Handwriting is a complex activity that depends on both fine motor skills and higher-level cognitive processes, including attention, memory, language processing, and executive functioning. Because writing requires the brain to coordinate multiple functions simultaneously, changes in handwriting may provide valuable clues about cognitive health. As people age, handwriting often becomes slower, less fluid, and more fragmented, raising the possibility that handwriting characteristics could serve as early indicators of cognitive decline.
To explore this possibility, researchers in Portugal conducted a study published in Frontiers in Human Neuroscience examining whether specific handwriting features differ between older adults with and without cognitive impairment. According to senior author Dr. Ana Rita Matias of the University of Évora, handwriting offers a unique view into brain function because it reflects not only motor ability but also the organisation and efficiency of cognitive processes. The researchers hypothesised that analysing the writing process itself might reveal subtle signs of cognitive decline that traditional assessments could miss.
The study involved 58 adults aged 62 to 92 living in care homes, including 38 individuals previously diagnosed with cognitive impairment. Participants completed several writing activities using a digital tablet and an inking pen. These tasks included simple pen-control exercises, such as drawing lines and making dots, as well as more cognitively demanding handwriting tasks in which participants copied or wrote sentences from dictation. Researchers measured a range of handwriting features, including writing speed, stroke organisation, timing, duration, and letter size.
The findings showed that simple pen-control tasks were unable to distinguish between participants with and without cognitive impairment. Copying sentences also failed to reveal significant differences, although the results suggested a possible trend. In contrast, dictation tasks clearly differentiated the two groups. Dictation requires participants to listen, process language, retain information in working memory, translate sounds into written words, and coordinate hand movements, placing substantially greater demands on cognitive resources than simpler writing activities.
Among participants with cognitive impairment, several handwriting measures emerged as important indicators. For shorter dictated sentences, delayed writing initiation and a greater number of strokes were significant predictors. For more complex sentences, vertical letter size, delayed start time, and longer writing duration were associated with cognitive impairment. According to the researchers, these timing and organisational features are closely linked to the brain’s ability to plan, coordinate, and execute actions. As cognitive abilities decline, handwriting tends to become slower, less efficient, and more fragmented, whereas some other handwriting characteristics may remain relatively unchanged during the early stages of decline.
The researchers believe that digital handwriting analysis could become a practical, non-invasive, and cost-effective tool for monitoring cognitive health in clinical and community settings. Because the method relies on simple writing tasks and accessible technology, it could potentially be incorporated into routine assessments in healthcare environments. However, the authors caution that the approach remains in its early stages. Larger and more diverse studies are needed to confirm the findings, evaluate long-term effectiveness, and account for factors such as medication use. Ultimately, the goal is to develop an easy-to-administer and affordable screening tool that can help identify cognitive decline earlier and support timely intervention.
More information: João Galrinho et al, Handwriting speed and pen motor control in older adults with and without cognitive impairment, Frontiers in Human Neuroscience. DOI: 10.3389/fnhum.2026.1820193
Journal information: Frontiers in Human Neuroscience Provided by Frontiers
