[Application of the Trail Making Test in the schizophrenia research]. / A Trail Making Teszt alkalmazása a szkizofrénia-kutatásban.

Even the Kraepelinian concept of dementia praecox suggests a link between schizophrenia and various cognitive deficits. Although cognitive impairment is not a fundamental symptom of schizophrenia, it is considered to be one of the basic features of the disease. The deficit can affect a number of cognitive domains and is most often specific. One of the most pronounced cognitive symptoms of schizophrenia is impairment in attentional and executive functions. The Trail Making Test (TMT) is a screening test commonly used in the clinic that is very sensitive to impairments in attention and executive functions. The aim of the present study is to summarise the research conducted in the last five years in which the Trail Making Test has been used to screen schizophrenics. A search was conducted in the PubMed database using the keywords "schizophrenia" and "Trail Making Test". A total of 43 relevant studies have been published on this topic since 2018. A review of the research on this topic shows that the TMT can be used to identify cognitive deficits in schizophrenics, affecting executive functions and attention. It also shows that schizophrenic patients performed significantly worse on the test than healthy individuals.

The Shape Trail Test Is Sensitive in Differentiating Older Adults with Mild Cognitive Impairment: A Culture-neutral Five-minute Test.

INTRODUCTION: The Shape Trail Test (STT) was developed based upon the Trail Making Test, as a culture-neutral test for measuring processing speed and mental flexibility. This study aims to evaluate the accuracy and validity of this five-minute test for differentiating individuals with normal cognition (NC), subjective memory impairment (SMI), and mild cognitive impairment (MCI). METHOD: The study included 210 participants aged 50-80 years, with 70 participants in each group matched for age, education, and gender. RESULTS: No significant difference in STT measures was found between the NC and SMI groups. In contrast, both the NC and SMI groups exhibited significantly better performance (shorter completion time in STT-A and STT-B and fewer STT-B errors) than the MCI group. No significant group differences were found in STT-A errors. Stepwise regression analysis identified three significant predictors for classifying the MCI group from the NC and/or SMI groups, including the STT-B completion time, the STT-A errors, and the interaction between STT-B completion time and STT-B errors. The composite score of these three predictors demonstrated good discriminatory power for classifying the MCI group from the other groups, with area under the curves (AUCs) of 0.76 - 0.79 (p < 0.001), sensitivities of 78.6% - 80%, and specificities of 60% - 61.4%. However, none of the STT measures or their interactions were significant predictors for differentiating the SMI group from the NC group. Besides, the STT measures were significantly correlated with age, education, and executive function measures. DISCUSSION: The STT could be a culture- and language-free, reliable test for assessing executive function and a sensitive test for predicting MCI.

Assessing the Relationship Between Digital Trail Making Test Performance and IT Task Performance: Empirical Study.

BACKGROUND: Cognitive functional ability affects the accessibility of IT and is thus something that should be controlled for in user experience (UX) research. However, many cognitive function assessment batteries are long and complex, making them impractical for use in conventional experimental time frames. Therefore, there is a need for a short and reliable cognitive assessment that has discriminant validity for cognitive functions needed for general IT tasks. One potential candidate is the Trail Making Test (TMT). OBJECTIVE: This study investigated the usefulness of a digital TMT as a cognitive profiling tool in IT-related UX research by assessing its predictive validity on general IT task performance and exploring its discriminant validity according to discrete cognitive functions required to perform the IT task. METHODS: A digital TMT (parts A and B) named Axon was administered to 27 healthy participants, followed by administration of 5 IT tasks in the form of CAPTCHAs (Completely Automated Public Turing tests to Tell Computers and Humans Apart). The discrete cognitive functions required to perform each CAPTCHA were rated by trained evaluators. To further explain and cross-validate our results, the original TMT and 2 psychological assessments of visuomotor and short-term memory function were administered. RESULTS: Axon A and B were administrable in less than 5 minutes, and overall performance was significantly predictive of general IT task performance (F5,19=6.352; P=.001; Λ=0.374). This result was driven by performance on Axon B (F5,19=3.382; P=.02; Λ=0.529), particularly for IT tasks involving the combination of executive processing with visual object and pattern recognition. Furthermore, Axon was cross-validated with the original TMT (Pcorr=.001 and Pcorr=.017 for A and B, respectively) and visuomotor and short-term memory tasks. CONCLUSIONS: The results demonstrate that variance in IT task performance among an age-homogenous neurotypical population can be related to intersubject variance in cognitive function as assessed by Axon. Although Axon's predictive validity seemed stronger for tasks involving the combination of executive function with visual object and pattern recognition, these cognitive functions are arguably relevant to the majority of IT interfaces. Considering its short administration time and remote implementability, the Axon digital TMT demonstrates the potential to be a useful cognitive profiling tool for IT-based UX research.

