Smartphone-based ecological momentary assessment for mild cognitive impairment: A feasibility study of measuring mood and stress responses in everyday setting

Background Neuropsychiatric symptoms (NPS) are highly prevalent among older adults with mild cognitive impairment (MCI) and predict faster cognitive decline. These symptoms likely reflect maladaptive emotional responses to everyday stressors, yet retrospective assessments cannot capture stress–affect dynamics as they unfold in daily life. Although ecological momentary assessment (EMA) has been adopted to measure emotions and cognitive functioning in MCI, whether older adults with MCI can identify and report stressor sources in real-time, which is essential for understanding stress appraisal processes underlying NPS, remains understudied. We evaluated the feasibility and acceptability of a tailored 7-day smartphone EMA protocol for older adults with MCI to capture momentary emotions and stress responses. Methods Sixteen participants with MCI (mean age=76.45; 50% female) received four semi-random EMA prompts daily for 7 days, assessing perceived stress, positive and negative emotions, and stressor exposure. Feasibility criteria: retention ≥80%, adherence ≥80% of delivered prompts, completion time< 3 minutes, no survey fatigue, and technical support requests. Acceptability was evaluated through user experience surveys and semi-structured interviews. Results All participants completed the protocol (100% retention). Mean adherence was 86.8% (range: 53.57%–100%), yielding 404 of 448 completed prompts (mean 25.25 surveys per participant; 2.21 minutes per survey). Time-series plots showed meaningful affective variability without evidence of fatigue. Participants described the protocol as non-burdensome, and several reported stressors via open-ended responses. Visual inspection suggested that mood fluctuations were aligned with stressor exposure. Conclusion Smartphone-based EMA is feasible and acceptable for capturing daily stressors and emotions among older adults with MCI, advancing our understanding of stress-emotion dynamics in this population.