Abstract

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.

摘要

评估认知表现的关键挑战之一是不仅要​​检测明显的损伤，还要发现细微的差异。计算机化测试尤其受益于获得细粒度的结果测量。但是，不能假设纸质测试和计算机化测试的等效性。Trail-Making-Test 是一种纸笔认知评估工具 (ppTMT)，已在许多研究中用于评估视觉运动能力和心理灵活性。已开发出称为 dTMT 的扩展 TMT（包括测量精细电机速度的条件）的数字版本。本研究旨在测试 ppTMT 和 dTMT 的 (1) 可靠性、(2) 等效性和 (3) 一致性。共有 53 名年龄在 19 至 82 岁之间的健康人（22 名男性，31 名女性；平均年龄 42.2，SD = 22. 8) 在每个 ppTMT 和 dTMT 条件下完成三个试验。M部分涉及遵循预定义的路径，A部分链接随机分布在空间中的数字，按升序排列，B部分在链接数字和字母之间交替。dTMT 评分具有高度可重复性，与纸笔管理的持续时间密切相关，并且可以区分年轻人和老年人。与基于 ppTMT 的测试相比，dTMT 评分的可靠性、敏感性和临床意义的测量是有利的。我们的研究结果支持 TMT 指数在计算机化评估中的可比性。虽然许多数字生物标志物的工作正在进行中（例如，神经退行性疾病），但 dTMT 通过其高灵敏度、替代形式和附加组件测量而与众不同。在这种情况下，