Background: Relatively few studies investigated the association between rest-activity circadian rhythm and cognitive impairment in population-based study, and the evidence from Asian populations is sparse. We aimed to examine the relationship of actigraphy measured rest-activity circadian rhythm with mild cognitive impairment (MCI) or cognitive impairment in Hong Kong healthy community-dwelling older adults., Methods: We recruited 174 Hong Kong healthy adults aged ≥65 years (36 male vs. 138 female) during April-September 2018, and followed up them for 12 months. Participants were invited to wear wrist actigraphy for 7 days in both baseline and follow-up study. We used the actigraph data to calculate their midline statistic of rhythm (MESOR), amplitude, acrophase and percent rhythm. Montreal Cognitive Assessment (MoCA) was used to assess their cognitive scores at baseline and follow-up. Multivariate logistic regression model was performed to estimate the association of rest-activity circadian rhythm parameters with MCI; whilst multinomial logistic regression model was used to examine the association between rhythm parameters and changes of cognitive scores (i.e., worsen: <-1, stable: -1 to 1, better cognition: ≥2) after 12-months follow-up respectively., Results: There was no association between rest-activity circadian rhythm parameters and MCI or cognitive impairment at baseline. Compared to those with an averaged value of acrophase (1:24pm-3:00pm), results of multinominal logistic regression showed that participants with a delayed acrophase (after 3:00pm) were less likely to have better cognition (adjusted odds ratio (AOR) = 0.32, 95% confidence interval (CI) = 0.11-0.88). Upon one year of follow-up, participants who delayed their acrophase for 24 min than their baseline measurements were also less likely to have better cognitive functions (AOR = 0.26, 95%CI = 0.08-0.79)., Conclusions: Results from both the baseline survey and follow-up study consistently confirmed that older adults, especially in light of the majority of participants being the females, with delayed acrophase were less likely to have better cognition in the Asian population., Competing Interests: None.Table A1Cutoff scores of changed of rest-activity circadian rhythm parameters after 12 monthsTable A1Changed of rest-activity circadian rhythm parameters 1Decrease/AdvancedStableIncreased/DelayedMESOR≤-31.62-32.62-15.84>15.84Amplitude≤-22.84-22.84-5.23>5.23Acrophase≤-36 min-36-24 min>24 minPercent rhythm≤-2.12-2.12-0.74>0.741All changes of rest-activity rhythms parameters were stratified based on their tertile distribution.Table A2Cutoff scores of The Hong Kong Cantonese version of Montreal Cognitive AssessmentTable A2AgeEducation (years)Cutoff percentile7th2nd65–690–31494–618137–9191610–122017>12232170–790–314114–615107–9181510–121918>122016≥800–61310>61513Wong A, Law LS, Liu W, Wang Z, Lo ES, Lau A, et al. Montreal Cognitive Assessment: One Cutoff Never Fits All. Stroke. 