Tracking Cognitive Health With Wearables in Telerehabilitation Female Participants: Could Nighttime Sleep Measures Be Used as Sex-Specific Digital Endpoints?

Abstract While changes in brain structure are common across the lifespan, it is difficult to differentiate benign variations from early disease pathogenesis, especially in patients participating in home-based rehabilitation. Cognitive decline is frequently linked with normative aging, but its early detection can facilitate preventative interventions, particularly in patients at high risk of cognitive impairment and dementia, such as older women. Although women have fewer modifiable risk factors for dementia than men, wearables have the potential to establish new digital endpoints that facilitate the management and/or prevention of abnormal brain aging. Sleep, which is necessary for maintaining overall brain health, is one behavior tracked via wearables, for which an ever-growing body of pilot and validation phase studies exists, yet endpoints defining optimal sleep are not one-size-fits-all, as individual chronotype variability necessitates new strategies to personalize care. Though sex-based differences in circadian rhythm are well established, little is understood about which sleep measures and thresholds are uniquely important to cognitive health in women, particularly those with high comorbid burden. In this viewpoint, we discuss recent findings on the use of wearables to track sleep and cognitive health in women, while highlighting challenges and opportunities for health outcomes and clinical trial researchers seeking to implement meaningful digital endpoints in future telerehabilitation programs.