A Stepping Trail Making Test as an Indicator of Cognitive Impairment in Older Adults.

Yosuke Osuka,Shoji Shinkai,Yu Taniguchi,Satoshi Seino,Hunkyung Kim,Hisashi Kawai,Narumi Kojima,Yutaka Watanabe,Shuichi Awata,Hiroki Inagaki,Ryota Sakurai

doi:10.3390/jcm9092835

Abstract

This study aimed to examine the concurrent validity of a novel motor-cognitive dual-task test, the Stepping Trail Making Test (S-TMT), as an indicator of cognitive impairment (CI), and compare its screening performance to that of motor or cognitive tests alone. This was a population-based cross-sectional study including 965 Japanese adults aged ≥ 70 years. To measure the time taken to perform the S-TMT, the participants were instructed to step on 16 numbers in sequence as quickly and accurately as possible. Motor and cognitive functions were assessed by gait speed and TMT part A (TMT-A), respectively. Participants were classified into CI (< 24 points), mild CI (MCI, 24–27 points), and intact cognition (> 27 points) categories based on their Mini-Mental State Examination score. Binary logistic regression models showed that the addition of the S-TMT to the covariates model gave the highest discrimination index (c-statistics), and significantly improved reclassification indices (net reclassification improvement and integrated discrimination improvement) for screening both CI and MCI compared to those of gait speed or TMT-A alone. These results show that S-TMT has a concurrent validity as a dual-task test for screening CI and MCI and better discrimination and reclassification performance than motor or cognitive tests alone in older adults.

Highlights

In 2020, the Lancet commission reported 12 modifiable risk factors for dementia [1]
This study showed that the Stepping Trail Making Test (S-TMT) time, gait speed, and TMT part A (TMT-A) time were significantly associated with the MMSE score; the S-TMT time was more strongly associated with the MMSE score than either gait speed or TMT-A time
Our previous study of the construct validity reported that the S-TMT was significantly associated with the Symbol Digit Substitution Task, TMT-A and -B as cognitive domain, and gait speed as motor domain, indicating that the S-TMT could assess two components: cognitive function requiring visuoperceptual ability, visual attention, and visuospatial memory, and a motor function that requires agility and stable balance for stepping [24]

Summary

Introduction

In 2020, the Lancet commission reported 12 modifiable risk factors for dementia [1] These factors include less education in early-life, hearing loss, traumatic brain injury, hypertension, excessive alcohol consumption, and obesity in mid-life, and smoking, depression, social isolation, physical inactivity, air pollution, and diabetes in later-life. Modifying these factors could either prevent or delay up to 40% of dementias [1]. A higher level of physical activity and dietary variety (e.g., the Mediterranean diet) in mid- and later-life has been reported to prevent dementia and cognitive decline through decreasing the risk of obesity, diabetes, and cardiovascular disease [2]. Adding a gait speed test to the standard screening is very useful for early detection of suspected dementia among community-dwelling older adults, especially in primary care settings or developing countries [13]

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