S2VQ-VAE: Semi-Supervised Vector Quantised-Variational AutoEncoder for Automatic Evaluation of Trail Making Test.

BACKGROUND: Computer-aided detection of cognitive impairment garnered increasing attention, offering older adults in the community access to more objective, ecologically valid, and convenient cognitive assessments using multimodal sensing technology on digital devices. METHODOLOGY: In this study, we aimed to develop an automated method for screening cognitive impairment, building on paper- and electronic TMTs. We proposed a novel deep representation learning approach named Semi-Supervised Vector Quantised-Variational AutoEncoder (S2VQ-VAE). Within S2VQ-VAE, we incorporated intra- and inter-class correlation losses to disentangle class-related factors. These factors were then combined with various real-time obtainable features (including demographic, time-related, pressure-related, and jerk-related features) to create a robust feature engineering block. Finally, we identified the light gradient boosting machine as the optimal classifier. The experiments were conducted on a dataset collected from older adults in the community. RESULTS: The experimental results showed that the proposed multi-type feature fusion method outperformed the conventional method used in paper-based TMTs and the existing VAE-based feature extraction in terms of screening performance. CONCLUSIONS: In conclusion, the proposed deep representation learning method significantly enhances the cognitive diagnosis capabilities of behavior-based TMTs and streamlines large-scale community-based cognitive impairment screening while reducing the workload of professional healthcare staff.

Cognitive impairment following sedative overdose.

INTRODUCTION: Patients with sedative overdose may have residual cognitive impairment at the time they are deemed medically cleared for discharge. Impairment could affect the performance of high-risk activities, including driving. The Trail Making Test is an alpha-numeric assessment that can be performed at the bedside to assess cognitive function. We examined whether there were differences in cognitive function when medically cleared between patients that overdosed on sedative and non-sedative drugs. METHODS: A prospective, observational study assessed cognitive function using the Trail Making Test between 2018 and 2021. Patients (16 years and greater) completed testing upon medical clearance if they spoke English and had no previous neurological injury. Continuous covariates were compared using t-tests or Mann-Whitney U tests and multiple linear regression; binary variables were modelled using logistic regression. RESULTS: Of 171 patients enrolled, 111 (65 per cent) had sedative overdose; they were older (median 32.1 versus 22.2 years) and more likely to be male (58.6 per cent versus 36.7 per cent). Benzodiazepines and paracetamol were the commonest drug overdoses. Patients with sedative overdose performed worse on Trail Making Test part A (37.0 versus 33.1 seconds, P = 0.017) and Trail Making Test part B (112.4 versus 81.5 seconds, P = 0.004). Multiple linear regression analysis indicated that patient age (P < 0.001, 1.7 seconds slower per year, 95 per cent confidence interval: 0.9-2.6 seconds) and perception of recovery (P = 0.006, 36.4 seconds slower if perceived not recovered, 95 per cent confidence interval: 10.8-62.0 seconds) were also associated with Trail Making Test part B times. Patients with sedative overdose were more likely to be admitted to the intensive care unit (Odds Ratio: 4.9, 95 percent confidence interval: 1.1-22.0; P = 0.04). DISCUSSION: Our results are broadly in keeping with previously published work, but include a wider range of drug overdose scenarios (polypharmacy and recreational drugs). While patients demonstrated some perception of their cognitive impairment, our model could not reliably be used to provide individual discharge advice. The study design did not allow us to prove causation of cognitive impairment, or to make comparison between the strength of an overdose to the trail making test time. CONCLUSIONS: Trail Making Test results suggested that patients who had sedative drug overdoses may have significant cognitive deficits even when medically cleared. Risk of harm may be minimised with advice to avoid high-risk activities such as driving. More profound impacts seen on the Trail Making Test part B than A may mean higher-order thinking is more affected than simple cognitive function.

