Non-dominant hand use increases completion time on part B of the Trail Making Test but not on part A

Which motor-cognitive abilities underlie the digital Trail-Making Test? Decomposing various test scores to detect cognitive impairment in Parkinson's disease-Pilot study

Since Parkinson's disease (PD) is a heterogeneous disorder with symptoms, such as tremors, gait and speech disturbances, or memory loss, individualized diagnostics are needed to optimize treatment. In their current form, the typical paper-pencil methods traditionally used to track disease progression are too coarse to capture the subtleties of clinical phenomena. For this reason, digital biomarkers that capture, for example, motor function, cognition, and behavior using apps, wearables, and tracking systems are becoming increasingly established. However, given the high prevalence of cognitive impairment in PD, digital cognitive biomarkers to predict mental progression are important in clinical practice. This pilot study aimed to identify those components of our digital version of the TMT (dTMT) that allow discrimination between PD patients with and without cognitive deficits. A total of 30 healthy control (age 66.3 ± 8.61) and 30 participants with PD (age 68.3 ± 9.66) performed the dTMT using a touch-sensitive tablet to capture enhanced performance metrics, such as the speed between and inside circles. The decomposition of cognitive abilities based on integrating additional variables in the dTMT revealed that the Parkinson's disease group was significantly more sensitive to parameters of inhibitory control. In contrast, the mild cognitive impairment group was sensitive to parameters of cognitive flexibility and working memory. The dTMT allows objective, ecologically valid, and long-term cognitive and fine-motor performance tracking, suggesting its potential as a digital biomarker in neurodegenerative disorders.

Hand Motor Dysfunction Is Associated with Both Subjective and Objective Cognitive Impairment across the Dementia Continuum

INTRODUCTION

Motor dysfunction is an important feature of early-stage dementia. Gait provides a non-invasive biomarker across the dementia continuum. Gait speed and rhythm aid risk stratification of incident dementia in subjective cognitive impairment (SCI) and are associated with cognitive domains in mild cognitive impairment (MCI) and dementia. However, hand movement analysis, which may be more accessible, has never been undertaken in SCI and rarely in MCI or dementia. We aimed to address this gap and improve understanding of hand motor-cognitive associations across the dementia continuum.

METHODS

A total of 208 participants were recruited: 50 with dementia, 58 MCI, 40 SCI, and 60 healthy controls. Consensus diagnoses were made after comprehensive gold-standard assessments. A computer key-tapping test measured frequency, dwell-time, rhythm, errors, and speed. Associations between key-tapping and cognitive domains and diagnoses were analysed using regression. Classification accuracy was measured using area under receiver operating characteristic curves.

RESULTS

Hand frequency and speed were associated with memory and executive domains (p ≤ 0.001). Non-dominant hand rhythm was associated with all cognitive domains. Frequency, rhythm, and speed were associated with SCI, MCI, and dementia. Frequency and speed classified ≥94% of dementia and ≥88% of MCI from controls. Rhythm of the non-dominant hand classified ≥86% of dementia and MCI and 69% of SCI.

CONCLUSION

Our findings show hand motor dysfunction occurs across the dementia continuum and, similar to gait, is associated with executive and memory domains and with cognitive diagnoses. Key-tapping performance differentiated dementia and MCI from healthy controls. More research is required before recommending key-tapping as a non-invasive motor biomarker of cognitive impairment.

Oxford cognitive screen: A critical review and independent psychometric evaluation

The Oxford cognitive screen (OCS) is a stroke-specific cognitive screening assessment. Although the test developers have provided psychometric information for the assessment, the OCS has received minimal external scrutiny, with which to triangulate the underpinning psychometrics. The purpose of this study is to provide a critical review and independent validation of the OCS. This study analysed data from an anonymised clinical database, which consisted of 316 patients who were assessed using the OCS on an Acute Stroke Unit. The rates of impairment on tests of memory and receptive communication were lower than expectation, suggesting that these subtests may be relatively insensitive. Patients with aphasia were more likely to be unable to categorised as impaired on non-language tests, suggesting that they remain sensitive to language processing or non-dominant hand usage. Some of the subtests of the OCS achieve high retest reliability, which makes them good candidates for measuring cognitive change over time. Although the OCS has many advantages, it is also important to adequately consider its limitations, that is insensitivity to memory problems, the potential confounding impact of non-dominant hand usage, and the potential that some tests may sample overall cognitive ability instead of domain-specific functioning.

