Handwriting speed among possible signs of cognitive decline in older people

Handwriting requires a combination of fine motor control and a complex set of mental skills, such as selecting, organizing, and interpreting sensory information, making it a cognitively challenging task. Because of its high demand on the brain, it is a potential marker of cognitive decline, especially as we age. Then, our handwriting often becomes slower or choppier.

Now, in a new Frontiers in Human Neuroscience study, a team of researchers in Portugal has examined if different handwriting features, including speed and stroke organization, differ between older people who show signs of cognitive decline and those who don’t and if handwriting features could therefore serve as a diagnostic tool.

“Writing is not just a motor activity, it’s a window into the brain,” said senior author Dr Ana Rita Matias, an assistant professor at the Department of Sport and Health at the University of Évora. “We found that older adults with cognitive impairment displayed distinct patterns in the timing and organization of their handwriting movements. Tasks involving higher cognitive demands showed that cognitive decline is reflected in how efficiently and coherently handwriting movements are organized over time.”

Ready, set, write

The team set out to determine whether the writing process could yield earlier and more sensitive indicators of cognitive decline than test scores or final outputs, which are the measures often analyzed in traditional assessments.

The study included 58 older adults, aged between 62 and 92, living in care homes. 38 participants had previously been diagnosed with a form of cognitive impairment. Participants performed two types of tasks using an inking pen on a digitizing tablet. During pen control tasks, participants were prompted to draw 10 horizontal lines within 20 seconds and make at least 10 dots on the paper during the same time frame. The handwriting speed task included noting down two sentences of varying complexity that were either shown on a card or dictated, respectively.

Results showed that neither of the pen control tasks could distinguish cognitive status between groups. As ‘simple’ tasks, they mainly rely on basic motor control and may not be enough to reveal subtle differences that more cognitively taxing tasks can show. Copying tasks, which are more mentally demanding than pen control but less demanding than dictation, also didn’t show group differences but demonstrated a trend towards significance. 

The results of the dictation tasks, however, showed clear differences between the two participant groups. This could be due to the higher cognitive demand such tasks place on working memory and executive functions. “Dictation tasks are more sensitive because they require the brain to do multiple things at once: listen, process language, convert sounds into written form, and coordinate movement,” said Matias. “Even within dictation tasks, differences can emerge. A longer, less predictable, or linguistically demanding sentence places greater strain on cognitive resources.”

In the group with cognitive impairment, two predictors – start time and number of strokes – emerged as significant for the shorter sentence of the dictation task. For the more complex sentence three predictors – vertical size, start time, and duration – were significant. This could be due to not all handwriting features reflecting cognition in the same way.

“Timing and stroke organization are closely linked to how the brain plans and executes actions, which depends on working memory and executive control. As these cognitive systems decline, writing becomes slower, more fragmented, and less coordinated,” explained Matias. “In contrast, other features can remain relatively preserved, especially in the early stages of cognitive decline, making them less sensitive indicators.”

Routine writing

The team said their approach, relying only on simple writing tasks and accessible digital tools, could serve as a practical way to monitor cognitive decline in a variety of settings, for example in doctors’ offices. Because it’s a non-invasive and relatively low-cost method, it could easily be integrated into routine clinical practice.

However, the approach remains an emerging methodology, and future research will have to confirm the effects, also in the long term, in larger and more diverse populations. The results of the current study may therefore not be readily transferable. It also didn’t consider the use of medications and their possible influence.

“The long-term goal is to develop a tool that is easy to administer, time-efficient, and affordable, allowing integration into everyday healthcare contexts without requiring specialized or expensive equipment,” concluded Matias.