Executive function deficits in patients with the first episode of late-life depression before and after SSRI treatment: A pilot fMRI study.

BACKGROUND: Executive function deficits (EFD) in late-life depression (LLD) has been reported to be associated with antidepressant treatment resistance, increased disability, and poor quality of life. However, the underlying neutral mechanisms of EFD in patients with the first episode of LLD remains unclear. METHODS: A total of 27 patients with first-episode, drug-naive LLD and 27 non-depressed controls (NC) were recruited for the present research. Participants underwent the Trail Making Test, the 17-item Hamilton depression rating scale (HAMD-17) test, and task-state functional magnetic resonance imaging scans under the neutral Stroop task. LLD patients' executive functions, depressive symptoms, and brain activity were examined again after 6 months of antidepressant treatment. RESULTS: Of the 27 LLD patients, 16 cases completed 6-month follow-ups. Patients in the LLD baseline group spent more time on the Trail Making Test A test than those in the NC group (p < 0.05). In the presence of an incongruency between the word color and meaning, the accuracy rate of the neutral Stroop task in the LLD baseline group was lower, and the reaction time was greater than that in the NC group, with statistically significant difference (p < 0.05). The HAMD-17 score in the LLD follow-up group was significantly lower than that in the LLD baseline group (p < 0.05). More activated brain regions were present in the LLD baseline group than in the NC group when performing the neutral Stroop task. Compared with the LLD baseline group, abnormal activation of relevant brains in the cingulate-prefrontal-parietal network of LLD patients still existed in the LLD follow-up group. CONCLUSIONS: LLD patients engaged more brain areas than the NC group while performing the neutral Stroop task. Abnormal activation of the cingulate-prefrontal-parietal network could be a contributing factor to EFD in LLD. TRIAL REGISTRATION: ChiCTR, ChiCTR2100042370 (Date of registration: 21/01/2021). LIMITS: We didn't enroll enough first-episode, LLD patients, the robustness of the findings need to be confirmed by large sample clinical trials.

Robust reference group normative data for neuropsychological tests accounting for primary language use in Asian American older adults.

OBJECTIVE: The present study aimed to develop neuropsychological norms for older Asian Americans with English as a primary or secondary language, using data from the National Alzheimer's Coordinating Center (NACC). METHOD: A normative sample of Asian American participants was derived from the NACC database using robust criteria: participants were cognitively unimpaired at baseline (i.e., no MCI or dementia) and remained cognitively unimpaired at 1-year follow-up. Clinical and demographic characteristics were compared between Primary and Secondary English speakers using analyses of variance for continuous measures and chi-square tests for categorical variables. Linear regression models compared neuropsychological performance between the groups, adjusting for demographics (age, sex, and education). Regression models were developed for clinical application to compute demographically adjusted z-scores. RESULTS: Secondary English speakers were younger than Primary English speakers (p < .001). There were significant differences between the groups on measures of mental status (Mini-Mental State Examination, p = .002), attention (Trail Making Test A, Digit Span Forward Total Score, p <.001), language (Boston Naming Test, Animal Fluency, Vegetable Fluency, p < .001), and executive function (Trail Making Test B, p = .02). CONCLUSIONS: Separate normative data are needed for Primary vs. Secondary English speakers from Asian American backgrounds. We provide normative data on older Asian Americans to enable clinicians to account for English use in the interpretation of neuropsychological assessment scores.

Toward Development of a Novel Proprioceptive Trail-Making Test: Comparing Healthy Dancers and Non-Dancers.