The role of hand preference in cognition and neuropsychiatric symptoms in neurodegenerative diseases

Handedness has been shown to be associated with genetic variation involving brain development and neuropsychiatric diseases. Whether handedness plays a role in clinical phenotypes of common neurodegenerative diseases has not been extensively studied. This study used the National Alzheimer's Coordinating Center database to examine whether self-reported handedness was associated with neuropsychological performance and neuropsychiatric symptoms in cognitively unimpaired individuals (n = 17 670), individuals with Alzheimer's disease (n = 10 709), behavioural variant frontotemporal dementia (n = 1132) or dementia with Lewy bodies (n = 637). Of the sample, 8% were left-handed, and 2% were ambidextrous. There were small differences in the handedness distributions across the cognitively unimpaired, Alzheimer's disease, behavioural variant frontotemporal dementia and dementia with Lewy bodies groups (7.2-9.5% left-handed and 0.9-2.2% ambidextrous). After adjusting for age, gender and education, we found faster performance in Trail Making Test A in cognitively unimpaired non-right-handers (ambidextrous and left-handed) compared with right-handers. Excluding ambidextrous individuals, the left-handed cognitively unimpaired individuals had faster Trail Making Test A performance and better Number Span Forward performance than right-handers. Overall, handedness had no effects on most neuropsychological tests and none on neuropsychiatric symptoms. Handedness effect on Trail Making Test A in the cognitively unimpaired is likely to stem from test artefacts rather than a robust difference in cognitive performance. In conclusion, handedness does not appear to affect neuropsychological performance or neuropsychiatric symptoms in common neurodegenerative diseases.

The effect of subthalamic nucleus deep brain stimulation and dopaminergic treatment on dual-task manual dexterity in Parkinson's disease

BACKGROUND AND PURPOSE

Dual-task manual dexterity is required to perform activities of daily living and is affected by cognitive functions. This study aimed to investigate the effects of two main treatment options, subthalamic nucleus deep brain stimulation (STN-DBS) and dopaminergic treatment (DT), on dual-task manual dexterity and cognitive functions of people with Parkinson's disease (PwPD).

METHODS

Twenty-one PwPD were assessed in four different conditions as medication "on-off" and STN-DBS "on-off" in random order. Motor symptoms were measured with the Movement Disorder Society-Unified Parkinson Disease Rating Scale, motor section (MDS-UPDRS-III). Single and dual-task manual dexterity was assessed with the Nine-Hole Peg Test (NHPT) and cognitive functions were assessed with the Stroop Test (ST) and the Trail Making Test (TMT).

RESULTS

Both DT and STN-DBS enhanced MDS-UPDRS-III, and the combination of DT and STN-DBS provided further improvement. Only STN-DBS enhanced dominant hand single-task NHPT scores. Non-dominant single-task NHPT scores and dual-task NHPT scores improved with both treatments alone; however, STN-DBS resulted in more improvement than DT. Dual-task interference, ST, and TMT scores improved with both treatments alone; however, combining DT and STN-DBS did not provide more improvement.

CONCLUSION

DT, STN-DBS, and combining both treatments have different effects on motor symptoms, single and dual-task manual dexterity, dual-task interference, and cognitive functions. These results indicate that DT and STN-DBS may affect motor and cognitive functions via different mechanisms. Effects of DT and STN-DBS on manual dexterity may depend on the degree of cognitive involvement in manual dexterity tasks.

Can Self-Regulatory Strength Training Counter Prior Mental Exertion? A Systematic Review of Randomized Controlled Trials

Background

Prior mental exertion consumes self-regulation and influences any subsequent physical or cognitive performance according to the strength model of self-regulation. However, the counteractive effect of self-regulatory strength training remains unclear.

Objective

This study aims to report a comprehensive systematic review investigating self-regulatory strength training programmes on physical or cognitive performance.

