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Clinical Manifestations.

Cuiling Wang1,2, Qi Gao2, Katherine H Chang3,4

  • 1Department of Epidemiology and Population Health, Department of Neurology, Albert Einstein School of Medicine, New York, USA, Bronx, NY, USA.

Alzheimer'S & Dementia : the Journal of the Alzheimer'S Association
|December 26, 2025
PubMed
Summary
This summary is machine-generated.

Smartphone cognitive assessments reveal faster processing speed decline in women, highlighting potential sex differences in cognitive aging. This technology may detect early disease stages more sensitively than traditional tests.

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Area of Science:

  • Neuroscience
  • Gerontology
  • Cognitive Psychology

Background:

  • Sex differences exist in cognitive performance and Alzheimer's disease risk, yet rates of cognitive decline are understudied.
  • Longitudinal studies of cognitive aging are complicated by practice effects from repeated testing.
  • Smartphone-based ecological momentary assessments (EMA) offer intensive, real-world cognitive measures to mitigate practice effects.

Purpose of the Study:

  • To investigate sex differences in cognitive decline using longitudinal data.
  • To evaluate the utility of smartphone-based EMA for assessing cognitive change.
  • To compare cognitive decline rates between men and women in older adults.

Main Methods:

  • The Einstein Aging Study used the Digit Symbol Substitution Test (DSST) and smartphone EMA Symbol Match (SM) over 6 years.
  • EMA SM was administered intensively (6 times/day for 2 weeks) annually.
  • Multi-level linear mixed effects models analyzed sex differences in cognitive decline, adjusting for practice effects and covariates.

Main Results:

  • Women performed better at baseline on DSST and EMA SM.
  • Significant processing speed decline was observed in men for both DSST and EMA SM.
  • Women exhibited faster decline in EMA SM completion time (216±88 ms/year, p=0.014) and slower improvement from testing exposure (p=0.002).

Conclusions:

  • Smartphone-based EMA detected significantly faster processing speed decline in women compared to men.
  • Conventional tests did not reveal the same sex difference in decline rates.
  • Digital EMA may be more sensitive to cognitive changes and identifying early sex differences in cognitive aging.