Enhanced Screening for Preclinical Cognitive Vulnerability Using Target-Specific Dwelling Time in the Digital Trail Making Test Part A-A Pilot Study

Community-based cognitive screening requires efficient, low-burden tools. We examined "dwelling time" (time spent by the pen-tip on a specific target) during the digital Trail Making Test (TMT)-A as a potential marker for early cognitive changes.

In this cross-sectional study, we included 91 community-dwelling older adults (mean age 74.4 y) classified into low Memory Performance Index (MPI) (preclinical decline, score <50.2, n=35) and normal groups (n=56). Using a tablet and stylus, dwelling times during digital TMT-A were analyzed, focusing on 5 high-interference targets most strongly associated with MPI.

The low MPI group had significantly longer dwelling times at the identified targets. In regression models, the sum of these dwelling times independently predicted MPI (β=-0.200, P=0.020), whereas conventional total completion time did not (β=-0.132, P=0.157). Adding this dwelling time metric to a demographic-based model improved the area under the curve (AUC) from 0.818 to 0.845.

For preclinical stages, dwelling time at specific targets is a more sensitive marker of cognitive decline than total completion time. This digital pen-tip behavioral analysis provides a quick, accurate, and low-stress screening tool for preclinical cognitive vulnerability in primary care.