NeuroTrax Science Team and Glen M. Doniger, PhD

In cognitive assessment, the most meaningful insights are not limited to test scores – they are reflected in how individuals function in daily life. Ecological validity, or the degree to which an assessment relates to real-world outcomes, has become increasingly important in neurology and neurodegenerative disease management. NeuroTrax, a digital neuromarker, demonstrates strong ecological validity by consistent alignment of objective cognitive performance with patient-reported outcomes (PROs), quality of life (QoL), mobility, balance, and long-term functional change.

A clear example comes from recent work examining quality of life in people with multiple sclerosis (PwMS). A 2023 study evaluated 171 PwMS using a computerized cognitive assessment battery alongside validated PRO measures, including the MSIS-29 for QoL, fatigue, and depression scales [1]. While depression and fatigue were strongly associated with QoL, cognitive domains, particularly attention and executive functioning, remained significant predictors of QoL even after controlling for physical disability, fatigue, depression, and demographics. These findings highlight that cognitive impairment independently shapes how patients perceive their well-being and daily functioning, reinforcing the need to include objective cognitive neurometrics alongside PROs when evaluating disease burden and treatment impact.

The link between cognition and everyday physical function is further supported by research on gait variability in individuals with mild cognitive impairment (MCI) and dementia. A case study from 2024 demonstrated that visual–spatial abilities were the strongest cognitive predictor of gait variability during both normal and dual-task walking [2]. Importantly, gait variability is not just a laboratory metric, it is directly associated with fall risk, mobility limitations, and safety in daily life. This study reinforces the ecological relevance of domain-specific cognitive assessment, showing that deficits captured by digital neuromarkers like NeuroTrax translate into measurable changes in real-world movement and independence.

NeuroTrax has also shown sensitivity to long-term lifestyle-related cognitive change. In a longitudinal study of men with cardiovascular disease, adherence to the Mediterranean diet was associated with better baseline cognitive performance and reduced cognitive decline nearly two decades later [3]. Cognitive outcomes were measured using NeuroTrax with particularly strong effects observed in visual spatial processing. These results underscore NeuroTrax’s ability to detect meaningful cognitive differences that align with known lifestyle factors and long-term brain health, an important dimension of ecological validity that extends beyond short-term clinical endpoints.

Balance and postural control provide another real-world lens through which cognition impacts daily life. A study conducted in 2016 examined the relationship between static posturography and specific cognitive domains in PwMS, again using NeuroTrax. It was found that correlations between cognition and balance varied by disability level: executive function and motor skills were most relevant in mildly affected individuals, memory and verbal function in moderate disability, and attention in those with severe disability [4]. This nuanced relationship illustrates how NeuroTrax captures domain-specific cognitive changes that meaningfully relate to functional abilities patients rely on every day.

Taken together, these studies demonstrate that NeuroTrax does more than quantify cognition; it captures cognitive domains that matter to patients’ lived experiences. By aligning objective neurometric performance with PROs, mobility, balance, lifestyle factors, and quality of life, NeuroTrax supports a more patient-centered, ecologically valid approach to cognitive assessment. In clinical care and research alike, this alignment is essential for understanding disease impact, guiding interventions, and ultimately improving outcomes that patients truly feel.

References:

[1] Bergmann, C., Becker, S., Watts, A., Sullivan, C., Wilken, J., Golan, D., Zarif, M., Bumstead, B., Buhse, M., Kaczmarek, O., Covey, T.J., Doniger, G.M., Penner, I.K., Hancock, L.M., Bogaardt, H., Barrera, M.A., Morrow, S., and Gudesblatt, M. (2023). Multiple sclerosis and quality of life: The role of cognitive impairment on quality of life in people with multiple sclerosis. Multiple Sclerosis and Related Disorders, 79:104966. PMID: 37690436

[2] Ofori, E., Delgado, F., James, D.L., Wilken, J., Hancock, L.M., Doniger, G.M., and Gudesblatt, M. (2024). Impact of distinct cognitive domains on gait variability in individuals with mild cognitive impairment and dementia. Experimental Brain Research, 242, 1573–1581. PMID: 38753043

[3] Lutski M, Weinstein G, Ben-Zvi S, Goldbourt U, Tanne D. (2022). Adherence to Mediterranean diet and subsequent cognitive decline in men with cardiovascular disease. Nutritional Neuroscience, 25, 91–99. PMID: 31965911

[4] Kalron, A. (2016). The relationship between static posturography measures and specific cognitive domains in individuals with multiple sclerosis. International Journal of Rehabilitation Research, 39, 249–254. PMID: 27171608

NeuroTrax Science Team and Glen M. Doniger, PhD

With hyperbaric oxygen therapy (HBOT) gaining traction as a targeted intervention for neurological recovery, the field faces an urgent need for a standardized, sensitive, and multidomain cognitive assessment. NeuroTrax has emerged as the clear leader, providing clinicians and researchers with precise, reproducible measurements that capture even subtle neurocognitive changes induced by HBOT. Its widespread adoption across conditions and clinical settings reflects a growing consensus: profiling of neuroplastic alterations begins with NeuroTrax.

