Traditional Trail Making Test Modified into Brand-new Assessment Tools: Digital and Walking Trail Making Test

Summary

Here, we present a protocol to show how to perform two types of cognitive assessment tools derived from the paper-pencil version of the Trail Making Test.

Abstract

The Trail Making Test (TMT) is a well-accepted tool for evaluating executive function. The standard TMT was invented more than 60 years ago and has been modified into many versions. With the development of digital technologies, TMT is now modified to a digitized version. The present study demonstrated digital TMT (dTMT) performed on a computer, and Walking TMT (WTMT) on the floor. Both revealed more information compared with the traditional version of TMT.

Introduction

With a rapidly aging population, dementia is considered to be a major public health concern. The number of elderly patients with dementia worldwide is about 47 million according to the World Health Organization¹. Executive function impairment is not only a common type of cognitive dysfunction in aged individuals, but has been reported as a predictor of progression from mild cognitive impairment (MCI) to clinical Alzheimer’s disease (AD)^2,3. As the third most widely used test in neuropsychology⁴, the Trail Making Test (TMT) is employed as a well-accepted too....

Protocol

The development of the dTMT and initial application was approved by The Seventh Medical Center of PLA Army General Hospital Review Board. Subjects signed approved informed consent documents prior to testing TMT.

1. General Method Development

1. Use a tablet (e.g., Microsoft Surface Pro 2) with high-quality inertial sensors embedded within the device and a compatible electronic pen (Figure 1).
2. Use the Intelligent Device for Energy Expenditure and Activity (IDEEA) monitor, composed of five sensors (each 16 x 14 x 4 mm³, 2 g), with one attached over the sternum, two attached to the fr....

Results

Seven aged patients with Mild Cognitive Impairment (Elderly with MCI), seven aged subjects with Parkinson’s Disease (Elderly with PD), and seven aged healthy individuals (Healthy Elderly) were recruited, and dTMT-A, dTMT-B, WTMT-A, and WTMT-B, were performed. After the tests, data were collected and analyzed using SPSS software.

As a whole, the demographical data of participants showed that all groups were matched well in terms of age, gender, educational level, dominant hand, Clinical Dementi.......

Discussion

Traditional paper-pencil TMT has been well used worldwide for more than 50 years. However, digital TMT is advantageous. First, traditional TMT is considered as an executive function tool, while both dTMT and WTMT have aspects reflecting motor ability besides cognitive function. Considering that the cognitive-motor dual task has gained great attention in recent years²⁶, digital technologies can provide researchers with more information on this integrated task compared with the traditional TMT

Materials

List of materials used in this article

Name	Company	Catalog Number	Comments
Minisun	LLC		Intelligent Device for Energy Expenditure and Activity (IDEEA)
Surface Pro 2	Microsoft		computer