Using Apple Watches to Monitor Health and Behaviors of Individuals with Cognitive Impairment: A Case Series Study.

Objectives: This study explores the potential of developing digital biomarkers from wearables for monitoring individuals with Alzheimer's Disease and Related Dementias, focusing on the feasibility of using Apple Watches for tracking health and behaviors in older adults with cognitive impairment.

Method: Data collection used the Amissa Health technology stack, which passively collects time-series data from smartwatches and provides a high-frequency cloud database for secure data storage, query, and visualization by clinicians and researchers. The platform consists of i) AmissaWear, a software app that runs on smartwatches and sends information to a cloud database using a secure API; and ii) AmissaOrbis, a centralized cloud portal for the collected data. Each participant was provided an Apple Watch configured to collect steps, calories burned, accelerometer and gyroscope readings, heart rate, and sleep information.

Results: Seven participants, with cognitive impairment diagnosed by a neurologist, were enrolled in the study from December 2023 through June 2024. The watches successfully collected more than 700,000 observations during the study. Each observation contains data recorded from over a dozen sensors (e.g., heart rate, pedometer, gyroscope, accelerometer). The participants wore Apple Watches for an average of 11.48 hours/day for 84.91% of days during a 6-month period without a decrease in usage over time. Overall, the technology yielded high wear adherence and participation within this pilot.

Discussion: This study demonstrates the feasibility of using widely available Apple Watches for continuous monitoring of individuals with cognitive impairment and provides insights into their daily health and activity patterns, which could aid in future development of digital biomarkers.