Associations of daily step counts with cognitive, clinical, and resting-state electroencephalographic measures in patients with cognitive decline due to Alzheimer’s disease

Abstract Sedentary behavior is a recognized and modifiable risk factor for cognitive decline and dementia across neurodegenerative conditions. This study used a smartwatch-based telemonitoring procedure combined with ecological cognitive assessment to examine whether step counts can capture sedentary behavior and its association with cognitive functioning in patients with mild cognitive impairment (ADMCI) and dementia (ADD) due to Alzheimer’s disease. Then, 19 ADD, 28 ADMCI, and 23 cognitively unimpaired older adults (Nold) were consecutively recruited. Participants underwent clinical assessment, resting-state electroencephalography (rsEEG), and neuropsychological testing. They were then monitored at home for approximately one week using Samsung Galaxy Watch 4–6 devices recording step counts (total, purposeful, and incidental) and activity intensity (peak 30-min cadence), together with the unsupervised SmartMe N = 19), Alzheimer’s disease with mild cognitive impairment (ADMCI; N = 28), and cognitively unimpaired older adults (Nold; N = 23), indicating reduced daily step volume and peak cadence mainly in ADD. c Representative significant associations within the AD clinical sample (ADD + ADMCI; up to N = 47), showing that step metrics were more closely related to cognition (MMSE) and depressive symptom severity (BDI-II) than to resting-state EEG activity, for which only limited associations emerged.