There is a pressing need for ecologically valid versions of traditional neuropsychological tests indexing executive function (EF), such as the Trail-Making Task (TMT), that incorporate movement and bodily awareness in healthy participants with varying abilities. We designed a proprioceptive version of the TMT (pTMT) that involved coordinated gross motor movement and proprioceptive awareness to investigate whether this measure of visual attention, task switching, and working memory positively correlated with a computerized version of the TMT (the dTMT). We aimed to establish the initial validity of our proprioceptive TMT (pTMT) by comparing performances on the dTMT and pTMT among a cohort of 36 healthy participants (18 dancers, 18 non-dancers; M age = 22, SD = 5.27; 64% female) anticipating that dancers would express higher intrinsic bodily awareness than non-dancers. Results revealed a mild to moderate but statistically significant positive correlation between dTMT and pTMT completion times [part A: r (36) = .33, p = .04; part B: r (36) = .37, p = .03] and numbers of errors [part B: r (36) = .41, p = .01] across both participant groups. These data suggest partial measurement convergence between these two TMT versions. Relative to non-dancers, dancers exhibited a higher level of performance (likely due to their better proprioceptive ability) through their faster completion times on dTMT-B [t (34) = 3.81, p = .006, d = 1.27] and pTMT-B [t (34) = 2.97, p = .005, d = .99], and their fewer errors on dTMT-B [t (34) = 2.93, p = .006, d = 1.0]. By identifying cognitive differences between these different groups of healthy individuals, our data contribute to both a theoretical understanding and the initial development of gross motor movement-based cognitive assessments, providing a path toward the further refinement of an ecologically valid full-body TMT.

Using Serial Trichotomization to Determine Fitness to Drive in Medically At-Risk Drivers.

IMPORTANCE: Clinical tests that identify fit and unfit drivers with 100% sensitivity and specificity would reduce uncertainty and improve efficiency of occupational therapists performing comprehensive driving evaluations (CDEs). OBJECTIVE: To examine whether serial trichotomization of clinical tests predicts pass-fail outcomes with 100% sensitivity and specificity in a sample of medically at-risk drivers and in drivers with and without cognitive impairment (CI) referred for a CDE. DESIGN: Retrospective data collection and analysis of scores on the Montreal Cognitive Assessment; Trail Making Test, Part A and Part B; and the Useful Field of View® Subtests 1 to 3 and outcomes on the CDE (pass-fail or indeterminate requiring lessons and retesting). Receiver operating characteristic curves of clinical tests were performed to determine 100% sensitivity and specificity cut points in predicting CDE outcomes. Clinical tests were arranged in order from most to least predictive to identify pass-fail and indeterminate outcomes. SETTING: A driving assessment clinic. PARTICIPANTS: Among 142 medically at-risk drivers (M age = 69.2 yr, SD = 14.1), 66 with CI, 46 passed and 39 failed the CDE; 57 were indeterminate. OUTCOMES AND MEASURES: On-road pass-fail outcomes. RESULTS: Together, the six clinical tests predicted 62 pass and 49 fail outcomes in the total sample; 21 pass and 34 fail outcomes in participants with CI; and 58 pass and 14 fail outcomes in participants without CI. CONCLUSIONS AND RELEVANCE: Serial trichotomization of clinical tests increases the accuracy of making informed decisions and reduces the number of drivers undergoing unnecessary on-road assessments. Plain-Language Summary: Clinical tests and their cut points that identify fit and unfit drivers vary substantially across settings and research studies. Serial trichotomization is one method that could help control for this variation by combining clinical test scores showing 100% sensitivity and specificity to identify pass (fit drivers) and fail outcomes (unfit drivers) and to reduce the number of drivers undergoing unnecessary on-road assessments.

Originalbeiträge (Originals). Zur klinischen Bedeutung reduzierter Exekutivfunktionen bei älteren Patient:innen mit psychischen Erkrankungen©.

On the clinical significance of reduced executive functions in elderly patients with mental illnesses Research question: Executive functions (EF) show increasing deficits in old age.There are also numerous studies demonstrating the importance of EF in relation to depression, anxiety disorders and post-traumatic stress disorder in older patients. METHODS: The study presented examined this question in a sample of patients in a psychosomatic clinic who were in middle (< 60years) and older age (≥ 60years) (N = 150) and compared them with a psychologically non-stressed comparison sample (N = 157).The survey instrument used to assess EF was the Trail-Making Test (TMT). RESULTS: The results show age and setting differences, i. e. older as well as mentally ill subjects showed worse results; an interaction effect was also found. Associations of symptoms and EF were found only in the elderly sample, but not in the middle-aged sample. CONCLUSIONS: The results show that the importance of impaired executive functions is a clinically relevant variable in psychotherapy of the elderly.