2015;46(12):3547-50.Table A3Odds ratio and 95% confidence interval of the association between selective characteristics and prevalent mild cognitive impairment or cognitive impairment at the baselineTable A3CharacteristicsCrude OR (95%CI)Adjusted OR (95%CI) 2Age1.06 (1.01–1.11)1.04 (0.98–1.10)Sex Male1.001.00 Female4.13 (1.53–14.48)3.52 (1.23–12.74)Educational attainment Never educated4.79 (2.29–10.23)2.65 (1.63–8.35) Educated1.001.00Marital status Married1.001.00 Single/Divorce/Widow1.39 (0.72–2.69)0.78 (0.36–1.63)Body mass index < 251.001.00 ≥ 251.27 (0.63–2.54)1.09 (0.50–2.35)Smoking Non-smoker1.001.00 Current/Ex-smoker1.01 (0.31–2.88)1.85 (0.46–7.46)Habitual alcohol consumption No1.001.00 Yes1.80 (0.51–5.93)2.23 (0.55–8.97)History of hypertension or diabetes No1.001.00 Yes1.06 (0.55–2.09)0.86 (0.42–1.78)Geriatric Depression Scale Non depressed (315.695 (33.3)1 (14.3)1.20 (0.06–24.47)3.08 (0.08–12.22)1 (14.3)0.30 (0.03–3.63)1.02 (0.05–21.23)19 (33.9)10 (34.5)1.05 (0.40–2.95)1.46 (0.43–4.92)10 (35.7)1.50 (0.48–4.76)1.43 (0.41–5.00)Amplitude ≤109.605 (33.3)2 (28.6)1.001.005 (71.4)1.001.0017 (30.4)9 (31.0)1.001.009 (32.1)1.001.00 109.60- 168.785 (33.3)3 (42.8)1.50 (0.17–13.23)0.36 (0.02–7.59)0 (0.0)––17 (30.4)11 (37.9)1.22 (0.40–3.70)1.46 (0.45–4.70)12 (42.9)1.33 (0.45–3.99)1.20 (0.39–3.73) >168.785 (33.3)2 (28.6)1.00 (0.01–10.17)0.87 (0.03–2.19)2 (28.6)0.40 (0.05–3.12)0.92 (0.05–1.82)22 (39.3)9 (31.0)0.77 (0.25–2.37)1.01 (0.29–3.52)7 (25.0)0.60 (0.19–1.94)0.50 (0.14–1.78)Acrophase ≤1:24pm2 (13.3)3 (42.9)1.50 (0.11–21.32)1.00 (0.05–2.19)3 (42.9)0.75 (0.06–8.83)0.56 (0.03–9.63)19 (33.9)12 (41.4)0.94 (0.32–2.78)0.95 (0.32–2.82)8 (28.6)0.57 (0.18–1.79)0.57 (0.18–1.79) 1:24pm- 3:00pm2 (13.3)2 (28.6)1.001.004 (57.1)1.001.0015 (26.8)10 (34.5)1.001.0011 (39.3)1.001.00 >3:00pm11 (73.3)2 (27.6)0.18 (0.02–2.15)0.11 (0.00–2.98)0 (0.0)––22 (39.3)7 (24.1)0.48 (0.15–1.53)0.49 (0.15–1.59)9 (32.1)0.56 (0.19–1.67)0.55 (0.18–1.66)Percent rhythm ≤8.166 (40.0)4 (57.1)1.001.004 (57.1)1.001.0018 (32.1)10 (34.5)1.001.007 (25.0)1.001.00 8.16–12.283 (20.0)1 (14.3)0.50 (0.04–6.69)0.52 (0.03–9.21)3 (42.9)1.50 (0.20–1.15)2.22 (0.21–2.34)17 (30.4)11 (37.9)1.16 (0.39–3.44)1.15 (0.39–3.41)9 (32.1)1.36 (0.41–4.48)1.37 (0.42–4.52) >12.286 (40.0)2 (28.6)0.50 (0.07–3.85)0.04 (0.24–5.97)0 (0.0)––21 (37.5)8 (27.6)0.69 (0.22–2.11)0.73 (0.23–2.26)12 (42.9)1.47 (0.48–4.53)1.45 (0.47–4.49)Abbreviations: OR, odds ratio; CI, confidence intervals, MESOR = Midline statistic of rhythm.1 Adjusted for the age at interview and education attainment in years.2 All rest-activity rhythms parameters were stratified based on their tertile distribution.Table A7Odds ratio and 95% confidence interval of the association between changes of rest-activity circadian rhythm and changed cognitive scores between baseline and follow-up measurements stratified by sexTable A7MaleFemaleChanges of rest-activity rhythms parameters 2Stable n = 71Worsen n = 36Better n = 35Stable n = 71Worsen n = 36Better n = 35N (%)N (%)Crude OR (95%CI)Adjusted OR (95%CI) 2N (%)Crude OR (95%CI)Adjusted OR (95%CI) 2N (%)N (%)Crude