Digital tools for assessing attention and executive functions in adults: a systematic review of validity and accessibility.

OBJECTIVES

Digital testing is being regularly used in neuropsychological research. However, critical questions remain regarding its psychometric robustness, availability, and usability, potentially limiting its clinical impact.

METHODS

This systematic review focused on the characteristics of digital tools for assessing attention and executive functions (EFs), two cognitive domains particularly suitable for being digitally tested. A systematic search was performed across three electronic databases (PubMed, Scopus, Embase). We only included studies performed on adults with validated tools.

RESULTS

Of 2,583 identified records, 236 studies met the inclusion criteria. From those, we extracted information about 107 distinct digital tools, ranging from computerized versions of traditional paper-and-pencil tests to emerging technologies such as virtual reality and eye-tracking hybrid systems. Most tools were administered in person (85%), while only 12% involved remote unsupervised assessment. Information on licensing, normative data, or source code availability was reported for approximately one-third of tools (34.9%). Most operated under paid licensing models, and only 6.5% were freely accessible. Only one had also source code available.

CONCLUSIONS

Several tools are available for assessing attention and EFs; however, most are not widely used. We discuss an imbalance between accessibility and validity whereby standardized batteries are often commercial and not necessarily more validated than less commonly adopted free-access tools. The limited validation of emerging technologies currently prevents their broader implementation. Overall, distinct digital tools offer complementary strengths rather than a single optimal solution. More standardized validation approaches and broader adoption of Open Science practices might support their integration into routine clinical practice.