A recent scoping review on cognitive assessment in hyperbaric oxygen therapy (HBOT) studies identified NeuroTrax as the most widely used and sensitive computerized test platform across multiple neurological conditions and countries [1]. Of 19 studies that used computerized test batteries, NeuroTrax was the most frequent choice. Notably, 100% of the 14 randomized controlled trials using this platform reported measurable cognitive improvements following HBOT.

The NeuroTrax digital battery evaluates memory, executive function, visuospatial perception, verbal ability, attention, information processing speed, and motor skills, providing standardized, reproducible measures of change. Its multidomain scope and sensitivity make it particularly effective in correlating cognitive recovery with imaging and clinical outcomes.

Notably, the authors of the review concluded that adopting a consistent, multidomain cognitive assessment framework, anchored by validated neuromarkers like NeuroTrax, would enhance comparability across HBOT studies, improve sensitivity to treatment-related changes, and create a flexible foundation for tailoring neurocognitive evaluation to specific patient groups.

Stroke and fibromyalgia are two distinct yet often debilitating neurological conditions that share a common thread: disruption of brain network integrity and function. While traditional therapies frequently plateau in restoring lost function, emerging research shows that HBOT when paired with advanced digital cognitive assessment like NeuroTrax can help unlock the brain’s intrinsic capacity for repair, even years after injury.

A recent case report describes a 45-year-old patient, 15 months post-hemorrhagic stroke, who presented with right-sided weakness, gait disturbance, and cognitive deficits. After completing 83 HBOT sessions (2.0 ATA, 90 minutes each), the patient achieved remarkable clinical and cognitive improvements [2]:

Clinical Outcomes:

• Regained independent walking using a quadruped cane
• Improved strength, coordination, and balance
• Enhanced speech fluency and articulation

Cognitive Outcomes (measured by NeuroTrax):

• +31.2% in verbal memory
• +10.7% in information processing speed
• +8.6% in attention

Imaging Correlates:

• DTI revealed increased white matter integrity
• SPECT imaging showed a +15.9% increase in cerebral perfusion across motor and frontal regions

These findings illustrate how HBOT can reactivate dormant but viable brain tissue, improving metabolic recovery and neuroplasticity. With NeuroTrax, clinicians were able to quantify cognitive gains with objective, reproducible data, aligning improvements across functional, cognitive, and imaging measures.

Another case involved a 62-year-old woman with treatment-resistant fibromyalgia linked to early trauma and persistent for over a decade. After 60 HBOT sessions over 12 weeks, researchers tracked changes using NeuroTrax, MRI-DTI, and SPECT imaging [3].

Clinical Improvements:

• Pain reduction (FIQR score decreased from 60.5 → 44)
• Discontinued Lyrica and reduced Cymbalta by 50%
• Improved sleep and physical endurance

Cognitive Outcomes (measured by NeuroTrax):

• +10% in global cognitive function
• +26.9% in attention

Imaging Findings:

• Enhanced cerebral perfusion in areas related to memory, emotion, and motor control
• Increased white matter integrity

Beyond symptom relief, these results demonstrated true neuroplastic change, repairing dysfunctional brain networks and improving both cognitive and emotional regulation.

Across both conditions, NeuroTrax provided data-driven evidence of neurological improvement, bridging subjective recovery with measurable cognitive and anatomical outcomes. When paired with neuroimaging modalities like SPECT and DTI, NeuroTrax enables clinicians to correlate clinical progress with quantifiable brain activity, strengthening the evidence base for personalized neurorehabilitation.

As the 2025 review illustrates, a standardized, validated assessment approach exemplified by NeuroTrax not only improves methodological consistency but also supports the development of specialized cognitive protocols tailored to specific patient populations as HBOT research evolves.

The integration of HBOT and NeuroTrax marks a turning point in neurological recovery, shifting from symptom management to measurable brain restoration. Together, they allow clinicians to track and validate cognitive and neurophysiological improvements, offering a framework for long-term, evidence-based treatment.

Contact us to learn how NeuroTrax can bring objective, data-driven insights to your clinical practice.

References 

[1] Torp, M., Strøm, C., Arenkiel, B., Miskowiak, K., Norup, A., Efrati, S. and Hyldegaard, O. (2025). Cognitive assessment in the context of hyperbaric oxygen: A scoping review, Journal of Clinical and Experimental Neuropsychology. PMID: 41251096

[2] Khairy, S., Mouzayan, G., Wang, Z., Qureshi, U., Zaitoun, R., and Efrati, S. (2025). Anatomical and metabolic brain imaging correlation of neurological improvements following hyperbaric oxygen therapy—post-stroke recovery: A case report. Journal of Medical Case Reports, 19:493. PMID: 41068989

[3] Mouzayan, G., Khairy, S., Wang, Z., Qureshi, U., Zaitoun, R., and Efrati, S. (2025). Efficacy of hyperbaric oxygen therapy in treating fibromyalgia linked to childhood trauma after late-onset and over a decade of symptoms: A case report. Journal of Medical Case Reports, 19:386. PMID: 40765001