Exploratory` study on driving ability of people with schizophrenia: Relationships among cognitive function, symptoms, and brain activity.

BACKGROUND: This study aimed to examine the relationships among cognitive function, symptoms, prefrontal activation, basic driving skills, and collision risk factors using a hazard prediction task in simulated driving. METHODS: Participants included 42 people with schizophrenia aged 20-50 years who had actual experience of driving. The Trail making test (TMT) A and TMTB, Wechsler Memory Test-Revised (WMS-R), and Zoo Map test (ZMT) were used to evaluate cognitive function. Positive and negative syndrome scale was used to assess symptoms, and brain activity was assessed by evaluating cerebral blood flow during a visual working memory task using functional near-infrared spectroscopy. Driving tasks that tested basic skills, such as brake reaction, steering wheel skills, and standard deviation of lateral position, were analyzed using multiple regression analysis. Three hazard prediction tasks were performed using discriminant analysis. RESULTS: Brake reaction associated with cerebral blood flow and TMT-A. Steering wheel skills associated with WMS-R, driving experience and depression. Significant differences were found between the collision and noncollision groups in the hazard prediction task, as shown by the ZMT, driving experience, and brake reaction. CONCLUSIONS: Brain activity in the frontal lobe during a desk task may be useful data for driving assessment. Assessment of processing speed and learning ability may be particularly important in the evaluation of basic skills for safe driving. In addition, for people with schizophrenia, foresight, as represented by proactive planning, experience, and quick braking may be an essential characteristic to anticipate danger and react quickly enough to avoid collisions.

Frailty is associated with worse executive function and higher cerebral blood velocity in cognitively healthy older adults: a cross-sectional study.

Frailty is characterized by an increased vulnerability to adverse health events. Executive function impairment is an early sign of progression towards cognitive impairments. Whether frailty is associated with executive function and the associated mechanisms are unclear. We test the hypothesis that higher frailty is associated with worse executive function (Trail Making Test) and if aerobic fitness, prefrontal cortex oxygenation (ΔO2Hb), or middle-cerebral artery velocity (MCAv) impact this association. Forty-one (38 females) cognitively health older adults (70.1 ± 6.3 years) completed a Trail task and 6-min walk test. Prefrontal cortex oxygenation was measured during the Trail task (via functional near-infrared spectroscopy) and MCAv in a sub-sample (n=26, via transcranial Doppler). A 35-item frailty index was used. Frailty was independently, non-linearly related to trail B performance (Frailty2: ß=1927 [95% CI: 321-3533], p = 0.02), with the model explaining 22% of the variance of trail B time (p = 0.02). Aerobic fitness was an independent predictor of trail B (ß=-0.05 [95% CI: -0.10-0.004], p = 0.04), but age and ΔO2Hb were not (both, p > 0.78). Frailty was positively associated with the difference between trails B and A (ß=105 [95% CI: 24-186], p = 0.01). Frailty was also associated with a higher peak MCAv (ρ = 0.40, p = 0.04), but lower ΔO2Hb-peakMCAv ratio (ρ = -0.44, p = 0.02). Higher frailty levels are associated to worse Trail times after controlling for age, aerobic fitness, and prefrontal oxygenation. High frailty level may disproportionately predispose older adults to challenges performing executive function tasks that may manifest early as a compensatory higher MCAv despite worse executive function, and indicate a greater risk of progressing to cognitive impairment.

Mayo normative studies: regression-based normative data for ages 30-91 years with a focus on the Boston Naming Test, Trail Making Test and Category Fluency.

