AUTHOR=Libon David J. , Swenson Rod , Tobyne Sean , Jannati Ali , Schulman Daniel , Price Catherine C. , Lamar Melissa , Pascual-Leone Alvaro 

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

JOURNAL=Frontiers in Neurology

VOLUME=Volume 15 - 2024

YEAR=2024

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2024.1354647

DOI=10.3389/fneur.2024.1354647

ISSN=1664-2295

ABSTRACT=Abstract (n= 257)
Background:  Digital neuropsychological tests reliably capture real-time, process-based behavior that traditional paper/ pencil tests cannot detect, enabling earlier detection of neurodegenerative illness.  We assessed relations between informant-based subtle and mild functional decline, and process-based features extracted from the digital Trail Making Test-Part B (dTMT-B).  Methods:  321 community-dwelling participants (56.0% female) were assessed with the Functional Activities Questionnaire (FAQ) and the dTMT-B.  Three FAQ groups were constructed:  FAQ= 0 (unimpaired); FAQ= 1-4 (subtle impairment); FAQ= 5-8 (mild impairment).  Results:  Compared to the FAQ-unimpaired group, other groups required longer pauses inside target circles (p< 0.050) and produced more total pen strokes to complete the test (p< 0.016).  FAQ-subtle participants required more time to complete the entire test (p< 0.002) and drew individual lines connecting successive target circles slower (p< 0.001) than FAQ-unimpaired participants.  Lines connecting successive circle targets were less straight among FAQ-mild, compared to FAQ-unimpaired participants (p< 0.044).  Using stepwise nominal regression (reference group= FAQ-unimpaired), pauses inside target circles classified other participants into their respective groups (p< 0.015, respectively).  Factor analysis using six dTMT-B variables (oblique rotation) yielded a 2-factor solution related to impaired motor/ cognitive operations (48.96% variance explained), and faster more efficient motor/ cognitive operations (28.88% variance explained).  Conclusions:  Digital assessment technology elegantly quantifies occult, nuanced behavior not previously appreciated; operationally defines critical underlying neurocognitive constructs related to functional abilities and yields selected process-based scores that outperformed traditional paper/ pencil test scores for participant classification.  When brought to scale, the dTMT-B test could be a sensitive tool to detect subtle-to-mild functional deficits in emergent neurodegenerative illness.