ActiTect: A Generalizable Machine Learning Pipeline for REM Sleep Behavior Disorder Screening through Standardized Actigraphy

Isolated rapid eye movement sleep behavior disorder (iRBD) is a major prodromal marker of $α$-synucleinopathies, often preceding the clinical onset of Parkinson's disease, dementia with Lewy bodies, or multiple system atrophy. While wrist-worn actimeters hold significant potential for detecting RBD in large-scale screening efforts by capturing abnormal nocturnal movements, they become inoperable without a reliable and efficient analysis pipeline. This study presents ActiTect, a fully automated, open-source machine learning tool to identify RBD from actigraphy recordings. To ensure generalizability across heterogeneous acquisition settings, our pipeline includes robust preprocessing and automated sleep-wake detection to harmonize multi-device data and extract physiologically interpretable motion features characterizing activity patterns. Model development was conducted on a cohort of 78 individuals, yielding strong discrimination under nested cross-validation (AUROC = 0.95). Generalization was confirmed on a blinded local test set (n = 31, AUROC = 0.86) and on two independent external cohorts (n = 113, AUROC = 0.84; n = 57, AUROC = 0.94). To assess real-world robustness, leave-one-dataset-out cross-validation across the internal and external cohorts demonstrated consistent performance (AUROC range = 0.84-0.89). A complementary stability analysis showed that key predictive features remained reproducible across datasets, supporting the final pooled multi-center model as a robust pre-trained resource for broader deployment. By being open-source and easy to use, our tool promotes widespread adoption and facilitates independent validation and collaborative improvements, thereby advancing the field toward a unified and generalizable RBD detection model using wearable devices.

Automated Mobility Context Detection with Inertial Signals

Remote monitoring of motor functions is a powerful approach for health assessment, especially among the elderly population or among subjects affected by pathologies that negatively impact their walking capabilities. This is further supported by the continuous development of wearable sensor devices, which are getting progressively smaller, cheaper, and more energy efficient. The external environment and mobility context have an impact on walking performance, hence one of the biggest challenges when remotely analysing gait episodes is the ability to detect the context within which those episodes occurred. The primary goal of this paper is the investigation of context detection for remote monitoring of daily motor functions. We aim to understand whether inertial signals sampled with wearable accelerometers, provide reliable information to classify gait-related activities as either indoor or outdoor. We explore two different approaches to this task: (1) using gait descriptors and features extracted from the input inertial signals sampled during walking episodes, together with classic machine learning algorithms, and (2) treating the input inertial signals as time series data and leveraging end-to-end state-of-the-art time series classifiers. We directly compare the two approaches through a set of experiments based on data collected from 9 healthy individuals. Our results indicate that the indoor/outdoor context can be successfully derived from inertial data streams. We also observe that time series classification models achieve better accuracy than any other feature-based models, while preserving efficiency and ease of use.