OBJECTIVE: Normative neuropsychological data are essential for interpretation of test performance in the context of demographic factors. The Mayo Normative Studies (MNS) aim to provide updated normative data for neuropsychological measures administered in the Mayo Clinic Study of Aging (MCSA), a population-based study of aging that randomly samples residents of Olmsted County, Minnesota, from age- and sex-stratified groups. We examined demographic effects on neuropsychological measures and validated the regression-based norms in comparison to existing normative data developed in a similar sample. METHOD: The MNS includes cognitively unimpaired adults ≥30 years of age (n = 4,428) participating in the MCSA. Multivariable linear regressions were used to determine demographic effects on test performance. Regression-based normative formulas were developed by first converting raw scores to normalized scaled scores and then regressing on age, age2, sex, and education. Total and sex-stratified base rates of low scores (T < 40) were examined in an older adult validation sample and compared with Mayo's Older Americans Normative Studies (MOANS) norms. RESULTS: Independent linear regressions revealed variable patterns of linear and/or quadratic effects of age (r2 = 6-27% variance explained), sex (0-13%), and education (2-10%) across measures. MNS norms improved base rates of low performance in the older adult validation sample overall and in sex-specific patterns relative to MOANS. CONCLUSIONS: Our results demonstrate the need for updated norms that consider complex demographic associations on test performance and that specifically exclude participants with mild cognitive impairment from the normative sample.

Bidirectional associations of high-level cognitive domains with hand motor function and gait speed in high-functioning older adults: A 7-year study.

BACKGROUND: Whether age-related decline in the musculoskeletal system may contribute to a decline in cognitive performance or vice versa is unclear. Understanding the direction of their associations and the extent to which upper and lower extremities similarly predict subtle changes in high-level cognitive performance will help elucidate their mechanisms, especially that of the hand dexterity. METHODS: We evaluated the bidirectional associations of motor performance and high-level cognitive domains in 165 highly cognitively and physically healthy older adults. Motor performance tests consisted of handgrip strength, hand dexterity, assessed with the Purdue Pegboard Test (PPT), and usual and maximum gait speeds. High-level cognitive measures included executive function and information processing speed. The Trail Making Test (TMT)B and the letter and category fluency tests (LFT and CFT) evaluated executive function, while the TMTA and Digit Symbol assessed processing speed. Measurements were taken at baseline and at 2-, 5- and 7-year follow-up. RESULTS: Generalized linear mixed-effect models showed that baseline hand dexterity and its trajectory predicted changes in TMTB, CFT, TMTA, and Digit Symbol over time, and vice versa. Baseline maximum gait speed was associated with LFT over time and vice versa. No associations were found for handgrip and usual gait speed. CONCLUSION: The positive bidirectional association observed both in hand dexterity and maximum gait speed with executive function performance and that of hand dexterity with processing speed over time highlights a reciprocal relationship where each factor affects the other and both factors are dependent on each other, suggesting commonality in their neural basis.

Racial differences in the effect of APOE-ε4 genotypes on trail making test B in Alzheimer's disease: A longitudinal study.

OBJECTIVES: The trail making test part B (TMT-B) evaluates executive functions, memory, and sensorimotor functions. No previous study was found to examine the longitudinal effect of APOE-ε4 genotypes on the TMT-B scores in Alzheimer's disease (AD) across racial groups. METHODS: This study used the data from Alzheimer's Disease Neuroimaging Initiative (ADNI): 382 participants with AD, 503 with cognitive normal (CN), 1293 with mild cognitive impairment (MCI) at baseline and follow-up of four years. The multivariable linear mixed model was used to investigate the effect of APOE-ε4 genotypes on changes in TMT-B scores. RESULTS: Compared with Whites, African Americans (AA) and Hispanics had higher TMT-B scores (poor cognitive function). Furthermore, Whites subjects with 1 or 2 APOE-ε4 alleles had significantly higher TMT-B scores compared with individuals without APOE-ε4 allele at baseline and four follow-up visits; however, no differences in TMT-B were found between APOE-ε4 alleles in the Hispanic and AA groups. No APOE-ε4 by visit interactions was found for 3 racial groups. Stratified by AD diagnosis, the APOE-ε4 allele was associated with TMT-B scores only in the MCI group, while there were significant interactions for visit by education, APOE-ε4 allele, and the Mini Mental State Examination (MMSE) score in the MCI group. In addition, TMT-B was significantly correlated with the MMSE, AD Assessment Scale-cognitive subscale 13 (ADAS13), tTau, pTau, Aß42, and hippocampus. CONCLUSIONS: APOE-ɛ4 allele is associated with TMT-B scores in Whites subjects, but not in the Hispanic and AA groups. APOE-ε4 showed interaction with visit in the MCI group.

