New research from UC Davis reveals that older adults can accurately evaluate their cognitive ability in real time, thanks to the innovative use of smartwatch technology. This groundbreaking study demonstrates a strong correlation between individuals’ moment-to-moment self-assessments of their thinking ability and their actual performance on cognitive tests. By leveraging ecological momentary assessment (EMA), researchers have captured a dynamic picture of cognition and mood in everyday life, moving beyond traditional retrospective evaluations that often fail to align with objective measures.
The study, published in the journal Neuropsychology, represents a paradigm shift in the measurement of subjective cognitive decline—an early potential marker of Alzheimer’s disease and other neurodegenerative disorders. UC Davis Health neuropsychologist Professor Sarah Tomaszewski Farias, the senior author on the paper, spearheaded the research. Her team utilized the Apple Watch to deliver frequent prompts to participants, enabling them to report on their mental sharpness and mood in the context of their current environment and engage in quick cognitive tests assessing processing speed and attention.
This method contrasts sharply with conventional clinic-based cognitive testing, which typically depends on patients’ memories of their cognitive function over weeks or months and occurs in sterile, artificial environments. By capturing data in real time during participants’ normal daily routines—whether performing household chores or shopping—EMA offers unparalleled ecological validity and sensitivity. It also reduces biases introduced by retrospective recall and mood states that can confound traditional assessments.
Over the course of one week, 162 older adults, with an average age of 72 and who initially tested within normal cognitive limits despite experiencing memory concerns, responded to four daily prompts on their Apple Watches. Each prompt asked them to self-rate their mental sharpness and mood dimensions such as stress, fatigue, and depression before completing brief cognitive tasks. These repeated measures allowed the researchers to examine fluctuations in subjective and objective cognition throughout the day and across varied real-world contexts.
Analysis of the data demonstrated a significant within-person association between ratings of mental sharpness and objective cognitive performance. When participants reported feeling less sharp than their personal baseline, their test scores mirrored a corresponding decline. This finding held true even after controlling for mood, age, and situational factors, underscoring that subjective cognitive assessments in the moment reliably reflect actual cognitive status.
Remarkably, the study found that mood symptoms like depression and fatigue, which often confound subjective cognitive complaints, did not distort the relationship between self-ratings of mental sharpness and cognitive test outcomes. This suggests that momentary appraisal of cognition might be a more precise and sensitive indicator of cognitive health than traditional clinical reports, which can be muddied by affective states. It highlights the promise of EMA as a tool for earlier detection of cognitive decline.
Another insight emerging from the research pertains to time-of-day effects on cognition. Participants consistently displayed sharper cognitive performance in the morning compared to later hours, aligning with clinical recommendations for scheduling mentally demanding tasks earlier in the day when alertness peaks. This temporal dimension of cognition could inform personalized strategies to optimize daily functioning for older adults.
The broader implications of these findings are profound. The ability to accurately monitor cognition in real-world contexts using wearable technology could revolutionize early diagnosis and intervention for Alzheimer’s disease and related dementias. Clinicians might use such data to tailor cognitive therapies, monitor disease progression, and support individuals’ self-awareness of their cognitive health outside the clinic setting.
Furthermore, widespread adoption of smartwatch-based cognitive assessment opens new avenues for scalable, cost-effective screening and longitudinal research. It might enable identification of subtle cognitive fluctuations that precede clinical impairment, providing a critical window for preventive measures or clinical trials targeting early-stage neurodegeneration.
The interdisciplinary collaboration behind this study brought together experts from UC Davis Health, Washington State University, and UC Merced, highlighting the power of combining neuropsychology, clinical neuroscience, and technology-driven approaches. The research was supported by the National Institutes of Health, underscoring its public health relevance and rigorous scientific basis.
Lead author Tomaszewski Farias envisions that this integration of subjective and objective cognitive metrics in naturalistic environments will enhance understanding of cognitive aging mechanisms. It offers a template for future studies exploring how contextual and internal factors influence cognition minute by minute. As wearable technology continues to evolve, its role in precision cognitive monitoring appears poised for rapid advancement.
In summary, this seminal research validates the accuracy of real-time self-assessments of cognition in older adults and establishes ecological momentary assessment via smartwatches as a pioneering method to track cognitive health. It promises to reshape clinical practice and research paradigms by enabling continuous, nuanced insights into brain function during daily life, paving the way for earlier detection of cognitive decline and more individualized care.
Subject of Research: Real-time assessment of subjective cognitive function and its relation to objective cognition in older adults using ecological momentary assessment via smartwatches.
Article Title: The Association Between Daily Real-Time Assessment of Subjective Cognitive Function and Objective Cognition Using Ecological Momentary Assessment
News Publication Date: 26-Jun-2026
Web References:
UC Davis Neurology
UC Davis Alzheimer’s Disease Research Center
DOI Link
References:
Tomaszewski Farias, S., Gavett, B., Weakley, A., Fox, J., Schmitter-Edgecombe, M., Luna, C., Dai, S., Zawadzki, M., & Cook, D. (2026). The Association Between Daily Real-Time Assessment of Subjective Cognitive Function and Objective Cognition Using Ecological Momentary Assessment. Neuropsychology. doi:10.1037/neu0001075
Image Credits: University of California Regents
Keywords
Neurophysiology, Clinical neuroscience, Dementia, Memory disorders, Cognition, Neurodegenerative diseases
