EC Neurology

The United States Department of War (DoW) transition from the Automated Neuropsychological Assessment Metrics (ANAM) to a next-generation cognitive assessment capability is an important advance in military brain health and operational readiness. However, contemporary operational environments demand a more comprehensive approach than behavioral cognitive testing alone. Advances in neuroscience, neurotechnology, multimodal neuroimaging, electrophysiology, biomarker science, and artificial intelligence (AI) now enable far more precise characterization of the structural and functional neural systems that subserve cognitive performance, resilience, vulnerability, and recovery. This essay posits that these capabilities should be constituent to a new enterprise of precision neurocognitive health; and proposes a paradigmatic approach, NeuroHOPE (Neurocognitive Health, Operational Protection, and Enablement) to establish individualized multidimensional neurocognitive baselines for service members, employ longitudinal monitoring throughout military service, and integrate evidence-based interventions to preserve and enhance cognitive readiness. NeuroHOPE combines structural and functional neuroimaging, quantitative electrophysiology, wearable neurophysiologic monitoring, digital cognitive phenotyping, validated biomarkers, and AI-enabled data integration to facilitate earlier detection of subtle neurologic change, improve diagnostic precision, personalize intervention strategies, and optimize operational performance while supporting informed return-to-duty and veterans’ disability determinations. Recognizing the unique sensitivity of neurobiological information, the necessity of rigorous neuroethical oversight and governance is advocated and recommendations are presented to guide phased implementation of NeuroHOPE paradigm within a DoW-wide Precision Neurocognitive Readiness Program toward strengthening force protection, enhancing mission effectiveness, and sustaining strategic advantage in an era in which cognitive superiority increasingly defines military success.

Keywords: Neurocognitive Testing; Military Medicine; Neurotechnology; Optimization; Neuroethics

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