Test-retest reliability of eye tracking measures in a computerized Trail Making Test.

The Trail Making Test (TMT) is a frequently applied neuropsychological test that evaluates participants' executive functions based on their time to connect a sequence of numbers (TMT-A) or alternating numbers and letters (TMT-B). Test performance is associated with various cognitive functions ranging from visuomotor speed to working memory capabilities. However, although the test can screen for impaired executive functioning in a variety of neuropsychiatric disorders, it provides only little information about which specific cognitive impairments underlie performance detriments. To resolve this lack of specificity, recent cognitive research combined the TMT with eye tracking so that eye movements could help uncover reasons for performance impairments. However, using eye-tracking-based test scores to examine differences between persons, and ultimately apply the scores for diagnostics, presupposes that the reliability of the scores is established. Therefore, we investigated the test-retest reliabilities of scores in an eye-tracking version of the TMT recently introduced by Recker et al. (2022). We examined two healthy samples performing an initial test and then a retest 3 days (n = 31) or 10 to 30 days (n = 34) later. Results reveal that, although reliabilities of classic completion times were overall good, comparable with earlier versions, reliabilities of eye-tracking-based scores ranged from excellent (e.g., durations of fixations) to poor (e.g., number of fixations guiding manual responses). These findings indicate that some eye-tracking measures offer a strong basis for assessing interindividual differences beyond classic behavioral measures when examining processes related to information accumulation processes but are less suitable to diagnose differences in eye-hand coordination.

Combination of Paper and Electronic Trail Making Tests for Automatic Analysis of Cognitive Impairment: Development and Validation Study.

BACKGROUND: Computer-aided detection, used in the screening and diagnosing of cognitive impairment, provides an objective, valid, and convenient assessment. Particularly, digital sensor technology is a promising detection method. OBJECTIVE: This study aimed to develop and validate a novel Trail Making Test (TMT) using a combination of paper and electronic devices. METHODS: This study included community-dwelling older adult individuals (n=297), who were classified into (1) cognitively healthy controls (HC; n=100 participants), (2) participants diagnosed with mild cognitive impairment (MCI; n=98 participants), and (3) participants with Alzheimer disease (AD; n=99 participants). An electromagnetic tablet was used to record each participant's hand-drawn stroke. A sheet of A4 paper was placed on top of the tablet to maintain the traditional interaction style for participants who were not familiar or comfortable with electronic devices (such as touchscreens). In this way, all participants were instructed to perform the TMT-square and circle. Furthermore, we developed an efficient and interpretable cognitive impairment-screening model to automatically analyze cognitive impairment levels that were dependent on demographic characteristics and time-, pressure-, jerk-, and template-related features. Among these features, novel template-based features were based on a vector quantization algorithm. First, the model identified a candidate trajectory as the standard answer (template) from the HC group. The distance between the recorded trajectories and reference was computed as an important evaluation index. To verify the effectiveness of our method, we compared the performance of a well-trained machine learning model using the extracted evaluation index with conventional demographic characteristics and time-related features. The well-trained model was validated using follow-up data (HC group: n=38; MCI group: n=32; and AD group: n=22). RESULTS: We compared 5 candidate machine learning methods and selected random forest as the ideal model with the best performance (accuracy: 0.726 for HC vs MCI, 0.929 for HC vs AD, and 0.815 for AD vs MCI). Meanwhile, the well-trained classifier achieved better performance than the conventional assessment method, with high stability and accuracy of the follow-up data. CONCLUSIONS: The study demonstrated that a model combining both paper and electronic TMTs increases the accuracy of evaluating participants' cognitive impairment compared to conventional paper-based feature assessment.

Warning signals only support the first action in a sequence.

