Dysexecutive difficulty and subtle everyday functional disabilities: the digital Trail Making Test

Area of Science:

• Neuroscience
• Digital Health
• Cognitive Assessment

Background:

• Traditional neuropsychological tests have limitations in detecting early neurodegenerative changes.
• Digital tests offer real-time, process-based behavioral data.
• Subtle functional decline is an early indicator of neurodegenerative illness.

Purpose of the Study:

• To investigate the relationship between informant-based functional decline and digital Trail Making Test-Part B (dTMT-B) performance.
• To determine if dTMT-B process-based features can identify subtle and mild functional impairments.

Main Methods:

• 321 community-dwelling participants were assessed using the Functional Activities Questionnaire (FAQ) and dTMT-B.
• Participants were categorized into unimpaired, subtly impaired, and mildly impaired groups based on FAQ scores.
• Statistical analyses, including regression and factor analysis, were used to examine dTMT-B variables and functional status.

Main Results:

• Participants with subtle or mild functional decline (FAQ 1-8) exhibited longer pauses within target circles and more pen strokes on the dTMT-B compared to unimpaired individuals (FAQ=0).
• Subtly impaired participants showed increased overall test time and slower line-drawing speed.
• Mildly impaired participants produced less straight lines connecting targets.
• Pauses within target circles effectively classified participants into their respective functional groups.

Conclusions:

• Digital assessment technology, specifically the dTMT-B, can quantify subtle behaviors indicative of functional deficits.
• Process-based scores from the dTMT-B outperform traditional tests in classifying participants.
• The dTMT-B shows promise as a sensitive tool for detecting early-stage functional decline in neurodegenerative conditions.