Clinical Manifestations

Motor disturbances are common in neurodegenerative disorders. Digital health technologies can be a tool for remote, accessible, and low-burden motor assessments. The ALLFTD Mobile App includes a finger-tapping test (mApp-FTT) to assess dexterity. We evaluated the reliability and construct validity of smartphone-based measures of finger tapping in an in-person sample.

Participants (n = 33; mean age=68.2 [SD=8.6]) completed the mobile finger-tapping test (mApp-FTT) on iOS and Android devices (two counterbalanced 20-second trials per hand) and the mechanical finger-tapping test (FTT). The sample included cognitively unimpaired participants (22.2%) and those diagnosed with frontotemporal dementia-spectrum disorders (41.7%), Alzheimer's dementia (22.2%), and progressive supranuclear palsy or corticobasal syndrome (13.9%). A motor domain was calculated based on neurological exam and added to the Clinical Dementia Rating® plus National Alzheimer's Coordinating Center-Frontotemporal Lobar Degeneration (CDR®+NACC-FTLD). Pearson's correlations assessed associations between mApp-FTT performance and FTT performance, clinical severity (CDR®+NACC-FTLD Box Score), motor rating scales (Progressive Supranuclear Palsy Rating Scale [PSPRS] and Unified Parkinson's Disease Rating Scale [UPDRS]), and cognitive function. Due to small sample size, PSPRS subdomains were dichotomized, and t-tests were performed to evaluate group differences based on symptom presence.

Total mApp-FTT taps on iOS and Android were strongly correlated (r = 0.86, 95% CI [0.76, 0.92], p < .001). mApp-FTT was associated with manual FTT on iOS (r = 0.70, 95% CI [0.52, 0.82], p < .001) and Android (r = 0.62, 95% CI [0.41, 0.77], p < .001). Among iOS users, total PSPRS score was negatively correlated with mApp-FTT (r = -0.60, 95% CI [-0.75, -0.39], p < .001). Worse mApp-FTT performance was observed in participants with higher limb rigidity (mean difference=15.46, 95% CI [3.40, 27.52], p < .001), limb dystonia (mean difference=19.22, 95% CI [5.67, 32.77], p < .001), and finger tapping (mean difference=12.74, 95% CI [3.42, 22.06], p < .001). Total UPDRS score correlated with lower mApp-FTT (r = -0.48, 95% CI [-0.66, -0.28], p < .001), as did disease severity (CDR®+NACC-FTLD Box Score; r=-0.46, 95% CI [-0.66, -0.22], p < .001).

Smartphone-based finger-tapping assessments effectively detect motor and cognitive impairment, with stronger associations for motor function. Findings in iOS users highlight the need to assess operating system-related biases and validate in Android. Remote smartphone assessments offer a scalable tool for tracking disease progression, warranting larger longitudinal studies.