Acting upon target stimuli from the environment becomes faster when the targets are preceded by a warning (alerting) cue. Accordingly, alerting is often used to support action in safety-critical contexts (e.g., honking to alert others of a traffic situation). Crucially, however, the benefits of alerting for action have been established using laboratory tasks assessing only simple choice reactions. Real-world actions are considerably more complex and mainly consist of sensorimotor sequences of several sub-actions. Therefore, it is still unknown if the benefits of alerting for action transfer from simple choice reactions to such sensorimotor sequences. Here, we investigated how alerting affected performance in a sequential action task derived from the Trail-Making-Test, a well-established neuropsychological test of cognitive action control (Experiment 1). In addition to this task, participants performed a classic alerting paradigm including a simple choice reaction task (Experiment 2). Results showed that alerting sped up responding in both tasks, but in the sequential action task, this benefit was restricted to the first action of a sequence. This was the case, even when multiple actions were performed within a short time (Experiment 3), ruling out that the restriction of alerting to the first action was due to its short-lived nature. Taken together, these findings reveal the existence of an interface between phasic alertness and action control that supports the next action.

Effectiveness of a Single Prolonged Aerobic Exercise Session on Executive Function Task Performance in Physically Active Adults (21-70 Years of Age).

We sought to examine the effectiveness of an acute prolonged exercise session on post-exercise executive function in physically active adults and to assess if age or pre-exercise cognitive performance was predictive of the magnitude of change in executive task performance. Self-registered cyclists were recruited prior to participating in a 161-km mass-participation cycling event. Cyclists were excluded if they had not previously participated in a similar endurance event, were young (<18 y), or were cognitively impaired (Mini CogTM < 3 units). Immediately after completing the exercise session, the time taken to complete Trail Making Test Part A and Part B (TMT A + B) was assessed. A faster time to complete the TMT A + B was observed after exercise (+8.5%; p = 0.0003; n = 62; age range = 21-70 y). The magnitude of change in TMT A + B performance (pre vs. post) was influenced by pre-exercise TMT A + B performance (r2 = 0.23, p < 0.0001), not age (r2 =0.002; p = 0.75). Prolonged exercise had a small-to-moderate effect on post-exercise compared to pre-exercise executive function task performance (Cohen's d = 0.38-0.49). These results support the effectiveness of a single prolonged exercise bout to augment executive function in physically active adults, irrespective of age.

Trail Making Test Could Predict Impairment in Cognitive Domains in Patients with Multiple Sclerosis: A Study of Diagnostic Accuracy.

OBJECTIVE: Cognitive impairment (CI) and executive dysfunction (ED) are prevalent in patients with multiple sclerosis (PwMS). The Minimal Assessment of Cognitive Function in Multiple Sclerosis (MACFIMS) is the gold standard neuropsychological battery (NPB) for detecting CI. Delis-Kaplan Executive Function System (DKEFS) NPB evaluates ED. We aimed to find practical test(s) from DKEFS with acceptable diagnostic utility for early detection of impairment in cognitive and executive domains. METHODS: Cognitive and executive tasks, physical disability, and depression scores of 30 PwMS were assessed (17 women, age: 38.1). Symbol Digit Modalities Test (SDMT), Paced Auditory Serial Addition Test (PASAT), and Controlled Oral Word Association Test (COWAT) from MACFIMS and Trail Making Test (TMT), Design Fluency Test (DFT), and Verbal Fluency Test (VFT) from DKEFS were selected. The association between patients' characteristics and performance in tests, and diagnostic accuracy of DKEFS tests in detecting impairment in cognitive tasks were evaluated, using Pearson correlation and receiver operator characteristic curve analyses, respectively. RESULTS: A significant correlation was found between disease duration and SDMT and TMT subtests. Expanded Disability Status Scale was significantly related to SDMT, VFT-switching, and TMT subtests. Beck Depression Inventory was significantly related to DFT. TMT-switching detected abnormalities in SDMT and PASAT with 100% sensitivity, 93.3% (for SDMT), and 85.7% specificity (for PASAT). TMT-letter showed 100% sensitivity and 90% specificity in identifying abnormalities in COWAT. CONCLUSIONS: TMT, particularly the switching condition, is a practical paper-based test that could predict impairment in cognitive tasks. Clinicians may use TMT as a screening tool among PwMS.