible for 50% of the most expensive claims, the technology has the potential to significantly alter how insurers understand and manage risk, the companies say.

"Traditionally, insurers have relied heavily on details such as the type of car, driver age, and location to predict those likely to be involved in the most serious accidents and to set insurance premiums," Mind Foundry CEO Brian Mullins said. "Mind Foundry's AI system goes much further in order to understand more subtle, hidden patterns in the data that can help to underwrite these risks."

The AI system studied numerous behavior patterns, such as harsh braking, erratic swerving, and sudden acceleration among drivers who had been in the most severe, large-loss accidents. It then analyzed similar patterns among a different set of older drivers to identify which risk factors could predict cognitive decline before it became dangerous.

Mullins said: "To ensure ethical practices, humans are involved in the decision-making process. AI doesn't make the decision. Rather, it informs the insurance experts about the potential customer's risks before determining the coverage and pricing for that individual."

Elsewhere, PIPRA AG, a medtech startup in Zurich, has developed an AI-based tool called PIPRA to predict postoperative delirium in people over 60 undergoing surgery.

"POD is a terrible condition, with symptoms that include agitation or profound inactivity, as well as changes to a person's attention, awareness, and cognitive ability," PIPRA CEO John Klepper told Business Insider. "It is also associated with an increase in postsurgery falls, longer hospital stays, increased nursing-home admissions, hospital readmissions, cognitive decline, dementia, and increased mortality."

It was Klepper's mother's experience after surgery that led him to his research. "For days, she saw monsters coming out of the hospital walls and thought the hospital staff were trying to kill her," he said. "While she was fortunate enough to 'recover fully,' she has a type of PTSD from the experience and, to this day, is still terrified of hospitals."

PIPRA's predictive tool uses AI algorithms that analyze clinical information routinely collected by healthcare professionals.

"In an ideal world, I would like to see our solution being integrated into healthcare facilities in every country," Klepper said. "That way, we will be creating measurable global impact and improving and saving the lives of millions.

"POD is one of the biggest and most expensive problems in healthcare. For scale, POD costs 60% more to healthcare providers than diabetes and affects at least 60 million around the world each year. However, it is often ignored."

Cognitive-fitness tech doesn't always have to be reactive. Incisiv, a Belfast-based neurotech company founded by Cathy Craig, a member of the Royal Academy of Engineering Enterprise Hub, focuses on monitoring neural fitness — how well the brain controls movement and makes decisions — using virtual-reality technology.

With applications in sports and beyond, Incisiv's technology has been adopted by world-leading sports teams, including the Italian Rugby Federation and the Elite Ice Hockey League.

In contrast to traditional concussion assessments, which involve questionnaires or symptom checklists, Incisiv's virtual-reality tests provide a more nuanced understanding of brain health. By measuring players' interactions with and processing of information at a finer level, the technology allows for a comprehensive assessment of cognitive function.

Incisiv aims to bring this technology into homes, enabling parents to monitor their children's brain health from a young age. In the context of children's sports, the tech can look at the brain before and after a game and flag any discrepancies, allowing parents and coaches to ensure safe playing.

The convergence of AI, medical technology, and neurotech is leading the fight against cognitive decline. From detecting subtle patterns in driving behavior to predicting postoperative delirium and monitoring neural fitness, these technologies offer a glimpse into a future where cognitive decline is not just managed but also prevented.

As these innovations continue to evolve, the potential to transform individual lives and alleviate the strain on healthcare systems globally becomes increasingly evident.

Correction: November 17, 2023 — A previous version of this article misstated Cathy Craig's role with the Royal Academy of Engineering Enterprise Hub. She is a member of the group, not a professor there.