OR (95%CI)Adjusted OR (95%CI) 2N (%)Crude OR (95%CI)Adjusted OR (95%CI) 2MESOR ≤-31.622 (14.3)4 (57.1)––3 (42.9)2.50 (0.25–24.72)3.25 (0.24–44.41)17 (32.7)8 (30.8)0.94 (0.29–3.00)1.02 (0.31–3.30)10 (38.4)1.32 (0.34–3.30)1.35 (0.43–4.26) -32.62-15.845 (35.7)0 (0.0)––3 (42.9)1.001.0018 (34.6)9 (34.6)1.001.008 (30.8)1.001.00 >15.847 (50.0)3 (42.9)––1 (14.2)0.24 (0.02–3.01)0.32 (0.02–4.82)17 (32.7)9 (34.6)1.06 (0.42–4.15)0.98 (0.31–3.10)8 (30.8)1.05 (0.32–3.46)1.03 (0.31–3.42)Amplitude ≤-22.845 (35.7)3 (42.9)1.80 (0.12–26.20)1.89 (0.08–4.21)3 (42.9)1.80 (0.12–26.20)1.75 (0.10–30.93)15 (28.8)10 (38.5)1.20 (0.39–3.65)1.26 (0.40–4.03)8 (30.8)0.96 (0.30–3.05)0.93 (0.28–3.09) -22.84-5.233 (21.4)1 (14.2)1.001.001 (14.2)1.001.0018 (34.6)10 (38.5)1.001.0010 (38.4)1.001.00 >5.236 (42.9)3 (42.9)1.50 (0.12–21.31)1.96 (0.08–4.55)3 (42.9)1.50 (0.12–21.31)2.19 (0.12–41.70)19 (36.5)6 (23.1)0.57 (0.17–1.89)0.60 (0.18–2.08)8 (30.8)0.76 (0.24–2.35)0.74 (0.23–2.39)Acrophase ≤-36 min6 (42.9)1 (14.3)0.17 (0.01–2.09)0.23 (0.01–4.10)3 (42.9)2.00 (0.15–26.74)3.77 (0.18–79.49)18 (34.6)6 (23.1)0.72 (0.19–2.75)0.57 (0.14–2.31)8 (30.8)0.39 (0.13–1.18)0.35 (0.11–1.15) -36-24 min4 (28.6)4 (57.1)1.001.001 (14.3)1.001.0013 (25.0)6 (23.1)1.001.0015 (57.7)1.001.00 >24 min4 (28.6)2 (28.6)0.50 (0.06–4.47)1.21 (0.07–2.01)3 (42.9)3.00 (0.21–42.63)16.93 (0.52–553.16)21 (40.4)14 (53.8)1.44 (0.44–4.70)1.36 (0.41–4.49)3 (11.5)0.12 (0.03–0.51)0.12 (0.03–0.50)Percent rhythm ≤-2.124 (28.6)2 (28.6)1.00 (0.09–11.03)0.82 (0.05–1.46)2 (28.6)0.67 (0.07–6.41)0.37 (0.03–4.79)19 (36.5)14 (30.8)0.49 (0.16–1.52)0.47 (0.15–1.49)9 (34.6)0.83 (0.26–2.69)0.81 (0.25–2.67) -2.12-0.744 (28.6)2 (28.6)1.001.003 (42.9)1.001.0014 (26.9)12 (46.2)1.001.008 (30.8)1.001.00 >0.746 (42.9)3 (42.9)1.00 (0.11–8.95)0.80 (0.06–1.17)2 (28.6)0.44 (0.05–3.98)0.23 (0.02–3.09)19 (36.5)10 (23.1)0.36 (0.11–1.22)0.39 (0.16–1.31)9 (34.6)0.83 (0.26–2.69)0.84 (0.26–2.73)Abbreviations: OR, odds ratio; CI, confidence intervals, MESOR = Midline statistic of rhythm.1 Adjusted for the age at interview, sex, education attainment in years.2 All changes of rest-activity rhythms parameters were stratified based on their tertile distribution.Table A8Interrelationship between rest-activity circadian rhythm parameters and educational attainment.Table A8CharacteristicsMESORAmplitudeAcrophasePercent rhythmEducational attainment Never educated253.4 ± 68.79116.1 ± 48.0513:44 ± 2:3110.1 ± 6.41 Educated299.9 ± 78.24156.5 ± 61.5414:24 ± 2:1010.9 ± 5.42 Mean square67733.0051174.0013.9720.89 F-value11.6814.862.760.65 p-value<0.01<0.010.100.42Abbreviations: MESOR = Midline statistic of rhythmInterrelationship between rest-activity circadian rhythm parameters and educational attainment was assessed by one-way ANOVA.Table A9Odds ratio and 95% confidence interval of the association between baseline rest-activity circadian rhythm and changed cognitive scores during the follow-up stratified by educationTable A9Rest-activity rhythms parameters 2Stable n = 54Worsen n = 25Better n = 27N (%)N (%)Crude OR (95%CI)Adjusted OR (95%CI) 1N (%)Crude OR (95%CI)Adjusted OR (95%CI) 1MESOR ≤244.2615 (27.8)6 (24.0)1.001.009 (33.3)1.001.00 244.26- 315.6917 (31.5)12 (48.0)1.76 (0.53–5.87)1.79 (0.51–6.29)10 (37.0)0.98 (0.31–3.06)1.04 (0.32–3.44) >315.6922 (40.7)7 (28.0)0.80 (0.22–2.84)0.80 (0.20–3.19)8 (29.6)0.61 (0.19–1.93)0.65 (0.18–2.30)Amplitude ≤109.6011 (20.4)6 (24.0)1.001.009 (33.3)1.001.00 109.60- 168.7818 (33.3)12 (48.0)1.22 (0.36–4.20)1.13 (0.30–4.23)10 (37.0)0.68 (0.21–2.19)0.64 (0.18–2.24) >168.7825 (46.3)7 (28.0)0.51 (0.14–1.88)0.46 (0.11–1.98)8 (29.6)0.39 (0.11–1.28)0.38 (0.10–1.44)Acrophase ≤1:24pm16 (29.6)10 (40.0)0.86 (0.26–2.87)0.86 (0.26–2.88)7 (25.9)0.37 (0.11–1.23)0.36 (0.11–1.19) 1:24pm- 3:00pm11 (20.4)8 (32.0)1.001.0013 (48.1)1.001.00 >3:00pm27 (50.0)7 (28.0)0.36 (0.10–1.22)0.36 (0.10–1.22)7 (25.9)0.22 (0.07–0.70)0.22 (0.07–0.71)Percent rhythm ≤8.1618 (33.3)11 (44.0)1.001.007 (25.9)1.001.00 8.16–12.2814 (29.9)9 (36.0)1.05 (0.34–3.24)1.02 (0.33–3.18)9 (33.3)1.65 (0.49–5.54)1.66 (0.49–5.64) >12.2822 (40.7)5 (20.0)0.37 (0.11–1.27)0.35 (0.10–1.25)11 (40.7)1.29 (0.41–4.00)1.38 (0.43–4.45)Abbreviations: OR, odds ratio; CI, confidence intervals, MESOR = Midline statistic of rhythm.1 Adjusted for the age at interview and sex.2 All rest-activity rhythms parameters were stratified based on their tertile distribution.Table A10Odds ratio and 95% confidence interval of the association between changes of rest-activity circadian rhythm and changed cognitive scores between baseline and follow-up measurements stratified by education.Table A10Changes of rest-activity rhythms parameters 2Stable n = 50Worsen n = 23Better n = 25N (%)N (%)Crude OR (95%CI)Adjusted OR (95%CI) 1N (%)Crude OR (95%CI)Adjusted OR (95%CI) 1MESOR ≤-31.6215 (32.7)8 (30.8)1.51 (0.43–5.36)1.49 (0.41–5.38)9 (38.4)1.13 (0.36–3.60)1.31 (0.40–4.33) -32.62-15.8417 (34.6)6 (34.6)1.001.009 (30.8)1.001.00 >15.8418 (32.7)9 (34.6)1.42 (0.42–4.83)1.42 (0.41–4.87)7 (30.8)0.73 (0.22–2.41)0.75 (0.23–2.51)Amplitude ≤-22.8416 (32.0)10 (43.5)1.63 (0.44–5.96)1.58 (0.42–5.97)11 (44.0)1.28 (0.39–4.23)1.44 (0.42–4.94) -22.84-5.2313 (26.0)5 (21.7)1.001.007 (28.0)1.001.00 >5.2321 (42.0)8 (34.8)0.99 (0.27–3.69)0.95 (0.24–3.76)7 (28.0)0.62 (0.18–2.17)0.74 (0.20–2.73)Acrophase ≤-36 min20 (40.0)5 (21.7)0.50 (0.13–2.00)0.49 (0.12–2.01)8 (32.0)0.44 (0.13–1.39)0.36 (0.11–1.22) -36-24 min12 (24.0)6 (26.1)1.001.0011 (44.0)1.001.00 >24 min18 (36.0)12 (52.2)1.33 (0.39–4.53)1.33 (0.39–4.53)6 (24.0)0.36 (0.11–1.25)0.36 (0.10–1.26)Percent rhythm ≤-2.1219 (38.0)6 (26.1)0.42 (0.12–1.49)0.42 (0.12–1.50)11 (44.0)0.77 (0.25–2.41)0.72 (0.23–2.28) -2.12-0.7412 (24.0)9 (39.1)1.001.009 (36.0)1.001.00 >0.7419 (38.0)8 (34.7)0.56 (0.17–1.86)0.56 (0.17–1.87)5 (20.0)0.35 (0.09–1.30)0.33 (0.09–1.25)Abbreviations: OR, odds ratio; CI, confidence intervals, MESOR = Midline statistic of rhythm.1 Adjusted for the age at interview and sex.2 All changes of rest-activity rhythms parameters were stratified based on their tertile distribution., (© 2021 The Authors. Published by Elsevier Inc.)