AbstractBackgroundChanges in mood, loneliness, pain, and need for assistance may be potential early markers of cognitive decline in older adults. These changes can be subtle, and fluctuating, and thus easily missed during intermittent clinic visits. Continuous long‐term monitoring of these self‐reported internal states and needs, and their relationship to developing cognitive impairment has not been assessed.MethodWeekly online reports of health‐related activities and mood in relation to MCI were assessed over four years in volunteers participating in the Oregon Life Laboratory, a study using home‐based unobtrusive remote sensing and monitoring of physical, cognitive, behavioral, physiological, and health‐related activities. Participants were older adult computer users living in retirement communities and free‐standing homes.ResultThe analytic sample included 129 cognitively healthy volunteers with a mean monitoring period of 2.9 ± 1.2 years completing 16,738 online surveys. Mean age was 83.5 ±7.8 years, mean education was 15.7 ± 2.7 years, and 76% were female. Twenty‐two participants (17%) developed MCI or dementia while 107 remained cognitively healthy. Results from longitudinal models with dichotomous outcomes including 1) loneliness, 2) low mood, 3) pain intensity and pain interference, and 4) in‐home assistance were run adjusting for covariates. Over time, those destined to develop MCI reported: 1) more loneliness (p=0.049), 2) more low mood (p=0.07), 3) greater pain intensity (p=0.026) and pain interference (p=0.011), and 4) needing more in‐home assistance (p=0.022) than those remaining cognitively healthy. Baseline standard clinical scale scores assessing these symptoms were not clinically concerning nor predictive of MCI. Baseline mean pain intensity scores (range: 0‐9) were 2.2 ± 2.0 among incident MCI and 1.8 ± 2.0 in stable cognitively healthy participants (p=0.23). Geriatric Depression Scale baseline scores were 1.0 ± 1.5 in incident MCI and 1.1 ± 1.7 in stable cognitively healthy participants (p=0.82).ConclusionContinuous home‐based online assessment of non‐cognitive aspects of function or internal states (loneliness, mood, pain, needing more assistance) can be sensitive early indicators of changes in brain function leading to cognitive decline. These clinically important measures may reflect both direct as well as indirect relationships to underlying neuropathology.