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Background <p>Circadian rest-activity rhythmicity, a behavioral manifestation of circadian rhythms, characterizes 24-hour activity patterns. Growing evidence links circadian disruption in late life to adverse outcomes, including functional and cognitive declines. Yet, most studies have been cross-sectional or restricted to a single monitoring period, limiting longitudinal inference. It remains unclear whether deterioration or improvement in circadian rest-activity rhythmicity reflects late-life vulnerability in aging populations.</p> Methods <p>We conducted a prospective longitudinal cohort study using data from the National Health and Aging Trends Study (NHATS), a nationally representative U.S. cohort of adults aged ≥ 70 years (<i>n</i> = 734; 55.8% female; mean age 79.2 years). Participants completed 7-day wearable monitoring and assessments of functional, cognitive, and neuropsychiatric outcomes at Cycles 11 and 12. Circadian rest-activity rhythm biomarkers were derived using cosinor and non-parametric methods (intensity, timing, regularity, fragmentation). Participants were classified into four transition groups based on longitudinal changes in circadian rest-activity rhythmicity: Optimal (persistently optimal), Improved (non-optimal → optimal), Deteriorated (optimal → non-optimal), and Adverse (persistently non-optimal). Survey-weighted regression and Cox models adjusted for sociodemographic factors and comorbidities with multiple testing correction.</p> Results <p>Longitudinal analyses revealed a graded hierarchy of risk. The Adverse group exhibited the broadest and strongest cross-domain associations with functional and cognitive decline; for example, lower rhythm intensity was longitudinally associated with greater Activities of Daily Living (ADL) disability, β = 0.90 [95% CI: 0.50, 1.30]; lower Short Physical Performance Battery (SPPB), β= −0.85 [− 1.11, − 0.59]; lower immediate recall, β= −0.34 [− 0.57, − 0.10]). Reduced rhythm regularity and increased fragmentation were linked to poorer outcomes across domains. The Deteriorated group reflected a dynamic transition state with attenuated, outcome-specific associations for rhythm intensity and regularity. For neuropsychiatric outcomes, high fragmentation was associated with incident probable dementia, whereas lower regularity was associated with anxiety/depression.</p> Conclusion <p>Circadian rest-activity rhythmicity is a robust and dynamic marker of late-life outcomes. Persistent weakness or deterioration in intensity and regularity was linked to accelerated decline in function and cognition, whereas improvement aligned with stabilization. These findings position wearable-derived digital biomarkers as an early biomarker of vulnerability and a potential modifiable target for scalable early risk detection, personalized intervention, and resilience promotion in aging populations.</p>

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Longitudinal digital phenotyping of circadian rest-activity rhythms via wearables as biomarkers for late-life function, cognition, and neuropsychiatric health

  • 期刊论文

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  • 发表日期：

    2026年6月2日

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  • Jinjoo Shim,
  • Jukka-Pekka Onnela

摘要

Background

Circadian rest-activity rhythmicity, a behavioral manifestation of circadian rhythms, characterizes 24-hour activity patterns. Growing evidence links circadian disruption in late life to adverse outcomes, including functional and cognitive declines. Yet, most studies have been cross-sectional or restricted to a single monitoring period, limiting longitudinal inference. It remains unclear whether deterioration or improvement in circadian rest-activity rhythmicity reflects late-life vulnerability in aging populations.

Methods

We conducted a prospective longitudinal cohort study using data from the National Health and Aging Trends Study (NHATS), a nationally representative U.S. cohort of adults aged ≥ 70 years (n = 734; 55.8% female; mean age 79.2 years). Participants completed 7-day wearable monitoring and assessments of functional, cognitive, and neuropsychiatric outcomes at Cycles 11 and 12. Circadian rest-activity rhythm biomarkers were derived using cosinor and non-parametric methods (intensity, timing, regularity, fragmentation). Participants were classified into four transition groups based on longitudinal changes in circadian rest-activity rhythmicity: Optimal (persistently optimal), Improved (non-optimal → optimal), Deteriorated (optimal → non-optimal), and Adverse (persistently non-optimal). Survey-weighted regression and Cox models adjusted for sociodemographic factors and comorbidities with multiple testing correction.

Results

Longitudinal analyses revealed a graded hierarchy of risk. The Adverse group exhibited the broadest and strongest cross-domain associations with functional and cognitive decline; for example, lower rhythm intensity was longitudinally associated with greater Activities of Daily Living (ADL) disability, β = 0.90 [95% CI: 0.50, 1.30]; lower Short Physical Performance Battery (SPPB), β= −0.85 [− 1.11, − 0.59]; lower immediate recall, β= −0.34 [− 0.57, − 0.10]). Reduced rhythm regularity and increased fragmentation were linked to poorer outcomes across domains. The Deteriorated group reflected a dynamic transition state with attenuated, outcome-specific associations for rhythm intensity and regularity. For neuropsychiatric outcomes, high fragmentation was associated with incident probable dementia, whereas lower regularity was associated with anxiety/depression.

Conclusion

Circadian rest-activity rhythmicity is a robust and dynamic marker of late-life outcomes. Persistent weakness or deterioration in intensity and regularity was linked to accelerated decline in function and cognition, whereas improvement aligned with stabilization. These findings position wearable-derived digital biomarkers as an early biomarker of vulnerability and a potential modifiable target for scalable early risk detection, personalized intervention, and resilience promotion in aging populations.