Digital biomarkers for brain health: passive and continuous assessment from wearable sensors

Continuous and scalable monitoring of cognition and affective states is critical for the early detection of brain health, which is currently limited by the burden of active assessments. This study investigated the potential of consumer-grade wearable and mobile technologies to passively predict 21 cognitive and mental health outcomes in real-world conditions. We collected data from 82 cognitively healthy adults, including passively measured behaviour, physiology, and environmental exposures longitudinally, for 10 months. Active data were gathered in four waves using validated patient- and performance-reported outcomes. Data quality assurance involved a data filtering resulting in average wearable data coverage of 96% per day. Artificial Intelligence-powered prediction was applied, and performance was assessed using subject- and wave-dependent cross-validation. Cognitive and affective outcomes were predicted with low scaled errors. Patient-reported outcomes were more predictable than performance-based ones. Environmental and physiological metrics emerged as the most informative predictors. Passive multimodal data captured meaningful variability in cognition and affect, demonstrating the feasibility of low-burden, scalable approaches to continuous brain-health monitoring. Feature-importance analyses suggested that environmental exposures better explained inter-individual differences, whereas physiological and behavioural rhythms captured within-person changes. These findings highlight the potential of everyday technologies for population-level tracking of brain-health and deviations from expected trajectories.