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. 2025 Jan;39(1):28-43.
doi: 10.1037/neu0000984. Epub 2024 Nov 18.

Capturing cognitive capacity in the everyday environment across a continuum of cognitive decline using a smartwatch n-back task and ecological momentary assessment

Maureen Schmitter-Edgecombe  1 , Catherine Luna  1 , Brooke Beech  1 , Shenghai Dai  2 , Diane J Cook  3
Affiliations

Capturing cognitive capacity in the everyday environment across a continuum of cognitive decline using a smartwatch n-back task and ecological momentary assessment

Maureen Schmitter-Edgecombe et al. Neuropsychology. 2025 Jan.

Abstract

Objective: Cognitive testing using mobile technologies can assist with early detection of cognitive decline. We use ecological momentary assessment to investigate the feasibility, reliability, and validity of a smartwatch n-back task (1-back) delivered to adults across the cognitive continuum.

Method: One hundred seventy-four community-dwelling individuals (Mage = 70.51) representing healthy older adults, individuals with subjective cognitive decline, and mild cognitive impairment completed a neurocognitive assessment battery and wore a smartwatch for 7+ days. Participants were prompted 4 times per day to complete an n-back task on the smartwatch.

Results: Across all groups, findings indicated an acceptable task adherence rate (> 78%; n = 174) and response rate (> 89%; n = 158 n-back analysis sample). Supporting external validity, participants with mild cognitive impairment were less accurate, had fewer total correct responses, and performed at lower initial levels than both healthy older adults and subjective cognitive decline, ω²s > .09. Intraindividual variability was greater for the mild cognitive impairment group compared to healthy older adults, but subjective cognitive decline did not differ significantly from either group, ω² = .12. For discriminant and convergent validity, n-back total correct correlated with performance on standardized assessments of executive attention, whereas intraindividual variability correlated with real-world factors (i.e., context, everyday function). Reliability assessment revealed stability for n-back measures after four to six posttraining trials and excellent test-retest reliability for total correct after 5 months. Finally, combining n-back and clinical measures improved classification accuracy.

Conclusions: Findings suggest the smartwatch n-back task is feasible for collecting cognitive data across the cognitive continuum with demonstrated reliability and validity in the everyday environment using ecological momentary assessment. (PsycInfo Database Record (c) 2025 APA, all rights reserved).

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Figures

Figure 1
Figure 1
1-back, N-back shape task Note. Black and white image; on smartwatch the ‘Yes’ button displays as green and the ‘No’ button displays as red. In this example, the first shape is a triangle and the second shape is a diamond, therefore the answer is ‘No’ because the second shape is not the same as the one right before. The third shape is a diamond, therefore the answer is ‘Yes’ because it is the same as the previous shape (diamond), and so on. Shape order is randomized for every trial.
Figure 2
Figure 2
Change in N-back Measures across Prompts
See this image and copyright information in PMC

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