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. 2025 May 28:8:e72824.
doi: 10.2196/72824.

Longitudinal Remote Sleep and Cognitive Research in Older Adults With Mild Cognitive Impairment and Dementia: Prospective Feasibility Cohort Study

Victoria Grace Gabb  1   2   3 , Jonathan Blackman  1   2   3 , Hamish Morrison  1   2 , Haoxuan Li  1   2   4   5   6 , Adrian Kendrick  7 , Nicholas Turner  8 , Rosemary Greenwood  9   10 , Bijetri Biswas  11 , Amanda Heslegrave  12   13 , Elizabeth Coulthard  1   2   3
Affiliations

Longitudinal Remote Sleep and Cognitive Research in Older Adults With Mild Cognitive Impairment and Dementia: Prospective Feasibility Cohort Study

Victoria Grace Gabb et al. JMIR Aging. .

Abstract

Background: Sleep holds promise as a modifiable risk factor for neurodegenerative diseases and dementia. Clinical trials to modify sleep in people at risk of or in the early stages of dementia are needed. Monitoring natural sleep from home could support pragmatic and decentralized large-scale clinical trials. However, whether longitudinal sleep research can be successfully delivered remotely in this population has not been established yet.

Objective: We investigated the feasibility of remote longitudinal research using wearable devices, web-based cognitive tasks, and a smartphone app to record sleep and cognition in older adults with mild cognitive impairment (MCI) or dementia.

Methods: Older adults with MCI or dementia due to Alzheimer disease or Lewy body disease and cognitively healthy participants completed at-home sleep and circadian monitoring (digital sleep diaries, actigraphy, wearable sleep electroencephalography, and saliva samples) and digital cognitive assessments for 8 weeks. Feasibility outcomes included recruitment, retention, and data completeness.

Results: In total, 41 participants consented (n=10, 24% participants with Alzheimer disease; n=11, 27% participants with Lewy body disease; and n=20, 49% controls). There were predominantly male and White British participants, with a mean age of 70.9 (SD 5.9) years. Retention was very high, with 40 (98%) participants completing 8 weeks of remote monitoring. Data completeness for sleep electroencephalography was 91% and ranged from 79% to 97% for all remote tasks and was overall high across all participant subgroups. In total, 30% (12/40) of participants reported receiving external support with completing study tasks.

Conclusions: High rates of retention, data completeness, and data quality suggested that longitudinal multimodal sleep and cognitive profiling using novel and remote monitoring technology is feasible in older adults with MCI and dementia and healthy older adults, even without study partner support. Remote monitoring should be considered for mechanistic and interventional trials. Careful consideration should be given to how to ensure remote monitoring technologies reduce burden and enhance inclusivity, particularly in communities traditionally underserved by research and those with lower digital literacy.

International registered report identifier (irrid): RR2-10.2196/52652.

Keywords: actigraphy; dementia; digital biomarkers; electroencephalography; feasibility; mild cognitive impairment; remote study design; saliva; sleep.

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Conflict of interest statement

Conflicts of Interest: EC has received funding from Biogen, Eisai, and Lilly for consultancy and providing educational resources. AH has received funding from Quanterix Corp for consultancy. All other authors declare no other conflicts of interest.

Figures

Figure 1
Figure 1
The study kit provided to the Remote Evaluation of Sleep to Enhance Understanding of Early Dementia (RESTED) participants. Participants were additionally required to use a smartphone or tablet to complete digital assessments. A: Sweatband to ensure tight fitting of Dreem 2; B: Dreem 2 electroencephalography (EEG) headband; C: Nonin 3150 WristOx 2 oximeter; D: USB-C charging cable (for Dreem 2 and AX3); E: Axivity AX3 actigraph and wrist strap; F: Saliva collection aid for passive drool; G: Collection tube for passive drool; H: Storage tube for oral swab; I: Oral swab.
Figure 2
Figure 2
Participant flow through the Remote Evaluation of Sleep to Enhance Understanding of Early Dementia (RESTED) study. MCI: mild cognitive impairment; MoCA: Montreal Cognitive Assessment.
Figure 3
Figure 3
Reasons for declining to participate in the study could be categorized according to the capability, opportunity motivation, behavior (COM-B) model of behavior change in blue. Opportunities to increase capability, opportunity, and motivation to take part in the research are outlined in gray.
Figure 4
Figure 4
Reasons for missing data are mapped according to the capability, opportunity motivation, behavior (COM-B) model of behavior change.
See this image and copyright information in PMC

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