Methods

To select relevant studies from the available literature, a thorough search was conducted on PubMed, Web of Science, EBSCOhost (CENTRAL, Psychology and Behavioral Sciences Collection, SPORTDicus), Scopus, and Google Scholar, as well as the sources of reference for gray literature. Only randomized controlled trials involving healthy humans, strength-based self-regulation training programmes with comparable protocols, and a physical or cognitive task associated with the study were selected for the current review. The Grading of Recommendations Assessment Development and Evaluation (GRADE) framework was used to develop the summary of findings.

Results

Twelve articles were included based on the selection criteria. Evidence certainty for outcomes was graded as either low or very low level. The majority of the studies reported that self-regulatory strength training programmes can significantly counter prior mental exertion and decrement of performance, while only one study did not find such improvement. According to the strength model, a period of training increased the ‘self-regulatory muscle.'

Conclusion

Strength is an important ingredient in the resource model of self-regulation and can be trained to counter prior mental exertion and improve subsequent physical and cognitive performance. The training effects are cross-domain (e.g., emotional and cognitive domains; higher and lower levels of executive functions). However, motivation plays a key role to mobilize this resource. Future studies should examine the mechanism that underlies the strength.

Systematic Review Registration

https://inplasy.com/inplasy-2022-1-0060/, identifier: INPLASY202210060.

[Relationship between performance on the Digital Trail Making Peg test and cognitive function in older adults]

AIM

To determine the relationship between performance on the Digital Trail Making Peg test (DTMP) and cognitive function in older adults.

METHODS

A total of 203 community-dwelling older adults (mean age: 76.4±5.1 years old) participated in this study. The five-cog test was used to assess the cognitive function. The DTMP measured completion time, number of errors and intra-individual variability for performance variability (coefficient of variation, CV; inter-elemental variability, IEV). Spearman's rank correlation coefficient (ρ) was calculated to examine the association between each variable. In addition, a multiple regression analysis was performed with the cognitive function score as the dependent variable and the DTMP completion time, number of errors, CV, and IEV as the independent variables, with adjusting for the sex, age, years of education, body mass index, medical history, depression, and physical function.

RESULTS

The rank correlation coefficients with cognitive function scores were as follows: completion time, ρ = -0.479 (P < 0.01), number of errors, ρ = -0.068 (P = 0.332), CV, ρ = 0.085 (P = 0.225), IEV, ρ = -0.316 (P < 0.01). The results of the multiple regression analysis showed that completion time (β = -0.566), CV (β = 0.164), IEV (β = 2.736) were significantly associated with cognitive function scores.

CONCLUSIONS

The shorter the DTMP completion time, the better the overall cognitive function. However, the intra-individual variability of CV and IEV did not show consistent results, with smaller values indicating less intra-individual variability.

Effects of task complexity or rate of motor imagery on motor learning in healthy young adults

BACKGROUND

A growing body of evidence suggests the benefit of motor imagery in motor learning. While some studies tried to look at the effect of isolated mental practice, others evaluated the combined effect of motor imagery and physical practice in clinical rehabilitation. This study aimed to investigate the effects of task complexity or rates of motor imagery on motor learning in health young adults.

METHODS

Eighty-eight healthy individuals participated in this study. Participants were randomly allocated to either Group A (50% complex, N = 22), Group B (75% complex, N = 22), Group C (50% simple, N = 22), or Group D (75% simple, N = 22). Participants in the complex groups performed their task with nondominant hand and those in simple groups with a dominant hand. All participants performed a task that involved reach, grasp, and release tasks. The performance of the four groups was examined in the acquisition and retention phase. The main outcome measure was the movement time.

RESULTS

There were significant differences between immediate (i.e., acquisition) and late (i.e., retention) movement times at all three stages of task (i.e., MT1 [reaching time], MT2 [target transport time], and TMT [reaching time plus object transport time]) when individuals performed complex task with 75% imagery rate (p < .05). Similarly, there were significant differences between immediate and late movement times at all stages of task except the MT2 when individuals performed simple task with 75% imagery rate (p < .05). There were significant effects of task complexity (simple vs. complex tasks) on immediate movement time at the first stage of task (i.e., MT1 ) and late movement times of all three stages of task (p < .05). There were significant effects of the rate of imagery (50% vs. 75%) on late movement times at all three stages of tasks (p > .05). Additionally, there were no interaction effects of either task complexity or rate of imagery on both immediate and late movement times at all three stages of tasks (p > .05).

