Cognitive Function, Consent for Participation, and Compliance With Wearable Device Protocols in Older Adults

Population-based studies of older adults increasingly use wearable devices to measure activity and sleep. Whether cognitive impairment reduces consent and compliance has not been assessed.

In the context of a nationally representative cohort of community-dwelling adults aged 62-90, individuals were invited to participate in a sleep and activity substudy that required wearing a wrist actigraph for 72 consecutive hours. Cognitive function in the parent study was assessed with the survey adaptation of the Montreal Cognitive Assessment, and individuals were categorized as normal, mild cognitive impairment, or dementia. Participants were asked to press an event marker on the actigraph when they started trying to fall asleep and when they awoke each day. Logistic and negative binomial regressions were used to link cognitive status to nonconsent, returning usable data, wearing the actigraph three full days, ever taking the device off-wrist during the 3-day study period, and pushing the event markers, controlling for demographics.

Cognitive status was not associated with nonconsent, returning usable data, off-wrist, or missing days. However, individuals classified with dementia were more likely to miss bedtime and wake-up event markers. Individuals classified as mild cognitive impairment were more likely to miss wake-up event markers.

Impaired cognition does not seem to be a barrier to compliance with simply wearing a device but may affect compliance with additional action such as pressing event markers.