TY - JOUR
T1 - Instrumented Trail-Making Task to Differentiate Persons with No Cognitive Impairment, Amnestic Mild Cognitive Impairment, and Alzheimer Disease
T2 - A Proof of Concept Study
AU - Zhou, He
AU - Sabbagh, Marwan
AU - Wyman, Rachel
AU - Liebsack, Carolyn
AU - Kunik, Mark E.
AU - Najafi, Bijan
N1 - Funding Information:
Partial support was provided by the National Institutes of Health/National Institute on Aging (award No. 2R42AG032748) and National Cancer Institute (award No. 1R21CA190933-01A1), the Flinn Foundation, Arizona Aging, and Cognitive Collaborative grant (award No. 1907), and Baylor College of Medicine, Michael E. DeBakey Department of Surgery.
Publisher Copyright:
© 2016 S. Karger AG, Basel.
PY - 2017/2/1
Y1 - 2017/2/1
N2 - Background: Objective and time-effective tools are needed to identify motor-cognitive impairment and facilitate early intervention. Objective: We examined the feasibility, accuracy, and reliability of an instrumented trail-making task (iTMT) using a wearable sensor to identify motor-cognitive impairment among older adults. Methods: Thirty subjects (age = 82.2 + 6.1 years, body mass index = 25.7 + 4.8, female = 43.3%) in 3 age-matched groups, 11 healthy, 10 with amnestic mild cognitive impairment (aMCI), and 9 with Alzheimer disease (AD), were recruited. Subjects completed iTMT, using a wearable sensor attached to the leg, which translates the motion of the ankle into a human-machine interface. iTMT tests included reaching to 5 indexed circles on a computer screen by moving the ankle-joint while standing. iTMT was quantified by the time required to reach all circles in the correct sequence. Three iTMT tests were designed, including numbers (1-5) positioned in a fixed (iTMTfixed) or random (iTMTrandom) order, or numbers (1-3) and letters (A and B) positioned in random order (iTMTnumber-letter). Each test was repeated twice to examine test-retest reliability. In addition, the conventional trail-making task (TMT A and B), Montreal Cognitive Assessment (MoCA), and dual-task cost (DTC: gait-speed difference between walking alone and walking while counting backward) were used as references. Results: Good-to-excellent reliability was achieved for all iTMT tests (intraclass correlation [ICC] = 0.742-0.836). Between- group difference was more pronounced, when using iTMTnumber-letter, with average completion time of 26.3 ± 12.4, 37.8 ± 14.1, and 61.8 ± 34.1 s, respectively, for healthy, aMCI, and AD groups (p = 0.006). Pairwise comparison suggested strong effect sizes between AD and healthy (Cohen's d = 1.384, p = 0.001) and between aMCI and AD (d = 0.923, p = 0.028). Significant correlation was observed when comparing iTMT number-letter with MoCA (r = -0.598, p = 0.001), TMT A (r = 0.519, p = 0.006), TMT B (r = 0.666, p < 0.001), and DTC (r = 0.713, p < 0.001). Conclusion: This study demonstrated proof of concept of a simple, safe, and practical iTMT system with promising results to identify cognitive and dual-task ability impairment among older adults, including those with aMCI and AD. Future studies need to confirm these observations in larger samples, as well as iTMT's ability to track motor- cognitive decline over time.
AB - Background: Objective and time-effective tools are needed to identify motor-cognitive impairment and facilitate early intervention. Objective: We examined the feasibility, accuracy, and reliability of an instrumented trail-making task (iTMT) using a wearable sensor to identify motor-cognitive impairment among older adults. Methods: Thirty subjects (age = 82.2 + 6.1 years, body mass index = 25.7 + 4.8, female = 43.3%) in 3 age-matched groups, 11 healthy, 10 with amnestic mild cognitive impairment (aMCI), and 9 with Alzheimer disease (AD), were recruited. Subjects completed iTMT, using a wearable sensor attached to the leg, which translates the motion of the ankle into a human-machine interface. iTMT tests included reaching to 5 indexed circles on a computer screen by moving the ankle-joint while standing. iTMT was quantified by the time required to reach all circles in the correct sequence. Three iTMT tests were designed, including numbers (1-5) positioned in a fixed (iTMTfixed) or random (iTMTrandom) order, or numbers (1-3) and letters (A and B) positioned in random order (iTMTnumber-letter). Each test was repeated twice to examine test-retest reliability. In addition, the conventional trail-making task (TMT A and B), Montreal Cognitive Assessment (MoCA), and dual-task cost (DTC: gait-speed difference between walking alone and walking while counting backward) were used as references. Results: Good-to-excellent reliability was achieved for all iTMT tests (intraclass correlation [ICC] = 0.742-0.836). Between- group difference was more pronounced, when using iTMTnumber-letter, with average completion time of 26.3 ± 12.4, 37.8 ± 14.1, and 61.8 ± 34.1 s, respectively, for healthy, aMCI, and AD groups (p = 0.006). Pairwise comparison suggested strong effect sizes between AD and healthy (Cohen's d = 1.384, p = 0.001) and between aMCI and AD (d = 0.923, p = 0.028). Significant correlation was observed when comparing iTMT number-letter with MoCA (r = -0.598, p = 0.001), TMT A (r = 0.519, p = 0.006), TMT B (r = 0.666, p < 0.001), and DTC (r = 0.713, p < 0.001). Conclusion: This study demonstrated proof of concept of a simple, safe, and practical iTMT system with promising results to identify cognitive and dual-task ability impairment among older adults, including those with aMCI and AD. Future studies need to confirm these observations in larger samples, as well as iTMT's ability to track motor- cognitive decline over time.
KW - Alzheimer's disease
KW - Amnestic mild cognitive impairment
KW - Balance
KW - Dual task
KW - Gait
KW - Motor-cognitive impairment
KW - Older adults
KW - Technology
KW - Trail making
KW - Wearable technology
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U2 - 10.1159/000452309
DO - 10.1159/000452309
M3 - Article
C2 - 27855415
AN - SCOPUS:84996605846
VL - 63
SP - 189
EP - 200
JO - Gerontology
JF - Gerontology
SN - 0304-324X
IS - 2
ER -