CONCLUSION

This study supports the use of higher rates (75%) of motor imagery to improve motor learning. Additionally, the practice of a complex task demonstrated better motor learning in healthy young adults. Future longitudinal studies should validate these results in different patient's population such as stroke, spinal cord injury, and Parkinson's disease.

White Matter but not Gray Matter Volumes Are Associated with Cognition in Community-Dwelling Chinese Populations

BACKGROUND

Few studies have investigated the association between cognition and brain volume associated with cerebral small vessel disease (CSVD).

OBJECTIVE

We investigated the association between cognition and brain volume and neuroimaging markers of CSVD in a community-dwelling population.

METHODS

Participants (n = 993, age≥35 years) from the community-based Shunyi Study were included to investigate the association between neuroimaging markers and cognition cross-sectionally. Magnetic resonance imaging markers included brain volume measurements of the total cerebrum, white matter, gray matter, and CSVD imaging markers. Cognitive performance was assessed using neuropsychological tests of the Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), Fuld Object Memory, digit span, Trail Making Test (TMT)-A, and TMT-B.

RESULTS

For brain volume measurement, subcortical white matter fraction was positively associated with MMSE score (β= 0.034, p = 0.0062) and MoCA score (β= 0.034, p = 0.0174), and negatively associated with TMT-A and TMT-B completion time (β= -2.319, p = 0.0002; β= -2.827, p = 0.0073, respectively). For evaluation of CSVD imaging markers, the presence of lacunes was positively associated with TMT-B completion time (β= 17.241, p = 0.0028).

CONCLUSION

In community-dwelling populations, reduced white matter volumes, as a consequence of aging and vascular damage, are associated with worse global cognition and executive function. Our findings provide potential insights into the correlation between cognition and CSVD-associated subcortical white matter injury.

The trail-making-test: Comparison between paper-and-pencil and computerized versions in young and healthy older adults

One of the key challenges in assessing cognitive performance is to detect not only apparent impairment but to also pick up on subtle differences. Computerized tests benefit especially from the acquisition of fine-grained outcome measures. However, the equivalency of paper-based and computerized tests cannot be assumed. The Trail-Making-Test is a paper-pencil cognitive assessment tool (ppTMT) that has been used in many research studies to evaluate visuomotor abilities and mental flexibility. A digital version of the extended TMT (including a condition measuring fine motor speed) called the dTMT has been developed. This study aims to test (1) reliability, (2) equivalence, and (3) agreement of the ppTMT and dTMT. A total of 53 healthy individuals aged 19 to 82 years of age (22 men, 31 women; mean age 42.2, SD = 22.8) completed three trials per ppTMT and dTMT condition. Part M involves following a predefined path, Part A links numbers randomly distributed in space, in ascending order, and Part B alternates between linking numbers and letters. dTMT scores were highly reproducible, correlated strongly with paper-pencil administered durations, and discriminated young from older adults. Measures of reliability, sensitivity, and clinical meaning for dTMT scores were favorable compared with ppTMT-based testing. Our findings support the comparability of TMT-indices in computerized assessments. While many digital biomarker efforts are in progress (e.g., neurodegenerative disorders), the dTMT sets itself apart through its high sensitivity, the alternate forms, and the additional component measures. In this light, it could serve as a starting point for an early diagnostic tool.

Evidence of Validity for a Newly Developed Digital Cognitive Test Battery

Clinical practice still relies heavily on traditional paper-and-pencil testing to assess a patient’s cognitive functions. Digital technology has the potential to be an efficient and powerful alternative, but for many of the existing digital tests and test batteries the psychometric properties have not been properly established. We validated a newly developed digital test battery consisting of digitized versions of conventional neuropsychological tests. Two confirmatory factor analysis models were specified: a model based on traditional neuropsychological theory and expert consensus and one based on the Cattell-Horn-Carroll (CHC) taxonomy. For both models, the outcome measures of the digital tests loaded on the cognitive domains in the same way as established in the neuropsychological literature. Interestingly, no clear distinction could be made between the CHC model and traditional neuropsychological model in terms of model fit. Taken together, these findings provide preliminary evidence for the structural validity of the digital cognitive test battery.