7 Minutes
A three-minute, passive brainwave test developed at the University of Bath—known as Fastball EEG—can detect early memory impairment linked to Alzheimer’s disease years before clinical diagnosis is typical. Unlike traditional cognitive exams that rely on participant responses, Fastball passively records electrical brain activity while a person views a rapid stream of images. Recent research published in Brain Communications and conducted with collaborators at the University of Bristol shows the test reliably identifies memory problems in people with Mild Cognitive Impairment (MCI), a syndrome that frequently precedes Alzheimer's disease.
The new study demonstrates, for the first time, that Fastball works reliably in people’s homes, outside clinical settings. This portability and low cost make it a compelling candidate for wider screening in primary care, community programs, and longitudinal monitoring. With disease-modifying antibodies such as donanemab and lecanemab showing the greatest benefit when administered early, an accessible objective marker of memory decline could significantly accelerate diagnosis, treatment initiation, and research recruitment.
How Fastball EEG Works
Fastball is a passive electroencephalography (EEG) protocol designed to measure automatic memory-related responses in the brain. Participants do not need to follow instructions, speak, or recall information; they simply watch a rapid sequence of images while an EEG records electrical activity from the scalp. Specific neural signatures—frequency-tagged responses tied to repeated or familiar images—are used to infer memory processing efficiency.
Key technical points
- Passive measurement: Because the test is noninteractive, it reduces bias introduced by education, language, or test-taking strategy.
- Short duration: The full protocol takes about three minutes, enabling rapid screening in clinical workflows or at home.
- Objective signal: The analysis relies on measurable electrical responses rather than subjective scoring of answers, improving reproducibility.
This combination of features addresses several longstanding barriers in cognitive screening: subjectivity, length, and accessibility. By quantifying memory-related brain responses directly, Fastball provides a physiological index that complements biomarkers such as PET amyloid imaging or cerebrospinal fluid analysis, which are more expensive and invasive.
Study Findings and Validation
The multicentre study reported that Fastball detected reduced memory responses in people diagnosed with MCI who were at elevated risk of progressing to Alzheimer’s disease. Key results include:
Principal findings
- Detection of early memory impairment: Fastball produced reliable differences between healthy controls and participants with MCI, including those who later developed dementia.
- Real-world deployment: The test maintained signal quality and diagnostic sensitivity when administered in participants’ homes, demonstrating feasibility for remote screening.
- Low-cost scalability: The protocol uses standard EEG hardware and automated analysis pipelines, making it suitable for primary care settings and longitudinal home monitoring.
The study builds on earlier 2021 work from the same team showing Fastball’s sensitivity to memory impairment in established Alzheimer’s disease. The latest results expand validation to earlier stages of cognitive decline and to nonclinical environments, which is essential for screening large populations and delivering timely interventions.
Dr George Stothart, lead author and cognitive neuroscientist at the University of Bath's Department of Psychology, said: "We're missing the first 10 to 20 years of Alzheimer's with current diagnostic tools. Fastball offers a way to change that -- detecting memory decline far earlier and more objectively, using a quick and passive test." The research received funding from the Academy of Medical Sciences and support from the dementia research charity BRACE.
Clinical Significance and Deployment
Early detection of Alzheimer’s has become increasingly urgent as new therapies targeting disease biology are approved. Donanemab and lecanemab—monoclonal antibodies that reduce pathological amyloid—have shown the strongest effect when started in early disease stages. However, many people with early Alzheimer’s remain undiagnosed: estimates suggest up to one in three people with dementia in some regions lack a formal diagnosis. This diagnostic gap delays access to treatment, support services, and clinical trials.
Fastball could play several roles in the clinical pathway:
- Screening in primary care: A quick in-practice EEG could flag patients who need specialist assessment.
- Remote monitoring: Home administration allows longitudinal tracking of cognitive function over months or years.
- Trial recruitment: Objective physiological markers can help select participants who are most likely to benefit from investigational therapies.
Limitations and considerations remain. Fastball does not replace molecular biomarkers (amyloid/tau) or clinical assessment but could be a cost-effective triage step. Further trials are needed to determine sensitivity and specificity across diverse populations, to standardize hardware and analysis, and to integrate results with existing diagnostic algorithms.
Chris Wiliams, CEO of BRACE Dementia Research, commented: "Fastball is an incredible tool that could offer anyone who, for whatever reason, cannot access a dementia diagnosis in a clinical setting. BRACE has been supporting the development of Fastball for several years, and we are excited to see what Dr Stothart's team will achieve over the next few years with ongoing support from the charity." These perspectives underscore both the promise and the collaborative effort required to translate Fastball into routine care.
Expert Insight
Dr. Anna Rivera, neurologist and clinical researcher (fictional expert), says: "Fastball addresses a critical bottleneck—identifying people early, when interventions are most effective. The strength of the approach is its objectivity and simplicity: three minutes of passive EEG can be deployed broadly. That said, rigorous validation in more diverse cohorts and an implementation pathway that links Fastball results to confirmatory testing and treatment access will be essential to realize its clinical impact."
Her assessment highlights practical next steps: cross-cultural validation, integration with biomarker tests, and establishing protocols for follow-up care after a positive Fastball result.
Related Technologies and Future Directions
Fastball sits at the intersection of several trends in neurology and digital health: portable EEG, automated signal analysis, and at-home diagnostic tools. Similar approaches are emerging for other neurodegenerative conditions and cognitive disorders. Future work could combine Fastball with blood-based biomarkers (plasma amyloid/tau) or mobile cognitive assessments to create multimodal, low-cost diagnostic pathways.
Regulatory approval, reimbursement models, and GP training will influence adoption. If scaled responsibly, Fastball could reduce the time to diagnosis, improve patient access to early treatment, and expand participation in clinical research—advancing both individual care and our collective understanding of Alzheimer’s disease.
Conclusion
Fastball EEG is a brief, passive brainwave test that detects memory-related neural changes linked to Alzheimer’s disease and Mild Cognitive Impairment. Validated in clinical studies and now shown to work in home settings, it offers a low-cost, objective screening tool that could accelerate diagnosis and treatment at a stage when disease-modifying therapies are most effective. Continued validation across diverse populations and integration with existing biomarker and clinical pathways will determine how Fastball contributes to routine dementia care and early intervention strategies.
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