# CogAdapt: Adapting Clinical ECG Foundation Models for Wearable Cognitive Load Assessment

arXiv: https://arxiv.org/abs/2605.22774 · HTML: https://mlsanity.com/paper/2605.22774/

## Key facts

- No citing papers in the map yet (data through 14 Oct 2026).
- Builds on 8 of its 25 references that are in the map.
- First posted on arXiv 21 May 2026.

## Builds on (most cited first, 8 of 8)

- [LoRA: Low-Rank Adaptation of Large Language Models](https://mlsanity.com/paper/2106.09685/) (2021)
- [ECG-FM: An Open Electrocardiogram Foundation Model](https://mlsanity.com/paper/2408.05178/) (2024)
- [Toward Foundation Model for Multivariate Wearable Sensing of Physiological Signals](https://mlsanity.com/paper/2412.09758/) (2024)
- [BioBridge: Bridging Biomedical Foundation Models via Knowledge Graphs](https://mlsanity.com/paper/2310.03320/) (2023)
- [Multimodal Brain-Computer Interface for In-Vehicle Driver Cognitive Load Measurement: Dataset and Baselines](https://mlsanity.com/paper/2304.04273/) (2023)
- [CLARE: Cognitive Load Assessment in REaltime with Multimodal Data](https://mlsanity.com/paper/2404.17098/) (2024)
- [A Systematic Review on Foundation Models for Electrocardiogram Analysis: Initial Strides and Expansive Horizons](https://mlsanity.com/paper/2410.19877/) (2024)
- [CLEF: Clinically-Guided Contrastive Learning for Electrocardiogram Foundation Models](https://mlsanity.com/paper/2512.02180/) (2025)

## Abstract (arXiv)

Assessing cognitive load continuously and at low latency would help adaptive human-computer interaction, but it remains hard because labeled data are scarce and models generalize poorly across subjects. Recent ECG foundation models, pre-trained on millions of clinical diagnostic ECG recordings, yet they do not apply directly to wearable devices when the sensor configuration and the task both differ. We present CogAdapt, a framework that adapts a clinical ECG foundation model to wearable cognitive load assessment. CogAdapt has two parts. LeadBridge is a learnable adapter that maps 3-lead wearable signals to a 12-lead-compatible representation. ProFine is a progressive fine-tuning strategy that unfreezes encoder layers in stages while limiting representational drift in the pre-trained model. On two public datasets (CLARE and CL-Drive) under leave-one-subject-out cross-validation, CogAdapt reaches macro-F1 of 0.626 and 0.768, improving over from-scratch baselines by 11.2 and 16.1 percentage points. The results show that a clinical ECG pretraining can support subject-independent cognitive load assessment from wearable sensors.